...a health presentation. I'm joined by Parth Mehrotra to my right, who's the company's Chief Executive Officer. Robert Borchert, who runs Investor Relations, is also up front, just took a bow, so many of you probably know him as well. A couple quick housekeeping issues. Remember, our disclosures are at our website at williamblair.com. More important, we will be up in Jenner B, that's on the second floor, for the Q&A session. So we'll do the formal presentation here, and then head up to Jenner B for any questions you might have. Just quick comments on Privia. This is one of our favorite names. It's one of the few names in the value-based care space that continues to grow profitably.
It's also a really unique model in that the company serves all payer and patient types, works with both PCPs and specialty groups, and takes on both commercial risk, Medicare, Medicaid risk, and does fee-for-service business. So really more of a future-proof model than what we've seen with some of the other vendors, and again, it's a testament to the profitability. Parth's become a little bit famous in the industry. He had a quote, saying, "They call it risk for a reason." That may or may not be in the slide deck today, but it's a great quote, especially given what we're seeing with increased utilization and the risk that's manifest with a lot of other providers. He's prescient in that.
So a lot of kudos to the way they've built this business model over the years to be truly future-proof and highly profitable. So I'll turn it over to Parth, and then again, Parth and Robert will join us up in Jenner B for the Q&A. Thanks.
Hi. Thank you, Ryan. Really appreciate you having us at the conference. Ryan's the only analyst that... We went public in 2021, and Ryan started getting to know the company in 2017, 2018, so he's tracked us for nine years. I can't hide anything because whatever I told him nine years ago, he holds me accountable for. So, but one of the few, only analysts that knows the company really well, so really appreciate you having us. So we'll get into it. What you have with Privia is a very unique physician alignment model that is at scale today. We serve and partner with providers across all specialties that serve every single patient across the demographic spectrum.
We work with all the payers across all reimbursement models, every flavor of fee-for-service or value-based care, and that essentially gives us one of the largest TAMs to work with, multiple ways to grow the business. Where the business stands today, the unit economics are proven already. We'll walk through those in a little bit detail. We're highly profitable, and we are very cash flow positive. We convert 80% of EBITDA to free cash, and we have no debt and close to $350 million of cash on the balance sheet. How we do that is through a very consistent, replicable strategy in every single state that we enter. The secret sauce of the business is on the left side. We enter every state, and we come with five things.
We form a medical group that provides all our providers with all payer contracts. We form a risk-bearing entity that can take risk in any value-based arrangement. We bring our tech stack, our services platform, and then we form a physician-led governance to manage the medical group and the risk entity that runs in parallel to the management team of the company. The combination of those five elements is what I think is the secret sauce. I think we try to get bucketed by investors or other analysts, and they miss that big picture, but it's, it's how we bring those elements together. And then we organize providers wherever they sit in the ecosystem. They could be small independent practices, large practices, practices employed by health systems.
They could be in clinically integrated networks or independent physician associations as to how they've pooled their risk and how they've come about over the last 20-30 years. We are really agnostic to where we find doctors, and we help them increase their top line, reduce their expenses, and ultimately try and get the doctors paid more and deservedly share for the value they bring to the healthcare ecosystem, being the lowest cost setting. And then we try to transition that whole network into value-based care across every single patient type. It's very important to recognize 50% of this country is commercially insured. That's not going to change as long as there's working-class America. You got 20-25% in MA, you got some in Medicaid, and then some self-insured.
We are trying to do value-based care with our payer partners across the spectrum, and that's a key differentiation for us. I'm gonna give you three examples of how this business snowballs. We started in Mid-Atlantic in 2012, 2013, with a single practice, 4 doctors. In the last 10 years, we've you can see the density, we've grown 5x, and become one of the largest medical groups in Virginia, Maryland, D.C., that area. In Georgia, started with one practice, came out of Piedmont in Atlanta, 15-doc practice. We've grown 13x in 9 years. You can see the density. We're one of the largest independent providers in Georgia. In Texas, we started with two anchor partners, one in Dallas, Fort Worth area, one in Houston. We've grown 3x in 7 years.
There are three very important things that happen when this takes place in any geography. Number one, the business starts to snowball. More providers join us. We can take that delivery network to the payers. We get into innovative fee-for-service and value-based arrangements that help us give more value-added economics to our provider partners. The sales funnel starts to get very heavy with referrals on the top end. The unit economics of the business and the profitability of these markets, number two, start to grow in an exponential fashion. And then, most importantly, what we have on the right here is a very durable asset in the healthcare ecosystem. We can now take one of the largest, independent, low-cost medical groups to any payer of healthcare, and do value-based care at scale.
That you cannot dismantle that, and that's operating at very high unit economics and margin profiles. So it's a very cash flow generating business. You can see in aggregate, we are now in 13 states and DC, partnering with close to 4,400 providers in 1,100 clinic locations. Collectively, our doctors see 5 million patients, and a fifth of those, about 1.2 million, are in some value-based arrangements. You can see we have very high patient NPS, and our gross provider retention is 98%. On a net basis, it's over 100% we because we are helping the practices grow same store. So really good metrics to track in aggregate.
You can think about Privia as sitting squarely at the intersection between payers of healthcare, the government, the large national insurance players, the Blues plans, and self-insured employers, and then providers in the community taking care of patients. We try to provide value to both of our key constituents. You can see on the right, to the payers, we can provide a very large, community-based, low-cost delivery network with the best relationship with the patient and the family, whether it's a kid, whether it's people like us in this room, whether it's, it's our seniors. We are able to do value-based care at scale, but more importantly, we are able to flex as demographics change and different payment models come about. It's a very sophisticated exercise, and an independent small practice is rarely able to do that on their own.
More importantly, we are keeping doctors from being acquired or selling their practice and keeping that small community physician practice alive in its entirety. For the providers, I think, again, we are trying to make sure that they get what they deserve, being the frontline of healthcare, best relationship with any patient in the household. We get better economics for them on the top line, and we help them and supercharge their practice, improve all their workflow, improve the tech stack, help them generate more take-home pay. We talked about the macro impact that we have. This is a case study at one particular provider group, and you can see it's a 35-provider group, 24 MDs, 11 APPs, some value-based lives.
We have grown the top line of this group close to 6x, close to 3x, sorry, since about 2013, and we've doubled the number of providers in the practice on a same-store basis and reoriented the practice more towards value-based care. This is the impact we are able to have to grow these practices same store. So once we get a practice, it doesn't stay static. We are looking to grow the installed base in a very interesting manner. So that provides very good same-store growth characteristics to this business, in addition to us getting new providers to join the platform. How we do all this is through three or four key things, which I'm gonna walk you through next. The first is our tech stack, and I want you to think about the physician's office that you all go to.
In my 20 years in healthcare, I've yet to come across, and if you can come across, let me know, we're still on the hunt, a single cloud-based ERP system that a medical, a sophisticated medical group and risk-bearing entity like us can use across this workflow that a patient... Put yourself in, on this racetrack, from the time you start to think about to selected your doctor's appointment, to how you do your visit, how your data comes in, what happens when you go home, if you're chronically ill, who takes care of you, and the cycle rotates 20 times a day for a doctor's office.
There's no single technology company that has built a cloud-based ERP equivalent for this kind of practice. Every single provider, every single specialty, every single patient, every single reimbursement model. So Privia has partnered or built on our own components.
They're really good companies that can solve a piece of the puzzle, but in my view, there's no IP in healthcare IT. It's the workflow that matters, so we supercharge this. We eat our own cooking. We don't sell this separately. All our providers are on the same tech stack or a couple of tech stacks, and this is what supercharges the guts of the practice. In addition to that, if you think about a practice on the left side of this page as being a plain vanilla fee-for-service practice to a very advanced practice on the right side of the page, there are scaled workflows that need to be optimized. Every single bullet at the bottom of this page, there has to be some work that is done at the care center level or by Privia.
So we go very deep with our practices and try to do a lot of this work for them, that they never learned in medical school on how to optimize. That gives us a very deep insight into the workflows. It's a very big, you can call it the mousetrap, investors like to use that word, or a very big economic moat around this business. Once you're on the, on the technology stack, once you're using our workflows, once you have our payer contracts, very hard to, very hard to get away from. And that's what provides a lot of stickiness to our business. That's reflected in the patient NPS, that's reflected in the provider retention rates.
This is a capability that we've developed over 10 years and keep improving it, and this is what provides scaled national services that a small community provider's practice just cannot develop on their own. All of that helps us to do value-based care in the broadest possible way. Like I was mentioning, the insurance mix in this country is likely not gonna change. 50% commercially insured, 20-25% MA, 10-15% Medicaid, and then some self-insured. We take the, we take the broadest view on how we do value-based care across all these buckets. Now it could vary by state. Some states will be more MA heavy, some states will be Medicaid heavy, but we are trying to take that delivery network and go to payers of healthcare and shift payment patterns from fee-for-service to value-based care across the spectrum.
There's a risk for a reason slide. When you're taking risk at the provider level, you're effectively trying to have capabilities that healthcare insurance companies have had, or some of those capabilities at the, at the ground level. We think there are three key components to manage risk. Number one, you got to pool the risk, and you've got to have diversification across a large number of providers, large number of payer contracts. So we manage collectively at Privia, close to $9 billion in medical spend across all our lines of business, all pools of risk on the previous slide. We add to that very robust oversight, actuarial capabilities, compliance capabilities, healthcare economics capabilities to get the data, look at the data across different payers, manage the risk at micro pool levels.
Then there's the operational execution at the ground level, which is led by physician-led governance, our clinical and performance management teams, and obviously, our tech stack that can help manage a very large set of population and risk contracts. So all of that allows us to take risk in a very profitable manner for the doctor and then for Privia, and we align ourselves financially perfectly with the docs. This slide shows the unit economics of the business. As the business snowballs, you can see in the last five years, we have reduced our customer acquisition cost by close to 40%, increased platform contribution per provider by about 32%. We've declined the payback period by 50% to under a year, and the LTV to CAC is now sitting at 22x.
These are some of the best stats I've seen in any SaaS business in the last 20 years. This is a derivative of that snowball effect that we have in how profitable it is to add every single new provider to join the platform at these unit economics. That translates into financial metrics for the company. These are six metrics that we guide to annually. The top two on the left are our units, so the business grows as we get more providers. They collectively, so we have 4,300 providers, as I said earlier, they collectively see 5 million patients. The second unit is how many of those patients are in some value-based arrangement, so that's approaching 1.2 million for us this year.
Collectively, our providers bill close to $2.8 billion in collections, and our sum total of our management fees, after our doctors have been paid and the office expenses taken care of, is what we call Care Margin. So that's gonna approach approximately $400 million this year based on our guidance. We have cost to serve there, so that's about 50% ratio from platform contribution to Care Margin. We got sales, marketing, and G&A, and then we get to EBITDA, which is sitting at 20% to Care Margin. Our long-term targets are EBITDA as a percentage of Care Margin at 30%-35%. Our mature markets, a couple of those that we exhibited earlier today, are already operating at that scale. So we are two-thirds way there already in a very proven business model.
And then not only that, we have very high EBITDA to free cash flow conversion. So our annual CapEx is less than $1 million. It's been around $100,000 in the last few years. The net PP&E on the company is less than $2 million. So it's a really good cash business where we are converting effectively almost all EBITDA to free cash flow, just affected for taxes, so burning through some NOLs. And we have a very conservative balance sheet, about $350 million of cash. We expect to be around $400 million+ by the end of this year and no debt, and we feel really confident about the guidance that we've given.
So all in all, just to summarize, with Privia, you're getting a very proven, unique business with good value proposition to both our constituents, pretty good economic moat. Business is operating at very good unit economics, very good financial profile, and we have a very conservative balance sheet. So hopefully, that's the pitch.