Morning. Welcome to Tenet Healthcare's Operational Update conference call. After the speaker remarks, there will be a question and answer session for industry analysts. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. Tenet respectfully asks that analysts limit themselves to one question each. I will now turn the call over to your host, Mr. Daniel Cancelmi, Executive Vice President and Chief Financial Officer for Tenet. Mr. Cancelmi, you may begin.
Thank you, operator. We're pleased to have everyone join us on short notice to discuss the press release we issued this morning related to Conifer. Tenet senior management joining me today include Ron Rittenmeyer, our Executive Chairman, and Dr. Saum Sutaria, our Chief Executive Officer. Listeners to this call are advised that certain statements made during our discussion today are forward-looking and represent Tenet management's expectations based on currently available information. Actual results and plans could differ materially. Tenet is under no obligation to update any forward-looking statements based on subsequent information. Investors should take note of the cautionary statement in today's press release, as well as the risk factors discussed in our most recent Form 10-K and other filings with the Securities and Exchange Commission. With that, I'll turn the call over to Ron.
Thank you, Dan, and good morning. We are pleased to host this opportunity to describe a bit more fully how we arrived at the decision and our views moving forward regarding Conifer. I'm joined by our CEO, Saum Sutaria, and our Executive VP and CFO, Daniel Cancelmi, for a Q&A after a few remarks just for context purposes. Let me start. As those of you who were present at the JPM conference in January 2018 will recall, the tone we set was to step back and view with both a critical eye and a more transparent approach Tenet's decision to improve quality, address clear gaps in performance, and take actions directly to enhance shareholder value across three key units of our enterprise.
For Conifer, this meant improving client performance and capturing margin expansion opportunities while producing an intellectually honest assessment of its market value and fit within the Tenet enterprise. Unfortunately, after many months in meetings with interested parties, it was clear their interest was really focused in a fire sale purchase, offering targets related to Tenet's cash collection expectations that were simply not acceptable, and ignoring what we determined to be realistic upside. Clearly, the perception of value that had been commented on was not realistic, nor was there a full understanding of the tax implications related to net proceeds as a deleveraging event in a sale. Realizing that sale path was a non-starter, we then refocused on potential JVs, possible mergers, and other thoughts. None of these proved out to be the best avenue to achieve value, nor significant as a deleveraging event for Tenet.
The most promising view was potentially executing a tax-free spin, which we announced as our go-forward decision. We spent considerable time and effort establishing the trajectory, including following the appropriate regulatory requirements. Additionally, we made numerous changes to the leadership as we framed the company to move in this direction. Importantly, we continued to state while we were on the path to spin, we also were on a path to maximize Conifer's performance, which was happening real time as we drove deeply into the operational and overhead areas. There is no question COVID slowed down many of these pathways. Realizing this, we pushed out the execution by a year. Factually, the environment driven by COVID was not cooperative. Conifer's ability to grow in the marketplace was hindered by COVID, and frankly, the market appeared to be less engaged in recognizing value driven by revenue cycle businesses.
As this progressed, we spent significant time evaluating current performance, adding additional opportunities to expand and reset the overall basis of expectations for the future. During COVID, we launched our global business center in Manila, which has now grown to about 2,200 associates despite the COVID quarantines. This was a defining move for Tenet and Conifer, allowing us to have an effective 24/7 environment with a highly educated and committed team, while also gaining a more effective economic base point for this type of work. It substantiated our ability to drive material change despite other significant distractions. Throughout the process, we remained steadfast on our view that if a spin was the best path, we would execute.
We were also very clear that the decision points, including the determination of Conifer's value to the larger enterprise and the best interest of our shareholders, whether markets would be engaged at a level to propel Conifer forward as a standalone enterprise, whether the deleveraging event would be material and impactful, and importantly, would Tenet and other Conifer clients have a better platform than what we have been able to achieve currently, and especially during the last four years. All of that would add up to be very important in the final decision. Over the last few months, including at our recent board meeting, management, our advisors and the board reviewed the current state as well as what we foresee as next steps.
After a very long and detailed review and discussion, we made the determination that the spin of Conifer was really not in the best interest at this point of our shareholders or the overall enterprise. As stated in the release, our conclusions were driven by the current performance of the Tenet enterprise and Conifer's role in that performance currently and into the future. Our view is significantly improved financial profiles of Tenet and Conifer, including Adjusted EBITDA margin improvements of more than 1,000 basis points at Conifer since 2017, supports the value we can drive by keeping it part of the Tenet enterprise. Expectations that Conifer will deliver full year 2022 revenue growth in the mid to high single digits with a strong margin and cash flow profile consistent with past years.
Ongoing benefits anticipated for revamping commercialization efforts, new sales talents and technology, and a focus on point solutions, all of which have started and have a very reasonable runway going forward. While this has been a long process, it has not been time wasted. It allowed us to understand, evaluate, and take action that improved performance rather than just hold an asset without achieving upsides. It provided the opportunity for a deep and thoughtful data-based evaluation, resulting in significant performance and right decisions going forward. As Saum stated, this is a compelling business with more opportunities that we are positioned to achieve. With that context, why don't I just open it now for questions? You got Dan and, Saum and myself on the phone. Operator, we're ready to start.
Thank you. At this time, we'll be conducting a question-and-answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. Our first question today is from A.J. Rice of Credit Suisse. Please proceed with your question.
Hey, AJ.
Hi, everyone. Just maybe ask, are there any things that Conifer was not doing because it was heading for the spin or was doing, I guess I should say as well, that now with the decision made definitively to keep it in-house, is that a strategy in any way, direction, or even the spending levels in any way?
Saum?
Hey, AJ. It's Saum. Listen, I think one thing that's important is that, you know, our Conifer team never lost focus on their primary objective, which is better client service, innovating inside of Conifer, you know, driving better results. You know, we really did not distract at all the operating team. We do see a lot of opportunities, both on the top line and also things that we're trying to do to improve efficiency and effectiveness looking forward. That agenda was always there, and it doesn't stop now. You know, obviously there are, you know, some things that were going on in terms of preparing the organization, various filings and other things that, you know, that now stop, right?
I really wanna emphasize that our operating team has remained focused on what Conifer should be doing, which is serving its clients. Dan, I don't know if you wanna add to that.
Okay.
No. That's exactly right. I totally agree with that. AJ, it's you know we're full speed ahead. We've been full speed ahead. As Ron mentioned, you know, significant margin improvement during this entire process at Conifer. You know, now we're back to revenue growth expectations and you know. Again, we feel very comfortable where we're at. In fact, we just wanna point out that we reconfirmed our guidance for 2022 in our press release this morning as well.
Sure. I would just to clarify on the cost associated with preparing for a spin-off and anything you were doing to set it up as a separate company. In the grand scheme of things, the fact that you did reaffirm your guidance suggests that it wasn't material to the overall Tenet entity that any expense that goes away, is that the right way to think about it?
That's correct, A.J. Absolutely.
All right. Thanks a lot.
Thanks, AJ.
The next question is from Jamie Perse of Goldman Sachs. Please proceed with your question.
Hey, good morning, guys. Just wanna get to the mid-to-high single-digit revenue growth. You know, curious how you get there between Tenet and external clients. Just, you know, whether that's new contracts you've signed in the last few months or quarters and if 2022 is the level of growth you're guiding to this year is sustainable going forward.
Yeah. Hey, it's a mix, you know, it's a mix of both. But really our focus is external to Tenet, from a growth standpoint, and it's really focused on deploying our point solution portfolio more actively in the market as the COVID surges begin to wane and our sales teams that we've built up are able to get out into the marketplace and have additional conversations. We also have clients, existing clients that are, you know, inquisitive and growing and developing themselves. They've performed well through the pandemic and are in positions of strength to grow and develop. You know, we're at their side from that perspective.
We're not giving, you know, guidance beyond this year, but it's obviously our intention to continue a growth trajectory at Conifer over a longer period of time.
Okay. The press release talks about new sales talent and technology. I'm curious if you've added any new capabilities to Conifer over the last, you know, few years or if we should be expecting any more that help you on that point solution focus.
Well, we're continually adding capabilities. I mean, beyond the offshore capability, there's a number of things that we've done to automate some of the work we're doing or predictive analytics that we talk about as part of the overall Tenet enterprise. That, you know, that's always, in our minds, included Conifer and the work we're doing there to, in particular in this environment, really be ahead of and on top of understanding the requirements from both our commercial and government payers is an important addition. There's, you know, a variety of things on the front end of the revenue cycle that we have been building into point solutions that are important. All of those are highly relevant.
All right. Thank you.
As a reminder.
Next question.
If you would like to ask a question, please press star one on your telephone keypad. Our next question is from Jason Cassorla of Citi. Please proceed with your question.
Great. Good morning, guys. Thanks for taking my question. I wanna follow up a little bit on A.J.'s question here. I just wanna understand, now that you're keeping Conifer, do you expect any potential pickup in demand from external clients that perhaps may have decided to defer contracting just during the process to see if there's any kind of bolus there that could help add revenue over time?
Saum?
Well, yeah. I mean, I'm not sure how to answer that question exactly. I mean, our focus on growth has always included a value proposition that was grounded in obviously the innovation that the Tenet petri dish, so to speak, provides Conifer as a way to trial solutions, build them, improve them, and then take them to market. That doesn't change. We do think that there are many providers out there who value that greatly in terms of how they think about the solutions that Conifer can offer. I mean, I think just, again, Ron was as straightforward as can be about this. You know, the focus on building these types of solutions 4 or 5 years ago was not there. Taking them to market while it could have happened earlier was blunted by COVID.
We've spent a lot of time improving the performance, the results, and the margins in anticipation of a more open environment to be able to bring these things to market. That's really where we're headed. I don't know that, you know, there's a more complicated story behind it. We do believe that, you know, the connection to the provider system is helpful, and by some clients is very valued.
Got it. Okay. No, thanks for the color. Just a quick follow-up here. You discussed your point solutions, but maybe can you just highlight Conifer's value-based care business, including the pipeline of opportunities there as you sign up entities for population health and risk management services, and maybe just how you see that business line contributing to revenue growth expectations for Conifer just moving forward? Thanks.
Sure. The value-based care business is an important and profitable part of the business. We don't break down, you know, in detail the revenues and margins. It's not a huge part of Conifer today. There are two businesses really in there. One, as you point out, is a financial risk management business that is very effective and has some very long-term clients servicing IPAs that take risk, both government and commercial risk. Then the population health management business, which is of increasing importance over time to both employers and employer representatives of employer organizations and/or retirees that many organizations may have that are looking for approaches to improve access to information and healthcare navigation for their members. Medicare Advantage in particular is an area where that set of products is very helpful.
That's really what the two businesses are. Obviously, in today's environment, both have an attractive future.
Okay, great. Thanks for all the color.
The next question is from Justin Lake of Wolfe Research. Please proceed with your question.
Hey, guys. This is Austin on for Justin here. Appreciate all the color and kind of the update. I did have a quick kind of question stepping back to the enterprise level. I recall you guys talking when the SCD transaction was announced, kind of the EBITDA mix coming from ambulatory and sort of how Conifer, you know, impacted that mix even just from a mathematical standpoint. You know, given the update here now, just kinda curious on the thinking of an EBITDA mix shift and how much will come from ambulatory. You know, where might that settle out? You know, do you perhaps start to look at the acute portfolio for increased opportunities and kind of driving that ambulatory contribution?
Yeah, this is Dan. I'll start on that one. When we've talked about having 50% of our EBITDA being derived from our USPI business, mathematically we always put that together and disclose it, but that did include Conifer. In fact, if you go to our most recent slide presentation, you'll see Conifer's in that equation. So this announcement really has no impact whatsoever on our goal of exiting 2023 with roughly 50% of EBITDA being generated by the USPI business. Listen, you know, one of the things we've been talking about, you know, the hospitals, our hospitals have performed so well over the past year that it's a good problem.
It's making it harder for us to achieve 50% coming from the USPI business. You know, like we've said, well, that's a nice problem to have when our hospitals are outperforming.
Awesome. Thanks, guys. Appreciate the color and, you know, congrats on the success here.
Thanks.
Thank you.
The next question is from Whit Mayo of SVB Leerink. Please proceed with your question.
Hey, thanks. As I reflect back on the history of Conifer a bit, it was established as an entity with its own infrastructure to potentially be a separate entity at one point. Are there opportunities or a thought here that you can collapse this or portions of this back into Tenet in the context of either, you know, shared support services or anything? I'm just wondering if anything changes the plan as you think out over the next few years.
Yeah. Hey, Whit, it's Saum. You know, let me make a couple of comments here, and I'm gonna just reiterate. What's most important in the way we structure Conifer is that it's set up appropriately to deliver the best results to our clients, obviously inclusive of Tenet. You know, there are some shared services already. I mean, you know, even our global business center in Manila has both our Tenet and Conifer colleagues co-located in the work that they do. There are opportunities there that, you know, we'll naturally look at and have naturally been looking at. What I would just say is what's most important to us is that we set up Conifer at this point, going forward, to most effectively service and grow the client base.
The decisions about how we handle many of those areas, whether they're support functions or direct operating functions, will be grounded in that goal.
Okay. No, that's helpful. Thanks.
There are no additional questions at this time. I would like to turn the call back to management for closing remarks.
All right. This is Ronald Rittenmeyer. Again, I appreciate everybody joining and taking the time, and I have nothing else to add. Dan or Saum, anything else to add?
No. Thank you, everyone.
Nothing. Thank you, everyone.
All right. Thank you, everyone. Have a great day. Bye-bye.
This concludes.
Bye-bye.
This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation.