Earnings Call: Q1 2021

Apr 28, 2021

Thanks, Patrick, and thank you everyone for joining us this afternoon. After the market closed, we reported another quarter of portfolio drove revenue of $454,000,000 in the first quarter, an increase of 151% over the prior year, including organic revenue growth of 69% for legacy Teladoc. As a result of the momentum demonstrated across our channels and geographies and the continued development of the pipeline of new and expanded opportunities. We are raising our full year revenue guidance by $20,000,000 to $1,970,000,000 to $2,020,000,000 for the year. Turning to utilization. Our network of clinicians provided 3,200,000 visits during the Q1, representing more than 50% growth over the prior year's quarter despite a historically weak flu season. We continue to see significant strength in non infectious disease and specialty visits, with mental health volumes in particular driving growth in both B2B and DTC channels. We're also finding that specialty growth is acting as a gateway into multi service usage. Our members who engage with specialty care are significantly more likely to utilize one of our other services. For example, members who had a specialty visit had 40% more general medical visits per member than those who use general medical alone. This is particularly encouraging given client trends toward multi product sales with over 40% of our members now having access to more than one product. Membership in the Livongo Chronic Care suite of products grew 66% over the prior year as we added 62,000 new chronic care members in the quarter. And our share of wallet continues to expand as we gain deeper penetration within clients. As a result, we've seen year over year revenue expansion within all of our top 10 chronic care accounts in the quarter. Particularly encouraging is that over 15% of chronic care members are now enrolled in more than one program compared to less than 5% a year ago. With 40% of adults in the U. S. Living with more than one chronic condition, the opportunity is significant. And we continue to execute on our whole person care to address the full spectrum of consumer health needs rather than just one particular disease. Enrollment in chronic care programs as percentage of recruitables remained strong throughout 2020 and into the Q1. Enrollment rates are consistent with of the various books of business, which is a significant achievement given that we have been addressing meaningfully larger populations and in some cases, population types to us such as government employee benefit programs, Medicare Advantage populations and people with hypertension. The strong enrollment performance as a direct result of our investments in data science, which has consistently led to greater consumer engagement across populations. As our differentiated and comprehensive product portfolio continues to resonate in the marketplace, we're seeing significant traction in both expanding our offering within existing clients as well as adding new clients. Earlier this month, we signed an extensive agreement to expand our relationship with original Blue Cross Blue Shield on the East Coast to offer our comprehensive whole person virtual care solution to its members. Beginning early next year, we will provide members access to our suite of products, including our virtual care solutions and a full suite of digital chronic conditions across diabetes, hypertension, diabetes prevention and mental health. This deal is notable as it covers all of the planned commercial books of business and represents another significant competitive takeaway. Moreover, it demonstrates the power of our broad and integrated suite of products and our proven ability to deliver industry leading utilization and merit engagement, which also provides clinical and financial ROI for our clients. In addition to large pipeline of new and expansion opportunities, we continue to see opportunities for competitive takeaways, particularly in the health plan channel as these clients look for enterprise platforms that can leverage technology and data at scale to deliver actionable insights. We're also seeing strong interest in our Primary 360 offering from health plans, employers and even hospitals and health systems. And our vision to reimagine the primary care experience is gaining traction in the market. Our primary 360 pilots that launched earlier this year are progressing well and delivering encouraging results for clients and consumers. And we've already signed several additional deals expected to launch later this year. Our comprehensive virtual care solution also continues to gain momentum in the international marketplace. Solutions to its members across Asia. In Australia, we recently announced a partnership with MetLife to offer access to a customized platform across our comprehensive virtual care service to MetLife's members in the region. In the hospital and health system market, Our industry leading enterprise platform solution continues to see strong demand around the world. In addition to new and expanded enterprise deals domestically. We reached multiple new agreements this quarter with health systems in Europe and Asia as our strategy to take the InTouch capabilities to the international arena continues to pay dividends. Similarly, the pipeline of opportunities to bring the Livongo suite of chronic care products to the provider market continues to grow, particularly among hospitals that are increasingly bearing risk through ACOs and their own health plans. And we've now signed several deals to bring our chronic care solutions to the health system market. Turning to an update on integration. We've made considerable progress across our key work streams. As we previously noted, our commercial organization has been fully integrated with sales teams selling across the entire whole person portfolio of products since early this year. We've now closed several deals for our new integrated mental health product that combines the Teladoc therapists and psychiatrists with the Livongo digital mental health capabilities to deliver a market leading solution. This is an important first step toward creating a seamless member experience that will allow us to engage with members more effectively across programs. Additionally, we recently enabled capabilities for clinicians to refer members into Livongo chronic care programs from within the Teladoc provider workflow, leveraging our combined data to deliver clinically relevant insights that aid in decision making and get consumers the right care at the right time. We're making significant investments to integrate and enhance our technology platform to capitalize on our robust data and behavioral science capabilities across the entire organization. Data is a significant part of what underpins our ability to provide a highly personalized experience and deliver longitudinal virtual care that's fully integrated with our digital solutions. The investments we're making in data capabilities will enable us to drive greater consumer engagement, expand the breadth and depth of our product offerings and consistently increase the value we provide to consumers, providers and clients. Our ability to deliver data driven insights combined with clinical expertise at scale will for our vision of becoming consumers' trusted destination for whole person health. Finally, while we're on the topic of innovation and data science. I'd like to welcome Klaus Jensen as our new Chief Innovation Officer. With more than 20 years of experience leading digital transformation at enterprise healthcare and technology organizations. KLAS has deep experience across product innovation, information systems, health informatics and data products. I'm extremely pleased to have Klaus join our team and look forward to its leadership and contributions to our growth. And with that, I'll turn the call over to Mala for a review of the Q1 as well as detailed guidance. Percent to $454,000,000 or 69% excluding acquired revenue. Total U. S. Revenue for the quarter was $416,000,000 representing growth of 175% over the prior year's quarter. Total international revenue of $38,000,000 increased 29% over the prior year. Access fee revenue for the Q1 increased 183 percent year over year to $388,000,000 and comprised 86% of total revenue, up from 76% in the prior year quarter. The increase in access fee revenue as a percent of total revenue is primarily due to the acquisition of Livongo and InTouch health, both of which generates the majority of their revenue from subscription access fees. Visitsea revenue for the Q1 increased 24% year over year to $54,000,000 and comprised 12% of total revenue as compared to 24% of revenue in last year's quarter. Turning to membership and access. We ended the quarter with U. S. Paid membership of 51,500,000 members, an increase first quarter. Note that as we discussed on last quarter's earnings call, the temporary members that were on board rolled off during the Q1 membership count. Individuals with visit feel of $1,000,000 at the end of the Q1. Total chronic care unique individuals enrolled in 1 or more of our company owned and fifty eight thousand members as of the Q1. And $1.76 in the 4th quarter. So increase in PMPM, Roughly half was driven by the contribution of an extra month of Lubumba revenue in the Q1. We provided 3,200,000 visits in the quarter, as Jason mentioned, through our network of clinicians representing 56% growth over the prior year's Q1, which represents eCounter facilitated by our license revenue platform and provided with an additional 1 point The annualized balance sheet was 19.6 and as compared to the prior year's Q1. Or 67.8 percent compared to 60% in the Q1. The 780 basis The increase in adjusted gross margin is primarily attributable to the higher gross margin profile Gross profit and adjusted gross profit in the Q1 of 2021 include the benefit of our customers in lower expenses on Livongo devices attributable to purchase accounting adjustments compared to $10,700,000 in Q1 of 2020. They are in the first quarter $7,000,000 attributable to purchase accounting adjustments mentioned previously. And better operating expense performance as we continue to make progress against cost synergies, including integrating back office functions, streamlining processes and consolidating vendors. As discussed previously, we anticipate reinvesting cost synergies back into the growth in the business over the remainder of the year. Overall, we continue to have a high degree of confidence in our ability to achieve was $199,600,000 compared to a net loss in the Q1 of 2020. And income tax adjustments primarily related related to the merger with Livongo. On a per share basis, net loss was 1.31 for the Q1 compared to a loss of $0.40 in the Q1 of last year. Net loss per share includes a deferred tax rate of $0.57 amortization of acquired intangibles of $0.30 and stock based compensation expense of $0.57 We ended the quarter with $723,000,000 in cash and short term investment recorded debt outstanding as of March 31 was $1,400,000,000 Now turning to forward guidance. For the full year 2020 of $7,000,000,000 to $2,000,000 up $20,000,000 from prior guidance driven by and strong growth in per member per month fees as well as particularly among special and operating results. We expect adjusted EBITDA in 2021 in the range of $255,000,000 to $275,000,000 including an approximately $20,000,000 benefit from lower expenses on Livongo devices attributable to the We expect increased spending outperformance of our integrated data platform. We now expect total visits in 2021 to be between of 12.5000000 and 13.5000000 visits, representing growth of 18% to 27 over the prior year. For the Q2 of 2021 of $495,000,000 to $505,000,000 representing growth of 105% to 110% over the prior year's We expect total paid membership in the range of $52,000,000 to $53,000,000 and anticipate total visits during the Q2 of between $3,200,000 and $3,400,000 visits. We expect 2nd quarter adjusted EBITDA to be in the range of $61,000,000 to $64,000,000 including an of approximately $6,000,000 on Livongo devices, segments related to the Livongo merger. With that, Before I turn the call over to Q and A, I want to take a moment to acknowledge the hard work of our team members around the world. This week, we were Time Magazine's first ever compilation of the 100 Most Influential Companies. Our inclusion along other cognition of our 4,500 colleagues and a direct result of all that we do for our members. And your first question comes from Lisa Gill with JPMorgan. Good afternoon. Jason, thank you for taking my question. I just really want to start with your most recent thoughts on competition. As we think about some of the that you talked about displacing others with some of your business wins, the idea of Someone that has a deep embedded I think a lot of questions around how do we think about Amazon Care, the fact that MD Live has been sold to Cigna, Doctors On Demand and Grand Rounds coming together. So can you just maybe just level the playing field for who are you seeing when you're out there winning these pieces of business And how you think about how that competitive landscape has really shifted and changed over the last couple of years? Sure. Thanks, Lisa. We focus on our competitive advantages and our competitive advantages as you mentioned are around the broadest set of clinical solutions ranging from acute episodic to specialty care, chronic care and complex care across all of the customer channels ranging from employers to health plans to hospitals and health systems and on a direct to consumer basis. More and more and I think this is really characterized by the makeup of our of pipeline. Clients are looking for comprehensive multi product solutions. They're not looking for point solutions that they have to integrate themselves to stitch together and get the benefit of that. And I think of the data that we talked about today about multi product usage and seeing a gateway and driving higher general medical visits is the consumer proof point behind that. There's really nobody in the market who comes close to comprehensive solution for both acute episodic and chronic care as well as the range for both digital and professional services in terms of our clinicians that we can bring to bear. And line based on the fact that it's characterized by larger deals than we've ever seen before. Multi product deals are sort of the preponderance of the pipeline and we see it in the competitive takeaways that we have booked as we mentioned on the call, large East Coast Blues are very large opportunities in the pipeline. With respect to the moves in the market that last summer when we announced the Livongo acquisition, We talked about the fact that the market had accelerated and that we foresaw the strategic chessboard moving and ours was a move to put the leaders together in the market to create an unmatched solution and bringing together InTouch Livongo and there is no comparable move that we didn't foresee. In some cases, we've seen success and increased interest as some of those smaller competitors have gone to health plans. And for the most part, one health plan doesn't want to buy from another competing health plan. And then in other cases, the moves in the market have been somewhat antagonistic in an effort to disintermediate them. It's always been our view to work with the healthcare system, against it and that's proven to be beneficial with our partners and bring them greater value. So at those levels, I think, in the form of what we expected. And I'm not going to call out individual solutions that you mentioned or competitors that you mentioned. But for the most part, many of them we almost never bump into and some of the new entrants were just not. Just as a Quick follow-up because you did say the word pipeline several times in that conversation and you know I love to ask about that as we think about the 4 year. Is there anything that you can give us around the size of the pipeline versus previous years or Quantify it in any way as we think about going into this next year for 2022? Yes, sure. So I would say a few things. 1, as you recall, 2 months ago when we reported the We talked about the fact that our pipeline of new members was about 50 percent larger than at the same time last year. It has only grown since then and it has also moved along in terms of the deal stage. So you'll also recall that we said that it was characterized by a larger sort of gross opportunity, but they were earlier stage deals and we've seen those deals move along the pipeline as one obviously one of those materialized into a very significant sale for us and we have others in very late stage. We're seeing more large multi product deals than we've ever seen before. And I'm very, very encouraged by faster than I would have expected opportunities arising for of the Livongo suite of products into the hospital and health system channel. That's moving along faster than I would have expected. And then maybe last, we've talked about our primary 360 to the offering. That pipeline has also increased materially since just 2 months ago and we see large deals moving along there. So when we look and you'll recall that It's very unusual for us to raise guidance at this time in the year. We did it last year, but that was in the face of the of massive wave that we've been hitting in the states. But I don't think before that we've ever increased our guidance at this time in the year. And I think the increase in our revenue guidance for this year is both based on the performance we're seeing today as well as the expectations that we have going forward. And your next question comes from Sean Wieland with Piper Sandler. Thank you very much. So I'm most interested in this whole person care at the Blues plan you mentioned. I know you said it includes Your whole book of business, but I'd really like to know beyond that, what role are you taking on to really coordinate the care, especially medical and behavioral. And are the economics on a contract like this any different than standard economics? So the what we said is it's for the entire commercial book of this Blues plan and that we're selling our full suite of telehealth and chronic care solutions. We will also bring to bear, as we mentioned, the integration within a single app of the ability to for the consumer to get access to the full set of services as well as the ability for power clinicians to refer across those solutions. So we have now executed on the first wave of that integration. That will continue to develop over the course of this year and we'll launch service for them early next year. And that resonates and that was part of the thesis behind bringing together all of these assets under one roof and it's a significant competitive advantage when we're going out to in this case displace a competitor. With respect to the economics, There are certainly some economies that we get from selling all of our solutions or a full suite into a single client. It's one data feed for multiple products. And Sean, as we mentioned, we get benefit from higher utilization when people use our specialty products. So we are able to bring it to bear at a more competitive price because of the economies that we get out of it and ultimately we drive higher revenue per user because they're using multiple services. And your next question comes from Sean Dodge with RBC Capital. Thanks. Good afternoon. Jason, on the Primary 360 program, you mentioned the pipeline there increasing. Can you give us a sense of how You think offerings like that with virtual primary care could ramp, maybe what kind of adoption you think you can achieve of it over the next few years? And then You said before the revenue opportunity for member there is much larger. Can you put any bookends around that, any quantification, maybe in some of the pilots, how much of virtual primary care, primary 360 enhanced revenue per member. Yes. So the pipeline is very strong. That we've already closed deals among several Fortune 1000s to launch in the second half of this year and we expect to roll out nationally over in the Q1 next year. We've always said we don't expect it to be a material contributor to our revenue this year and we've taken that into account even as we've increased our guidance for this year. We do expect it to be a meaningful contributor next year and to increase over time. When we talk about for the revenue opportunity per member. It's still a mixed bag when we talk about what's in the pipeline and what clients are looking for. Some of them are happy with a higher PMPM and higher visit fees that reflect the increased value that each one of those visits and the increased intensity at each one of those visits. Others are looking for more sort of value based risk arrangements where we have the opportunity to really benefit from the savings that we generate. We're going to migrate into those over time. That's not going to be the preponderance of arrangements in the short term. But I do think that that's where we're going to go. And I think we have a unique opportunity and capability to do that because of our scale relative to anyone else in the market. The other thing I'd also add, Sean, is it's one of the reasons why as we think about PMPM over the sort of medium to Long term, it is an opportunity for us to expand our PMPM because by its very If you think about TimeBury 360, it is multi product. So we will be looking to capture economics both from the expansion of PMPM because of that and the equilateral populations. Thanks for taking my question. Jason, wanted to follow-up on the strength in the behavioral business. It sounds like from our channel checks that that's one area in particular that not only has benefited unfortunately due to COVID with an increase in need for care, but So more insurers and employers wanting that and then more of a sustained movement towards telehealth versus in person visits It is truly conversational and maybe has a stigma, etcetera. So I'm curious if you can just dive a little bit more into what you're seeing in that market, both in the D2C and then and more emerging B2B market for the organization. Thanks. Yes, Ryan, you're exactly right. Mental health continues to be the fastest growing specialty in our portfolio. And we are seeing the need for that service continuing to increase, the attraction of our product continuing to increase. I mentioned we're bringing together the Longo digital assets with our therapists and psychiatrists capabilities into a single offering and that's clearly resonating in the market. We talked last year, Ryan, about growing our B2B mental health visits by over 500% in 2020 and we're on track to more than double that this year as well, even after that incredibly explosive growth in 2020. So that should give you an idea of how much traction we're getting. The other thing that I think is meaningful is that fees and certainly mental health is sort of leading second product, if you will, to General Medical. On the direct to consumer side, we also continue to see to surging demand for that product. We also see utilization continuing to shift toward more live interactions. What used to be many years ago a service that was focused primarily on text based interactions, has migrated to more live interactions between the therapist and the consumer and our ability to continue to scale that I think is a credit to the team, for purpose to work with us and to the scalability of the platform. It also enables us to continue to bringing significant value to consumers at an attractive price point both for the consumer and one that is economically advantageous for us. And your next question comes from Stephanie Davis It's been about 6 months since the Livongo deal closed. So I was hoping we can get an update on the platform integration Where are you on the back end? And when could we see an integrated front end to really bring the platform together from an easier experience standpoint? Yes. Well, thank you, Stephanie. Appreciate your comments. We're very excited about the progress of integration. We mentioned the rapid progress on the commercial side and I think that the team we mentioned that we have now launched the 1st wave of consumers who can access the Livongo capabilities and products through the Teladoc app. That's really just the first step. I would spec early next year to have a completely redesigned user experience that integrates all of those capabilities and really sort of optimizes the experience for the consumer and optimizes the sort of funnel, if you will, into those different products. The provider integration burial because we believe that providers referring into those programs will be a significant source of consumer engagement, which of course drives directly drives revenue in those products. And then on the back end, you asked about the data platform and the data integration is really critical. We just have an incredible treasure trove of data and the more we can integrate the 12,000,000 plus, twelve 500,000 plus visits that we'll do this year and all of the data from those visits with from the more than 2,000,000 blood glucose readings a week we get, for example, as well as from all the other products. It just makes everything much more powerful, much more personalized for the consumer and much more able to move the needle on consumer behavior change, which results in better outcomes and more ROI for our clients. So, we are deep in that process. I'm really excited that Chris Jensen is joining us. We We spent some time today just talking about the vision for what that can be. And I think we're going to really get the benefit of bringing the teams together and his leadership as well. I'd also add, Anthony, the good thing is we have a very, very clear roadmap and have spent a fair enough time as a leadership team prioritizing that roadmap. So that the investments we put against That as we've talked about, I expect 2021 to be an investment year. It is stacked and aligned against those very clear priorities in the R and D roadmap, whether it be in terms of data integration, as you asked, recognizing a unique number from an And eligibility and an identity perspective, that requires deep intuition and I would say we are well on our way to it. And your next question comes from Daniel Crosswhite with Citi. Hi, thanks for taking question, just a couple of questions around BetterHelp specifically. I think last quarter you mentioned that you had started to sell that into the EAB. So I was curious how that will work alongside your traditional B2B behavioral health platform. And then on the DTC side, we've heard that CAC remained pretty elevated in behavioral specifically, particularly for paid search. Curious how that's impacting your marketing strategy this year And if there's any changes to the previously mentioned 50% revenue growth in BetterHelp? Yes. Actually, we continue to see revenue per dollar spent on customer acquisition increase in our DTC channels that continues to get more efficient as well as I look like I think we are benefiting from the fact virtually has increased substantially. And so awareness also provides a tailwind that I believe helps in addition to all of the test and learn that we've gotten over the course of the last several years. So we're not seeing a challenge relative to customer acquisition cost in that channel. The EAP services actually are always alongside behavioral health services that are built into the benefit package. It's really not an or, it's an and for most large employers. And there are different buyers on the health plan side. So most of the large insurers also offer an EAP and sell them together and some of them we're selling our commercial behavioral health B2B services into the same health plan that's also bundling our better health capabilities into their EAP. Because EAP generally has limited number of visits And so the recipe there is that we are there for the consumer to provide them with those visits. And then if they exhaust that benefit, they have the option of rolling in on a direct to consumer basis. So that becomes an opportunity for us to continue the relationship with the consumers. And coming back to your question on CAC and as Jason mentioned, the Efficiencies that we continue to see in that. We monitor, as we have said, a lot of metrics across our business, including our DTC. And we continue to see gains in terms of better tension and that drives greater lifetime value. So there are Sort of the underlying levers that drive the revenue growth are still strong. And your next question comes from George Steele with Deutsche Bank. Good afternoon, Jason and Malin. Thanks for taking the question. Jason, you kind We talked about a clear product roadmap, but the space continues to evolve pretty rapidly as it relates to partnerships and M and A. I guess so, can you talk about the opportunities that you guys don't touch and maybe how you think about moving up the value chain into higher dollar cost areas as it relates to your clients? Thank you. Yes. Thanks, George. Continued to expand the scope of our clinical portfolio. And you saw earlier this year Make some announcements around chronic kidney disease. I think you'll continue to see us develop along the cardiometabolic. It has higher dollar impact and therefore a higher in care and sales and marketing and marketing and marketing and marketing and marketing and marketing and marketing and marketing. I think you'll see my guess is we'll continue to see more of a trend toward at home diagnostics and that provides us with an opportunity to expand the scope of what we do and the value we can deliver for the consumer. And then the opportunity for us to bring our Lovato solutions in as they into both the hospital and health system channel as well as internationally will continue to provide us with opportunities. So I don't see an end to our continuing expansion and as always buy and partner. And your next question comes from Jalendra Singh with Credit Suisse. Jason, you talked about the faster than expected arbitrage and the health system market. These hospitals' health systems you have been successful in contracting with, whether have those been available to employees of their health system? Your differentiation there, what is resonating with these health system clients? Yes, most of them are cross ongo capabilities into our existing hospital and health system clients on the Teladoc and InTouch side. The big move and the big shift, Joe Andra, is moving from the HR department, which is where Livongo used to sell into the C suite because the C suite of the hospital or health system is focused on in their ACO or within their own sort of owned or captive health plan. So whether that means that they're in a direct contracting relationship or they've stood up a health plan or they have a JV or an ACO relationship with a health plan, More and more of the hospitals are going at risk for populations and their ability to discharge one of their patients with Livongo capabilities is a massive step up in terms of their capabilities and ability to avoid And your next question comes from Richard Close with Canaccord Genuity. Great. Thanks for the question. Great. Thanks for the question. On the Q4 call on membership, and in your answer to Lisa's pipeline question. You ended with the raised guidance. However, the membership guidance didn't change. So On these takeaway deals that you're referencing, does that provide upside to 2021 potentially? Or should we think of it more on start from business? Yes. So thanks, Richard. It's a good question. Change. I would say the membership increases and the sales that we're closing over the course of this year will have a much bigger impact on 2022 than on 2021. And actually, I have great confidence in what 2022 looks flight based on the current status of our pipeline and our line of sight into significant deals. Where we're likely to see upside in 2021 is in increased Livongo chronic care enrollment. We've factored in essentially no flu season in the back half of this year. So if we were to see a more normal flu season in the back half of this year that would be upside to our revenue numbers. And of course on our DTC channel that's performing incredibly well. And if that were to accelerate, it would also provide upside in 2021. Yes. Thanks for taking the question. Jason, one of your competitors today talked about Opening their platform, particularly for 3rd party developers to add additional capabilities. I think they're working with Google Cloud as well. Can you talk about sort of how you think about the broader ecosystem going forward and maybe some of the opportunities that presents for you guys In that kind of area, as you think about you talked about buy build kind of decision making on investments. Can you talk about sort of that with for Teladoc platform. And can you remind us, I don't know if you talked about sort of who you're using as a cloud partner, but maybe you can just remind us that as well? Thanks. Sure. On the cloud side, we're multi platform. So we don't work with only 1 cloud provider, rather we work across cloud providers to sort of take advantage of the best of all of them. And we think it's best to be able to be a little bit more diversified. And then with respect to the platform and my vision of what we want to of own and partner and open. I see it as concentric circles where There are things that we really want to own and deeply integrate because that's going to deliver on the vision of Whole Person Care. It's going to best impact the outcomes from a clinical perspective as well as a financial perspective for the consumer and the client and it is integral to the consumer experience. Then there's a set of things in what I think of as the next circle that are areas where we need deep partnership because it's really important to the consumer experience, but they're not assets that we want to own for all kinds of reasons, either it's not part of our core competencies or it's not a beneficial economic model. Profile, but we do think that there's opportunity for deep partnership in order to optimize the consumer experience. And then there are many things outside of that where we will open the opportunity for other I don't intend to open the platform for integration to all comers. I think it's our responsibility quite frankly to rate to curate that set of in the 3rd ring, but also areas where we can bring value to the consumer as well as value to parties by providing access to that large population that we serve. And I think that unmatched population and meaningfully larger scale than anyone else in the market makes us the ideal partner. The question. Mollie, you said that you expect increased spending over the course of the year. Where specifically is that increase coming from? Is that from out? Is that from BetterHelp? And then also is that an absolute increase or as a on our revenue. Yes, it's a great question. We talked about and the fact that more so we will want to continue to grow our business and continue to grow our business. We're roadmap we have. So I would say, the investments will be against that, whether it be an integrated data platform, whether through the unified product experience that we intend to deliver. Definitely Primary 360, it's It's a big bet for us. It is something that, as Jason talked about, it's a multiyear ramp and it will require investments. So that is definitely something. We will continue to be an investment for us. So that would be those are the kinds of areas that we are looking at from an investment perspective. Going to your revenue versus absolute, we look I marketplace. At the end of the day, what I'm looking at is we have, how do we stack them and most importantly, what are the returns, what we make. Definitely, I do look But I also know what priorities it's easing. And your next question comes from Kevin Calito with UBS. Hey, thanks for the question. This is Adam Noble on for Kevin. I just wanted to circle back a little bit to your comments around the PMPM in the quarter. I think you mentioned that of the for the quarter and $0.48 substantial jump versus 4Q, half of that came from the extra month of Livongo. Dollars beyond that. And I'm curious if you could break that $0.24 down between the growth in behavioral business, the sequential growth just in the chronic air business itself as well as the upsells and other dynamics. Yes, Adam. We don't provide very specific breakout on the different components of our business and therefore the different components of PMPM. But what I will generally is, I do we have With the numbers that we have given out in our prepared remarks, you can see the sort of the buckets of drivers that drove the expansion in PMPM. And as we have talked about the overarching trends in the business, whether it be multiproduct, whether it be multiservice usage and I would say even with the addition of Livongo now, Those are all key drivers of the continued expansion in PMPM that I do for us. Maybe just a couple of stats. Some of them we talked about in our prepared remarks and some of them may be incremental. But we talked about the fact that Now 15% of our chronic care members are using more than one product, up that's more than tripled since a year ago. And we're now at the point where about a 3rd of our chronic care clients are buying more than one product from us, up from about 18% a year ago, right? So when we talk about multi product sales. It's across really our entire portfolio, both on the chronic care as well as acute. And then maybe lastly, I think per look like and our revenue per chronic care client is up 33% versus a year ago. Right. So when you combine all of those, you can understand that we're not only getting more revenue per client, but we're also getting more revenue per member. And all of that contributes to increasing PMPM. And by the way, it also shows that there is significant runway to continue to Right. So the fact is it's growing and there's enormous runway Same thing if you think about the clients that we are contracting with. So the point is we've made progress and there is significant room to continue that expansion. And that is all the time we have for questions.