All right. Good afternoon, everyone. Thanks for joining us for the management presentation for Option Care Health. My name is Matt Larew, and I cover Option Care here at William Blair. Pleased to be joined this afternoon by President and CEO, John Rademacher, CFO, Mike Shapiro, and SVP Corporate Controller, Nicole Maggio. So thanks for the Option Care team for making the long journey down from Bannockburn this afternoon. Two quick things: the breakout session is upstairs in Burnham B right after the presentation. And then for my compliance officer, I'm required to inform you that for a complete list of research disclosures or potential conflicts of interest, please visit williamblair.com. So again, very pleased to have Option Care here again, and John, you can take it away.
Great. Thank you. Good afternoon, everyone, and thank you for your attendance today. Normal housekeeping disclaimer around maybe making some forward-looking statements today, under the Safe Harbor Act of 1995. If you will, please go to our website to get any of the updates around that, as well as any non-GAAP measures that are utilized, the reconciliation of that will be part of it. So with that, for some of you that are new to the story, I wanna give a little bit of background about Option Care Health. So the organization has been around for over 40 years, with a design and purpose around providing infusion in the home or in an alternate infusion suite.
As the one of the leading providers of home and alternate site infusion services, we are licensed in all 50 states. We have over 7,500 team members. We have the ability to reach about 96% of the U.S. population, given the footprint that we have, and that ability to provide that extraordinary care of being able to take a prescription, compounding it or dispensing it from one of our 95 pharmacies, and then getting it to the doorsteps of a patient or to one of our infusion suites to be overseen by a nurse that is part of our nursing network, is the way that the business operates.
When we look at how we're aligned to be able to capture market demand and be able to work with the prescribers through that environment, we have dedicated resources that are aligned to work with hospitals and health systems to identify patients that are in the hospital, that are stable enough to be discharged, but still require infusion services. And many of those are shorter duration products, and those are what we categorize as our acute therapies, and they tend to be in the areas of antibiotics and antifungals, as well as nutrition support, type of products that we provide there. The second area that we focus on is really making certain that we're calling on physician practices and clinics.
Those opportunities that we have is to support those patients that have been diagnosed with a chronic condition, that their care plan requires an infused drug or an injected drug that requires healthcare professional oversight. And we'll take those patients onto service, and it's a little bit longer process, as you would expect with the patient administration aspects, with prior authorization to be able to move effectively and efficiently to bring them onto service. So the organization is really aligned around that. Clinically driven patient is at the center of everything that we do and making certain that we're providing that high-quality care. But we're really aligned to make certain that we can support that patient in the home or in one of our infusion suites.
We operate over 170 infusion suites across the U.S. We have over 600 chairs that we capitalize on and utilize as part of that care plan. That's an important aspect when we think about how we're going to align to look for operating efficiencies, to drive a better patient experience, as well as to reduce the total cost of care and driving some operating efficiencies through that process. We spend a lot of time in working with the payer community to make certain that we are in network. So I'm proud to say that we're in all 10 of the top 10 national payers.
We have over 800 payer relationships, over 1,400 contracts, and that's important when we're working with those discharge planners or the nurse and care coordinators within the clinics to know that the vast majority of the health plans, Option Care Health is in network and is able to provide the services to the patient or the member. So, an important aspect of that, about 4,500 of our team members are clinicians, and that's nurses and pharmacists, pharmacy technicians, dietitians, and nurse practitioners as part of that model.
So a lot of the organization is aligned around making certain that we're well-positioned not only to capture market demand in working with those discharge planners, case managers, hospitalists, care coordinators within the clinics, but then to be able to bring the patient onto service through patient administration, benefit verification, authorization, and then ultimately to get into the pharmacy for compounding, dispensing, and distributing, and ultimately marrying it up with a nurse to oversee the infusion event. When you think about the market position that we have and really how the landscape exists, it's a fragmented market. There's over 800 home infusion providers in the country.
Those range from organizations that are part of, of some of the largest health plans, and part of those organizations, to local, you know, single-site facilities in those local markets. Then in between, where you have some hospitals that have their home—their own home infusion capabilities through that. We see our position as being one of strength, as being one of the nation's largest providers. And we use that, that strength of the size of the organization and, and really using scale as a competitive advantage, but knowing that we can use that to drive efficiencies around the technology and, the infrastructure. But care is really done at a local level.
And so knowing that, each of the markets has different dynamics and how we align our resources, as well as the different, competitive dynamics within that environment, we really customize it around that local, need and that local market to make certain that we're driving, you know, the best response, within that, within that local, position. We talk a lot about the different categories of therapies that we're able to administer in the acute and chronic space. So, as I had mentioned earlier, in the acute space, a lot of that is around infection, infectious disease, as well as, nutrition support on that. These normally tend to be shorter duration therapies, and they. Most of those are generic in nature, as the products themselves.
They possess a higher gross profit for us, but as the actual spend and the actual drop-through of the dollars, it tends to be lower because of that lower price of the products. On the other end of the spectrum is the chronic portfolio of products. A lot of these are the brand names that you see advertised in many different ways, and they tend to be a higher price branded product, in which, again, we are, you know, dispensing that product and marrying it up with nursing. They tend to have a higher price for the product, a lower gross profit on the margin side.
But when we look at the value that it creates and the absolute dollars that it drops through, it's, you know, very efficient and economic for us to be able to use that. These patients tend to be on therapy for a much longer duration, months, years, and in many instances, a lifetime. And so managing that census and aligning our resources around that continuity of care for those patients and being able to meet their needs and help them manage their best life with their chronic condition are the things that we're able to do within that. There's diversity in the portfolio that we have. There's hundreds and hundreds of drugs that are part of our portfolio and formulary of products that we manage, and we're able to administer from that.
You know, one of the things we talk a lot about in these types of settings is not all of those products move in the same way. We have some that are at different levels of their maturity curve. Some of them are new, emerging products that are growing quickly. Some of them are kind of more mature, and we do have some that are in decline. It's a matter of managing that totality of the portfolio, understanding where they are in their life cycle, but also in thinking through and managing the pipeline of new products that are entering the marketplace, that are going through FDA approval, and/or commercialization, as they enter into that. That diversity of the portfolio is extremely important.
It's something that we manage efficiently and effectively, and that we see different growth profiles, not only for the acute and chronic, but then the subsets of the therapeutic categories and the drugs themselves within that process. We think that that breadth of both the acute and chronic and the diversity of the portfolio really positions us uniquely in the marketplace, not only with the product portfolio itself, but then that ability to have that consistency of care and that consistency of our service model across the country. We talk a lot about the ability to serve a patient consistently and effectively in Portland, Maine, or Portland, Oregon, or any place in between.
That level of consistency from the clinical quality and the clinical outcomes is something that we focus on as an enterprise, and more importantly, we're able to articulate as part of that unique value proposition for the organization. From a financial performance standpoint, you know, the organization has consistently grown. To give a little bit more of the history of the enterprise, as I said earlier, you know, the company has heritage going back 40 years. In the recent era, Option Care was a spin-out from Walgreens in 2015. It was a carve-out from a corporate standpoint to private equity. Many of us, Mike Shapiro, myself, Nicole Maggio, all joined in that timeframe when that spin-out happened.
And from 2015, really until 2019, we spent a lot of time making certain that we were building a durable and sustainable infrastructure and building towards an organization that was gonna have that sustained growth. And so a lot of investment into the people, process, technology, and facilities, really to build an industrial strength infrastructure and allow us to have that capacity to be able to grow. In 2019, we were approached by a BioScrip that was a publicly traded company, about, potentially coming together. Ultimately, we were able to come to a, a, a transaction in which they acquired Option Care Health, but we took control of the company at that point in time.
Really, from that period of August of 2019 to where we are today, you see the growth of what that combined organization is and our opportunity to release trapped value, not only in driving operating efficiencies, in realigning our commercial resources, in expanding our reach and frequency, of continuing to invest in our people, our process, our technology, expanding that infusion suite footprint, all in a, with that eye towards expanding our capability set and, more importantly, capturing what was a growing part of the market demand in the marketplace. So, you know, focusing around top-line growth, census growth of those that we have under management, a really strong focus around the operating efficiencies that come with that. Revenue cycle management is a big component of healthcare, and it's a really important component of home infusion.
That ability to make certain that from the moment we receive a referral, we're focusing around creating a perfect claim so that we can convert a claim to cash, right? And really drive it from that perspective has been something that the organization has focused on. And I tell you, you know, one of the proud, you know, prouder aspects of us as a management team and that focus is how much value that has released through that process. So, you know, the public records will show the BioScrip entity was probably in that 4%-5% of revenue in their bad debt associated with that. As we operate today, we're below 2%.
That ability to really focus around, having that perfect claim from the moment of receipt and doing everything that's necessary to submit a clean claim to the payer in order to seek reimbursement, is something that has significant, you know, performance benefits for us as an organization, not only in the EBITDA, but more importantly, on the cash flow. You know, that is a big part. We talk a lot about, you know, the EBITDA doesn't pay the light bills, cash does. The organization is aligned to make certain that we're doing that in a very efficient and effective way. What that has allowed us is to continue to invest in the business, right? And to be very focused around how we do that. And we're very efficient in the CapEx.
On you know, a range basis, on an annual basis, we spend between $35 million-$40 million of CapEx. We're very efficient in the way that that's deployed, but that also gives us degrees of flexibility to take a look at how to deploy that capital as we move forward, albeit in different forms of through M&A, in which we've made some strategic tuck-ins and some add some additional value through a nursing network build that we've done or through share repurchase. And really, since January of 2023, we have deployed over $290 million in cash to do share repurchase as a way to drive value and deliver value back to our shareholders.
So a lot of, a lot of focus around that, capital deployment, being efficient and effective in the way that we're utilizing it, understanding that it's our shareholders' money, and that we need to do everything we can to make certain we're bringing the best, return on, on that cash, in the way that we're looking at our capital deployment. When you look at the value proposition roadmap and really how we think about, the execution along that, there are a lot of steps in the process, and we look and try to operate so that we are driving value across each of those dimensions, being easy to do business with.
So, that patient engagement and the way that we're working with referral sources to efficiently and effectively bring those patients onto service, to make certain that we're doing everything that we can to create that perfect claim from the moment of receipt. And that we're taking every step in that process with documentation and making certain that we have all the pieces that allow us to drive a very efficient and effective care plan, and then, more importantly, that we're able to submit those claims for reimbursement in a clean and effective way. The diversity of our network, all of our facilities operate on the same platform.
We have a very resilient network that allows us to workload distribute where necessary to be able to step aside where we have natural disasters or other things that affect the business. And that network resilience is something that is really important when you're thinking about the care that is needed to be delivered and the way that we've structured the model so that there's interconnectivity in which we can reach across state lines where necessary, and how that entire ecosystem really evolves around the need to be able to meet the needs of the patient and the referral sources on that.
It also is very effective when you have patients that are transitioning, whether snowbirds in the winter that are coming from the northern climates and going to warmer climates, and being able to transition and serve those patients as they make those transitions. It supports when you have academic medical centers that are centers of excellence that are bringing patients from a wide geography and being able to help transition those patients back to their local communities.
It allows us to really align around having some redundancy and certainty around the way that we can be responsive in those local markets, building that on the strength of the entire network, but being very local where that's necessary. As I mentioned earlier, certainly the resilience of our portfolio and the breadth of the products that we have to offer, we think is a strength. Having the ability to serve both patients that are being discharged from an acute episode of care, or those that have some of the most complex chronic conditions, is all part of a comprehensive approach that we have on our go-to-market. We have over 500 resources that are dedicated as part of our commercial team, that are calling on hospitals or calling on integrated delivery networks, physician practices, clinics, that are aligned around that.
And that ability to really sell that broad portfolio of products and knowing that the point of care in our nursing network is a big part of that value proposition, is the way that we align in establishing that resilience of the portfolio, and looking for ways to differentiate ourselves in the marketplace. And then, as I mentioned, certainly, there's agility in the strength of our balance sheet. For those of you that have been with us for the journey, you know, when we went through the combination with BioScrip in 2019, we were 6.2 times levered on a pro forma basis at that point. As we exited the first quarter of this year, even with some of the challenges with the Change Healthcare situation, we were about two times levered.
So that ability for us to strengthen the balance sheet, to kind of reset that cap structure and grow into it, is something that, you know, the team has really done a great job, and we really focus on, and it gives us flexibility as we're thinking about the ways that we want to operate, moving forward. We do focus around making certain that we hit every of the quality metrics that are out there. We have independent accreditation by accrediting bodies like URAC, ACHC that come in inspect our pharmacies. At times, we are inspected by FDA. We're inspected by the state's boards of pharmacy.
And again, that investment into a quality management system, the internal capabilities to manage and measure, the quality and the performance of the organization, and provide that feedback loop to key stakeholders, whether it's our payer community, our prescribers, and then upstream to pharma. All of those things are an important aspect of differentiating our platform and being able to use it in a much more efficient and effective way. So, yeah, as an enterprise, a lot of that, that focus around the quality of care, and knowing that there's a loved one at the receiving end of every dose that we're dispensing, helps to create the culture, that we operate within and helps to drive those high standards across the organization. We also spend a lot of time on making certain that we are recruiting our team every single day, right?
As much as we've invested into our technology and our facilities and that infrastructure, the need to have high-quality clinicians, as part of that service model is, is critical to our success. And so a lot of work has been done to make certain that we are an employer of choice. We focus around the culture of the enterprise. We do, you know, surveys to make certain that we're understanding the voice of our employees through that process, and, and deploying programs that help support them and their families' needs as they're thinking about their career and their career progression. That's a really positive aspect and something that we believe, you know, is, is an important aspect for the business.
It's great to get the independent validation of organizations like Gallup that have identified us as being an exceptional workplace, and that's two years running. We spend that time to make certain that we're putting together programs around our total rewards, and other benefits that are aligned with what the needs are of our employee base. And again, we recruit every single day knowing the importance of those talented individuals as part of the delivery model that we're operating. And so, you know, as a leadership team, but as an organization, we've invested a lot. The positive aspects of that is, you know, turnover today is lower than it was, you know, pre-COVID. So, you know, we continue to see the benefits of that. Nursing will continue to be a area in which we will focus.
Anyone that will tell you that it's easy to recruit nursing probably isn't telling you the truth. It's, it's gonna be challenging moving forward. Those investments to make certain that we are an employer of choice, that we're doing the things that is recruiting and retaining that talent, and that we have programs that align around the needs of our, of our employees, is something that we think pays that type of benefit for us as we move ahead. We highlighted the first quarter, you know, some really strong performance. You know, Mike and I had the privilege of being able to articulate into the marketplace, even with some of the challenging environment with what happened at Change Healthcare and the impacts that that had really across the healthcare ecosystem.
Our team rallied quickly around that. We were using Change for 100% of our clearing house, both on the pharmacy and the medical claims. Our team responded immediately, found ways to create manual workarounds, continue to bring patients onto service. We did not feel any implications from a revenue event in the sense of we were able to continue to manage our existing patient population, continue to expand and take on additional patients, even in that time of turmoil around that and then have been working aggressively behind that to make certain that we were putting all the pieces in place, as those systems came back online, to not only submit those claims and then continue that process of getting back online, through it.
But even with that, you know, net revenue of $1.2 billion was up about 12.8%. We had highlighted that, you know, a portion of that growth was from some of the new products that were entering the marketplace that are at the lower margin for us as an organization. These are some of the rare and orphan. The team did an incredible job of executing around that and, you know, we were really pleased with that top end and top-line growth, but knowing that it was gonna create a little bit of distortion in the product profit as a margin as we looked at that. Adjusted EBITDA of $98.3 million, again, up 4.8% over the prior year.
There was some disruption that we had called out. A couple of the things with that was a transitory benefit that we were receiving last year that was part of just our our trade relations team and our procurement doing an exceptional job of being able to take an opportunity to really drive outsized of of value that we could create there. And we knew that was transitory, and we had kinda called that out through that process. But again, continued strong progress, continued to hit the marks from our perspective, and really driving that forward. We also, in the first quarter, up until the point of the Change news, as that started to break at the end of February, had deployed $40 million in cash and repurchase.
We paused that at that point in time as we were making certain that from a liquidity standpoint, we were preserving cash wherever we could, given the uncertainty of the environment at that point in time. And, you know, I think as we had said, that as things start to move back in alignment, we will continue to take a look at the right way to deploy that capital, whether through M&A or reactivating around the share repurchase. And we also opened additional infusion suites, and infusion suites are an important part of our value proposition and the way that we're looking at providing broader access to our patient population, to look for ways to drive operating efficiencies and to continue to focus around patient satisfaction through that process. So that is something that we have found high utility.
We have talked publicly about these centers as being very capital light. They're operating efficient. What we start to see is really after, you know, into the second year of those operations, we can get a lift of about 20% of productivity within kind of the standard as we look at those facilities. And that really is around nursing and being able to use those facilities to help drive nursing efficiency. Not only does it help from cost, but it also expands capacity. So if you can get about a 20% lift in your nursing productivity by utilizing those facilities, you actually get about 20% more nursing hours that are available to be consumed by other patients as we're continuing to grow.
So, something we're continuing to be excited about. Again, we're very measured in the way that we look at geo-mapping and where we place them, but we think that there is high utility, and we also believe that there are still opportunities for us to grow, to continue to sweat the assets that we have, already invested, and to continue to utilize them to expand capacity and serve more patients.
The other thing that we highlighted is we raised the lower end of our EBITDA guidance ranges, and again, showing the confidence that we have in the business, the performance, the consistency of where we are as an enterprise, and that opportunity for us to really capitalize on what we think is a unique position that we have to grow in a marketplace, to be that partner of choice at that local level, to have the resilience of our operating model, in times of turmoil or times of uncertainty.
The stability that we were able to provide, that ability to continue to bring patients on the service, even with some of the challenges with the Change Healthcare, we think creates that goodwill and continued opportunities to be that partner in the marketplace, for the referral sources. Again, I won't necessarily dive into the reconciliation to non-GAAP measures. That's something for Mike and Nicole to talk to you on that. But, again, just for you guys to have it as part of that reference, this is, you know, a synopsis of a really strong quarter in a period in which there were some challenging events associated with that.
But the team has shown an incredible resilience, that focus on the patient and the ability for us to continue to set the standard of care in home and alternate site infusion therapy. So with that, thank you very much.