Good afternoon. You guys ready? Good afternoon, everyone. My name is Lisa Gill, and I am head of Healthcare Equity Research, Healthcare Services. With me this afternoon, I have Option Care. How it's gonna work is, John Rademacher, who is their CEO, is going to make some prepared comments, and then John is going to join myself and CFO Mike Shapiro, where we will run through some questions. With that, let me turn it over to John.
Thanks, Lisa. Good afternoon, everyone. Again, thrilled to be here and participate in the 42nd annual JP Morgan conference. So, been busy, you know, a couple of days, certainly spending time with a lot of you in the room and being able to tell the story around Option Care Health. For those that are not as familiar with the story, wanted to kind of walk through the organization and more importantly, give you a sense around the positioning that we have in the marketplace. Before I do that, you know, normal housekeeping aspects of we may make some forward-looking statements with our commentary today.
Again, with that, we ask that you review not only this presentation that's available on our investor site, but also any of our SEC filings around the risks and opportunities that exist with the business. So for the organization itself, Option Care Health is the leader in home infusion services across the United States. We're licensed in all 50 states. We're independent in our structure and design. We have over 90 pharmacies that operate. Those are, you know, clean rooms. Within those pharmacies, we do everything from aseptic compounding through the dispensing of the chronic meds that are associated with that. As an organization, as you can see, we have over 170 facilities.
That's not only those pharmacies, but also, ambulatory infusion suites, that we operate, that allow us to be able to serve patients, in those markets, whether they're in the home or if they're out in the ambulatory and doing activities of daily living, to be able to be serviced in one of our infusion suites. When you look at, you know, that overall structure, we have over 4,500 clinicians that are part of, our organization, primarily pharmacists, pharmacy technicians, dieticians, nurses, that all wrap around the needs of the patient, that understand that care plan, that help to execute, around, delivering that care and that service, in support of the infused products. We have a broad array, of products that we provide.
We talk about that in really two, specific categories of, those products that are aligned with acute episodes of care. A lot of those are the antibiotics, nutrition support, inotropic, products that are part of that, as well as a broad array of, infusion products for patients that have chronic conditions. Again, serviced out of the organization, be able to, to do that.
We have a proven track record of execution around that efficiency that is required within this type of model, not only getting the right dose to the right place at the right time and marrying that up with a nurse to oversee the infusion event, but also to be working as an extension of either the discharging hospital or an extension of the four walls of that physician practice to make certain that we are providing that care in alignment with the doctor's written orders, to be aligned with the overall recovery or maintenance aspect of their therapy set, and really focused around that extraordinary care that we believe we provide to the patients on that.
Through that journey, and as we really moved forward in 2019, when we did a reverse merger to be Option Care Health and combining with BioScrip, we have continued to focus around the execution of the business, of strengthening of the balance sheet, of making certain that we were focused around revenue cycle management and converting claims to cash and driving the business forward. Where we sit here today, and we'll go through some of the more details, again, the strength of the balance sheet has never been stronger as an organization from a leverage profile, we're at 1.7 times, and that gives us a lot of flexibility as we're thinking about the business, what it takes to invest, but then more importantly, how we would utilize that capital as we move forward.
When you think about the markets that we serve and the overall total addressable market, best sizing that we have is that the infusion market is about $100 billion. Home infusion of that is about $17 billion-$18 billion in addressable market, and we participate within that. When we look at the way that the market is organized, we by best estimates that we have, is we're anywhere between 23% and 25% of that market. There are other scaled providers in the marketplace that have a national or near national presence that occupy another, let's call it 20%-25%, and then it's pretty fragmented after that. A lot of local providers within the market, there are hospitals that have their own home infusion capabilities as part of the service model.
But we have scale as an organization, and we have an opportunity as that national independent provider to use that scale as a competitive advantage, not only to provide consistent, high quality care, you know, across the country, but to be able to take the best practices that we've been able to create and be able to extend that based on the technology investments that we've made and the architecture that we operate to. When you look at the portfolio of products, as I talked about, about 27% of the revenue comes from those acute therapies, and about 73% comes from chronic therapies.
As we're looking at, you know, that structure and design, that also falls into alignment of about 80% of that revenue is from commercial payers, about 12 from government-supported programs. And talk a little bit about that, but part of that is because of lack of access at a Medicare fee-for-service standpoint, and the limited access that beneficiaries have. But also, we see that within the 88% of the commercial, we do participate vigorously with those health plans that have a Medicare Advantage exposure, that are sponsors of those type of programs, because as those payers are looking at the total cost of care and they're thinking about: How do we offer high-quality care at an appropriate cost in a setting in which patients want to receive that?
We fit within that model and the direction that we move forward. We have a broad spectrum of products that we're able to offer. We have over 50 limited distribution drugs that are part of that portfolio, and we continue to focus around: How do we use this platform to not only serve more patients within the existing structure that we have, but also be working upstream and downstream, upstream with biopharma to identify new products that could be entering into the marketplace, as well as continue to be a partner of choice with those referral sources? When you look at the financial performance of the business, again, continuous growth on that.
We have characterized the, the marketplace as being a high single digit top line, and we can drive that through the efficiencies that we operate to leverage growth of low double digits. We've been able to perform, you know, extremely well over the last four years of hitting those marks or above, through that, that standpoint. So we've been outpacing, you know, the market when you look at the, the growth on that. Our ability to use the scale that we have and the, the investments we've made into people, process, technology, our facilities, to really drive out cost and waste within that and drive that efficiency, has allowed us to expand that margin, even though, you know, the, the growth of the chronic portfolio exceeds that of, of the acute.
As I said, we've continued to strengthen the balance sheet from a leverage ratio standpoint of you know the ability for us to convert claims to cash to really be focused around driving those operating efficiencies. And that has allowed us to get upgrades from the rating agencies around you know our credit rating as well as gave us the opportunity to deploy over $200 million... or $250 million of shares back in a repurchase program that was authorized last year and that ability to deploy. So we've had that consistency of performance and the ability to deploy. We've also used some of those dollars to invest in M&A.
We have expanded our, our footprint through that aspect, whether it was buying some local pharmacies that allowed us to continue to deepen our market presence. We also created a nursing network in an organization, through acquisition of Infinity Infusion Nursing, as well as Specialty Pharmacy Nursing Network, that created an organization called Naven Health, that allows us to have over 1,500 nurses within that nursing network, that helps us, meet the needs of, of, the growth, that we've been on, but also to serve the patients, as we've expanded the patient census in the portfolio. When you look at the value proposition and the roadmap, for the organization, again, our focus is around being patient-centric, putting the patient at the center of everything that we do.
We've deployed technology to enable that, to drive that efficiency, to make certain that we understand that voice of the patient in the process, and that we're being very responsive through that process. We utilize all the tools available to help those patients safely transition out of the hospital into the home, or into one of our infusion suites, or those that are living with a chronic condition to live their best life, to be able to receive their drug therapy and their care plan in an efficient and an effective way. And that allows us to enjoy high patient satisfaction scores, high Net Promoter Scores, and really focus our energy around the impact that we can have at that patient level.
The diversity of our network, our ability to utilize the independence that we have to be in all 10 of the top 10 national payers. We have over 800 payer relationships, over 1,400 contracts on a national basis, and that allows us to really use this national platform to serve the needs at the local market. Healthcare, even though we have this national presence, is still local. We understand that, and the ability for us to have that network diversity, resiliency within the network, our ability to continue to grow and provide service and care, a broad set of clinical resources and capacity in order to do that, allows that diversity of the network to really help us drive that growth and make certain that we're doing it in a very efficient and effective way.
We have resilience in our portfolio, and when you take a look at the breadth of the products that we're able to offer, both from a therapy set in the therapeutic categories, as well as our ability to work upstream, with biopharma to identify new products to come, into service, to use the platform in support of the needs, and in some instances, the unique needs of their patient cohorts. We are really, you know, focused on making certain that we optimize the use of that platform, and that we have that diversity in the product portfolio, and more importantly, diversity in the therapeutic categories that we're able to serve.
When you look at the way that we're focusing around deployment of capital, you know, as I talked about before, is we've been building out our infusion suite capability. We're now over 600 chairs in which we operate within that infrastructure. That brings ease of use to many of our patients that are out doing activities of daily living, going to work, going to school, out in the community, and being a way to extend and expand the capacity within that. And that investment has, you know, continued to be at a pretty brisk pace of building out that network in order to support those markets.
A lot of our focus right now is around thinking about how do we deploy the capital from an M&A standpoint that will continue to focus around the core aspects of our business, right? Which is the pharmacy, the infusion pharmacy that infusion suite, and the capabilities around that. We don't underestimate the privilege that we have of being able to serve patients in their home, and the knowledge that we are able to gain through that process, and being able to wrap ourselves around the needs of that patient as we're thinking not only about their infusion therapy, but more importantly, their total care plan.
So we're thinking of ways in how we would utilize that capital in order to deploy, to help either extend geographically, deepen ourselves within certain markets, look for enhanced capabilities that will allow us to continue to increase our relevance and drive better outcomes for the patients that we serve. And then when you think about the size and the scale, I mean, as an organization in 2022, which is the last real numbers that we have, we served over 265,000 unique patients. So that ability to use that scale and the knowledge and the best practices and extend that across all of our operations is something that's really important.
Measuring and monitoring that patient satisfaction and the ability for us to have conversations with the health plans and those plan sponsors around the positive impact that we have on their patients, not only in offering high quality care, in a setting that they want to receive it, also doing it a very cost-effective manner, being able to offer high quality within that and drive high patient satisfaction or member satisfaction. That's an important aspect for the health plans as they're thinking about who they're partnering with, who's in network, and how they're looking at the organization, broadly. From a quality standard standpoint, we continue to focus around a lot of our activities, making certain that we're offering that highest quality care.
We do things internally around our quality management system, but I think the best validation of that is the independent accreditations that we enjoy, both from a URAC as well as ACHC, that give us the confidence and the ability to articulate the quality of the care that we're able to deliver to the patients that we have the privilege to serve. And then as much as we invest into our plant and our equipment and our technology, it's still a people business.
We know that recruiting and retaining top talent in the clinician space is something that is of critical importance, and we spend a lot of time and energy as part of a management team and within our infrastructure to focus around our team members, to understand kind of those needs and make certain that we're driving high retention, that we're recruiting the best and the brightest, that we're creating an environment in which they wanna be a part of, not only as an employer of choice, but also as a destination within healthcare. And so a lot of energy and effort that we have as a leadership team is really focused around making certain that we have that right talent and the right people in the right place through that standpoint.
So that size, that, scale, that ability for us to think more broadly allows us to innovate rapidly and continue to move the business forward in meeting the needs of, of how we focus on really those five Ps of our patients, of pharma, of the payers, of providers, and then our people. And when we focus around delivering value across those five dimensions, we know that that brings real value to our shareholders, through that process. Some of the recent highlights, you know, as an organization, again, we're not in a position to unpack 2024, fourth quarter of 2023 or give guidance for 2024, but, after coming out of the third quarter, again, really strong results, as an organization. We continue to see that strength of the top line.
have the ability for us to look at Adjusted EBITDA and really drive that through efficiencies and the effectiveness of our procurement team and other aspects. Cash flow from operations continues to be very strong and gives us flexibility in not only driving down that net leverage ratio, but giving us the flexibility to do things like the share repurchase as well as continue to look for other opportunities within mergers and acquisitions and looking for additional capabilities on that. You know, as I just highlighted, in the fourth quarter, we were able to utilize additional $75 million and fulfill the original $250 million of authorization for repurchase, given the strength of the balance sheet and the strength of the cash flow.
Our board of directors, in support of that, reauthorized and gave us an additional $250 million of authorization as we're looking forward to move that forward. And we've talked about the multidimensional aspects of how we're looking at capital allocation. Certainly, share repurchases and outlet that we'll take a look at. We're gonna continue to be disciplined in the way that we're looking at acquisitions and opportunities for us to expand in the marketplace.
But we still have very high standards in which we're looking to execute those hurdles that we put in place to make certain that anything that we're doing is in alignment with not only strategic aspects but also the economics that are associated with it, are things that Mike and I you know continue to focus on as we're looking at moving that forward. And then finally, earlier this week, we had announced you know some work that we will be doing in a partnership with Palantir around deploying some artificial intelligence machine learning within our environment. And we're really excited about the opportunity that we have to be working with an industry leader on that.
It allows us to not only focus and be able to take some best practices and a tried and true platform in order to advance some of the work there. But we think the initial use cases that we have and the areas that we'll focus initially are really gonna be around some of those administrative functions, thinking about ways that we can deploy the technology to support our teams, to drive operating efficiencies, to look for ways to drive productivity through that process.
You know, those use cases can be anything from thinking about nurse scheduling and optimizing from that standpoint, through some of the revenue cycle management aspects of prior authorization or reauthorization or denial management through that process, as well as things that we can do from a procurement standpoint to be more efficient in the way that we're acquiring product and making certain that we're looking at inventory management and other aspects. So we're really excited about this. It will, again, we have the opportunity to innovate quickly, given that platform, and really an opportunity for us to continue to think differently around how do we drive operating efficiencies, how do we drive a better operating model?
How do we get our teams to be working at the highest level of their licensure by utilizing machine learning, robotic process automation, and artificial intelligence to really take some of the rote and more mundane aspects out of their day-to-day, and allowing that to be done in a much more efficient and effective manner. So, you know, a strong track record of execution. You know, our expectations are as we continue to move forward, that will be the hallmark of the organization, is delivering on the commitments that we make, driving that operating efficiency, and using scale at a national level to create a competitive advantage, but also knowing that we have to operate really efficiently and effectively at that local level.
Knowing that, we've got to be well-positioned with the referral sources as a partner of choice to be able to bring their patients onto service with us and continue to execute the care plans that they are prescribing. Finally, I won't go into the reconciliation, but again, as part of our normal process and certainly the way that we've posted into the investor site, there is a full reconciliation of any of the non-GAAP measures that we've utilized as articulating the direction as well as the performance of the organization.
Great. Thank you, John.
You're welcome.
So, let me start with, you know, 2023 was a very eventful year for Option Care, to say the least. When we think about 2024, what do you view as your biggest incremental opportunity?
So, I will start by saying I really feel like we're exiting 2023 stronger than we've entered 2023 as an organization. I think when you look at the balance sheet and the performance, we continue to execute really well. We've talked a lot about the strength of the core business, and our excitement around that, and the ability for us to continue to execute well on that. I think that's indicative of the way that we exited Q3, and I think the way that we've articulated our confidence in the guidance that we provided for the full year. As we sit here today, looking forward, there's still a significant number of opportunities for us to drive operating efficiency and effectiveness within the organization.
I think the ability to partner with payers as they're looking at the total cost of care as more and more patients are in capitated programs and medical loss ratios are under strain through that process. Being on the right side of that conversation of offering high-quality care at an appropriate cost in a setting in which patients want to receive, we still see the positive aspects of that. And the first question that a patient asks when they're admitted into the hospital is: "When can I go home?
Right.
We're on the right side of that, and so we believe there still is significant opportunity. And when you look at the market share that we enjoy today, we know that there's opportunities for us to take share, through execution and to be that partner of choice. We know that there are new products that are entering into the marketplace, and our ability to work upstream with biopharma in creating programs like what we did with Krystal Biotech and the VYJUVEK therapy on that, that those are the types of opportunities that we can capitalize, and this platform allows us to do that in working both upstream with biopharma and working downstream with payers and the patients to deliver better care through that. And I think that thesis remains.
I think our level of excitement remains high on that. I think as we're looking at 2024 and beyond, I think all of that holds true.
You know, if I think about the mix that you talked about today, chronic versus acute, and today, acute is about 27%, right? But acute carries the higher margin. I think many of you know that that's because a lot of those are generic drugs versus that the chronic area, that there's less generic drugs. When we think about that mix going forward, I think, you know, if I go back a couple of years ago, that acute component was closer to 40%. How do we think about that shift in mix over time, number one? And number two, what's been the real driver of that shift between acute and chronic?
So I'll start, and Mike can certainly go through some of the mechanics associated with that. So, as Lisa called out, the acute products do have a higher margin on a gross profit basis, given many of those are generic. They're lower value in the dollar cost of those products, as you would expect with that. And so, you know, when you look at the patients that we serve, that's still a big portion of the patient census, right? They're turning over. They're shorter in duration through that aspect. As there has been, you know, new products that have entered in the marketplace to support products like HIV or disease states like HIV and Crohn's and chronic inflammatory disease, our ability to participate in that has been robust, and that's why you're seeing that bigger growth.
These are branded products. They have higher price points on that. And so as an organization, our ability to participate in driving value and delivering value there, has been a big part of that growth, is why we've gone from, you know, that 60/40 to 73/27. And we think that's going to continue, right? There are some really, you know, important drugs that are there that are higher in that price point. The margin associated with that, when it's a high-priced branded drug, again, we will get a lower margin as a percentage, but the actual dollars that drop through to us-
Are better.
-are meaningful.
Right.
And so, you know, we're always finding that balance to make certain that we have the right approach to that, you know, if you're a pharmaceutical company that has a novel branded product, you're not looking to give discounts as you would as if there was competition within that space or ultimately at a generic level. And so, we walk that tightrope to be able to make certain that we do that. But, you know, the way Mike and I always look at it is, what is the drop-through in the dollars, and is it meaningful, and does it, you know, align with kind of the hurdles that we've put in place there?
And we expect that, that's gonna-- we're gonna continue to feel that pressure, given that we're gonna see those situations where more and more patients in the chronic area will come onto service with us.
You know, one of the things that stands out in 2023 is, Mike, you did a great job around procurement in 2023, and that was really beneficial.
That's good until 2024.
Well, that, that's what I was just gonna ask about. As we think about 2024 and the ability to replicate some of that, are there incremental opportunities, or will this be somewhat of a headwind as we start to think about 2024?
Yeah, look, it's a good point. And, you know, John and I pride ourselves on trying to be as transparent with the investor community as competitively responsible. We identified that in 2023, we expected to realize around $30-$35 million of extraordinary procurement benefits. We also were transparent in saying, and as we sit here today, those benefits and that dynamic has dissipated to the point where we don't expect that to continue into 2024. Look, we've got the best business development and procurement team in the business, and part of the benefit of our scale is we have direct relationships with virtually all of our pharmaceutical manufacturing suppliers.
We're not going through middlemen, so we have the ability to collaborate with them directly, both to procure the best procurement levels in the industry, but to create symbiotic relationships where we're also monetizing patient experience data, we're providing certain hub and patient support services back to them. And, you know, this business is a strategy of looking for the proverbial coins in the sofa cushions.
Yes.
Every single year, we have dozens of procurement wins, and we have procurement losses. Some of our suppliers have disruptions. Our team makes it look good. It typically nets to a modest positive. Team doesn't take a day off, and we'd expect going into 2024, that we'd be, you know, holding ourselves to muscle out some modest procurement gains. I don't anticipate anything of the magnitude of what we quantified and articulated in 2023.
As I think about the robust pipeline that's out there for specialty drugs, I'm sure you're going to talk to lots of pharmaceutical manufacturers while you're here. I look at the comments you made today and you've made in the past about limited distribution relationships. I think you said 50 today.
Yes.
When I think about that pipeline, and I think about what fits squarely into the kind of product that you want, what are some of the areas that you're most excited about?
Yeah, you know, a lot of conversation around the Alzheimer's products.
Yes.
And again, we've been very conservative in our approach, given some of the uncertainties around medical policy and how that is going to be applied, and then, more importantly, what's the path to payment from a reimbursement standpoint? But over the long run, we do see there's a lot of development within the neurological space, and when you look at what we can do as an organization, not only the pharmacy platform, but the clinical expertise that we have, as well as that nursing network, we think that there's real opportunities to continue to leverage that platform and move it forward. We're always working upstream. And one that, you know, I mentioned previously, but that we are really proud of, is the relationship that we have with Krystal. Again, this is a very unique product.
It is a small patient cohort. There's about 3,000-3,500 patients across the country that have DEB that would benefit from it. But what we were able to bring was a national platform, the sophistication of our technology that allowed us to compound and dispense and get the product, which is a topical product. It's not an infused product, so it's a topical administration and be able to train our nursing to be able to execute around that and be able to execute those care plans. We can do that on a national basis. We can use the scale associated with that. We can use our national logistics center to help manage that effectively and make certain that we have the right resources and the right product at the right place.
So those are the types of things that we, we look at, Lisa, and I, I think that as we look for some rare and orphan that require healthcare professional oversight, that have some level of sophistication around, and complexity around that practice of pharmacy dispense, that have the needs for the supply chain, and the distribution, capabilities that we have. All those things we look at, and, and in our conversations are helping to identify where we can play a meaningful role. If it's an oral solid that can be dispensed through a, a central fill pharmacy somewhere in Kansas, that's not something that we would add value to, and-
Right.
We recognize that. So we continue to have those conversations and look for those opportunities where healthcare professional oversight's involved, the practice of pharmacy is at a level of complexity, and we can leverage the platform to its fullest, in order to drive value for all of the key stakeholders.
One, one of the comments you made was around reimbursement, and if we think about Medicare today, they don't reimburse for the nursing services, just for the drug. Where do you think we are in potential legislative changes around that? And then how does that dovetail also with this idea of this shift in site neutrality, where, again, you know, hospitals were being paid a lot more for services versus someone like yourself?
Yeah. So, an update on where we are within trying to get a fix in Washington. So for those of you that aren't as familiar with the story, there's limited access to home infusion for Medicare beneficiaries on a Medicare fee-for-service basis. That's somewhat of a remnant of some bad policy going back years, and then some modernization that was supposed to happen with the Twenty-First Century Cures Act in 2017. We've been working both independently as well as with National Home Infusion Association, to get this corrected, to get bipartisan support in order to move that forward, and we continue to try to advance that through the process. Where it stands today is, we have bipartisan support both in the House as well as in the Senate.
We're trying to move that forward. One of the things that we're moving forward with is to get a CBO scoring of that legislation. We expect that to probably be in the second quarter of 2024. And again, within Washington today, I think for all of you that read the same newspapers as I do, it's hard to get things moving forward. It's impossible if it's a budget buster on that. And so, you know, our expectations are we're looking for ways for it to be either neutral or a savings that allows us to advance it, you know, through that process, and we're looking for the right legislation to affix it to, to move it forward.
So I think by the time we get to midyear, Lisa, we'll have a better sense around that success of what we're trying to do. One of the dilemmas that exists, and, you know, that CMS has to try to operate through, is the trust funds for Medicare Part A, Medicare Part B, Medicare Part D, sit independently, and what we found is a lot of what we do would reduce costs in Part A. So when you think about discharging a patient faster from the hospital because they can transition onto service in the home, the savings get generated in A. You can't take savings in A and apply it to a cost in B. And so that's the dilemma that they have, and that's why it requires really an act of Congress or a legislative fix in order to move that forward.
Again, we believe we're on the right side of this of this conversation. We believe we can add significant value to Medicare beneficiaries. We think we can save U.S. taxpayers, you know, dollars through that process, but it's a matter of putting all those pieces in place and having the proof points around it.
When I think about your long-term, you know, model and the long-term targets, I won't say guidance, that you've talked about, low double-digit EBITDA growth, we clearly talked about the procurement headwind going into next year.
Mm-hmm.
But, and I, I know we're on a webcast. I fully appreciate you're not ready to give 2024 guidance, Mike, but is there anything ex procurement for us to think about that, you know, would drive your, your EBITDA growth in 2024?
Well, a creative way to try to ask about 2024. Obviously, we're not in a position to share, but look, as we shared on our third quarter call, our updated guidance of $420 million-$425 million of adjusted EBITDA for 2023 is inclusive of a $30 million-$35 million procurement benefit.
Right.
Simple math, if you back that out and assume that our jump-off point is around 390-395, I would highlight that's still $10-$15 million ahead of our initial midpoint off the 370-390 guide entering into 2023. We, we feel confident and, and, you know, what we've reaffirmed is, while we're not in a position to share it, our conviction around the double-digit earnings, horsepower under the hood, so to speak, remains firmly intact. And, you know, that gives us a very solid position going into 2024 with a very strong performing organic-based business.
You're in a very good cash position, Mike. I mean, I look at, you know, you look at where your leverage is today, and maybe this is for you and John, when we think about capital deployment, but, you know, you clearly thought about doing a large transaction in 2023, I guess, did a little more than think about it. But, as we think about this going forward, I understood the-- you know, the fundamental merits of trying to put those two companies together. Are there things that you think you could add to your business model that are more tangential? Do you think that from here, it's just more kind of bolt-on and tuck-in acquisitions? How do we think about, you know, when you're thinking about your strategy around M&A?
Yeah, look, first and foremost, EBITDA doesn't pay the light bills, cash does, and we're maniacal around focused on generating cash flow. Our guidance for this year, for 2023, was to generate at least $350 million of cash. $110 million of that was from the breakage fee, but normalized more than a quarter of a billion dollars. How we deploy capital from a strategic perspective for our shareholders is something we take very seriously. We like to say it's our shareholders' cash, it's not ours. Going into 2023, we developed a multifaceted capital deployment strategy, both through share repurchase. We repurchased $250 million last year, as John mentioned. We remain very active on the M&A front.
We tried to clarify on the third quarter call that: look, we learned a lot through the Amedisys exercise. Nonetheless, we see a number of very attractive opportunities on the M&A front that we think can be both strategic, and I know sometimes you hear the word strategic, and you prepare for dilution. But you know, for it to pass our filters, it has to be both strategic as well as represent compelling economic cash-on-cash returns. The good news is, we're in a position where we have, again, a very strong performing base business. We don't feel the pressure of all the things John and I think about at 2 A.M., getting an M&A headline is not one of them, and so we have the ability to be very patient and thoughtful.
The good news is, this isn't a large neighborhood. We know the folks that live on the street. We know those providers and those assets that are attractive, and we're not just waiting for a banker to ring our bell. We proactively connect and correspond with folks that we think would represent an attractive combination. And, I think more to come on this front, but again, one of the things we're concerned about is not a shortage of attractive assets to engage with. But again, we're not gonna, we're not gonna chase a multiple or an asset just for a headline.
We're basically out of time. We have one minute left. So, John, what do you feel that investors don't appreciate about Option Care today that hopefully in the next 12 months, they will?
I think the consistency of performance and execution. When you look at what the team does on a daily basis, it's a lot to choreograph to get that right dose to the right place at the right time and marry it up with a nurse. The investments that we've made into people, process, technology, our facilities, allows us to use that scale as a competitive advantage, but also to be very competitive at the local level. And, you know, when you look at some of the constraints in the marketplace around clinical resources, we've done a lot to put the pieces in place that allow us to continue to grow, continue to support the needs of our patients, continue to drive better clinical outcomes through the interactions and the interventions of our team.
And I think, again, that consistency is something that you're gonna continue to see, and, I think where we sit today, feel really good about the position we hold, knowing that we've got to compete every single day, in order to, capture that market demand. But, I think the team is well positioned, and I think we've made the right investments in order for us to continue to capitalize on the privileged position that we have.
Great.
Yeah.
Thanks for your time.
Thanks, Lisa.
Thank you, everyone.
Thank you, everyone.
All right.