Good day, ladies and gentlemen, and welcome to the Progyny, Inc. First Quarter 2022 Earnings Conference Call. At this time, all participants have been placed on a listen-only mode, and the floor will be open for questions and comments after the presentation. It is now my pleasure to turn the floor over to your host, James Hart, Vice President of Investor Relations. James, the floor is yours.
Thank you, Paul, and good afternoon, everyone. Welcome to our first quarter conference call. With me today are Pete Anevski, CEO of Progyny, Michael Sturmer, President, and Mark Livingston, CFO. We will begin with some prepared remarks before we open the call for your questions.
Before we begin, I'd like to remind you that today's call contains forward-looking statements, including, but not limited to, statements about our financial outlook for both the second quarter and full year of 2022, including our expected utilization rates and mix, the impact of COVID-19, including variants on our business, clients, member activity, and industry operations, our ability to acquire new clients and retain and upsell existing clients, our market opportunity, size, and expectation of long-term growth, our plans for the expansion of our business, including expansion into other markets and the services offered, our business performance, industry outlook, strategy, future investments, plans and objectives, and other non-historical statements as further described in our press release that was issued this afternoon.
These forward-looking statements are subject to certain risks, uncertainties, assumptions, and other important factors, including those related to Progyny's growth, market opportunities, general economic and business conditions, and the impact of laws and regulations, including laws and regulations restricting reproductive rights. We have based these forward-looking statements largely on our current expectations and projections about future events and financial trends that we believe may affect our business, financial condition, and results of operations. Although we believe these expectations are reasonable, we undertake no obligation to revise any statement to reflect changes that occur after this call. Descriptions of these risks and other important factors that could cause actual results to differ materially from these forward-looking statements are discussed in our periodic and current reports filed with the SEC, including in the section entitled Risk Factors in our most recent 10-K.
During the call, we will also refer to non-GAAP financial measures such as adjusted EBITDA, adjusted EBITDA margin, gross margin excluding stock-based compensation and operating expenses excluding stock-based compensation. Reconciliations with the most comparable GAAP measures are also available in the press release, which is available at investors.progyny.com. I would now like to turn the call over to Pete.
Thanks, Jamie. Thanks, everyone for joining us today. We're pleased to report that we've had a solid start to the year, achieving record quarterly revenue with growth of 41% over the first quarter of 2021, as well as the continued expansion of our adjusted EBITDA margins as compared to the year ago period. These strong results demonstrate that our member activity has returned to the levels we would typically expect to see, and based on what we see, we believe that the impact of COVID and the Omicron variant, more specifically, is behind us. In addition to our strong financial results this quarter, we also successfully onboarded a record number of new clients who collectively represent more than 1.2 million new covered lives that now have access to our solution.
In any year, the first quarter is a critical time for us because a substantial majority of our new clients will look to begin their fertility benefit at the start of their health plan year, which for most companies is January first. To address this dynamic, each year, we prepare for a step function increase in our business volumes, which encompasses everything from the number of inbound contacts to our PCAs, to the amount of appointments booked, to the level of patient activity that we are actively monitoring across all the clinics in our network. Coming on the heels of our record selling season, we had the largest sequential step-up business volumes in our history this quarter.
We have successfully managed the addition of our newest clients while also continuing to provide industry-leading service to all of our existing clients and members, demonstrating our continued ability to scale our operations at an accelerating rate. Although the 2022 selling season has only just begun, we're pleased to report that the early activity we've seen so far, as well as the caliber of the logos we're engaging with, is continuing to confirm our momentum as the brand of choice for fertility and family building benefits amongst the best-known and most successful companies in the world. At this point in the selling season, our sales team is actively working on building pipeline through all the traditional channels, including direct outreach to prospective accounts by engaging with the benefit consultants and channel partners, by participating in important industry events and conferences, and by responding to inbound RFP opportunities.
Lastly, in addition to pitching new logos, we're also re-engaging with the deferred accounts who have given us a not now response in a prior selling season, as these companies may now be in a better position to consider adding the Progyny benefit. The early activity we've seen throughout all of our sales channel has been positive, and we're seeing strong year-over-year growth across all the internal metrics that we use to measure sales momentum, including new pipeline added, overall size of pipeline, and closed deals to date. We're also seeing the market for fertility benefits continue to mature as the conversations with prospects are less and less about whether or not they should add fertility coverage to their benefit packages. Instead, the discussions are primarily focused on understanding the strength of our solution versus the alternatives.
We believe this ongoing shift is a positive indication that benefit buyers are increasingly becoming aware of the relevance of fertility and family-building benefits to their targeted workforce and their need to offer the coverage in order to attract and retain the best workers. Not only is this shift translating into more selling opportunities for us overall, it's also allowing us to spend more time demonstrating how Progyny is differentiated from any other fertility benefits manager, particularly with respect to member experience and our clinical outcomes. In any sales year, we set for ourselves a goal to grow the absolute number of new clients and covered lives as compared to the prior year.
Although it remains very early, given the strength that we're seeing in the sales season thus far, we believe we're on track to meet our internal expectations at this point. As we've done in the past, we expect to share more insight with you as the season progresses. We continue to anticipate that the majority of client decisions, as usual, will be made at the end of the summer and early fall. Another important development during the quarter was that the CDC and the Society for Assisted Reproductive Technology released their latest facility outcomes data, which affirmed that Progyny continues to significantly outperform the national averages. This not only marks the sixth consecutive year that we've achieved industry-leading clinical outcomes in fertility, but in our most recent data, we also achieved across-the-board improvements to all of the relevant metrics.
This once again reveals that Progyny is uniquely helping people get pregnant faster, have healthier pregnancies, and deliver healthier babies. To highlight just a few of the key results in the latest data, our pregnancy rate improved to 17% better than the national average, while our live birth rate, which had been 25% better than the national average a year ago, is now 27% better. To give you a sense for just how impactful this is, our high live birth rate means that Progyny clients need to fund on average significantly fewer rounds of treatment than they otherwise would had they been using either a carrier program or one of the VC-backed startups.
In addition to sparing an employee the emotional and physical toll of having to endure multiple rounds of unproductive treatments, our higher birth rate also translates into meaningful cost savings, not only for the client who is sponsoring the coverage, but also the employee who generally has an out-of-pocket cost share. The latest data also shows that while Progyny's pregnancy rate and live birth rates have continued to improve since 2016, the national averages, in contrast, for those metrics have largely remained flat, revealing that while we have continued to improve our solution and the results we achieve year after year, the other benefit managers don't seem to be making those improvements, suggesting they either lack the focus or the ability to do so.
Finally, our single embryo transfer rate improved to 91%, the highest it has ever been, while our multiple birth rates improved to 2.5%, which is also the best it's ever been. If you aren't aware, multiple births are a driver of high-risk pregnancies and the leading cause of preterm births, both of which have costly consequences for employers and patients. Our superior outcomes translate into significant downstream medical cost savings in the form of lower maternity and NICU costs, as well as a reduction in chronic care costs associated with low birth rate babies. The sustained superiority of our outcomes, as well as our ongoing focus on creating the best possible member experience, as evidenced by our leading NPS scores, is a key reason why the world's leading brands are choosing to work with Progyny.
To conclude, we're very pleased with our results this quarter, which demonstrate that we've continued to execute against all of our strategic initiatives. The early momentum we're seeing in our sales season is also increasing our belief that Progyny is in its strongest ever competitive position, that our market opportunity remains largely unpenetrated, and that all the macro factors that have contributed to our growth remain intact. Let me now turn the call over to Mark to walk you through the quarter.
Thank you, Pete, and good afternoon, everyone. I'll begin by taking you through the first quarter results and then provide our expectations for the second quarter and the full year. Revenue grew 41% over the first quarter of last year to $172.2 million, exceeding the high end of our guidance. The growth versus the prior year was primarily due to an increase in our number of clients and covered lives as compared to a year ago, which more than offset the impact the Omicron variant had on member activity in January, which we discussed with you last quarter. Looking at the components of the top line, medical revenue increased 25% over the first quarter last year to $110.9 million, again, due to the growth in clients and covered lives.
While pharmacy revenue increased 84% in the quarter to $61.3 million. The growth in pharmacy revenue was primarily driven by an increase in the number of clients who have the integrated solution. A year ago, 73% of our clients had Progyny Rx. Today, 83% do. This increase reflects not only the strong take rate we saw among our newest clients in the most recent selling season, but also our continued success with upselling among existing clients. While we continue to be very pleased with the progress of pharmacy adoption since we launched this service, there remains a future upsell opportunity to a meaningful portion of the client base. We ended the quarter with 264 clients, representing an average of 3.9 million covered lives during the quarter.
This compared to 179 clients and an average of 2.7 million covered lives in the first quarter last year, reflecting 48% growth in covered lives over the past year. Taking into account those clients who launched their benefit following March 31, we have over 265 clients today with at least 1,000 covered lives, reflecting more than 4 million covered lives, consistent with the expectations we shared with you on our fourth quarter call. Turning now to our utilization metrics. During the quarter, there were more than 8,900 ART cycles performed, representing our highest ever total of cycles. This reflects a 36% increase in cycles as compared to the first quarter of last year.
The female utilization rate in the quarter, which principally drives our financial results, was 0.45% as compared to 0.47% from a year ago. I'll remind you that as the year began, we saw a peak of the Omicron variant, causing short-term interruptions or delays in the treatment journey for certain members. Nevertheless, our female utilization rate remains consistent with the historical ranges we've typically seen, excluding that brief period at the onset of COVID two years ago when most clinics closed, which again reinforces both the essential nature of fertility treatments as well as the time sensitivity for most patients. A contributing factor to our revenue each quarter is treatment mix. In particular, the utilization associated with consults and diagnostic testing, which occur at the earliest stages of fertility treatment, contribute less revenue than the procedures that happen later in a member's fertility journey.
Our revenue in the first quarter reflects a higher proportion of that early treatment revenue than we typically expect to see in other quarters of the year. Lastly, I'll note that utilization rates will always vary from quarter to quarter due to other factors, such as the timing of when new clients go live, the time of the year, and the demographic mix of the newest clients. Turning now to our margins. I'll also remind you that late last year, we issued a broad-based grant of new equity across our workforce, which increased the level of non-cash stock-based comp expense across the P&L. We have included a table in our press release today to show you the impact that stock comp had on our gross margins and operating expenses.
Gross profit increased 14% from the first quarter last year to $32.9 million, yielding a 19.1% gross margin, reflecting a decrease from the year ago period, due primarily to the impact of non-cash stock-based comp. Excluding the impact of stock comp in both periods, our gross margin of 22.7% reflected a decrease of 200 basis points from the first quarter of 2021 due to the impact of onboarding care management resources in advance of the client launches happening beyond March 31, as well as the temporary inefficiencies experienced during the initial ramp-up period of a new pharmacy partner. Given that the majority of the clients who were scheduled to launch after March 31 are now live, we anticipate that second quarter gross margins will improve on a sequential basis.
Turning now to our operating expenses, sales and marketing expense was 5.8% of revenue in the first quarter as compared to 3.3% in the year ago period. Excluding the impact of stock comp from both periods, sales and marketing was 3% of revenue in the quarter, reflecting an increase of 30 basis points from the year ago period. G&A was 13.4% of revenue this quarter, as compared to 10.7% in the year ago period. Again, excluding the impact of stock comp from both periods, G&A as a percentage of revenue improved 270 basis points from the year ago period to 5.5%, reflecting the inherent nature of our expanding margins on G&A as we grow revenue.
With our strong top-line performance and operating efficiencies, adjusted EBITDA grew 44% this quarter from $17.3 million a year ago to $24.8 million, which was slightly above the higher end of our guidance range and in line with strong revenue. Our adjusted EBITDA margin of 14.4% this quarter reflected a 30 basis point expansion from the year ago period. Net income was $5 million in the quarter, or $0.05 per share. This compared to net income of $15.2 million or $0.15 per share in the year ago period. The decrease was primarily due to higher non-cash stock-based compensation expense in 2022, partially offset by operating efficiencies realized on our higher revenues. Turning now to cash flow and our balance sheet.
Operating cash used during the quarter was $11.3 million, which compares to $ half a million of operating cash generated in the year ago period. As a reminder, we generally see a short-term use of working capital at the beginning of any year as we work through the integrations for those newest clients who have recently launched the benefit. In addition, each period was impacted by timing items, including the timing of member activity, both for the current quarter, which is back-end weighted, and Q4 as well, which was much more front-end weighted. The negative impact of this timing on cash flow was further exacerbated in both periods due to the previously disclosed impacts of the Omicron variant.
Also, as a reminder, we signed new pharmacy partner agreements, including new rebate agreements, which represented a significant improvement in the economics on the Rx business and extended payment terms an additional 90 days. As a result, as our Progyny Rx business grows, we'll experience negative timing on cash flows, which is the effect of the combination of our actual growth plus the extended payment terms, particularly for the first two quarters of this year, which have significant growth over the prior year due to favorable adoption of Progyny Rx. As of March 31st, we had total working capital of approximately $180 million, reflecting $105.7 million of cash equivalents, and marketable securities, and no debt. Turning now to our expectations moving forward.
Given the strong start to the year, we are pleased to be in a position to revise our guidance upward for 2022. For the full year, we are raising the low end of the range and now expect for revenue to be between $735 million-$775 million, reflecting growth of between 47%-55%, or approximately 51% growth at the midpoint. We are also raising our guidance on profitability.
We now expect adjusted EBITDA of between $111 million and $122 million, while for net income, we now expect between $7.3 million and $14.2 million, or between 7 cents and 14 cents earnings per share on the basis of approximately 105 million fully diluted shares. I'll remind you that our net income projections do not contemplate any discrete income tax items, including the income tax benefit related to equity compensation activity. To the extent the related activity occurs, we will continue to benefit from those discrete tax items throughout 2022. At the midpoints of this guidance, we are expecting to see continued expansion of our margins in 2022, with an adjusted EBITDA margin of incremental revenue of more than 19%.
For the second quarter of 2022, we are projecting revenue between $188 million-$193 million, reflecting growth of between 46%-50%. For adjusted EBITDA, we expect between $28 million-$30 million, along with net income of between $1 million-$2.3 million or between $0.01-$0.02 earnings per share on the basis of approximately 102 million fully diluted shares. With that, we'd like to open up the call for your questions.
Thank you. Ladies and gentlemen, the floor is now open for questions. If you have any questions or comments, please press star one on your phone at this time. We ask that while posing your question, you please pick up your handset if listening on speakerphone to provide optimum sound quality. Once again, please press star one if you have questions, and please hold while we pull for questions. Your first question is coming from Anne Samuel from J.P. Morgan. Anne, your line is live, you may go ahead.
Hi, congrats on a great quarter, and thanks for taking the question. You talked about seeing, you know, some early commitments already this year. Was wondering how common is that for you this early in the year, and how many of those are net new versus maybe new pipeline wins?
Thanks by the way. It's common. Every year we get commitments this early, and every year, those commitments grow versus the prior year. This year is no different. Every year, the number of early commitments that we get that are from the not nows grow over prior year. Again, this year is no different. It's sort of a continued trend as you might imagine, because the volume of not nows, some of those, by the way, are not nows, not only from the prior year, but literally two or three years ago when they come in, that continues to grow each year because, you know, as we get, you know, further and further in our tenure, if you will, as a company, we have more opportunities around not nows.
it's not surprising. It's certainly positive and certainly a good indicator of what's happening, but not surprising that we have commitments that exceed the prior year, and that's a trend.
That's helpful. Thank you. When you set the full year guide last quarter, you had kind of spoken to the delta between the low end of the range and the high end of the range for the year as being some COVID conservatism. You said in your prepared remarks that you think, you know, a lot of Omicron and some of the COVID disruption is behind us now. I was wondering how should we think about what the delta is now between the low end and the high end in terms of what you're embedding?
Yeah. Hi, Anne, it's Mark. I think when we talked last quarter, and looking at the range and sort of characterizing it, you know, I think we said, you know, it's always based on sort of what we're seeing, and things obviously are looking, you know, fairly consistent with what we were seeing, a couple of months ago when we last spoke. But we did say that, you know, it was, you know, our view of it tends to be closer, towards the higher end of the range as being, you know, what that expectation is and that we had built in, you know, some contingencies as utilization can go up and down. There could be impacts of variance.
There's any sort of those variety of sort of eventualities like we saw last year. Given that we're a couple of months down the road now and that we've gotten a solid quarter, we've also, as we said, launched you know significant majority of those new clients now. We haven't seen really an extensive amount of utilization from them yet, just in terms of time. In fact, we had some launch even this week. It's always helpful for us to see more as time goes on there. Those are sort of the pieces that are baked into the range, and again, why we felt it was appropriate to bring up the low end.
Great.
COVID wasn't the only reason for the range is sort of the short answer. Other factors, mix, you know, slight change in expected utilization, et cetera, you know, timing of the new launches all could impact that range.
Very helpful. Thank you.
Thank you. The next question is coming from Michael Cherny from Bank of America. Michael, your line is live. You may go ahead.
Hi, this is Charlotte on for Mike. Thanks for taking my question. Just want to start with, you mentioned earlier how you're viewing the competitive landscape right now, and you just discussed the competitive positioning with other solutions in the market. Could you just outline what you think the biggest differentiators are for your service for your clients?
Sure. It's really the totality of what we do, right? It starts with our unique plan design, our approach to, you know, offering a solution that's all inclusive in terms of the benefit. It starts with the network that we have, that's also unique. You know, 20% of the providers in our network generally don't take other carrier coverage or very limited in terms of maybe taking one other carrier coverage. It also is the overall solution, the details of it, and the collaborative relationship that we have with our providers, and the process that we have, which is very data-driven in terms of monitoring best practices to ensure best outcomes for the patients.
The last piece of it is the care navigation that we do through our Patient Care Advocates. It's all of that combined, and obviously there's a lot of detail around that that makes us differentiated versus anybody else out there, which is why, you know, we're now in the seventh year, marking six years in a row, demonstrating favorable outcomes versus national averages. It's also why we haven't seen really national averages move, despite the fact that we've continued to improve.
The only thing I'd add to that is we're an incredibly data-driven organization, not just in how we operate, but also how we can help support our providers and help drive those outcomes. I think one of the biggest differentiators we have is, you know, working with seven years of experience and tens of thousands of cycles and patients and the outcomes.
Ladies and gentlemen, please remain on the line while we reconnect the speakers.
Hello?
Hello?
Hello, you may go ahead, Michael. The speakers are back in.
Charles, we don't know what happened. We just for whatever reason, the phone went dead, so we're back.
Not sure where we dropped off.
That's okay. I think you were just discussing the data-driven nature of the business and support from providers.
Yes. Any other questions?
Yeah. I guess just the next one would be, you know, any color around the selling season so far, particularly as it relates to the pharmacy benefit and any updates there would be really helpful. Thanks.
Sure. I'll let Michael take that.
Hi. Yeah. No, as we sort of said in the prepared remarks, you know, we're seeing you know good early activity across all of our key metrics in our pipeline right now. That is the same for what we're seeing around pharmacy activity as well. You know, again, early in the year, still a long way to go, but all indications are positive for both medical and pharmacy.
Great. Thank you.
Thank you. The next question is coming from Sarah James from Barclays. Sarah, your line is live.
Thank you, and congrats on the quarter.
Thanks, Sarah.
When we last spoke, you guys talked about some of the puts and takes going into your guidance, and I think at that time, there was an assumption of no dollar impact from COVID or on utilization. How are you thinking about that piece now as it relates to your 2022 guide?
As Mark just was going through it, the assumption in the range that still continues, but in the range that was there that we put out in the beginning of March, you know, potential impacts from variants was part of the assumptions, but also other variables, which would be mix, you know, any slight variation from our expected utilization, et cetera, timing of launches from new clients. It's all part of it. There is some assumption built into the overall guidance range, potentially for you know, anything like another variant. As you recall from last year, the variants had a short-term impact. The one in the fourth quarter had the biggest impact because it was so late in the year, and so it had impact on the year.
The others sort of seemed to, you know, work through themselves, if they're mid-year. That's why it's not a huge variable in the range, but it is a variable.
Got it. On the legislative front, there's been some articles around Roe v. Wade and just how that relates to fertilized embryos used in IVF or potential future legislation around that. I'm wondering if you guys have any thoughts and what your exposure is to some of those states that would have trigger legislation.
Yeah. Of the states that have what they call trigger bans out there, they all vary slightly relative to defining what an abortion is in the ban. For us and from our point of view in terms of what states would have the biggest impact, the biggest one by far for us is Texas. Texas's trigger ban is explicit around an embryo during pregnancy as opposed to others which are more general around you know simply an embryo and not explicit that it's an embryo in the body.
Texas also happens to be a state that has a mandate to offer fertility, and so, you know, there's not a belief that that state, which for us again is the most important, is gonna have an impact relative to IVF as it relates to the trigger bans. That said, even the other states, you know, I'm not sure that anybody believes that that's where they're going, although there's potentially a risk, and for us, again, smaller impact in terms of the other states, although a risk, you know, relative to the trigger bans right away. I think the focus is more on banning abortion as opposed to extending it to IVF.
Got it. Thank you.
Thank you. The next question is coming from Glen Santangelo from Jefferies. Glen, your line is live.
Hi. Yep. Good evening, and thanks for taking my question. Hey, Pete, I just wanted to talk about, you know, the selling season. Kind of encouraging that you're already starting to see some positive signs. You know, the reason I bring it up, right, is 'cause some of the other companies in the space that sell into the corporate environment are starting to come back with a message that they're starting to see sales cycles get elongated. Maybe corporates are starting to prepare for the potential for a recession. It sounds like you're not seeing that at all and early signs are kind of encouraging. I'm just kinda curious, in your conversations, does the potential outlook for a recession come up at all or even factor into their decision-making?
This is Mike. I'll take that one. The short answer is no, we're not seeing that in our sales activities. You know, really the cadence of buying appears to be back to more historical patterns. Again, a reference back to sort of the remarks earlier, you know, we're seeing strong levels across multiple different pipeline activities and measurements. It's also worth noting, you know. You know, there is an urgency and an emphasis around family building and fertility as a priority for employers.
Companies are recognizing that, you know, the need to provide that coverage and services across their workforce, you know, including in the millennial workforce in particular, where family building and fertility benefits is close to the top of the list around priority. Again, we're, you know, again, a long way to go in the sales season, but, you know, a positive start to the year.
Maybe let me just follow up on utilization. Pete, I think in your prepared remarks, you said member activity sort of back to normalized levels. You know, if we look at the utilization rates in the quarter, they're lower for all members and female only this quarter versus where they were four quarters ago. I'm guessing maybe we saw some modest disruption due to Omicron in the beginning of this quarter. You know, could you maybe talk about utilization year over year and how we should think about that? Maybe as you think about the quarter, you know, progressed and we got past Omicron, have you seen utilization increase? Now, you know, we're already into May here, maybe you can talk about what the spring, you know, has looked like from a utilization perspective. Thanks.
Sure. One quarter itself is always difficult in terms of measuring utilization and saying whether or not that is or isn't an indicator of what's gonna happen for the full year. I think the most instructive thing I could point you to is the fact that our guidance, you know, we're right at the low end of our guidance. We're comfortable with the high end of our guidance. That didn't change. As Mark said before, when we generally guide, we guide based on what we're seeing from a utilization pattern perspective that's generally towards that high end, and then the variables that we talked about could impact whether or not, you know, we're in the range versus closer to the high end. We're seeing patterns that are more normal.
The early first quarter results versus a year ago are slightly down, but ever so slightly. It is partially part of that early in the quarter impact from the Omicron variant that spilled over into the early part of the first quarter. Hard to know exactly how much of that, you know, sort of recovered, if you will, by the end of March. Overall, you know, when we say, you know, it's important when we say utilization patterns are, you know, more typical of what we'd normally expect to see, you know, that's sort of us analyzing by company, by industry expectations, right?
Mix always impacts overall utilization and because it's just a blend of different companies and industries that have different, you know, cohorts of employees at different age brackets, if you will, and more or less concentration of employees in childbearing years. The typical that we refer to is sorta what we expect to see given that backdrop.
Okay, thanks for the comments.
Thank you. The next question is coming from Stephanie Davis from SVB Securities. Stephanie, your line is live.
Hey, guys. Congrats on the quarter, and thank you for taking my questions. We have heard of a number of large RFPs out in the market for fertility benefits, so I was hoping to hear a refresh on your head-to-head win rates. Just given some of the comments that we heard of earlier and some of your, the other employer-facing names having a tougher time competing against the privates, I'd love to hear how you're differentiating versus the private competitors in the space as these VC dollars are still flowing.
Well, I'll take the first part of your question first. Although there are more RFPs out there in volume versus a year ago, the substantial majority of opportunities that we are talking to actually aren't through RFP. That still continues, continued last year, continued in prior years. We're still not seeing sort of the competitors that you're referring to the majority of the time competitive. It's very early in the season to talk about our win rates [that] are not relative to our competitors. Our overall win rates are good, it's early.
Sort of, you know, it's very early to talk about win rates at all because the majority of commitments, as we talked about, happen for us every year, this year would be no different, at the beginning sort of, you know, near the end of the summer, you know, going into, you know, essentially October. Really early to sort of give you more color than that. But just overall, although more RFP activity is happening, majority of opportunities are still being done, you know, without RFPs, if you will. I'm sorry, what was the second part of your question?
You pretty much covered it, just kind of how you are differentiating versus the private competitors in the space.
Yeah. We talked about that before. It's the same things but, you know, continuing to improve on the same things, which is, you know, we're in a favorable position versus our competitors because we have a direct contracted network of providers that enable us to do many more things with them, share data back and forth, collaborate, do best practices, and drive and achieve the outcomes that we achieved vis-à-vis what's happening nationally, right? Nationally effectively are the alternatives that are out there. You know, that plus the concierge service that we have through the PCAs and all the other things that differentiate us.
Most importantly, you know, the head start that we have now 7 years in market, where we continue to refine and improve on our benefit and our benefit offering and every aspect of that, you know, throughout the program, which you're not catching up on anytime soon. And by the time you think you caught up, I'll be 6 years ahead of you after that, you know, is really sort of the gist of it.
Super helpful. One quick follow-up is you talked about some of the record levels you're seeing in your pipeline. Does that reflect any of the large RFP activity we're seeing in the market, or is that potential upside versus where you are today?
Well, the overall pipeline and it being up over prior year, yeah, part of that is the RFPs that are out there. Again, you know, the majority of them aren't RFPs. It's sort of both, right? It's if you sort of look at, you know, RFP volume and dollars in pipeline versus non-RFP volume and dollars in pipeline, both are growing really nicely year-over-year.
Helpful. Thank you so much.
Thank you. The next question is coming from Dev Weerasuriya from Berenberg. Dev, your line is live.
Hey, good evening. Thanks for taking my questions and a great quarter to kick off the year here. I'd like to just.
Thank you.
Touch real quick on the market. If you kind of think of a flywheel effect from saturation or maturity of the fertility market, you know, as more employers provide fertility solutions, it may prompt the rest of the market to adopt fertility solutions more quickly, you know, which could accelerate adoption. You know, if you kind of think of this, you know, maybe as an exponential curve, you know, where do you think, you know, we are currently in the market? I have a quick follow-up to that.
I'm not sure how I would, you know, sort of quantify or illustrate where we are. We're early in the curve. We're certainly still on the way up. That's really demonstrated by the fact that we continue to have opportunities year after year, growing not declining, and we continue to win business year after year, growing not declining versus prior years. That's probably the best indication that we're still on its way up. I think the math sort of supports that as well. You know, the percent of the market that's still underserved, the percent of the market that we've penetrated versus what's out there, 265 clients on 8,000 large self-insured employers, not including the labor market, et cetera.
There's still significant opportunity, you know, and we're very early on that curve.
Okay. Thank you. Just circling back to the competition here, I just wanted to focus on the clinical outcomes. You know, how has your guys' clinical outcomes has improved, but how does the delta between you and you know, maybe the second-best player change over time? You know, it's interesting that these players are not catching up more quickly. What do you think, if you can provide some color as to why that may be? Is there something you know, that's operationally different that's hard to do? Maybe relationship or partnerships that are hard to mimic or change? Thank you.
Yeah. Happy to answer that. First of all, the nice thing about that question is nobody else has published outcomes, so I don't know who the second best is because they're actually not out there. I always say the reason why that is 'cause without a directly contracted network of providers where you're requiring to get that data and get it on every patient and report it on every patient, you don't even know what your outcomes are, right? Most of the competitors out there have some form of reimbursement model. A reimbursement model isn't impacting anything. It's simply just, you know, reimbursing is exactly what it sounds like. You're not managing anything. You're just reimbursing the cost, right?
At the end of the day, when you're only reimbursing and you're doing it via a rented network, which a lot of them do, you don't really know the outcomes, which is why you're not reporting them. Interestingly enough, even the large carriers that could do that because they have directly contracted networks, they're just not focused on it, right? Which is why they're not publishing it. It's hard to sort of describe why the number two, how far behind they are and whether there is a number two. I don't even know who that is. You know, the reality is nobody else but us continues to publish outcomes year after year, you know, on every member that engages with the benefit.
Great. Thank you.
Thank you. That's all the questions we had in queue. I'd like to hand the call back to James Hart for any closing remarks.
Thank you, Paul. I appreciate it. If anybody has any follow-up questions, please, as always, never hesitate to reach out to me. Otherwise, we look forward to speaking with you next quarter. Thank you.
Thank you, ladies and gentlemen. This does conclude today's conference. You may disconnect at this time and have a wonderful day. Thank you for your participation.