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Evolent Health, Inc. (NYSE:EVH) Q1 2024 Earnings Call Transcript

Evolent Health, Inc. (NYSE:EVH) Q1 2024 Earnings Call Transcript May 9, 2024

Evolent Health, Inc. isn't one of the 30 most popular stocks among hedge funds at the end of the third quarter (see the details here).

Operator: Welcome to the Evolent Earnings Conference Call for the First Quarter Ended March 31, 2024. As a reminder, this conference call is being recorded. Your hosts for the call today from Evolent are Seth Blackley, Chief Executive Officer; and John Johnson, Chief Financial Officer. This call will be archived and available later this evening, and for the next week via the webcast on the company's website and the section titled Investor Relations. I will now hand the call to Seth Frank, Evolent's, Vice President of Investor Relations. Please go ahead.

Seth Frank : Thank you, and good evening. This conference call will contain forward looking statements under the U.S. Federal laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the company's reports with filed with the Securities and Exchange Commission, including cautionary statements included in our current and periodic filings. For additional information on the company's results and outlook, please refer to our first quarter press release issued earlier today. Finally, as a reminder, reconciliations of non-GAAP measures discussed during today's call to the most direct comparable GAAP measures are available in the summary presentation, available in the Investor Relations section of our website or in the company's press release issued today, and posted on the IR section of the company's website ir.evolenthealth.com and the Form 8-K filed by the company with the SEC earlier today.

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Finally, in addition to the reconciliations, we've provided details on the numbers and operating metrics for the quarter in both our press release and our supplemental investor presentation on the IR website. With that, I'll hand the call over to Evolent's CEO, Seth Blackley.

Seth Blackley : Good evening, and thanks for joining the call. Evolent had a strong first quarter with above expectations, revenue growth, and adjusted EBITDA in line with the first quarter guidance. Tonight, we'll cover updates on various fronts, including new customer arrangements, new client go live, and announcement of the completion of our M&A integration work stream and our technology innovation agenda. Let me first provide a few highlights from our first quarter results. Revenue totaled $639.7 million growth of 49.6% year-over-year. This result exceeded the top end of our Q1 revenue guide of $610 million by almost $30 million. This high revenue growth is driven by strong membership in our performance suite arrangements and new specialty technology and services agreements.

Evolent's specialty of care offerings now account for 91% of total revenue up from 60% just three years ago. Enabling our organization to focus on our specialty strategy year-over-year, specialty care revenue grew approximately 69% as reported and 62% after normalizing for the NIA acquisition in January, 2023. On the membership front, we average 39.9 million unique members, net of Medicaid redeterminations, and new implementations during the quarter. Total product members eclipsed 80.6 million in the first quarter are just over two products per unique member on average. On the profitability front, adjusted EBITDA was in line with the midpoint of our guidance at $54.1 million. Our cash position remains strong with $165.1 million in cash and equivalents after what is always a historically high cash outflow quarter associated with higher working capital requirements that moderate as the year progresses.

Let me now update you on each of our three principles for shareholder value creation of one, strong organic growth, two, expanding profitability, and three discipline capital allocation. On the first principle of organic growth. We are announcing today that we signed three new revenue agreements during the first quarter. Two of our new revenue agreements are with Molina, building on that highly successful long-term partnership. We will be implementing both cardiology and oncology performance suite across both Medicaid and Exchange lives in South Carolina and Mississippi. We anticipate implementing these solutions by the fourth quarter of this year. Financially, we anticipate the impact of South Carolina and Mississippi to contribute together at least $50 million of new annual revenue contribution once live.

The addition of these states increases our presence with Molina to nine states after these two states go live. Our revenue will be below 50% of the total opportunity at Molina within the current scope of services we provide today. Excluding new solutions like MSK Performance Suite, leaving what we believe to be a significant opportunity to continue expanding our partnership and impact for our partner. Our third new revenue agreement is a specialty technology and services contract. We signed with a longstanding Evolent Medicaid health plan on the East coast. This health plan will be adding our MSK specialty offering to help manage orthopedic surgery costs, utilization and outcomes. We anticipate implementing this solution in the third quarter across several hundred thousand Medicaid members.

This contract will contribute towards the $4 million of quarterly adjusted EBITDA earnings go get we provided in our bridge illustration for achieving the 2024 year-end exit adjusted EBITDA target. Today's announcements bring us to seven new revenue agreements year-to-date. In addition to new revenue agreements, Q1 was productive for successful go lives. In total, we launched 25 Specialty Go Live across multiple health plan customers for the performance suite and the technology and services suite. These included major go lives and new geographies for performance suite, including oncology and cardiology for Molina in Florida, and cardiology for Florida Blue. During the quarter, we also began a national implementation with Centene for our MSK Technology and Services Suite, covering several million numbers.

Recall, we announced this agreement back in February fulfilling a significant portion of the promised initial revenue synergies from the NIA acquisition. From a macro perspective, industry demand remains very strong. Beyond our normal product value proposition, healthcare utilization pressure and health plan margin pressure are accelerating our core inbound sales opportunities. Our belief is that typical savings levers outside of specialty care are more limited in the current environment, making high-cost specialty management a critical and growing focus for health plans. As a result of these factors, our sales pipeline remains very strong, driven by interest in both regional and large national health plans. As a result of all of these dynamics, we are raising the midpoint of our revenue guidance for 2024 by $115 million, as John would detail shortly.

Moving to our second operating priority to expanding profitability, I'm excited to announce that in March we successfully wound down the NIA transition services agreement we had in place since January of 2023. With NIA's former owner, the transition was the largest and most complex IT project and the company's history involving hundreds of professionals globally. Most importantly, we were able to continue serving all of our customers with limited disruption. I want to thank the Evolent teams who work tirelessly through weekends to achieve this important transition. This transition in the quarter marks another important step towards our year end run rate EBITDA target, and the achievement of our $15 million of NIA cost synergies. Next, I'm pleased to share that we continue investing in the artificial intelligence opportunity at Evolent through our initial product testing.

Based on our work thus far, we believe that there's a significant opportunity to reduce the cost for specialty case review, while maintaining or even enhancing service quality and providing a superior user experience. As additional benefit of our AI investments, we expect we'd be able to redeploy our human capital pool to higher value work streams that improve our product and our value proposition. We expect these benefits to begin making a more significant impact in 2025. Third, our results in Q1 demonstrate the benefit of our balanced approach to value-based specialty care with earnings growth from both our non-risk and risk products, and our non-risk products continue to account for approximately 70% of our annual adjusted EBITDA. As John will share in detail, we saw increased utilization in our performance suite risk business in Q1, and we have lower data visibility than is typical for this point in the year.

Those factors do impact our Q2 guide, but because our data visibility will increase across the year, because the increases in utilization have moderated across early Q2 and because of the contractual protections available to us around prevalence and other population changes that John will detail, we remain confident in our 2024 exit run rate adjusted EBITDA commitment of $300 million and our annual guidance. Finally, I'm proud of the team for continuing to drive efficiency, as we grow with our SG&A expense down sequentially versus Q4 despite substantial revenue growth. And I feel we've been able to drive these efficiencies while maintaining a strong culture and talent orientation. Regarding our third investment theme of disciplined capital allocation, our principles remain consistent with our communications over the last few years, which are ensuring strong organic innovation, carefully managing to our leverage targets and pursuing accretive M&A to accelerate our leadership position in value-based specialty care.

With respect to organic innovation, we have consistently talked about building more services to help members and their families navigate their conditions in their moments of need. Our strong belief is that, shared decision making with an engaged member helps drive the highest quality, most efficient care. We've addressed this opportunity thus far through our end-of-life solution, which we primarily bundle into our performance suite. Our data shows that, when our end-of-life solution is integrated with our oncology and cardiology solutions, we have materially higher member engagement rates generating greater referrals into palliative care, reducing the overall total cost of care versus the status quo, while most importantly, aligning clinical care with patient identified goals and values in order to improve their quality of life.

Last August, we also announced a pilot program with a large Blue Cross, Blue Shield plan partner to offer shared decision making and better navigation of the healthcare system for patients diagnosed with cancer. Today we are accelerating this initial navigation work by announcing a strategic partnership with Careology, a privately held UK-based company with what we believe to be the most robust digital cancer care platform available. The Careology platform is being used extensively across the UK National Health Service to connect patients to caregivers, to monitor and report symptoms associated with chemotherapy, and to monitor vital signs and overall well-being. In addition, the platform manages schedules, appointments, and the overall care process.

A doctor looking at their computer, discussing their patient's care options with a group of experts.
A doctor looking at their computer, discussing their patient's care options with a group of experts.

We believe this solution will help to manage the cost and quality of our performance suits numbers as a bundle offering and potentially become an Evolent technology and services offering in the future. From a business perspective, Evolent has secured the exclusive long-term right to distribute and integrate the product in the United States for the payer market. We believe this patient navigation arrangement is another good example of both innovating our solution and doing so in a capital efficient way. Before I hand it to John to talk through our financials and guidance, I want to take a step back and comment on where I believe Evolent is headed in the future. First, we are proud to have built an incredible and what we believe is a differentiated specialty platform, currently growing organically at over 50% annually, driving strong profitability and cash flow.

The strong growth and profitability, we believe, are indicators of customer confidence and our ability to innovate and execute over the long-term. Second, a rising utilization environment creates significant financial and operational pressures on health plans, requiring more innovative solutions, given the need to aggressively manage utilization pressures in specialty care. This will create, I believe, an important opportunity for our company for years to come. And third, our innovation across areas like patient navigation, artificial intelligence and specialty expansion all provide meaningful opportunities to accelerate our platform. We understand the investing environment for small and mid-cap publicly traded healthcare organizations has been challenged as of late, and Evolent’s no exception.

However, we remain very optimistic about our future and fully committed to using all the tools available to ensure shareholder value creation. With that, let me hand it to John.

John Johnson : Thanks Seth. We are pleased with our first quarter results and anticipate the continued solid outlook for 2024. We are raising the midpoint of our revenue guidance by $115 million and reiterating both our in year adjusted EBITDA outlook of $235 million to $265 million and our 2024 year-end exit run rate of $300 million in adjusted EBITDA. Revenue growth was nearly 50% year-over-year versus the same quarter last year, outperforming internal and external expectations from two factors. First, about $25 million from membership growth across our performance suite, and we expect this level to be the new quarterly baseline for the rest of the year. Second, based on CMS data we received in the quarter and our consistent revenue recognition policies, we recognized an additional $18 million in shared savings for MSSP performance year 2023, along with an offsetting expense accrual of $14 million in gain share for our physician partners for $4 million of adjusted EBITDA.

Both items were ahead of our expectations for this time in the year. Note that consistent with our past practice, our cumulative accrual for [QY] 2023 shared savings remains at the conservative end based on data received to date and we anticipate an incremental step up once final settlement data is received in Q3, demand for our technology and services product also continues to be strong. We generated Q1 revenue of $89 million despite losing an estimated 6 million in quarterly tech and services revenue to Medicaid redeterminations in conversions to our performance suite, representing underlying year-over-year growth of nearly 25%. Regarding Medicaid redeterminations, we estimate that the process for our Medicaid population was over 80% complete as of 331, and we estimate a same store weighted membership decline of 10% as of the same date.

Recall that our biggest Medicaid states started the process later. So our commentary here differs slightly from national MCOs. Our outlook continues to anticipate a gross decline in the mid-teens and the processes complete in the summer consistent with our expectations and our initial forecast in 2023. Turning to profitability, we continue to drive efficiencies in our cost structure as we grow with adjusted SG&A costs of 8% of revenue down by 166 basis points sequentially versus Q4, adjusted gross margin in the quarter was 16.4%, down 185 basis points sequentially versus Q4. The change in growth margin is principally driven by growth in our performance suite products combined with higher unit medical expenses. The drivers of medical expenses in the quarter are as follows.

First, net favorable prior year claims development in the quarter was approximately $15 million, consistent with our expectations and demonstrating our continued prudent actuarial processes and conservative approach to reserving in our risk business. This $15 million was associated with revenue refunds to our clients from corridors of approximately $10 million for an approximate net $5 million benefit to gross profits. Again, consistent with our expectations. This favorability was offset by higher estimated medical expenses for Q1, driven both by lower data visibility and our continuous review of leading indicators. On the first, because of dynamics impacting our partners, including the change health care outage, we closed the quarter with lower claims visibility than is typical even for long-standing clients.

This is exacerbated by the volume of recently launched Performance Suite revenue approximately 2.5x more than the same quarter last year, which typically has lower visibility overall. The mechanics of this lower visibility in our reserving approach combined with macro commentary across the industry regarding elevated utilization creates incremental conservatism for the first quarter and our guide for Q2. Second, we incorporate leading indicators like volume and disease prevalence from authorization request into our reserving models, and our reliance on these leading indicators is higher if our claims visibility is lower, like it was for this quarter. During the latter part of first quarter, we saw increasing activity on these indicators rising to a peak in March.

This observed activity from our authorization data was in both oncology and cardiology specialties for particular markets in both MA and Medicaid. Note that these indicators declined in April from their March peak. Now as a reminder, we've previously highlighted two distinctive features of our model. The first is that, we have intentionally built a diversified business that balances both risk and non-risk products and we continue to generate close to 70% of our expected adjusted EBITDA across the year from our Technology and Services business. And so, any potential impact of higher utilization in our Performance Suite is buffered by the other two-thirds of our EBITDA guide. The second is that our performance suite products typically contain certain contractual protections that may adjust our capitation rates, based on population changes outside of our control.

As Q1 claims complete and our visibility improves, if these elevated leading indicators translate into elevated paid claims, we estimate that, over 70% of the reported cost increases in Q1 can be addressed by contractual adjustments resulting in rate changes over the next 3 to 12 months. It is important to note that, this is a normal course part of our business. Over the last few years, we have regularly used these mechanisms to work with our partners to update rates for changes at the market and line of business levels. You will also recall that, we included in our original adjusted EBITDA guidance for 2024 a $10 million buffer for changes in medical utilization based on dynamics in the market. If the leading indicators from Q1 persists beyond March and translate into claims, we will be quickly implementing the contractual changes available to us.

However, there may be a timing lag between that elevated cost and increased fees to Evolent, which could cause our results for Q2 to be adversely impacted. As a result, we are taking a conservative approach to our adjusted EBITDA guidance for Q2 with a range of $48 million to $62 million. Let me be specific about what could take us to the high or the low end of this range for the Q2. In scenarios where the leading indicator data in late Q1 is transitory and or we obtain increases in our capitation rates for the quarter, we could see the top end of our range for the quarter or beyond. In scenarios where that leading indicator data translates into persistently elevated claims expense and the process for obtaining corresponding rate increases extends beyond the quarter, we could see the lower end of the range.

Because trends mitigated in April, and because we have several levers to drive profitability across the year, including but not limited to these contractual protections I mentioned, we remain confident in our full year adjusted EBITDA guidance and our 300 million exit run rate target. Let's go through the path to that exit run rate target. Further updating the bridge, we provided on the February call. On Medicaid redeterminations, currently, we are running in line relative to our forecast for a $3.5 million quarterly headwind versus Q4 ‘23 with one quarter to go. We estimate a Q1 in quarter impact of about 2.5 million. On NIA synergies, as Seth discussed, we are on track to realize the total $8.75 million quarterly benefits by the end of this year across both cost and revenue items with about half of this value included in Q1 results.

On the performance suite, we are still early in our journey to capture the first leg of maturation that drives the $12.5 million quarterly expectation here, but we are pleased with the leading indicators of value creation in populations launched in ‘23 and ‘24. Authorization data suggests that new plan members under our management are on average experiencing higher quality, more cost-effective treatment regimens in oncology and cardiology, and we look forward to seeing these shifts reflected in the claims data. Finally, on the organic growth side, we estimate that the combination of strong membership performance and recently announced tech services deals closes approximately 25% of our quarterly adjusted EBITDA, leaving just under $3 million as a go get.

Shifting to cash generation. First, we remain on track to meet or exceed our target of $150 million in cash flow from operations for Calendar ‘24. Recall, that the first quarter of the year is seasonally our biggest use of cash, given the timing of working capital changes. Second, after the quarter closed, we closed out the NIA earnout for $88.75 million slightly ahead of our initial expectations based on what has been a very successful acquisition that was additive to our corporate performance during 2023, we elected to fund 100% of this earnout in cash, avoiding dilution to our common shareholders. Turning to guidance, for the full year, we are raising our revenue outlook to between $2.53 and $2.6 billion, and reiterating our adjusted EBITDA outlook of between $235 million and $265 million, as mentioned above.

We continue to expect capitalized software development of approximately $30 million and total cash flow from operations in excess of $150 million, including the technology initiative Seth discussed. For the second quarter, we are anticipating revenues between $625 million, $645 million, and adjusted EBITDA between $48 million and $62 million. In closing, we remain confident in the value of our unique and diversified platform, and we are excited to continue driving the value for shareholders, employees, and the partners and patients we serve. With that, we will now open it up for Q&A.

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