All right. Good morning, everyone. I'm Steve Baxter, the Healthcare Services Analyst here at Wells Fargo. Really pleased to have HCA with us today. HCA is, you know, among the largest operators of acute care hospitals in the country. From the company, we have CEO, Sam Hazen, and CFO, Michael Marks. Thanks again for being here.
Thank you.
Did you wanna make any opening comments [crosstalk]
I'll make some comments, and we can go to questions, if that
Okay
if that's helpful. Good morning to everybody. I think, for us, as a management team, you know, we find the company on this long journey that we've been on, and we've been pretty consistent throughout the last really decade and a half about who we are as an organization. I think that discipline around our core competencies has allowed us to really grow at a level that's unprecedented for the company. If you roll back to 2011, when the Affordable Care Act was passed, our company was positioned, we thought, reasonably well, but there was a lot of chatter, Steve, in the market about hospitals, and cost centers, and value-based care, and population health, and all these different things that were going on.
We made a strategic decision inside of the HCA casino, so to speak, to double down on being the best provider system we could possibly be. I think that that decision allowed us to refine our market provider system model very clearly for our teams. We started to resource that, plan around that, and really execute around our market flywheel, if you will, and that produced a lot of growth for the company. From 2011 to 2019, the company's market share grew from 23%- 29%, or 27% at that point in 2019, and it really changed the relevance of who we were in the markets where we competed.
We added programs, we added services, we added facilities, positions, new relationships with affiliates, and so forth, and it put our our system in a really strong position. So as we started to turn the corner into the next decade, we were asking ourselves: "Okay, what's next? How do we have an even better decade?" Obviously, COVID hit, and one of the things we challenged ourselves as a team is to power through COVID and hopefully come out on the other side in a much better position than we were going into it. We didn't know exactly how we were gonna do that, and we have, in fact, done that on three very important elements of our organization.
First, we think our culture and reputation as an enterprise actually improved, given that we dealt with our people appropriately, we dealt with communities, we dealt with the government even, and given the CARES Act money back, and we dealt with our shareholders, we thought, very fairly throughout that whole process, and so we think our reputation as an organization has actually been burnished, and that becomes an intangible asset for us as we push forward. The second thing is we improved our competitive position during that period. We actually saw our market share grow from 27% to 28% when we started looking at sort of data in non-COVID periods.
Yes.
We added some facilities, we moved some physicians, we made some capital investments and so forth during that period of time that strengthened our competitive positioning, and again, we've been able to sort of set that up for the rest of this decade, we think, and then thirdly, our financial position improved. Our leverage ratio improved. We've been very active in sort of capital allocation in a very material way, and that's positioned us, we think, really well and given us a lot of optionality on how we think about capital, as we push through the rest of this decade, so we're at a great point strategically, and so we're trying to find our pathway forward, and we think we have to, you know, accelerate through the rest of this decade.
So our strategic initiatives are really geared around three things. First, is expanding our networks even further. We've been very particular about the portfolio of markets that we serve, and we think we have a unique portfolio of communities inside of HCA that are benefiting from some of the national migration that's taking place to Texas, to Florida, to Tennessee, to South Carolina, Utah. I can go down the list. Excuse me. And pretty much all of our communities, I think, are benefiting from some of that, and it's really given us an opportunity to invest further in our network model. So we're adding outpatient facilities. Today, we have maybe thirteen outpatient facilities as part of an ecosystem for each hospital. That's an average.
We think that will grow to somewhere between seventeen and twenty by the end of the decade, simply because, excuse me, we want to extend the reach of our network for our patients, make it more convenient for them to start their process of care, somewhere in the HCA system. So we got a lot of capital going to outpatient development, inpatient, capacity, clinical technology, and so forth. The second thing for us is really geared toward tapping into the embedded value we see inside of HCA. We see a lot of opportunities outside with growing market share and building out our networks, as I just mentioned, but inside the organization, we see a lot of opportunities still to improve performance, and we think our pathway toward that is our digital agenda.
And I know a lot of CEOs wanna talk about artificial intelligence, but in our business and how our business actually gets processed, the power of artificial intelligence has unique capabilities to advance the clinical performance and better care for our patients, more efficiency for us and our colleagues as they deliver the care, and then really as a management team, giving us better insights into actually running the business. So our digital agenda is a very important pathway for us... as we push through the rest of this decade to extract the value that we see inside of the variation that exists across our company. And then the last part of our long-term strategy is really around value creation for our shareholders.
And we think, again, the optionality that we have with our free cash flow allows us to invest heavily in the business and really advance our agenda, but at the same time, look at opportunities to benefit our shareholders in how we allocate capital. If we finish the year as we expect, this year, we will have acquired $25 billion worth of the company's stock in four years. And we think at a good value for our shareholders in that the performance of the stock has continued to elevate over that time period. So the purchases we made over the last four years have been very productive for our existing shareholders.
So those three areas, Steve, are areas that we think are going to continue to position the company for long-term success, respond to the communities appropriately, and then deliver value for our shareholders.
Yeah, well, that's a great start. So I think it's always been clear to the investing community, the level of investment that you're making on growth CapEx is always standing out versus your local market peers. I guess, as you think about how that's maybe even widened further during COVID, it feels like you were able to clearly keep investing at a very high level. Maybe your peers did not. How long does that take to translate through to the market share gains that you'd hope to drive?
I think market share is not necessarily just a function of capital spending.
Yeah.
There are a lot of things that go into delivering market share growth, and we've had a nice pattern, not just as a company as a whole, but within the portfolio. A lot of our markets have achieved, top-level performance, and reached new heights with our market share. We have about $6.2 billion of capital that we've approved, that's in some form of construction or development at this particular point in time, that will come online in, you know, a little bit, the rest of this year, quite a bit in 2025, a lot in 2026. And that goes toward, again, building out, the networks and expanding them appropriately. So it takes a while.
Some of the outpatient facilities start to see activity sooner, and then you have, inpatient investments are larger and more long-lived assets, and so those take a little bit longer. But it's very important that we have capacity to execute our in-market strategy. And our operating capacity today is being utilized at about 72%-73%, on an inpatient basis, which is actually a high watermark for us as well. And so we're gonna need capital to receive our patients downstream, if in fact, they need inpatient care. And so outpatient capital, very efficient, not that much. Inpatient capital, more significant from an investment standpoint. We have to execute physician strategies, quality strategies, all of these components that really make you competitive
And allow you to grow share. But at the end of the day, Steve, it's execution, and our teams do a wonderful job of executing the details in the market to develop relationships, to respond to the patients, to make it easier to navigate the system. So you infuse capital into that sort of execution mindset, and that's why we think we are able to gain ground.
And then, you know, you mentioned you're in great markets, seeing a lot of benefits from, you know, migration across the country. You've been incredibly selective historically, about the markets that you've gotten into and invested in. Do you think there's potential still to get into, to new markets today? Do you feel like you're seeing different opportunities to maybe enter new geographies where you haven't historically been able to?
We've added new markets over the last five-seven years. Not that many, but a few. You know, our industry doesn't present itself for inorganic growth as easily as other industries. Most of our competitors are tax-exempt systems that aren't motivated by asset optimization, so to speak, and or stock price. And so it doesn't necessarily create the kind of ideal flow on the inpatient health system side. There are plenty of communities we would love to be in, and we, you know, we have markers on communities and opportunities, and we explore those whenever they come up. But in most instances, assets on the hospital side
Yeah
Don't come up unless there is stress financially for the tax-exempt facility, serious stress.
Mm-hmm.
So it usually is a broken system that we believe we can execute a strategy around. However, we are very active in outpatient acquisition . Because that's sort of a normal industry dynamic, where folks are looking to optimize their return on capital and so forth. And so we have infused outpatient acquisitions in market
Yeah
to our systems to strengthen our system offerings. We bought a great business in Houston. Last year, we bought an outpatient business in Tampa St. Pete. Last year, we bought a small hospital rural system that was complementary to our DFW system.
Yeah.
This year. So little things like that are being done all the time. They don't move the company needle as a whole, but they're very complementary to our positioning.
Yeah
in market.
On the outpatient side, you think about the required overlap versus your existing network. Is there a threshold that has to be? Like, would you do acquisitions if they ever had assets that were outside of your current end markets?
Possibly. We don't rule that out. We think there's value to local network scale. There's synergies within the market that come from that. It's better for our patients. It really provides, you know, the comprehensive aspects that we think are necessary to compete. We do have some outpatient facilities that are in sort of markets that are on the periphery of our core markets and we're dabbling with what does that mean? Are we seeing the returns? Does it distract our management from the opportunities in market? So we are working our way through that, but right now, we don't see a lot of opportunity on that.
Okay. As you think about the current demand environment, it's obviously, you know, been quite strong. You have a number of sources of strength, just between your traditional managed care, the exchanges, there are a lot of things that are going really well for the company at the moment. When you updated your guidance, you know, you're assuming that strength continues into the back half of the year. Wondering, you know, if you could speak to what gives you the confidence to do that? And obviously, we're getting more questions on the macro environment. So any kind of update on whether you're seeing any kind of impact there.
Just speak to the volumes as forecast for the rest of the year, and then I'll, I'll speak to the macros. Sure. I mean, based on what we were seeing through the first six months, both in terms of the depth and the breadth of our volume growth, and we look at it by geography, we look at it by service line, we look at it by payer category, as you were mentioning. On the payer side, through the first six months, you know, we had good growth in managed care.
Yeah.
But, you know, with healthcare exchanges included and without, I mean, we're almost a 5% growth on equivalent admissions with our managed care book, excluding the exchanges. The only payer category on the first six months that was down was Medicaid, with the Medicaid redeterminations, which is down about 10%. Some of those lives, those patients, migrated to exchanges, so, I mean, that's a piece of why the exchanges were growing so strongly in the first six months. But, you know, everything that we can see in our volume through the first six months gave us confidence that we saw no reason why it would slow down materially in the back half. Our comps through the back half of the year were pretty steady, as you look at the last half of 2023.
So, you know, if you think about an equivalent admission growth through the first six months at about 5.2%, you know, that's kind of the midpoint of the range
Yeah
that we updated our guidance to. I think it's important to note that, you know, our long-term guide on volume historically has been in the 2%-3% range. When we came into this year, we went to 3%-4%, just because
Yeah
We saw elevated demand a little bit last year as well. So, you know, I don't know if we're quite ready to change our long-term guide, but, as it stood right now, we felt comfortable enough from what we were seeing in the first six months that it felt consistent for the back half of the year, and so we updated our guidance accordingly.
Okay. So another question on, you know, some of the volume and inpatient versus outpatient admission dynamics this year. We're getting a lot of questions about Two-Midnight Rule. Could you update us on what, if any, impact you think that's having on your business this year?
Sure. I would describe it as a modest benefit to the company in the first six months. We are seeing our the physician community adopt the Two-Midnight Rule for Medicare Advantage.
Uh-huh.
We're seeing that with them writing more patients with inpatient orders and decline in observation visits, especially for accounts over two-midnight
Yeah
which is expected with the rule. And I think it's important, like, the CMS adopted this rule for Medicare Advantage, we think, for a very good reason.
Mm-hmm.
So if you look back in the past, these are patients that were largely in inpatient beds
Okay
and getting inpatient level of care, you know, the nursing care and the food and all of the structure that we put around inpatients. They're in inpatient beds.
Yeah.
So, you know, this made a lot of sense to us for this adoption of the rule. And then if I think about the second part of how you validate, you know, what we're seeing with the
Yeah
That is how the payers are paying. We have seen, you know, a slight or modest improvement in their denial rates for accounts over two midnights, so that's encouraging.
Yeah.
We think the payers are adopting it to a degree. There's still too many denials,
Yeah
on accounts over two midnights, so we're still working with our Medicare Advantage payer partners to, you know, to get the rule fully adopted, and that will, you know, that will continue into the future. But I think net-net, overall, it's been supportive of inpatient admissions.
Uh-huh.
I would say for, you know, the impact on overall inpatient admissions was probably about a half a point of growth for us
Okay
in the first six months of the year, and you know, I think we'll see continued improvement as the payers continue to adjust their systems.
Okay. Half a point on the overall or half a point within the
Overall.
Within the MA book?
Overall.
Okay.
Yeah, overall.
And Sam, I cut you off. You were gonna speak to the macro as part of the volume and demand backdrop.
Mike mentioned our long-term forecast
Yeah
And guidance for volume, at least in our markets, we think it's, you know, 2%-3%. What we see in our markets as being structural lift for demand is really centered around a handful of things. One, we think population will continue to grow and deliver demand for healthcare in the markets that we serve. That's number one. Number two, we're still in, you know, a wave of aging baby boomers starting to hit the system and need more services, so that's sort of part of the structural aspects of demand that we see. The third thing, and, you know, there's pluses and minuses on this, you know, chronic conditions continue to exist, and, you know, there's drugs that may compensate for that a little bit, but we think that's another factor.
And then I think, the last thing for us is market share gains. And so those four things are very important to, our viewpoint on the macros, and we believe we can continue to grow market share, over the balance of the year. We have a goal of getting to 30% by 2030, and we think that's viable for us as we continue to execute, as I mentioned earlier. But those structural pieces have delivered, we think, an environment where demand for healthcare, broadly, will be in that two to three zone. We need to finish the year, as Mike alluded to, to judge what the 2025 implication may be. It could be that we're still in an elevated position compared to that long-term demand-
Uh-huh
but we need to get through the last six months of the year and really judge what we're seeing. Obviously, coverage is another factor. Coverage, we think, elevates a little bit of demand, and in our markets, there's greater coverage of citizens than there has been in the past through Medicaid, through the Affordable Care Act, through private employers with job growth and so forth. So that's a positive also at this particular juncture. And again, we'll have to judge that as we move through the next few years to see if that persists. If it does, it may lift the long-term guide.
Okay, that is good to hear. So then natural, you know, kind of segue there would be the exchanges. It's obviously been an incredibly important source of growth for you the past couple of years. You know, I know you don't have a crystal ball. As you think about potential for the enhanced subsidies to maybe not be in place beyond 2025 , any update on how the company is thinking about that? Is there any real differences in how this population uses the system or presents from a profitability perspective, maybe relative to a managed care book, that are important for the investor to be thinking about?
Yeah, you know, it's still a little early. There's a long time between now and the end of 2025 . And I think to really know what's gonna happen with the enhanced subsidies, we're gonna have to first get through the election
Mm-hmm.
and get a sense of what happens, not only with the presidency, but the House and the Senate. There's, you know, a lot of dynamics there related to what the net balance of power is. Is there a trade between tax policy and, you know, exchanges? And so we got to kind of get through that to really know exactly what, you know, the impact will be. I mean, clearly, if the enhanced subsidies just sunset, right? That'll be a bit of a knock in the forehead for us.
Yeah.
I mean, it's, you know, healthcare exchanges are roughly our second-best payer.
Mm-hmm.
Not quite as good as commercial, better than Medicare.
Yeah.
So you can get a sense of that. I think the second part of the question really kind of deals with what happens, right?
Mm-hmm.
And so, you know, everyone who's on an exchange now will not leave if enhanced subsidies go away. And so, you know, and some of those who do leave will end up going back to employee-sponsored insurance. And so it's not a net zero, but it is an impact.
Mm-hmm.
And, you know, we'll know a lot more after the election, and then frankly, a lot more as we get into 2025 . So we'll keep you updated as we continue to model it. I would say this, that, you know, part of the management team's work is to prepare for eventualities like this, contingencies like this.
Mm-hmm.
It speaks to the importance of the other aspects of our strategic plan, and I'll call one specifically, as our resiliency agenda and our tech agenda that Sam mentioned earlier. So, you know, we're working to make sure that we have a very strong Resiliency Program that can help us offset impacts like enhanced subsidies. If they were to sunset, it would, you know, wouldn't offset entirely the impact in one year. But, you know, that's part of our planning process, is to make sure that we have a set of activities and strategies that will help us deal with challenges as they occur.
And we're pretty active in the political arena, as you would expect. So we've got different, I'll call them, war games, inside the Beltway and outside the Beltway with respect to campaigning
Yeah
for, you know, some kind of extension here, simply because there are a lot of people who are benefiting from the Affordable Care Act, and appropriately so.
Right.
And so we think there, it's some nuance here that's never before existed, given the fact that there's so many people in Florida, so many people in Texas that are now covered. These are red states for sure, but we've got to make sure the leaders, the political leaders in those states, and who represent in Washington, understand the implications for their own citizens. So there's a dynamic here that's new and we think favorable, as it relates to that, but we need to wait and see, as Mike said
Okay
that that's the case. But, you know, I think for us, I mean, we've navigated through different economic cycles. We've navigated through different governmental policies.
Mm-hmm.
We've navigated through a pandemic. The staying power
Yeah
of a hospital-centric health system, the staying power and the durability of HCA Healthcare is a unique attribute. And our management teams embrace the realities that come before them, and that allows us to just sort of power through these things. Nothing goes in a straight line.
Yeah.
But over time, we're really confident we can work through whatever policy implications might exist here. And it may create new opportunities for us that we're not even anticipating.
Mm-hmm.
Because if it's a negative for HCA, it's a bigger negative
Sure
for others.
Yeah.
Simply because they aren't in the same position
Uh-huh
to adapt or have the same willingness to adapt that we do, so we're, you know, we're hopeful that we can get the right answer politically, but if not, we've got contingencies, as Mike alluded to, and then we have a culture of responding to whatever those realities are.
Okay, and then just one more question on the elections. I guess there's obviously been a lot of focus on, you know, the enhancement of Medicaid reimbursement across, you know, a significant number of your markets. Do you view those programs as being sensitive to the outcome of the elections?
Short answer is no.
Yeah.
But I'll let Mike give you more detail on that.
I think it's really important when we talk about Medicaid supplemental payment programs, to connect them back to Medicaid.
Yeah.
You know, I think the federal and state governments over the last, really, these are long-standing programs, you know.
Mm-hmm
fifteen, twenty years. We have programs that are twenty years old.
Yeah.
I think the governments recognize that providers need help to deal with the kind of chronic and historic underfunding of Medicaid.
Yeah.
And so these programs are there to help hospitals and health systems provide access and care to the Medicaid population. They're really important to the safety net hospitals.
Yeah
are really important to the tax exempts as well, in addition to us. And they're really focused on that goal
Yeah
which I think we have seen good support from in both red states and blue states. We've seen historically good support from in both Republican presidential administrations and Democratic presidential administrations. So they feel way more durable.
Yeah.
And you know, the other thing I would say is that if you go and look at the new rule that was issued earlier.
Mm-hmm
This year, we actually view that rule as being both positive and supportive. It was the first rule update since 2015. It confirmed the ceiling as the average commercial reimbursement. It didn't put a cap on total federal expenditures, so there were some aspects of that rule we deemed very favorable.
Mm-hmm.
and then the last thing I would say, and I think everyone knows this now, but remember that providers, you know, are part of the funding mechanism to draw down the federal funds. So, you know, part of what we do as a provider network to help the communities and get these Medicaid supplemental payment programs, is we incur expenses-
Mm-hmm.
that are part of that funding process, and those expenses show up in our income statement as other operating expenses.
Yeah.
They do feel more durable to us.
Okay. And I know that, you know, from, like, a modeling perspective, these programs have been very hard for the investment community to kind of keep up with. I guess, as you step back and think about where you might be in terms of, "Hey, we're in the innings of this reimbursement improvement," do you think that we're in the later innings of the story? Do you think there's still states where it looks like they're materially under indexed to these programs? I guess, how should we be thinking about the potential there?
I mean, I think we're in the later innings.
Yeah.
I mean, we have eighteen of our twenty states that have Medicaid supplemental payment programs now.
Okay.
And in all of our big states.
Mm-hmm.
And so, you know, that's for sure. Now, and we talk about this often because it is complicated.
Yeah.
These programs are not uniform, and states will have multiple programs.
Mm-hmm.
And so, you know, we always try to talk to our investor community to say that, "Look, these are, these are complex. There's a lot of variability in both the revenue and expenses that happen on a quarterly basis." We tend to try to talk about them annually.
Yeah
as best we can, 'cause we feel like that gives us a bigger time period to, you know, project and talk about when there are changes, and there are changes that occur quarter to quarter.
Mm-hmm.
Some of which you can project and some of which you can't in, you know, earlier in the year. We tell you, right?
Yeah.
So when there's a material impact in a quarter, we'll let you know. But largely, you know, I'd say that you know, we're in a pretty steady place here on Medicaid supplemental payment programs. There's definitely a couple of newer programs that are floating around out there, which are great, but you know, largely, that's how I would describe it.
Yeah. Okay.
And there's probably a natural, organic aspect to them over time as more people are covered by Medicaid and states grow, that there will be some organic.
Yeah.
Yeah.
But if you think of a new adoption in a state like North Carolina last year-
Mm-hmm. Yeah
that's an inorganic aspect to these programs.
Yeah.
We don't have many inorganic opportunities, 'cause like Mike said, 18 out of 20 states have adopted
Mm-hmm
some form, but there could be some adjustments to those programs-
Yeah
that happen, you know, could go either way. But, we're working closely with advisors in the states to understand how to apply different learnings, 'cause we see a lot of learnings.
Yeah.
So if we see something in Texas that could have application to Florida
Yeah
we'll work with the Florida agencies-
Yeah
to understand what that might mean to their program. So, you know, that's part of what we're trying to do as well.
Okay, so you think there's potential over time, that even if you're not adding new programs, you still see some drift up in terms of
Yeah, I think that's possible.
Yeah.
Okay.
I mean, average commercial reimbursement is an example of that.
Yeah.
You know, not all of our states are up to the top. So, you know, I think over time, there's opportunity to continue to support the Medicaid population.
Yeah. Okay. Then, you know, on the commercial side, obviously, the improvement in, you know, commercial rates that you've seen over the past couple of years to help compensate for some of the higher labor costs that you incurred earlier during the cycle, you know, have been pretty meaningful. Can you speak to where that sits as we're entering 2025 ? Should we think we're on a path to more normalized levels of commercial rates?
We're in a cycle, as we always are.
Yeah
in negotiating. And right now, I would say we're maybe 75%-80% for next year, you know, fully contracted on the commercial and MA side, for the most part. And on the commercial side, our targeted, you know, escalators have been in that mid-single digits, and for the most part, we're achieving that, with, I'll say, basic elements of the rest of the contract being in place, so nothing material has changed. We're probably about 50% - 60% contracted for 2026, at similar levels. So we've been able to achieve our targets and compensate for the wage inflation, the pro fee inflation that we've incurred
Yeah
and such, so we're pretty pleased with where we are, and I think that speaks back to our networks. Our networks are relevant, and that relevancy allows us to negotiate properly and create value, we think, for the patient, but also create value for the health plan by being accessible, by having different services to offer. We have urgent care, we have emergency room, we have hospital surgery, we have ambulatory surgery, so we have an omni sort of channel approach, and that creates, we think, a value proposition
Mm-hmm
for the plan that's helpful to their objectives as well, and so that weaves into the overall discussions.
Okay. And you mentioned the spike in professional fees, obviously, you know, caught seemingly the industry kind of off guard. When you think about the trajectory of Valesco over the next couple of years or, you know, your providers outside of Valesco
Mm-hmm
can you speak to, you know, whether they're on much firmer financial footing post the rate increases we've seen, and how you think about that for the next couple of years?
We do, we do see pro fees moderating.
Yeah.
We spoke to that in our earnings call, and we're starting to anniversary some of the real pressure-
Yeah
some of the absorption of Valesco. You know, our mindset now is, how do we turn Valesco into a strategic asset?
Mm-hmm.
And a strategic asset for us would be having a capability to absorb other issues if entities struggle financially, and we need to step in for our facilities, providing more clinical value because we're able to sort of influence and work with our physicians in a different way, providing efficiency by helping us with case management and other initiatives, and even supporting our growth agenda with different staffing models, scheduling, and so forth, that will allow us to open capacity and use capacity more wisely. So we're pretty excited about the possibilities here.
Got it.
Valesco, in and of itself, is not gonna be a massive profit engine for us.
Sure.
It's just not.
Yeah.
It's a component of operating really sophisticated hospitals. And so, in that sense, we think we've got opportunities to use that entity to help us with graduate medical education and physician training, and so forth. So there's a lot that goes into turning this now into something that before was just a vendor relationship.
Mm-hmm.
Now that we have full absorption, we're starting to get different management insights, and we're hopeful we can improve the financials a little bit.
Yeah.
We're on our plan this year. But, there'll be some, maybe some incremental improvements going forward. Not meaningful in the sense of changing the company's trajectory, but really supporting the base business, and that's why we did the deal. You know, people were criticizing me, like: "Why'd you do that, Sam?" I'm like: "Well, if you would've been in my shoes, you would've done it, too." And now we have something to work with because we were able to protect the enterprise, take on a little financial risk, and we can take on a little financial risk. And now we have an opportunity to turn this into something that's even more differentiating and allow the company to really execute its growth strategy, its clinical strategy, in a way that we couldn't before.
At the Investor Day, you spoke to $600 million-$800 million of efficiencies that you guys were looking to drive from the business. I think touching on your digital agenda probably explains some of that, but can you speak to the sources of where you think these savings are coming from?
Yeah.
and whether those are available, you think, largely to earnings, or do you think they're used to reinvest in the business? How should we think about that as translating?
Yeah, you know, our Resiliency Program is deep and wide, and really
Yeah
gaining not only maturity, but momentum. We kind of break our resiliency work streams into three main categories. You know, the first one is to continue to expand our shared services platforms. You know, we mentioned at Investor Day, laboratory is an example of that, you know kind of a clinical core service that we've been able to support differently with consolidated laboratories. We've got new support models and shared service platforms setting up for our environmental services footprint, our food and nutrition footprint, our plant operations footprint. So, you know, this leveraging of scale to drive both effectiveness and efficiency through shared services is a powerful part of our Resiliency Program, and still has a lot of innings left as we continue to look for opportunities there.
The second is really digital and AI, and you know, you've heard Sam earlier talk about the importance of the digital strategy for the company. It has a lot of application administratively for us.
Yeah.
I mean, if you think about our revenue cycle, our supply chain, just the volume of transactions that we have, you know, the power of big data, the power of these tools are gonna really help us to advance these operations, find ways to become even more efficient, and we're pretty efficient already. So, you know, digital and AI kind of getting applied both administratively and operationally. I mean, we mentioned at Investor Day, length of stay in case management.
Mm-hmm.
And, you know, we're starting to build AI tools into our workflow tools for our case management staff, and it's paying dividends.
Yeah.
I mean, you're seeing our length of stay, for example, through June, year to date, down 2%.
Right.
It was down 3% last year, 2023 versus 2022. So, you know, that's a big part of that, and we're excited about that. And the third one is really our benchmarking reporting analytics work, where, you know, it sounds basic, but when you have 180-plus hospitals-
Mm-hmm
finding variability and cost and operations, and then finding the best practices of those facilities that have figured out a better way, and then transferring those best practices across the enterprise in a really effective way, drives efficiency from the bottoms up across our really wonderful set of management teams. So our resiliency strategy, you know, has got both a short-term and a long-term objective. In the short term, we're using our resiliency strategy to fund our tech and innovation investments, primarily right now. The second thing that I, and I mentioned this earlier, that it gives us the ability to use those to deal with challenges.
Yeah.
So as
Mm-hmm
unexpected challenges occur, you know, we have a set of work streams that we can count on to deliver offsets and savings. And then as we get to the back half of the decade, you know, we see this as very supportive of our margin agenda. And, we hope over time to allow us to, to push through
Okay
and continue to expand margins.
I think that's a great place to leave it. Thanks so much for the time today.
Thank you, Steve.
Thank you.
Appreciate it.
Yes.