Morning, everyone. Welcome to the JP Morgan Healthcare Conference. My name is Annie Samuel, and I am the healthcare technology and distribution analyst here at JP Morgan. We are thrilled to have Progyny with us this morning. CEO Peter Anevski is gonna do a presentation, and then afterwards, we'll do Q&A with the team. If you have a question, please feel free to raise your hand. Someone will bring you a mic. I'm sure there's lots to talk about. With that, let me turn it over to Pete.
Okay. Thank you so much, Annie. Thanks everybody for joining. Michael Sturmer, our President, and Mark Livingston, our CFO, are here with me. After the presentation, we'll do Q&A. We're happy to be here. This is a very exciting time for Progyny. We appreciate the opportunity to share our thoughts. We'll begin. We're gonna pause here so you can take note of the caution regarding forward-looking statements and non-GAAP financial measures we may discuss today. For anyone that might be new to our story, Progyny was created to solve very real problems with fertility benefits offered through traditional health plans. They're our largest competition today and the primary option for employers prior to us launching in 2016. We're a mission-driven company seeking to make anyone's dreams of parenthood come true through healthy, timely, and supportive family-building journeys.
We've achieved early success growing revenue at an 80+% compounded annual growth rate over the past seven years, and we're proud of that. We're able to achieve this by pioneering value-based care and family-building solutions. We've implemented a data-driven approach to plan design and benefit management. From day one, we focused on providing care that's both equitable and comprehensive. Our benefit is available to everyone, including the LGBTQ+ population and single parents. For the past seven years and through today, we're the only family-building solution publishing outcomes for every one of our members and for every treatment that they go through. This gives our clients and you all an unprecedented level of transparency into the efficacy of our program. We've also established a unique and unparalleled level of collaboration with our provider network.
This is in contrast to the relationships that you generally see that are antagonistic between providers and health plans across the U.S. The fertility journey, if you don't know, is complicated and very specific to the individual going through treatment. Fertility patients typically haven't had any experience with going through this part of healthcare. What we do is we provide an extraordinary level of education and emotional support through dedicated patient care advocates to help make the patient's journey as easy as possible because it's a difficult one. As a result of our focus on the quality of care, Progyny is driving a better patient experience and more effective spend for our clients, the plan sponsors. We're also producing tangible improvements in the metrics driving our clients' business through more efficient recruitment, higher retention, and better employee productivity. That's important today.
Now let's take a deeper dive into our rapid growth. We went live in 2016 with just five clients and 110,000 covered lives. Now including this past selling season, our strongest ever, with 105 new client commitments, half of which hadn't offered fertility benefit before. We now have over 370 clients with 5.4 million covered lives. Even with a 50x increase in covered lives since 2016, we're only mid-single-digit % penetrated against our initial target market of large self-insured employers. In other words, early innings. We started in just two industries concentrated on the West Coast, and today we're in over 40 industries with clients and covered lives throughout the U.S. We'll get into that later.
This growth reflects the strong demand for family-building benefits, a demand that's persisted throughout varying macroeconomic cycles, including the global pandemic that we all just went through. Our unparalleled solution, achieving seven consecutive years of superior clinical results across hundreds of thousands of patient journeys, has earned us an NPS score of +81. We've achieved a near 100% client retention rate every year, and we've never had one client, not one, from Progyny go back to their carrier. Even in the face of a more challenging macroeconomic environment, none of our existing clients reduced their benefit for 2023. In fact, more than 25% of our clients increased their program with us in some way. Remember, generally, they're making these decisions in the third or fourth quarter.
Employers certainly were aware of the current economy when they made these decisions to and chose to prioritize this benefit. When you consider the rapid results from the selling season, again, with half our newest clients adding fertility for the first time and many existing clients adding to the benefit with none reducing it, plus the near 100% client retention rate. This validates, in my opinion, a couple of things, both the resilience of family-building benefits even in this economy and our differentiation when compared to other alternatives. It's not surprising when you consider those plans attempt to control cost of care by restricting utilization with dollar maximums, step therapies, prior auths, and treatment exclusions. Their approach results in inferior live birth rates and high-cost, high-risk pregnancies and multiple births, which negatively impact employers.
The good news in all of this is that employer adoption does continue to grow. What's driving the demand? It's increasing prevalence and societal macro trends. Let's unpack that. The CDC reports nearly one in five women of childbearing age are unable to conceive. On top of that, 26% of pregnant women are having difficulty carrying to term. Add to that male factor infertility, which accounts for one-third of infertility amongst heterosexual couples. Black women who are twice as likely to suffer from infertility, but less likely to have coverage. Lastly, same-sex couples or single parents who will require treatment to achieve success. Without coverage, it's expensive for everyone, and for many, unaffordable. It's no wonder that family-building benefits are critically important to employees. How important? 46% of employees would forego higher pay for generous health benefits.
Millennials, the largest population in the workforce, prioritize family-building benefits when they decide where to work. 45% of workers look for a company, not surprisingly, that offers fertility benefits, and 80% of employees choose a company, again, not surprisingly, that prioritizes diversity, equity, and inclusion. These things are really important to people, and our solution addresses all of them, plus much more. Even though more and more companies are recognizing the need to offer this benefit in order to attract and retain the best talent, the market is still significantly underserved, with only less than half of large employers today providing even some type of coverage for family building. When companies decide to add or improve their family building program, employers have alternatives, including their carriers. Here's how we're differentiated.
Progyny redefines fertility benefit management by leading with the member experience, having collaborative partnerships with the best providers, and managing every aspect of a comprehensive solution. This produces, again, a better member experience and delivers superior results at scale every year. We achieve this starting with our plan design. It's focused on optimizing treatment success, and it's uniquely flexible for the complicated journeys that I mentioned for each member. And members have unlimited access to a dedicated patient care advocate that provides both the education and emotional support necessary to empower decision-making that drives those outcomes, which means a healthier pregnancy. Next, we work with our provider network collaboratively to positively influence the standard of care that they provide. We contract directly with them to receive comprehensive reporting on every Progyny patient that they treat.
This uniquely allows us to actively manage and monitor what's happening in our network for adherence to best practices and ensures that our members truly receive the best possible care. Lastly, we provide our doctors with the latest tools and technologies, which are included in our treatment bundles, also designed to achieve optimal care. Although there are alternatives to Progyny, we're the only solution with all of these core competencies and have a proven track record of delivering value through these clinical results. Value-based care remains a goal for many in healthcare. For us, it's a reality. Progyny is actually delivering on that promise, and we've continued to deliver on that promise each and every year. I keep saying we have better results. What am I comparing to?
Well, the clinics in the U.S. are required by law to report the results for all ART cycles annually to the CDC. When we compare the national averages reported to the CDC, Progyny members see significantly higher pregnancy success, experience substantially fewer miscarriages, which are very difficult, by the way, for the person to go through, and have healthier pregnancies overall. You can see how our program translates into measurably better results as compared to the national averages reported. Remember, the national averages are essentially akin to the results of the carrier plans. For members, this means our patients get pregnant faster, but more importantly, avoid the strain of unnecessary rounds of treatment. They're already going through a very difficult time. When they get pregnant, it's primarily singletons.
This reduces the rate of high-risk pregnancies, extended NICU stays, and chronic care conditions that often result from multiple births. When you think about it, avoiding unnecessary treatments and reducing costly high-risk pregnancies saves money. The typical Progyny client will realize 25%-30% savings compared to a carrier program. This doesn't even include the savings associated with improved recruitment and retention, higher productivity, and lower absenteeism, which we are also impacting significantly for our clients. Since our inception, national averages have been relatively consistent and not improving. This demonstrates, in my opinion, either a lack of focus or structural limitations in their approach, which is why they haven't improved. Our program continues to improve and significantly outperform year after year. In fact, we've been and still are the only fertility solution in the market that's been measuring and publishing these outcomes.
We've taken an additional step this year by having an independent third-party actuarial firm issue a report which validated our reporting, and that report's available. We believe companies should expect nothing less from their family building benefits provider since they're investing in this area. This is just another example that further advances us as the industry leader in fertility solutions. Now let's switch to the overall trend in healthcare costs. Over the past decade, employers in the U.S. have grown used to single-digit increases in healthcare costs every year. 2023 will be no different. Medical costs are expected to go up 5%-8% according to Mercer's recent survey. Not with Progyny, though. We provide additional value by helping our clients mitigate the effects of medical cost inflation, we've been doing that every year.
In 2023, we expect to hold client rates either flat or slightly down, even in this economy across our network. Well, how do we do that? Well, as we continue to rapidly penetrate the market. For example, just in the last two years, we've more than doubled the covered lives we provide for our practices. This gives them significant incremental patient volume they would otherwise not see, which on a marginal cost basis is very appealing. That's why we're able to continue to go on our favorable rates from them. That's how we're able to keep medical costs in check for our clients. While cost control is critical, we're even more differentiated to the other competing models in family building in other ways. We believe the effectiveness of a family building benefit can be measured in two ways: depth of management and access to care.
For management, models at the high end, us, extensively coordinate collaboratively with the provider and have contractually committed data sharing. This enables network monitoring for adherence and outcomes measurement, again, for every patient. Conversely, models at the low end, not us, do very little to influence patient care because they're not in a position to do it, honestly. With access to care, models at the high end, again, us, have provider networks with broad geographic reach, significant choice, including the most sought-after clinics and comprehensive coverage. While models at the low end have narrow networks or rented networks. I don't know why anybody honestly pays extra for somebody else's network. No relationships and plan designs that create a scarcity mentality, forcing patients into making compromises in their care. When you plot both of these factors, it helps to reveal the differences in the competitive landscape.
Take a look at the models in the lower left quadrant that are typically reliant on out-of-network practices and single case agreements. There's no patient-specific data collection, no monitoring or reporting. The result is really low benefit management across a narrow network with no measurement or management of provider performance and no ability to impact outcomes. In contrast, we're in the upper right where we get data sharing written into our contracts for all member journeys, and this allows for comprehensive scorecarding that we do with our clinics, plus the ability to favorably impact success rates, which result in the most efficient use of healthcare spend for our clients. We apply this framework to the various models in family building. This reveals how differentiated Progyny really is. The carriers largely sit in the middle of these quadrants as their programs achieve some of the goals of accessing care management.
They're ultimately restrained because their approach includes dollar maximums and one-size-fits-all utilization management. Based on the national averages, we see the limits with this approach. The reimbursement programs and the own clinic hybrid models with rented networks have significant limitations as well. Their plan designs incorporate many of the worst features of a carrier plan without any of the corresponding advantages. Let's switch now to our ever-increasing penetration across industries. We're definitely benefiting from the network effect. Since launching our solution in just two industries, as I mentioned, we're now in over 40, and the clients that we've added this past year represent the broadest and most diverse cohort in our history. This graphic shows the year we won our initial client within each of the 40-plus industries. As you can see, we penetrated new verticals at a steady and consistent pace throughout our existence.
Our clients come from both white and blue-collar industries, old and new economy companies. That's what demonstrates that family building is a human need and truly universal. New industries are important to us in terms of both diversification as well as helping to lay the groundwork for future growth, because there's also a network effect within industries. Companies tend to compete for the same pool of talent, and employers generally know who the leader in their industry is and use those as benchmarks. Some employers generally won't typically be the first to add a new benefit like fertility. Once they see that the leader in their industry is separating themselves by adding coverage, they're gonna respond soon by adding the benefit in order to reestablish parity and remain competitive. You see here a few examples of how this pattern has played out for us in different industries.
On each occasion, once we won our initial client, we've been able to expand in that industry every year. Diversification is important both for our growth but also in reducing our concentration of risk within any one area. We continue to grow in tech. That said, since our IPO in 2019, approximately 90% of the aggregate members that we've added through new sales have come from outside of tech. Although tech remains one of our largest verticals overall, our concentration in any industry, including tech, is less than 20% of our member base. Why do I mention this? Well, we know this is of interest to people since we've been hearing drip of headlines regarding layoffs in tech.
The reality is that the impact of these layoffs collectively on our member base has been negligible, and we believe it's going to be more than offset by the growth in other industries that are continuing to hire, such as healthcare, hospitality, and services, as evidenced by the most recent jobs report last week. Here you see just a small sample of the more than 370 employers that we work with today. Our clients are industry leaders, with many of them routinely listed as best workplaces for women or LGBTQ +. Many of these companies are driving the U.S. economy and are amongst the most sophisticated buyers who do the most comprehensive reviews when they make their benefit decisions. We believe the caliber of this group emphasizes how Progyny has become the brand of choice for family-building benefits.
On the last slide, our results demonstrate the scale we've achieved, the scalable infrastructure that we've built, and the inherent operating leverage within our model. Starting on the left, you can see the pace of our top-line growth. At the high end of our guidance, we're expecting 57% growth in 2022 compared to 2021, which is 45%. We also achieved profitability at a very early stage, even with our continued investment in our business every year, we've been continually expanding our margins. We've also been highly efficient from a capital perspective, generating significant positive operating cash flow. For example, we expect approximately $50 million in just the fourth quarter of this year alone, which will yield a 60%+ conversion of operating cash flow to adjusted EBITDA at the high end of our guidance for the full year.
This is an improvement over last year, which was 38% conversion. In conclusion, today's presentation highlighted several key themes that we think are important to our investors. Let me summarize. There are multiple societal macro trends fueling the need for family-building solutions, and we don't see any signs of that whatsoever slowing down. The growing need and demand amongst employees has impacted the pace at which we're adding new clients and lives across industries. This, plus our near 100% retention rate, demonstrates the resiliency of fertility and family building and the growing appeal amongst employers to offer this very important benefit. In fact, looking at just the last month or so, the number of conversations we're already having with prospective clients is really encouraging and reinforces that employers, even in this economy, are continuing to prioritize this area of benefits.
Our comprehensive approach uniquely positions us to continue to deliver superior results and value versus all available alternatives. Our financial results underscore both the strength of our business model as well as our continued ability to execute at scale. In 2023, we continue to invest in our current offering. We'll be rolling out enhancements around preconception and male infertility services. We'll also be making investments within maternity and women's health in areas where we believe we can make a difference. We are in the strongest competitive position that we've ever been, and we're incredibly excited for what our future holds. We look forward to providing you with insight into our expectations for 2023 on our earnings call next month. With that, Michael and Mark and myself will take some Q&A. Thank you.
Thanks, everyone. Just wanted to remind you, if you have a question, you know, please raise your hand, and we'll have somebody bring you a mic. I'm gonna kick it off with the first question. First I wanna thank you for providing that incremental color on your customer base. I think that was really, really helpful for everyone. It's been a question that we've been getting a lot, and I think it'll, you know, really help people understand how much you've diversified your business since the time of the IPO. Maybe just, you know, kind of starting really high level, when we look at the backdrop for fertility and the opportunity for you to penetrate the market, you know, 50% of the market is untapped at this point.
Can you discuss, you know, some of the factors that are causing employers to wake up and realize that this is an important benefit that they really should have for their employees?
Sure. It's some of the stuff that I mentioned in the presentation. The question is, discuss some of the factors that continue to create awareness around why this is a benefit that's become really a need to have, not a nice to have. The answer really is the trend of couples and people choosing to have babies later and later in life is driving a very real medical need in order for people to be able to achieve their family-building journeys and dreams, right? At the end of the day, that reality and its increasing prevalence, again, not my data, the CDC's data, plus alternative paths to parenthood growing more and more common, all drive the need.
Employees are squarely focused on this benefit. If you look at social media, you see how many employees talk about the benefits that are being rolled out, talk about the deficiency in those benefits that are being rolled out by others, not with Progyny, and are really squarely focused on the details of what they're getting 'cause it is really important to them.
Maybe another question, just, you know, as we're thinking about macro and, you know, kind of moving into a potential recession. I think a lot of people look at birth rates and think that that's the right metric to look at instead of understanding maybe the urgency of an IVF patient and how they're making maybe different decisions than everyone else. Can you talk about that? You know, are people gonna make different decisions heading into a recession? I would think if they have a benefit, they would, you know, kind of continue to plan forward. How are you thinking about that?
Yeah. The question is: Is the current economy gonna impact people's decisions to pursue treatment because they're dealing with other, you know, inflationary concerns? In the past year, inflation isn't new. It didn't come this month. We've been dealing with it all year long, hearing about it all year long. That was probably one of the most common questions, in addition to, "Are we going to sell the business?" where we ended up with a record sales year. Most common question is, are people gonna not pursue treatment because they have member responsibility or because it costs money to have a baby? The answer for us was no. In fact, we raised guidance 3 times, that guidance raise is a function of utilization increase, not decrease. There's no evidence of that. We don't see any evidence of that.
I think the reality is, as I said jokingly to somebody last night, people aren't going to forego their family-building journey understanding their likelihood of success goes down dramatically each year just 'cause of the cost of milk, to be honest. They wanna build a family, and they're gonna do it.
You know, and maybe we could just, you know, kind of talk about, you know, past recessions, you know, particularly, you know, 2009 and 2001. You know, cycles, you know, first off rebounded very quickly once the economy rebounded. I think it's also important to talk about how the fertility market is different from back then. You know, a lot more cash pay. You know, what proportion of the market maybe back then was cash pay versus now, and how could it potentially look different this time?
Yeah. The question is comparison to the financial crisis in 2008 and 2009 versus.
today's economy. It's a great, it's a great comparison for one reason. Back then, fertility was primarily paid by people themselves. There was very, very little coverage. Even in that time, which is much more significant and impactful to today from an economic perspective, the industry still grew. Grew slower, but it still grew. Unlike today, where you do have coverage and have increasing coverage, I think that's probably the biggest indicator that fertility as an industry is resilient and will be resilient through this economy.
The only thing I'd add to that too is that in the prior recessionary period, you had much higher unemployment rates, which is, you know, this is obviously a very different type of situation. To the extent that you maintain that very high employment rate, you know, the dynamic of having coverage and high employment is, you know, very different.
You know, maybe just one more on macro for me before I open it up to the room. You embedded flat organic growth in your 5.4 million lives target for next year. Can you talk about how much contribution you've had historically from organic growth and how that might be a little bit different this year?
Sure. In the past, each year, when you look at the lives we enter the year, organic growth has contributed something in the 100,000-200,000 lives, you know, a year, and every year varies a little bit based on what's going on in those individual companies. It's not material. The material part of our growth, the driver, is us adding new logos and upsells and the organic growth is the smallest piece.
You can raise your hand if you have a question in the room. Okay, great.
I have a question in the back. I'm hiding behind the wall. Two-parter. The first one is, I think you are clearly very outcomes driven. Could you just talk about when you maybe make the decision to eliminate a provider from the network? Like, do you give them some sort of a remediation period? Is that something that's instantaneous, and how often does that happen? The second part is just the agreements you have with these clinics. Seems like you might agree on rates individually with these clinics, but then you offer bundled pricing to your clients. I guess on what % of the base might you be losing money? Like is that less than 1% of your member base?
Like if it's an overly complicated procedure that, maybe your clients are paying you X dollars for, but the clinics are gonna charge you X plus maybe $20,000.
I forgot the second one, so I don't know.
Ah.
I'll do the first question first, and then Annie will help me with the second one. I couldn't make it out. The first question is, how do we monitor the network? When the network isn't performing relative to adhering to best practices and driving good outcomes, how do we remediate? The answer is a, all of our clinics in our network get quarterly clinic scorecards. Our provider account management team, you know, meets with them and goes through those results. To the extent that there's remediation necessary of any kind, we do put them on probationary periods. To the extent that they don't improve, they get excluded from the network. It's sort of as simple as that. What was the next question?
I think the second question was a little bit because you talked about value-based care. You know, what is the risk if a patient procedure is more expensive than what the employer paid you for, I think was the question.
That's our risk from a margin perspective. That doesn't occur on a significant frequent basis in terms of surprises like that. Our margin has been relatively steady and improving. If you look at our gross margins, what we report, our overall margins, et cetera. Yeah, that is our risk. That's the model, and that's how it's designed, but it's not a substantial risk for us or hasn't proven to be.
I think just to clarify it from a rate card perspective. We contract with the providers for specific treatments at specific locations, a particular rate. We also charge our clients in the same way. It's a particular provider for a particular treatment cost. It isn't that we are, you know, broadly charging one rate across the country for a particular service and if you will, managing the margin up and down across the country, it's a little bit more tightly designed than that.
Thank you.
We had a question in the front of the room.
Thank you. If you compare the number of babies born through IVF in U.S., it's less than 2%, which is about approximately 50% of the average in other markets in the world on that side. How do you think that Progyny will support that growth going forward? What would you think that the number of IVF babies born will be five years from now in U.S.?
The question is, why is the rate of utilizing fertility in the U.S. or fertility services lower than it is globally?
Yes.
The answer is, it's expensive. It's really expensive and more expensive in the U.S. generally than it is outside of the U.S. With that expense, most people can't afford it. The nice thing about it is and how are we gonna support it is the other part of the question. With increasing adoption and us continuing to educate employers at how important this is to adopt the benefit, we've been part of what's driving the growth in the fertility industry, compounded annual growth rate of 10% a year over the last 10 years. Ultimately, it will catch up as we continue to penetrate the market and educate employers. Thank you.
Do we have any more? I think there was another one in the front over here.
I just have one follow-up. I wasn't clear on the contracting comment. You mean, like could the procedure cost $20,000 for one employee and $100,000 for another, and you would charge the employer a different amount based on that? I wasn't clear.
No. For, for any given treatment at a particular location, there's a cost that we pay the provider and an amount that we charge the member and the client, depending on member cost share, obviously. That doesn't, that doesn't vary. We have a handful of rate cards, essentially it's one price. For us, we understand what the margin is that we'll earn on any particular treatment provider combination. Let's say that's in San Francisco. In St. Louis, it will be a different cost to the provider and actually a different rate that we would charge to the client member, because pricing is not the same across the country. It tends to be more expensive on the, on the coasts. Does that help?
Sure.
Pete, you made an interesting comment in your prepared remarks that over 25% of your client base increased how much they were using with you. I think that's really interesting. Can you talk about how much of that was, you know, maybe becoming more generous with increasing number of cycles? Was it egg freezing? You know, was it the RX benefit? Where are they looking to bolster their benefits?
It's all of those things. It is, you know, a client, for example, may have launched and didn't include fertility preservation in terms of egg freezing, and they'll add it. A client may have launched and didn't take the pharmacy benefit with our medical benefit, they'll add it. A client launched with maybe a two cycle or a one plus one cycle, they'll add a cycle, so it's now three cycle lifetime benefit to the employee. Maybe they didn't include tissue transfer or tissue storage, et cetera. Maybe they didn't have adoption and surrogacy as part of their benefit, they'll add it, you know, 'cause we provide that as well. All of those elements are different ways that they add to the benefit.
You know, maybe just one more on the presentation. You gave us something maybe that was a little bit new, which was you're thinking about in making investments or enhancements in, you know, preconception, maternal health. Can you talk about, you know, what that might look like for you? Is that something you're thinking about, you know, kind of building versus buying? How should we think about how that can round out your portfolio?
Well, let's start with the preconception and male infertility services. We announced beginning of last year that we're gonna be building those, standing those up. They're ready, and now they're gonna be in market as a natural extension to what we already do in our family building product. As it relates to our investment in maternity, and other women's health areas, they're investments that if we can and want to accelerate through acquisition, we will. So far, we don't see anything that's that attractive, and we think we could build something that's superior to what's out there.
You know, maybe just one more on, margin expansion. You talked about, you know, 20% incremental margins. What further opportunities are there for you to expand your margins, and how should we be thinking about the long-term margin profile for Progyny?
I'll let Mark, take that one.
Since the beginning, we've been pointing towards margin incremental revenue as sort of being indicative of where we see the business going. We, we don't set an external target for that. With that being said, we've continued to expand even that number. We don't cap ourselves, if you will, on where we see the business going from that perspective. Again, year after year, we've continued to be able to leverage those lines that we've got, you know, both through renegotiations with our providers upon renewal with our pharmacy partners. Some of the benefit of those savings we have kept, which has helped drive some of our margin expansion.
Some of it we've passed on to our customers, and you could, you know, saw that in Pete's chart where the unit cost, and rates for our clients are going down. Even just managing the organization, we continue to get better and better at how we manage the service cost, all the patient care advocates. We use AI and different things to help really enhance the, you know, the way that we provide that member experience, year-to-year. Of course, it's an exciting time for us right now with just bringing on all these new customers here in January. Certainly the office has been buzzing as we've been servicing them. You know, sales and marketing and G&A, you know, we've continued to leverage those year after year, particularly in G&A as we've grown.
Last chance for a question in the room.
Thank you. I guess it's kind of clear you're in a growth phase in terms of adding new logos. Maybe you could touch on, I guess once the industry matures, what is the moat around the business? You talked about the moat around the business. You talked about leveraging data, membership experience, collaboration with providers. It doesn't seem like any of those is kind of exclusive relationships with providers. Many companies are able to leverage data. I'm just wondering, once you enter a level of maturity, how do you think about the kind of moat?
Sure. I think your question is how are we gonna remain differentiated? In theory, anybody can use data and do what we do. Here's the really interesting part, nobody is, and nobody has, and we're seven years now doing it. If it were that easy, it's nuanced, right? There's a lot of detail to what I'm describing that we've figured out, continue to improve on, continue to invest in every year. If it were that easy and anybody just could use data, where are they? Where are their results in terms of delivering value every year? We're confident that the head start that we have, even if those wanna try and catch up, by the time they catch up seven years from now, I'll be seven more years ahead of them, and that is the reality.
It is complicated, and it takes detail in terms of dealing with the clinics and dealing with it all.
Pete, in our last minute here, what are you most excited for in 2023?
Look, I'm excited to continue to penetrate our existing market. We're so under-penetrated. I'm excited by the early success we've had in expanding our initial target market, where we're now had success with union and labor markets that we weren't going after before, and we're doubling down on that investment and go to market. I'm excited by the opportunity in governmental and municipalities again that we haven't been going after that we're gonna go after. Even the initial target market is so under-penetrated. I'm also excited about looking into these other areas of healthcare that we could help impact and make people's lives a little better. All of it is pretty exciting. Where we're sitting now, if, if we didn't hear the headlines of the economy and inflation and all that, we're not failing.
We're continuing to grow the business successfully and expect to do so for years to come.
Great. Well, thank you to Progyny for presenting today, and thank you all for joining us.