Joanna Gajuk, the Equity Research Analyst at Bank of America. I cover some of the home care companies here. And thanks again for joining our third annual Home Care Conference. It's my pleasure to host now this session with Option Care, the largest home infusion provider in the U.S. And today with us, we have John Rademacher, President, CEO, and also Mike Shapiro, the CFO of the organization. John and Mike, thank you so much for joining us. And I guess we'll go right into Q&A, and as the operator mentioned, there's an ask question function, so those in the audience please feel free to utilize that little window to pose a question, and I'll be happy to ask it on your behalf. I guess maybe we should start with the third quarter results.
We've been obviously getting some questions there around the guidance. Quarter itself was solid, right? And you actually raised the guidance for the higher benefits from the procurement savings here. And now the guidance for Q4 really implies, call it, you know, EBITDA $109 million or so. If you exclude the procurement benefit, right, it, you know, the kind of people doing the math, and they look at, "Hey, you know, it's a 4% year-over-year growth, so how should we think about that?" Because obviously that's below the long term growth argument for the company in the low double digits. So kind of help us frame the third quarter heading into fourth quarter and kind of.
I know there's a lot of moving pieces, but I guess, you know, there's a lot of questions around that. So maybe, I'll have you first walk us through the fourth quarter, and I guess heading into fourth quarter from third quarter.
Yeah, Joanna, it's Mike. Good morning, everybody, and really appreciate being included in the conference again this year. Maybe I can help with detangling the math, because obviously coming out of the third quarter call, which, as you said, we were thrilled with the results. We delivered 28% earnings growth. Understand and fully appreciate that, especially in 2023, there's some nuances of this year that definitely create a little bit of a muddy growth viewpoint, just given some of the large variables that were injected into the year. Such as the fact that we sold off a respiratory therapy business at the end of December 2022. We, as we highlighted, we've exited two therapies completely, which obviously represents some headwind.
And then obviously some of the procurement nuances that we've called out this year that obviously were a tremendous benefit and something we thought was warranted to call out for the investment community. Look, as we think about going into the fourth quarter, we've highlighted that, you know, around the procurement benefits, and as you know, this is a dynamic business. It's not just results with or without procurement. There's a lot of different moving pieces behind the scenes. We see that benefit starting to dissipate, and we, as we sit here today, we see it pretty much evaporating going into the first quarter, as we called out on the third quarter call.
The one thing I would highlight in multiple conversations with some of the investors is: look, last year in Q4 of 2022, we delivered $94 million of Adjusted EBITDA. That includes the respiratory therapy business that we exited. That also includes the two benefits. So engineering and reengineering the numerator to back off the procurement, but not adjusting the baseline, I think is a little bit of short-sighted math. When you normalize, and again, it's hard to do in this business, given the meaningful dynamics and variables, but when you normalize for the exited therapies and the business that we sold that aren't in our fourth quarter results this year, it's still double-digit earnings growth. And I know it's this year presents some larger challenges.
But again, when you normalize for that, and if you, you know, simply pulled out the $30-$35 million procurement benefit that we quantified and sized up on the, on the third quarter call, that still implies our, our guidance range for the year of $390 million-$395 million, which is still considerably above the midpoint of where we entered the year with the preliminary guidance. So overall, we're thrilled with how 2023 is shaping up. We fully appreciate there are some moving pieces, but again, as folks try to dissect the Q4 math, and we just don't disagree that that's a fair snapshot of the growth trajectory of this platform.
No, exactly, and there's always some moving pieces, so that's very helpful, you know, to hear you talk about this. And I guess you mentioned the overall total number for the year, $35 million. The way you kind of talk about this procurement benefit, obviously that creates a bit difficult year-over-year comp, because as you said, you expect this to pretty much go away essentially at the end of the first quarter. So how should we think about this? Because I guess when you, to your point, when you exclude this for 2023, you know, kind of the rest of the business, I guess, the this guidance implies is growing, you know, 14% this year, right?
So when we think about next year, is it kind of fair to assume a similar, you know, kind of growth at the core, excluding the procurement benefit? Is there anything that you would point us to, you know, that this number should be different?
Yeah. I'm gonna start with the response that you're fully gonna expect, which is we're not in a position at this point to unpack 2024. As we said on the third quarter, we traditionally do that on our fourth quarter call, which, you know, we're targeting sometime in the latter part of February, at which time we will absolutely unpack our expectations. I think you bring up a point, you know, again, back just to rewind, entering the year, our initial guidance was $370-$390 of earnings for the enterprise. We're exiting this year at this point with guidance of $420-$425, which again, we're very comfortable with. That's considerably above where we were expecting this enterprise to land.
Again, a lot of that was much in part due to not only the execution by the team, but also some of the procurement wins. So I think normalizing back to that $390-$395 is a reasonable jump-off point, which again, I would just remind you and others that that's considerably ahead of where we are. You know, since we've put this enterprise back together in 2019, you know, John and I, and the leadership team are well aware of, you know, our reputation and track record of delivering on every year and every quarter that we've outlined.
And so going into next year, when we get to February, I think we'll take that, that same approach and articulate to, to, to the investor community a high degree of confidence of expectations for the year. While we're not in a position to, you know, to affirm guidance, what we have said on the third quarter call and in many, many conversations since then, is our conviction in the, in the growth algorithm of this business over the medium term, which is high single digit top line, translating into leveraged low double-digit earnings growth, remains firmly intact. How that relates to, you know, you know, one specific year, we'll, we'll get into that in February.
But again, you bring up a good point, which is, and we've been very explicit, that that benefit does come out, but when you bring it out, when you pull it out, we're still considerably, you know, ahead of where we guided folks to entering the year.
And I guess just thinking about the business, right? So you mentioned, you know, thinking on the top line in the high single to mid to high single digits. And can you break it down for us, you know, the acute versus chronic therapies? Because I guess the question is like, you know, can chronic therapies, that part of the business, continue to grow at double digits?
Yeah, maybe I'll start with the mechanics and quickly hand it over to John. Like, what we've said is, we see this enterprise as a high single-digit top line. There's a little bit of a barbell effect. Roughly 28% of our revenue are acute therapies, which are growing very low single digits. These are mature therapies. We've been very open that they're a valuable part of our portfolio, but they're growing low single digits. At the other end of the barbell is the portfolio of chronic therapies. These are a lot of the therapies you see advertised on TV, the ones that are being introduced for underserved or, you know, not served populations. And those are. We view those as growing in the low double digits as a basket.
As we think about the broader portfolio, it's great diversification, but very different growth profiles.
Yeah, and Joanna, a couple of points, going back even with where Mike was on our opportunity in 2023. First and foremost, you know, the team has executed extremely well. I know we harp on the procurement benefit that we've been able to get, but that's because our team has been out effectively onboarding patients, managing our patient census, making certain that we are a partner of choice through that process. And I think that just speaks around the execution of the organization and the ability of our commercial and operations team to work in partnership.
To that point, and as Mike said, you know, our focus around being local, and having the footprint that we have with the 95 pharmacies and the ability for us to be very responsive in those local markets, we think continues to position us extremely well, especially for those acute therapies, where you have to be hyperresponsive, you have to be very local. The ability to help that discharge of a patient safely and effectively out of the hospital into the home, and be able to be there within 12 hours, you know, of being able to deliver the product and coordinating the nursing care, is something that we do extremely well.
I think that as we continue to make investments into the business, as we invest into our infrastructure, as we make certain that our commercial team has the reach and frequency and is that partner of choice with those referral sources, we think we'll be really well positioned to continue to be well positioned within those local markets and capture market demand that exists there.
The barbell, as Mike said, and that existence between the acute and chronic, you know, our focus is always around increasing our census, you know, the number of patients that we serve, making certain that we have the capacity, not only within our pharmacy infrastructure, our infusion suites, and our nursing network, to continue to build that momentum or build on that momentum and continue that moving forward. We feel really well positioned on that. There are always gonna be puts and takes in products, as we saw this year, that may be moving to sub-Q or oral, as we saw with some of the products, and new products emerging into our portfolio.
So the comprehensive approach that we take to not only managing upstream with our biopharma partners to understand what's in the clinical pipeline for FDA approval, what that product launch is going to look like, being able to use our platform to its fullest in support of new products, as well as understanding where market demand exists on our existing portfolio. All of those things we think are things that we do on a daily basis and are gonna continue into the future as we're looking at the opportunities. The prevalence of disease is not decreasing. The number of products that are coming into the portfolio continue to expand. The relevance of our infrastructure, not only the infusion suites that we're building out, but also our nursing network, we think is of high value.
And so, you know, we believe in the growth thesis that Mike outlined, which is that, you know, mid- to high-single-digit on the top line, and a leveraged growth profile, given the efficiencies that we can operate through our scaled infrastructure. We feel really, really good about the position that we're in and that growth algorithm moving forward.
No, thank you. You mentioned there's always different therapies coming and going, so maybe just kind of touching base on a couple of those. So one is, I guess, Stelara. So there's the biosimilar, I guess, now it sounds like the launch was maybe delayed to 2025, actually. So maybe this would be one of the examples, but can you, can you talk us, walk us through how does a biosimilar, I guess, impact your business?
Yeah. We've talked about this multiple times with different products. So, you know, with the Stelara, you know, ultimately having a biosim that's gonna enter into the marketplace, you know, it's a little bit of a balancing act for us on that. When you have a branded therapeutic and one in which there is not competition, there's normally higher revenue, as you would expect, because they're able to charge more for the drug without that competitive dynamic. But the margin tends to be a little bit lower for us. And so as biosimilars get introduced or you have that competitive environment, what we may see is we may see some pressure on the top end of the top line, seeing some pressure around the total price that's being charged there.
But it gives us an opportunity to negotiate from a procurement standpoint, to make certain that our acquisition cost is in alignment with those competitive dynamics that are out there. So, you know, in some of those scenarios, we'll potentially feel some pressure on the top line, but we can hold or expand some of the margin as we're looking forward. And, you know, it'll be interesting to see how that patterns out. Each product is different, each therapeutic category is somewhat different on that standpoint.
But our expectation is that as if it follows kind of the standards that we would operate, we'll feel a little bit of top-line pressure, but we'll be able to preserve or expand margin, as we look forward and as we have those competitive dynamics, you know, working, and our ability to use our procurement capacity or capabilities to their fullest in that type of a scenario.
And I guess there are two other key therapies here, Entyvio and Ocrevus, right? So there's subcutaneous formulations that these manufacturers are working on. So when, I guess, do you expect these to be launched in the market, and what kind of impact would you expect to see? I mean, it sounds like maybe that's nothing immediate, but I'm sure you know, you're watching those, and just curious to hear your opinion about these formulations coming to the market and how they would impact the business.
Yeah, you know, sub-Q formulations are always on the pathway from a political standpoint, right? The pharmaceutical companies are always looking for, you know, the easiest form of administration. Ultimately, if they can get it to a pill, you know, that would be, you know, the way that they would look at it. Some of the molecules just don't work well within, you know, a pill aspect. So, you know, our expectations are like we've seen in other products, and IG is a perfect example of that, where you have both the IV as well as the subcutaneous forms of those products.
You know, our expectations are that what we hear from our referral sources is, if a patient is responding well to the therapy and to the administration that they're receiving, in most instances, physicians don't wanna make that conversion unless there's some reason behind that that they would be pushing towards. Our expectations is that this will be a part of the portfolio moving forward. It will certainly have an impact for some of the patients, whether they're naive patients that are coming on to service, that move directly on to the sub-Q aspect, or whether there is some conversion. You know, we expect over time that we would feel some of that.
But, you know, that equilibrium kinda hits, and as I said, I mean, people have been talking about IG for years, and the IV administration going away, and yet here we are, 10 years, 12 years later, and we're still—it's a meaning part of our portfolio, and it's a meaningful part of the way that physicians prescribe and the care path for patients for the best outcomes. And so our expectations is that we'll continue to service patients on both of those products moving forward through the IV administration.
The other thing is we are working, as we're thinking around our role within the healthcare ecosystem, how we can help patients achieve the best outcomes, is thinking about how to use our clinical resources and how to work with the payers around site of care initiatives and other things that they have. Front and center is they're looking at the total cost of care and driving better clinical outcomes to utilize our clinical resources as part of that care team that's helping to administer the best outcomes for those patients.
So there are scenarios where, even today, with subcutaneous administration, our team is still involved in that, whether it requires a healthcare professional oversight or whether we're working with them around the clinical outcomes, thinking about the care plan administration, thinking about medication adherence, all of those aspects, Joanna, we continue to work because we can play a really important role with our pharmacists, our pharmacy technicians, our nurses, our dieticians in support of the total care of that patient over the long run.
So on the last point, which is very interesting, you know, talking about medication adherence, obviously, that's a big part of the, you know, what payers want to improve. You know, the other day we heard of, you know, Irada talking about this and clinical outcomes. So can you talk about your involvement? Do you have contracts in place currently that kinda, I guess, pay for these additional services? Or when you, I guess, negotiate a rate for certain therapies, do you get some sort of, you know, maybe a bonus or some other payment structure for this additional work?
So, can you kind of frame for us, you know, how meaningful, I guess, those things currently are and what you think it could be the next couple of years?
Yeah. I won't disclose too much for various reasons, but, b ut to give a little bit more context around that. So, we are working both upstream with biopharma partners, where they're looking for the ability to track patients, track patient outcomes, and we have ways in which we are capturing that data and sharing it in a de-identified way to then have a better understanding around, you know, their products and how they're being used within the marketplace.
And so we continue to do a lot of work within that, and given the amount of data that we capture, both at the point of care as well as through the entire administration of a therapy, we've got a significant amount of interest from pharma around utilizing that data as part of the way that they're managing it. We're in conversations with key health plans around that adherence aspect. You know, there is aspects, especially for some of these high-priced products, that require that administration to happen consistently and effectively, that they want to have that oversight to ensure that administration is happening and that the care plans are being executed on that.
When you have either, you know, challenges with patients from their dexterity, or you have challenges with patients of being able to truly self-administer in that, there is a level of interest in providing this oversight and making certain that we're following that patient on a longitudinal basis and providing that feedback back to the system or to the health plan within that process, as well as the prescribing physician. We're working on multiple dimensions, given the important role that our team plays to clinically manage these patients. We think this is part of, you know, our value proposition. We think this is part of the way that healthcare improves and you drive better clinical outcomes, is with that administration and that oversight that can be provided.
With the infrastructure that we have, both with our nursing network as well as our infusion suites, as well as the data sets that we capture and the investments that we've made into our core technology in order to capture and analyze and then provide insights back to us as an organization, we think that this is a big part of, you know, the way that we will administer thinking about those chronic patients and the ability to follow them on a longitudinal basis.
This is helpful, and I guess, another therapy that's topical and I guess a question from the audience as well, when it comes to the Alzheimer's drug, like, as a class, right? So that rollout may be a little bit slow, but are you seeing, I guess, more traction in terms of, Medicare Advantage plans covering, those different therapies? And then, I guess, how big of an opportunity this could be for Option Care, and, does it really rely on Medicare Advantage, or is it, more of a kind of, you know, optionality if Medicare Fee-for-Service actually starts covering the, you know, I guess, home infusion therapies, broadly speaking, only then would this be a more meaningful opportunity for you?
Yeah, I mean, we look at it in a couple of ways. Number 1 is, given the prevalence of disease in the elderly, this is one that will, you know, significantly fall within, you know, the Medicare, let's call it, age population, through that process. So, our expectations are that over time, both Medicare Fee-for-Service, as well as Medicare Advantage members, will seek these type of products, through their benefits, that they have. And, you know, to your point, it's been a slower uptake than I think some folks had been, predicting. We've always been cautious around, you know, this, as a class, knowing that there are a lot of hurdles, not only in the diagnostic side of it, but the maintenance side, of these products moving forward.
And really, the refinement of those medical policies and reimbursement pathways has got to be a part of that path for uptake, and to make certain that people understand what are the financial obligations that they would have, either patient out-of-pocket, and/or any provider on a reimbursement model. And that still is not, you know, 100% clear, Joanna. That still is developing. And, you know, as we're starting to enter into the new year, we expect that there will be refinement on that and having better understanding around the medical policy as well as the reimbursement pathway. We truly believe that we are part of the solution. I mean, when you look at just the sheer scale of the number of p otential patients that could benefit from these class of therapies.
When you understand at least some of the numbers that are being pushed out there, around, you know, 2 million Americans that have mild cognitive impairment that could benefit from these products. When you think about how many infusions that would be, you know, through that process, our infrastructure, not only with our pharmacy and our nursing, but the infusion suites that we are built out. I mean, we have over 600 chairs that are part of our service model, and we continue to expand that as part of our overall value proposition. We think we are well positioned to provide capacity.
We think we are well positioned to support patients and their family as they are receiving these types of products, these therapies and infusions. And even if it moves to subcutaneous and it requires healthcare professional oversight, again, well positioned to capture that. But a lot of that is going to be dependent upon that medical policy, the clinical or the reimbursement pathways. And as that starts to become more refined, as physicians start prescribing it more, as family members start demanding it more, we think that we will be well positioned and continue to take a look to expand the number of patients that we have on service as part of that growth of this therapeutic class.
You know, the Lilly product is continuing to move down that pipeline, that pathway. Certainly the Eisai product, you know, we're very well familiar with both of those manufacturers, and we're also very well familiar with those products and the unique demands that they have, and how we can have the clinical protocols already developed in order to quickly support the patients, if we get certainty around both that medical policy and the reimbursement pathway.
No, I appreciate it, caller. I guess so, I guess, still to be seen, I guess, how it's gonna evolve. But you mentioned also earlier, so Alzheimer's is just one of the drugs coming to the market, and you mentioned there's always new therapies coming in. So how should we think about this, trend. B ecause I guess, you know, the, I guess, the bigger number when it comes to the market, the broader infusion, not just the home, right, is like $100 billion, something like that. So when you think about that, the bigger picture, you know, when it comes to the shift into the home setting, is there a way you think about, you know, how much or what percent of that, of that bigger market could actually therapeutically be shifting into home?
Or is there another way you kind of think about kind of the broader market opportunity for the organization?
Yeah, I think, you know, as we had laid out, you know, within the growth algorithm that we had talked about, I mean, that is really volume, right? It's hard for us, and Mike and I are, you know, been around long enough that we're it's difficult to predict pricing on that, especially on those therapeutics. So when we're talking about that growth algorithm, we're talking mostly about, you know, expanding the number of patients that we serve, and that's really the volume based on that. And that's those puts and takes, right? You're gonna have some products that are going to move towards those easier, or those different forms of administration, of self-administer, certain subQ, as well as entrants of new products.
I think as we've talked about our platform and we've talked about not only the relationship that we have upstream with biopharma and the limited distribution drugs that we have as part of our portfolio, we expect that every year there's going to be, you know, 2-3 new products that will enter in, that, you know, we'll be well positioned to bring into our portfolio and to leverage our infrastructure, not only our commercial team, but our pharmacy and nursing platforms in order to really support not only those new entrants, those new products as they launch, but also tap into the healthcare ecosystem and those referral sources.
So that's kind of how we've always looked at it, and I think, you know, history has proven that's a pretty good basis as we look at those opportunities for those new products. Now, some of them are for small cohorts of patients, kind of in the rare and orphan area, on that, and where our clinical oversight can provide substantial amount of advantage through that. Some of them are a little bit larger launches when you're talking about things like Alzheimer's and some of those other therapeutic categories. So, you know, it, in some ways, it's gonna move a little bit based on the indications and the size of the patient cohort that could benefit from those product launches. But we are in active conversations given the platform that we have.
You know, part of the value that we bring, Joanna, to those innovators that are launching those new products is, you know, this national network that we are able to execute. We talk about, you know, our ability to consistently and effectively service a patient in Portland, Maine, and Portland, Oregon, and every place in between, given the infrastructure. We cover 96% of the U.S. population, from the estimates that we have, within our infrastructure. The technology that we've invested in allows us to establish those clinical protocols and then have our team members effectively execute them across that. We have a learning management system that allows us to push training and education, you know, broadly across our organization in a very consistent and effective way.
And what we can do not only with our national logistics center, that allows us to help support moving that product into our infrastructure, as well as all of the technology support that we can provide around the data that we capture and then can provide back.
All those things are part of that reason why pharma and the innovators choose us and our platform is that consistency. On top of that, you then throw the network access that we have from a market access standpoint and the payer relationships that we're able to bring into that, given the fact that we have over 800 payer relationships, over 1,400 contracts, we're in all 10 of the top 10 national payers. All those, you know, lead to a really robust solution set that we can bring, and why we believe we're well positioned to be that partner of choice for innovators as they're looking to bring their products into the marketplace.
No, that makes sense. Before we go there, but I also have another question from the audience. I guess follow up to a discussion, maybe, we started earlier on the guidance and the outlook, because I guess the question is around the cost in. So I guess clearly there was cost inflation the last two years, 2022, 2023. So it may be estimated to be $55-$60 million or so. And I guess the question really is about how much of, you know, these kind of costs that you've seen in terms of the outsized inflation, how much is really sticky versus cyclical, and how much you can really offset by better rates from payers?
So I guess you partially answered the question, talking about you don't assume much of a, you know, being, you know, your top line being driven by pricing. But I guess there's a question that, you know, we, we've experienced the outsized inflation for the last two years or so. So I guess the question is, you know, how much is sticky, how much cyclical, and anything about, you know, being able to offset some of the cost inflation from payers.
Yeah, maybe I'll try and grab, catch my breath and jump in. Look, one of the things that we're really proud of, and we have a high degree of confidence in, is our leverage ability of earnings on this business. You think about in 2022, we weren't talking about procurement benefits. We were talking about extraordinary inflationary pressures on our cost structure that faced virtually every enterprise and across the economy. Yet we still expanded our EBITDA margins by driving leverage in the business, by absorbing and offsetting some of those cost pressures. And so, look, as we go forward, you'll be shocked to know that, you know, when oil prices go down, our suppliers don't call us up to tell us they're cutting our costs on medical supplies and transportation. The reality is, we still operate in an inflationary environment.
Those inflationary pressures are more commensurate with historical trends that we're used to offsetting. And it's things like, obviously, you know, looking for lean opportunities within our pharmacy operations, driving our infusion center strategy, which has driven considerable clinical leverage, as well as some of the procurement strategies. Those have been a larger lever than rate increases. However, as John mentioned on our third quarter call, as those payer contracts have come up, we have had some reasonable level of success at articulating and negotiating better clinical services and nursing rate increases. And so our expectation and the way that we operate is we expect that our costs to increase over time, whether it's clinical labor, whether it's transportation, whether it's just, you know, the general cost of operating 95 highly regulated and controlled compounding pharmacies across the U.S.
That's our rally cry, and that is also part of our confidence that we can still drive leverage and EBITDA margin expansion over the medium term, taking all that into account. And that's part of the value prop of this enterprise.
No, exactly, and I guess that leads me to another question. When it comes to cash flow, right, this entity generates pretty good free cash flow. So now the obvious question is, you know, what do you do with this, right? What's your capital allocation strategy? And, you know, you spoke about this before, but I guess, you know, still we need to ask that question when it comes to your ability to, or your willingness, I guess, to spend that money, right? So it sounds like acquisition is a primary, a primary source, or the use of the cash flow. And I guess on the call, you kind of mentioned, you know, you tend to have this target in the past around the leverage. So you kind of talk about, you know, willingness to lever up.
That, that created some confusion. So can you talk about-
Sure.
your acquisition strategy and what you should, we should be expecting, you know, from, from this organization in the near to medium term when it comes to capital allocation?
Yeah, maybe I'll jump through some of that. And you're a tough judge, Joanna. We're gonna generate more than $350 million this year of cash flow from ops. So, pretty good. I strive to be a great or outstanding, I guess, on your measuring stick. Look, and again, that also includes $100 million of the break fee. So even when you normalize for that, we're gonna generate more than $250 million in cash flow from ops. One thing that this team is extraordinarily proud of is the improved capital structure that we have driven over the last several years. Again, we inherited a stressed capital structure. At the time of the merger, we were pro forma 6.2x leverage.
We exited the third quarter at 1.7 times leverage, and we've seen tremendous response from the rating agencies. We sit here now at a BB- credit, and that's, that's an affirmation of the financial resiliency and strength of this enterprise. It's also a testament to the confidence of our cash flow generation ability going forward. And again, as you've heard us say a million times, it's not our cash, it's our shareholders' cash. How we deploy that to create additional value is a responsibility we take very, very seriously. Obviously, we invest a meaningful amount back into the business to drive more efficiencies and resiliency within the platform. We also have a multifaceted capital deployment strategy that involves M&A as well as share repurchase.
In our first year buying back shares, we've already repurchased $175 million against our first-ever $250 million authorization. We did say on the third quarter call that while we've made tremendous progress on share repurchase, we do see M&A as a priority. We haven't said that we aren't looking at share repurchase. We just said that going forward, the way that we see our ability to create value for shareholders would, would focus on M&A as well as share repurchase as the two levers where we can deploy capital. Just to clarify, too, we said it on the call, and this is our stated capital policy: We're willing to deploy capital and, and go above 3 times net leverage.
The only reason we would go above 3x net leverage is if we had a high degree of confidence and a highly accretive opportunity, and if we had a glide path, which we would communicate externally, on a glide path to get back under 3x in a relatively expeditious manner. We're not looking to, you know, sacrifice our balance sheet and go to 3x-4x net leverage. You can imagine, as we evaluate opportunities, we're taking into account, you know, interest rates and cost of capital right now. Anything that we would do that would lead us to go above 3x, you can imagine, would be a highly accretive and economically attractive opportunity for this enterprise.
And so as we think about M&A, we're constantly looking at, are there, are there assets where we can create, you know, both strategic and economic value? As John said on the third quarter call, we've heard feedback from the shareholders that, you know, we're going to focus on things that are much more of an adjacency to the enterprise and the platform that we've established. And the reality is, we're in a very favorable position. We have a spectacular balance sheet. We're generating additional cash, and we don't feel an urgency or an anxiety that we have to do M&A.
It's highly complementary, and it's based on the fact that we have a very strong performing base business, and we view that as a complementary investment opportunity, but one that we don't have to do to continue to deliver on the base organic horsepower of the platform. And so we view ourselves going into year-end in an enviable position with a great balance sheet, with a number of opportunities that we're looking at, as well as continuing to toggle and weigh the returns of M&A versus share repurchase through capital deployment.
No, thank you. This is great. And a quick follow-up here, I guess, from the audience, and you partially answered that question, but, but the question is, given the market reaction after the Amedisys acquisition, does this imply that, you know, another home health, I guess, acquisition is, is off the table for now?
Yeah, I'll take that one. As we've been saying all along, I mean, we thought that the Amedisys transaction, we thought Amedisys was a unique asset in many of the things that it was able to provide. You know, as we look forward, we're going to, as Mike said, and the commitment was, we're gonna think around things that are closer to the core or those near adjacencies that are gonna help us continue to increase our impact in the healthcare ecosystem and think more broadly around where we need to be positioned to continue to grow and continue to be well positioned into the future.
So, you know, you never say never on those, but we, we've committed to both economic and strategic, as well as closer to the core capabilities that we have. And we've been, you know, articulating out there that as we look at those opportunities, you know, there are things that we can be doing as we're thinking about our platform, when we're thinking about the technology that is required to support it, when we're thinking about, you know, additional ways to go deeper in markets or do things while we're in the home to collect additional data and insights. All those things are things that we're gonna continue to take a look at, and again, put our shareholders' money to work for the best return through that process.
I just have to reiterate, you know, a point that Mike made, and that is we don't feel like we have to do any deal, right? The growth thesis that we had put out there, we believe holds true, and we love the organic business and the growth that we have from that standpoint and the opportunities that sit before us. However, you know, there are opportunities to look to, for us to expand, to grow, to deepen our relevance, all those, in alignment with our capital allocation process. We just think that, given the strength of the balance sheet, and the performance of the business and how we're looking forward, that there's a real opportunity to deploy that in a way that will bring real returns to our shareholders.
Great. This is a great way, I guess, to end this meeting. Thank you so much, Mike and John, for joining us, and thanks, everyone, for taking part of the conference, and I hope you stay for the rest of the day and also for tomorrow. We invite you to join us tomorrow as well. Thanks, everyone.