Acadia Healthcare Company, Inc. (ACHC) Earnings Call Transcript & Summary

All right. Good morning. Good morning to those of us join in person. We appreciate you being here, and good morning to those of you joining through the webcast. I'm David Duckworth, CFO of Acadia. On behalf of the Acadia team that's here and that's back at our facilities, we want to welcome you to our Investor Day being held today in New York. We're excited about the day. We're excited about the agenda for you to hear more about the company's mission, what we do and our outlook for the company's growth. Let me quickly review the agenda for the day. We want to start with an introduction to Acadia from our CEO. We want to then provide more information about our clinical services from our Chief Medical Officer, followed by a discussion of each of our service lines. from some of our strong operational leaders. We want to then pause and have a Q&A panel that would be the clinical and service line leaders. So save your questions for that time. That will be limited to 15, 20 minutes, but you'll have a chance throughout the day, including lunch today to engage with some of those leaders. And then we want to come back and discuss our growth in more detail as well as our financial outlook. And then we will have another Q&A panel to wrap up the day. Let me just quickly highlight that we will be making forward-looking statements today as well as include some non-GAAP financial measures in today's materials. You can find reconciliations within the document, and I would refer you to our disclosures with the SEC to discuss those risks and uncertainties relating to our forward-looking statements. Now before we introduce Chris to the stage, we would like to start the day with a video to just let you know more about Acadia. [Presentation]

Thank you, guys, so much for being here. We've put a lot of time and effort into getting to this point. It is amazing that Acadia has been a public company for 11 years, and this is our first ever Investor Day. So we are so excited about sharing what we're doing at the company and our very optimistic outlook for the future. I've been CEO for almost 8 months, it will be 8 months next week, and have just been so impressed by the progress that we've been able to make, the commitment of our 22,000 employees and so many of our executive leaders that are here today. But I think one thing that binds all of us together is our commitment to the mission, inspiring -- improving the lives we touch. And so frequently, I hear stories from our leaders. You'll hear many of them today as well as employees as to what draws them to the company. For me personally, just a quick story. When I was 15 years old, one of the people that I most respect in the world was unexpectedly diagnosed with bipolar disorder. And so as a young 15-year-old, I saw an acute inpatient facility for the first time. It was a really scary time, a lot of uncertainty, a lot of fear, and yet I also saw the benefit of what really strong clinical care can do and what the outcome of that can look like in a very positive way. So we have so many of those stories that we see across the company, and we're going to be really excited about sharing some more of those a little bit later in the day as we go. So I'm going to get started here and move to our next slide. We are really pleased to have this position as the single largest stand-alone behavioral health company in the country. 246 facilities across the nation. 75,000 patients that we have the true privilege of serving daily. And we really feel like we have a strong foundation to build on during a time of record demand for behavioral health services, particularly coming out of this COVID pandemic. We really feel like this is an inflection point for the industry. And we feel like we can be the company that meets the industry where it needs to be and really takes a leadership role in moving the entire industry forward. As someone that has been in health care for a long time and who most recently came from the payer side, I'm frequently asked, what is your perspective on behavioral health and the opportunity to Acadia? And this is a slide that I put together to really address that. You can see on the left-hand side, none of this is new. The significant unmet need that is universally recognized really across the world coming out of the pandemic. 30 million Americans with mental illness receive no mental health treatment at all. There's been a 3x increase in depression symptoms for adults in the United States during the pandemic. And a 30% increase in death by suicide just between 2009 and 2021, so frequently exacerbated by some of the issues and COVID-19. I would contrast the left side of this slide with what you see on the right. This is an industry that is still very immature, highly fragmented when you look at the acute facilities, the substance use disorder facilities that are out there, even the CTCs. There's so much fragmentation still in this industry today. Integration relative to so many other parts of health care, you don't see the level of integration between behavioral health and physical health that you see elsewhere. And we think that's an opportunity. And why does that matter? Someone that is diagnosed with a behavioral health condition is going to consume 4x the amount of resources that someone does not have a behavioral health condition. So that integration between physical health and behavioral health will need to continue. And then finally, technology. Very few parts of technology and very few parts of the health care industry have the level of paper that we still see in the behavioral health industry. So I think it's well documented, known that the 2009 HITECH Act $25 billion did not include the behavioral health industry. So you don't see the prevalence of EMRs. You don't see analytics -- data and analytics leverage to the extent that you see in other parts of health care and the economy. And all of that together, this large unmet need that's highly recognized and the low industry maturity together provide a real opportunity for Acadia moving forward. So our strategy as a company is this simple, it's to become the indispensable behavioral health provider for high-acuity and complex needs patient populations. And we have 3 primary strategic priorities. The first is to fuel facility growth through our JV partnerships, de novo builds and also launching programmatic M&A. And you're going to hear from several of our leaders today: Isa Diaz, who leads all of our joint ventures; Dr. Jeffrey Woods, who leads our de novo builds; and Andrew Lynch, who is our new Chief Strategy Officer, who will be going through this first prong in more detail. Secondly, accelerating the expansion across the care continuum, particularly for patients with opioid use and other substance use disorders. So Dr. Nasser Khan leads our CTC business unit. He'll be talking to you more about OUD and the opportunity we have with our comprehensive treatment center facilities. Steve Quigley, who is our newly appointed President of our specialty division; and Angie Castro, who is our Chief of Staff for the organization, they will all be spending more time on the second prong of our strategy. And then third, strengthening capabilities and emphasis on selectively leveraging technology to increase access, improve care delivery and, ultimately, increase clinical integration. And we'll spend some time throughout the day talking about some of the early work that we're doing to bring technology into our core business with the intent of driving better clinical outcomes and enhancing operational efficiency. So our strategy is built on a very rich legacy and several existing sources of differentiation that have continued to serve the company well this year. So there are 4 of these. The first is our national footprint and scale, and we'll come back and do a slide on every single one across our lines of business, whether it's Acute, RTC, Specialty, PHP/IOP, or CTC service lines. Our second source of differentiation is our patient-centric approach with services that run across the continuum of care, which is so important to referral sources. Third, our strong operational discipline, which is something the company has been known for, for a long time to generate not only operational improvements but also strong financial returns. And finally, a strong financial position and attractive balance sheet to accelerate our strategy, particularly on the M&A front going forward. So just one quick industry slide. This is, as you all know, a very large market. We estimate it's $185 billion behavioral health market, and we're breaking this out between mental health and substance use. You can see the navy box represents complex mental health treatment, the higher acuity cases, which is really where we strategically have decided to position the company. Between that navy box, which is $65 billion, and the substance use, which is the light blue box on the right, that's $110 billion of the $185 billion, which is 60% of the market. So that is where we're focused. You can see the estimated growth rates from 2018 to 2021, 7%, 8% for mental health and substance use estimated to continue to climb, which given the trends that you can see, the growth drivers on the right that everyone is familiar with from the destigmatization of mental illness to the unmet need for complex care, bipartisan support that we continue to see for behavioral health as a priority, the 988 hotline that's rolling out and really the continued focus that we see, particularly from payers and the interest in integrating physical and mental health. So back to our strategy. We really feel like we are uniquely positioned to execute against a broad range of opportunities across our service lines. And we talked to investors about these categories in the past. For us, it starts with facility expansions, our 246 facilities, we have an opportunity to add beds so frequently to those Acute and Specialty and RTC facilities. We've been able to average about 300 beds a year, and we expect that to continue going forward. Joint ventures. We've worked hard on joint venture partners. You saw the video and Dr. Jaewon Ryu, who is the CEO of Geisinger. We have 18 joint venture partnerships that have been signed; 8 are actually operational, 10 more will be coming online in the coming years. David Duckworth is going to spend some time taking you through the visibility we have with those and Isa will as well in terms of when they're coming up, what the bed additions look like and how that gives us good visibility into our earnings. On the de novo front, we feel like there's significant opportunity, not only on the Acute and Specialty side, but also with CTC. And that's something that you will hear from our leaders talk about today in much more depth. We think that there is significant opportunity as we canvass the landscape of attractive MSAs and underbedded markets to continue to fill in and add and bring differentiated services. And then finally, on the M&A front, we've been active in M&A. Historically, we had high leverage levels during the U.K. era. But as we've delevered, we think this will increasingly be a very important part of our growth going forward. And then you can see at the bottom our continuum of care as well. Dr. Genovese will talk about our PHP and IOP programs, which are step-down programs that we've added since 2019 as well as the virtual care offerings that play an important role and that we really accelerated during the pandemic. So this ability to fuel facility expansions is the first prong of our strategy. The second prong of our strategy is being able to enhance this continuum of care. And you can see on the right side in blue that when we talk to referring clinicians, their #1 priority in sending referral over is the breadth of behavioral health conditions that can be treated. And that's why it's so important, as you see on the left side of this graph, our ability to play on the acute inpatient side to detox, to residential treatment, to partial hospitalization, intensive outpatient, virtual, even mobile vans with CTC. We have a wide variety of -- across the continuum of care that we're looking to always continue to build out. That really differentiates us relative to competitors, particularly given that 85% of referring providers want integrated offerings and they want that diversity of service offerings as well. So this second part of our strategy will be something that you will hear in significant depth today and certainly going forward. And then finally, the third part of our strategy, continuing to enhance our capabilities to drive excellence and financial results. The first 2 should not be a surprise because they're clinically oriented. We want to compete on clinical. We want to have the best and proven clinical health outcomes. And it's the reason that the speaker that is going to follow me is Dr. Genovese because I want him to share with you all some of these innovative treatments that range from transcranial magnetic stimulation, which is an FDA-approved procedure, to esketamine and the use of drugs that sometimes are not working in traditional settings. We'll talk also about the level of clinical integration, physical health and behavioral health as well. John Hollinsworth, our EVP of Operations, will talk to you more about operational efficiencies, which we have done a really good job on, I think, this year and continue to -- we'll continue to focus on going forward. We will wrap up by showing our really strong leadership team. The most recent addition to our leadership team is Brett Bearfield, who has joined us from outside the organization and has a real track record in successfully driving operational efficiency across scale companies as well as doing integrations at scale. So we're thrilled to have his expertise and joining our team. And then the bottom 2, I think, frequently go together, people and technology. We, as leaders in behavioral health, need to attract more clinicians into our industry. It actually serves as a competitive disadvantage when we don't have EHRs and we're using paper charts. Nurses that are coming out of nursing school, they don't want to work in paper. It's slowing the industry down. It's impairing our ability to attract the level of talent that we need in. So we continue to think that our investment in technology will, hopefully, lead the industry, but we want the entire industry to come with us because we think it's critical. And finally, I would just say on the people front, this has been a very tough year, continued difficult labor market. We want to be the employer of choice. We feel like we have a great story to tell. We have to be much more intentional as a company about sharing career progression and career opportunities across Acadia, which we're really committed to focusing on. Frequently, leaders in an individual facility don't know about the opportunities that there are in many other facilities and geographies across the company. And that's something that we're going to be spending time on in the coming months and years. So just to recap, 4 major areas of differentiation: our national footprint, our patient-centric approach, our continued strong operational discipline and our strong financial position. And I'm going to do a slide really quickly on each one of these just to reinforce what we think is our strong differentiation as a company. So first, many of you have seen a version of this slide before. This just speaks to our geographic reach. The 246 facilities we have across the country, you can see the green dots are Acute facilities. We have 51 Acute facilities. The orange dots are the Specialty facilities, and we have 37 Specialty facilities across the U.S. And then our Comprehensive Treatment Centers are in light blue. We have 148 of those, following the small acquisition of 4 that we did in Georgia last month. And finally, our Residential Treatment Centers that you can see in purple that we have 10 of those. Dr. Genovese is going to talk about these in more depth. But I think the other thing I would really like for you all to take away is the density that you're beginning to see in these regions in a way that Acute and Specialty and CTC can frequently work together. That will be an important part of our strategy, the interplay between the lines of business that we're going to be more intentional about going forward. The second point of differentiation is our patient-centric approach. And as I mentioned earlier, we increasingly have made a strategic choice to focus on the higher acuity patients that have the most severe conditions, think schizophrenia, bipolar disorder, various psychoses, comorbid conditions. These 2% of patients at the top of this pyramid consume 16% of total spend. So roughly $6,000 per member per year just in behavioral health. And obviously, we've talked about the downstream physical health implications as well. Now as a company, we want to reach more of the underserved and that's something that we're going to continue to focus on as we look lower down into the pyramid. We already are serving many patients further down. But our core experience and where we really feel like we have the greatest strength as an organization are the more acute patients and needs. The third part of differentiation is operational discipline. This is something I had heard about before I had even joined Acadia, and it's a focus each and every day for the company. So just a few quick statistics. 77% inpatient occupancy rate, which is about 300 basis points above our acute care peers. Recruiting. We have put very robust recruiting practices in place that we will continue to refine. We are constantly looking for ways to differentiate ourselves to attract new talent in across the country. Cost controls. This is something you're going to hear significantly today from John, the discipline that we're putting in place and continue to have in place, which I think is reflected by the financial performance that the company has been able to sustain. Deep behavioral health expertise. And I would reinforce our ability to build these behavioral health facilities as a real differentiator. Jeffrey Woods is going to take you through that process, the way that we are trying to compress the time line by which we bring some of these JVs and de novos up, our use of prefabricated materials. We are always looking for ways to enhance the way that we build facilities. And finally, and I think most importantly, clinical outcomes. We have done a great job as a company being able to get rate increases from our payer partners. But I think the way for us to continue to compete as a company over time is by continuing to demonstrate superior clinical health outcomes that demonstrate that we're providing superior care, and that's something that will continue to be a focus for us in the days ahead. So the final point, last but not least, is our strong financial position that we really believe enables us to accelerate our strategy going forward. So you can see double-digit projected annual organic revenue growth. M&A will be incremental to the figures here. We have increased our outlook to 10% to 12% projected annual EBITDA growth from '24 to '28. David will go into that in a little bit more depth. We feel like we can double the size of the company from a revenue standpoint to $4.5 billion to $5 billion by 2028. And we feel like there's significant opportunity for the company because, post U.K. divestiture, our leverage levels have decreased. We've delevered from over 5x only 2 years ago to 2.1x today. So we have ample dry powder to do M&A and to continue to invest in our capabilities going forward, and we really see that as a tremendous strength and something that we're really pleased with and excited about. Okay. So this is my final slide, last but not least. This is our team. And you frequently hear from David and I, you don't get the benefit of hearing from so many of these other talented leaders. Many of them are back running the business. Today, we couldn't have everyone here, but we've got greats. In the dark circle are those individuals that are going to actually present today. We have over 300 combined years of experience in healthcare across this team, over 60 years of experience at Acadia. You can see on the right-hand side, these are three, you all know Gretchen, our VP of IR, but Nasser, Steve and Jeffrey are in new roles. Nasser coming to us from the outside, Steve and Jeffrey being moved into new roles and promoted into new roles more recently. And you can see there's one hole on this management team that's really important kind of around 10:30, 11:00, our Chief Information Officer. We've done a national search for this position. Given the significance of technology, we wanted a leader that had experience with transformation and building technology at scale. Done a national search, have been extremely pleased with the outreach from the candidate pool, and we expect to have an announcement on that role here likely by the end of the year. So a terrific day ahead. I'm so excited about you all getting an opportunity to hear from our other leaders. And we've just got a great day planned. So we're going to intermix a number of videos throughout that we think really give you an opportunity to see inside some of our facilities and to better tell our story as we go deeper in each of these service lines. And hopefully, that will help bring it to life as well. But so much of this new CIO's focus is going to be on clinical. And so I think it's very appropriate that I would turn things over from here to Dr. Mike Genovese, who will do the clinical overview. So Mike, over to you.

Hi, everyone. Thanks for joining us today. I'm Mike Genovese. I'm the Chief Medical Officer at Acadia Healthcare. And I get to tell you about our patients and the services that we provide them. So Chris showed you this slide, and you're going to get a lot of detail from others about it as we go through the day. But I thought that I would start by telling you about our 4 service lines from a high-level view to contextualize it. So it makes more sense as we go through the day. I'm going to start with the Acute facilities. In our Acute facilities, as the name would suggest, we're treating the sickest patients. These are patients with schizophrenia, characterized by terrifying hallucinations and delusions; detached from reality testing; patients with bipolar disorder with deep mood swings and fluctuating mood swings such that they're unable to make rational decisions; patients with major depressive disorder that come to us sometimes with suicidal ideation or maybe having recently just survived a suicide attempt. So if you're analogizing this to the medical surgical world, this would be the ICU. This is where we're truly saving lives. Next service line is our Specialty service line. Now in our Specialty service line, we treat patients with other life-threatening diseases, substance use disorders, eating disorders. These patients in the Specialty facilities are less acute than the patients in the Acute facilities. So they can be in a less restrictive setting. These are open campuses, but they provide a 24-hour therapeutic [indiscernible] with doctors and nurses and therapists available to them, everything that they need, peer support, counseling. They can stay there for 30 days. And just as in the acute setting, they can step down to PHP/IOP, sometimes CTC, depending on their situation. In our Comprehensive Treatment Centers, we treat patients on an outpatient level. We treat patients using medications like methadone and buprenorphine, and naltrexone. But it's really important to point out that it's not just the medications that treat these patients. In the CTC, patients receive wraparound services that are essential for healing. There's group therapy. There's individual therapy. There's vocational training. There's peer support. Everything that people need not only to get into recovery but to successfully maintain that recovery. You can't just give out pills and hope people get better. We're also going to talk about our Residential Treatment Centers. Again, this is a setting where we treat children and adolescents that are really sick. These are kids who have been in and out of acute facilities, they're often involved in the judicial system, they're really, really tough to treat, but our staff does a fantastic job with them. So I'm told all have seen this slide before. I think it's worth noting, I guess, on the left that our Acute is our largest in terms of revenue, our Acute service line, followed by Specialty, then CTC, then RTC. In terms of our payers, Medicaid is our largest payer. And you can see we have a diversified payer mix with commercial on the right-hand side of that chart. And then in terms of our geography, we have a large footprint. We have the largest in Pennsylvania and then California, Arizona and then all around the rest of the country. So you hear a lot about the numbers at Acadia. I think it's important to talk about the people, the people that we treat because when you hear about those numbers and when you hear about the effective operational management that my friends effectuate every day, we have to take into account the most unpredictable entity in the world, human beings. And these people are afflicted with diseases, brain diseases that make them that much more unpredictable. And when I go to our facilities and I talk to our clinicians, they know I'm going to ask them, would you send your mom here? Would you send your kids here, right? The answer has to be yes, right? But why are we doing this? You go tell your family, hey, I'm going to go to a medical school. Oh, you're going to be an awesome doctor. No. What? It makes no sense. The answer has to be yes. So first, let's talk about our Acute service line. So in this case, [indiscernible] Daniel, [ like I said ], post suicide attempt brought to the emergency room, then transferred to one of our facilities, Mount Carmel in Ohio. He can be treated there on an intensive basis, intensive observation, seen daily by his physician. He can step down when he's sufficiently stabilized potentially to a PHP/IOP. John Hollinsworth will tell you more about that. He could also potentially be stepped down to a specialty facility because lots of people have more than one disease, right? You can have a sore throat and a broken ankle. You can have major depressive disorder and alcohol use disorder. If we look over here to the right, we see a patient named Jane. Jane has been admitted to Sierra Tucson for alcohol detox. I have to say that Sierra Tucson has a special place in my heart. It's the first place that I worked at Acadia, and we do a really good job with patients like this. And we talk a lot about the epidemic of overdose, but a lot of people don't recognize detoxification is essential because you can die from withdrawal, particularly from alcohol, benzodiazepines. So we have the capability of managing that medically at Sierra Tucson and our other specialty facilities. And then we continue with about a 30-day program, where people are treated by doctors and psychologists and social workers and nurses and they get peer support. And family is involved, and we treat the whole person. And then they can step down to an appropriate level of care. The RTC I mentioned, this is where we treat children and adolescents. Alicia is an example of one of these kids. As I mentioned, they're frequently in and out of hospitals. Alicia has been stabilized in one of our hospitals in Arkansas, Conway Behavioral Health. After that, she gets stepped down to Millcreek. And there, because these kids are so pathologically burdened and there are so many other social determinants of health weighing against them, we treat them for months, sometimes years. And our staff do a fantastic job. And then in the CTC, Albert is a good representation of what we see. Dr. Khan is going to talk to you about the patients that we treat in our CTC. But like many people, Albert went through his primary care physician, trying to deal with this opioid use disorder. Primary care docs want to do whatever they can to help people. They don't have the tools. They don't have the time. They don't have the training to treat patients with opioid use disorder appropriately. So they make the decision together to have Albert come to one of our comprehensive treatment centers. And as the name implies, Albert gets comprehensive treatment there. Like I said, it's not just, here's your pill and go. There's a structure to the CTCs. People need that structure when they are early in their treatment. They need that structure as they continue in their treatment if they're going to be successful in achieving a full recovery. So we have to continue to focus on our critical capabilities. We're enhancing our ability to cross-refer within Acadia, and to me as a doctor, that just means a streamlined continuum. It has to be seamless when a patient is going from one site of care to another. It can't be -- they can't feel like they're being bounced around. It has to be a warm handoff. We're scaling EMRs across our facilities. Chris mentioned, these operational efficiencies allow doctors and nurses and therapists to really focus their time where it needs to be with the patients. More face-to-face time results in better care, better outcomes and better lives for our patients. Safety is the hallmark of our facilities. Think about one thing, what do people need at our facilities? They need to be kept safe. So we are using tech-enabled monitoring to make sure that we're doing the best job we possibly can of keeping those people safe. We've launched virtual care, you'll hear more about this again from Dr. Khan, to reach people who would otherwise not be able to access it. About 50% of people in our CTCs are receiving some virtual care. And we've also enhanced our ability to track and assess our patients progress as they go, how much better are they getting, right? And we want to know this clinically. And we want to know this so we can collaborate with innovative payers. So I'm excited for you to speak with the rest of our team, hear from them. But before that, we're going to show you a video. So can we please show the video? Thank you. [Presentation]

[indiscernible] watching that every time. Laura Longstreet, our CEO of Belmont, does a wonderful job at that facility. And I'm privileged to lead 50 other acute CEOs that are dedicated to taking care of our patients every day. And then watching that video reminds me why I've been in this business for almost 30 years, the chance to save lives and to improve lives every single day. So my name is John Hollinsworth, I'm the Executive Vice President of Operations for Acadia Healthcare. And while, I have to say, I never thought I'd play Carnegie Hall. It's a big moment for me. I'm going to present today on the Acute service line as well as the residential service line for adolescents. But first, I want to talk about our operations team. I personally have 29 years experience in behavioral health leadership. And I lead an operations team, a very experienced, seasoned and talented professionals. My three acute facilities operation presidents have over 90 years of experience in behavioral health, and our financial operations team is truly the most seasoned and experienced team in the industry. Our operations team is very disciplined in execution of our multiple marketing plans, our cadence of meetings, our review of key metrics, but more importantly, our response to our review of key metrics. We have strong corporate support teams that support all key functions of our facilities. And despite our size, we remain very nimble and responsive to opportunities and the needs of our facilities. And all of this goes into operational excellence. But I'll have to say, to achieve true operational excellence, you need talent, you need culture and you need teamwork. And Acadia has that in abundance. Okay. Moving to our Acute service line. The acute market in the United States is approximately $35 billion. Acadia is $1.3 billion of that or 3% to 4%. We're the largest pure-play provider in that space at about 3% to 4%. And we're the third largest health care system in that market. We're very excited about the growth and opportunities on the acute service line for three reasons: because of the growing demand, unmet need, and increased awareness of mental health and increased acceptance of mental health. A sad statistic is, since 2019, there's been 26% increase in emergency department visits of use that have attempted suicide. We know that there's been a 3x increase in reported depression due to the pandemic. We know there's 100 underbedded MSAs in the United States, and there's a critical shortage of inpatient psychiatric acute beds of 75,000 in the United States. Now I mentioned the pandemic. Not many positive things came from the pandemic, but one significant positive thing did come from this pandemic and that's the increased awareness for mental health and the increased acceptance of mental health treatment. That, coupled with well-known sports figures that have been very open about their personal struggles with mental health, Naomi Osaka, the former #1 rank women's tennis player; Simone Biles, the gold medal U.S. gymnast; Hayden Hurst that plays football in NFL for Cincinnati Bengals. And ironically, this morning, when I was getting ready, taking a break from rehearsing this and watching SportsCenter, there's a renown UFC fighter, Paddy Pimblett. And he was on SportsCenter this morning talking about mental health awareness, the need to decrease the stigma of mental health and how more men should be speaking up about their mental health issues. So there's never been a time in this country where there's more awareness about mental health and more acceptance of mental health treatment. And we see that play out in Capitol Hill, where there's more bipartisan discussion and legislation around mental health than there ever has been. Where the acute service line fits in Acadia? It's the bedrock service line for Acadia. At 51% of the total revenue, the payer mix is approximately 50% Medicaid, 25% commercial and 25% Medicare. We have strong quality measures. We have a reputation for clinical excellence. I'm proud that in our communities, we offer specialty, acute services to meet community needs and a great example that I'm most proud of is our dedicated units across the country to treat our active duty military and our veterans. And I really believe because of Acadia's reputation, their scale, their ability to provide programs to communities that are needed is why we lead the country and JV partnerships with med-surg systems. And Isa Diaz is going to speak more about our JVs later in the program. I'd be remiss if I didn't bring up labor. We all know the labor market has been very tight in behavioral health across all of health care and really across so many industries in the country. I'm really proud that our facility operators have maintained a stable workforce during this time. They've been able to continue to treat our patients and admit patients that need treatment. Our corporate operations and HR team have worked diligently to make sure they have state-of-the-art tools in recruiting, that they have efficient and effective applicant flow process and then we build out a corporate -- a robust corporate recruiting team to support them. We know that recruiting and hiring employees is crucial, but so is retaining them. And once again, our operations -- our corporate operations and HR team have worked hard and developed retention best practices that we've deployed to the facilities and it's having positive effects. I feel confident that moving into the future, Acadia will be able to maintain a stable workforce. An investment that I'm excited that I think will also help employee retention is investment in technology. Dr. Genovese mentioned our investment in tech-enabled employee -- maybe we shouldn't monitor our employees, I'm sorry, tech-enabled patient monitoring, which will improve -- sorry about that, will improve staffing efficiency, but more importantly, improve patient safety and decrease risk. So excited about that investment and providing more technology that enhance our care and improve efficiencies. I want to talk to you about our continuum of care in the acute service line. We have, of course, the inpatient acute units. We have partial hospitalization. We have intensive outpatient programs. And I'm going to talk about all three. Our goal at Acadia, as for every inpatient program we have, is to have a complementary partial and IOP program. To meet criteria to be admitted to an inpatient acute unit, you have to be an imminent risk of danger to yourself or others. Though these units are locked, admission can be voluntary or involuntary. And while in treatment, you will see your physician every day for medication management, and you will participate daily in individual and group psychotherapy. And a mental health technician will check on your well-being every 15 minutes, 24 hours a day and document that. Usually, you're there 7 to 10 days. And at that point, most patients are stable enough to step down to a less restrictive level of care, which would be our partial hospitalization program. Our partial hospitalization programs are outpatient services at unlocked space. They meet 5 to 6 hours a day, 5 days a week. And in that program, you will see your physician 2 to 3 times during the week and continue to participate in individual and group psychotherapy. The average length of stay in these programs are 10 to 14 visits. At that point, you'll generally step down to our less restrictive intensive outpatient program, which meets 3 to 5 times a week, about 3 hours a day. You'll see a physician upon admission and participate primarily in group psychotherapy in that program. Our goal as Acadia is to provide the most appropriate, less restrictive, most affordable level of care. Time to recap our Acute service line. We are very excited about the opportunities for future growth in this service line, again, because of growing demand, unmet need and increased acceptance of mental health and mental health treatment. To reiterate Acadia, because of its scale, experience, operational excellence and high quality of service, is uniquely positioned to capitalize on this growth opportunity to treat the patients that need our services. And with our 4 growth levers, bed additions, de novos, JVs, and mergers and acquisition, we can strategically enter any market that we target. That's kind of a brief overview of our acute service line, and I do want to touch base on our Residential Treatment Centers that we serve adolescents. This service line represents about $290 million of revenue for Acadia or 11% of our total revenue. The payer mix is predominantly Medicaid at 86%. And most of our referrals come from state agencies and most of our youth have justice involvement and/or probably in the foster care system. We treat primarily trauma, posttraumatic stress and pain recovery in these facilities. And to qualify for admission into these facilities, you have to fail acute inpatient and outpatient multiple times, which means that our acute Acadia facilities are natural referral sources and step-downs to our residential treatment facilities. We still continue to see strong demand in these facilities. And we've added 60 beds in the last couple of years, and we will continue to evaluate existing markets for future expansion. I'm going to be very selfish here, and I'm going unscripted so I could get in trouble. But we can have a round of applause. I just want to tell everybody that I got a round of applause in Carnegie Hall. So thank you all for that. I'm excited to introduce Angie Castro and Steve Quigley, who are going to present on our Specialty service line. But first, I hope you all enjoy this video on our Specialty service line. Thank you all. [Presentation]

Good morning. My name is Steve Quigley. I'm the Group President for the Specialty division. Full disclosure. This is my third week in the job today. And I think when I accepted the job, it was after I took the job. They said, hey, by the way, you've got to go to New York and do this talk. So you've got to give me a little bit slack for that today. But it's incredible to be here, and I'm very excited to talk about our Specialty division. Just so you understand, I have been with Acadia for the past 14 years. My last role was as the division president, and at that time, prior to entering this role, we did our operations more geographic-based than we did by product line. So I live in Pittsburgh, and I oversaw the facilities in Pennsylvania, up into Massachusetts, Virginia, all the way down into North Carolina. And back, I think, in September, Chris and leadership team decided that Specialty should be its own distinct product line, and we'll talk a little bit about that maybe today, what makes Specialty different than Acute and some of the opportunities we can leverage as we look at it as an individual product line. As we go forward -- slide, please.

Yes, I can go. Angie Castro, Chief of Staff here at Acadia. I've been with the company for 7 years, in this role for just about 5 months. So like Steve, I took the job and then I was also told I was going to be doing this today here. The good part is Steve and I actually worked together for a couple of years within the Philadelphia, Pennsylvania market. So it makes sense for us to be up here together and presenting. So I've been, like I said, with the company for 7 years, but I've also been in the field for 29 years. I've worked at a CTC level, acute level and specialty level. So I'm proud to be part of a company that offers that full continuum and provides really good care. On another note, I actually have a son who is bipolar and autistic, so I'm proud to work for a company who puts quality and priority of their patients first. So glad to be part of this journey.

If we look at the what's now called substance use disorder market, it really encompasses two distinct programs: one is our chemical dependency programs, and the other is our eating disorder program. As you can see, that makes up a $45 billion market spend, of which Acadia generates $550 million annually, and we have about approximately 1% market share. One of the things that you're going to hear consistently today and already have started with today is this unmet demand across all our service lines, and specialty is certainly no exception to that. We know last year, there were 40 million people that were in need of substance abuse or eating disorder treatment, and only 4 million, 1 out of 10, actually accessed care. There's a couple of different reasons why that have always been known throughout the industry. One is the pathology of addiction. Just pure denial. People who are in need of care but are unwilling or unable to accept that they need the help. Second issue that I think we started talking about a little bit this morning was really lack of quality behavioral health services across our country. And as a result of that, we see people who make up that 36 million last year that did not get treatment who needed treatment. And as we go forward, there's probably going to be some factors that could actually make that number even larger. And Angie will talk about those.

Yes. So like Steve just mentioned, there is an unmet need and a demand that has increased for our services. Since the pandemic, roughly 30% of Americans have reported a significant increase in alcohol consumption and illicit drug use. Down in Washington, there's a bipartisan legislation to improve services and increase access. Despite all that visibility around the demand, we are still dealing with the opioid epidemic. Although we primarily treat OUD patients within our CTC service line, we treat them within all of our service lines, specifically within our specialty and our SUD programs. With this demand and Acadia's expertise, we are perfectly positioned to meet the needs of our community.

If we were to look at a couple of the overall business metrics that are important today, as I already mentioned, Acadia in substance use disorder market generates approximately $550 million annually. That makes up approximately 22% of the company's overall revenue. We have 37 specialty facilities across 14 different states, makes us one of the top 5 providers of that substance use disorder across our country. The one thing I want to point out this morning is our payer mix. Unlike our acute care services in specialty, commercial insurance makes up 62% of our payers and 27% comes through Medicaid. It's really one of those reasons that I think the decision was made to look at specialty as a distinct service line and look at the opportunities that we can leverage as we go forward in terms of using our programs. And our programs are unbelievable. We have rare services that provide unbelievable care. And some of those highlights I'll turn over to Angie again to let her speak to.

Thanks, Steve. So all of our specialty programs come with a multidisciplinary team, which is comprised of physicians, psychologists, nurse practitioners, nurses and social workers. They all work very closely together to create individualized treatment plan for our patients. Also, our specialty programs can offer unique services to meet the needs of our patients, like, I think it was mentioned earlier in John's presentation, our first responders program and our military and family services. With all this clinical expertise and our knowledge of the market, we plan to accelerate our specialty de novo by adding roughly 80 beds in 2024. Now I'll talk a little bit about our full continuum. But before I get there, like I know you've heard John talk about it, Dr. G. You'll hear a few other folks throughout this presentation talk about the full continuum. Because we're so proud of it. Not all facilities or businesses actually offer this. And I'm extremely proud because to have a company who looks at the patient as a whole and treats the whole person and are able to offer that is great thing to be part of. I remember 15, 20 years ago when I worked at a CTC clinic, and we were looking at how can we set patients up? If they need higher level of care, how do we make this happen? And I remember calling these facilities, these higher levels of care and asking who could take our patients. Out of 15 programs, one program could take our patients. And to know now that we can take a patient in at any level within our system and move them through our care is great to be part of. So our specialty programs offer a full continuum of care, starting with inpatient services and outpatient services. So the inpatient services include detox, rehab and residential services. These are our most intense level of care for this service line. Our detox service is medically monitored program, typically lasts 3 to 5 days for a patient. Our rehab and residential services usually last about 28 days, and this is offered to our SUD and our eating disorder patients. Most of our patients can benefit from stepping down into a lower level of care, which we have within our full continuum, which is our outpatient service line. Our outpatient service line includes PHP and IOP. PHP and IOP are the most intensive level for our outpatient service lines. These programs usually last about 3 to 4 weeks per treatment episode, and patients would have to attend care 3 to 5 times -- 3 to 5 days a week. Acadia has the ability to meet a patient wherever they are at in their treatment episode. So a person can enter care at any point within this continuum. A person can enter, of course, at our detox and flow through the full continuum and at our IOP, but they could also be prescribed to go to a partial program and recognize they need a greater level of care, and we can bulk them up to residential or rehab or we can also -- they can also go right to our outpatient level of care. The benefit of our full continuum is that not only can they go up and down through our service lines, they actually can move throughout all the different service lines, so they could also go to acute level of care and our CTC level of care. So you'll hear a lot of focus on our cross-referral initiative. It really is how we move patients throughout our system. And you'll hear a lot of talk about technology and how we're continuing to enhance it, invest in that. So as we're continuing to advance and invest in our technology, you'll see that it will help us leverage more of how we move patients through our continuum and through our cross-referral initiative. And I believe Andrew Lynch, our Chief Strategy Officer, will touch on that a little bit more later.

For me, this is -- running the Specialty division is coming full circle. I started 33 years ago as a drug and alcohol counselor in outpatient in Harrisburg, Pennsylvania. What's really interesting to me is how this market has evolved and how our treatments have continued to evolve. When I started, there was a clear delineation between mental health services and chemical dependency to the point where if someone came in for chemical dependency treatment, and they were perhaps taking a medication for a mental health illness, that was an exclusionary criteria. Mental health was here, chemical dependency was here, and that's how we provide care. As I think the market started to evolve and treatment started to catch up with how people really are, we started to combine the two. And that led to what now is called dual-diagnosis treatment. But even dual-diagnosis treatment, especially when it was first started 31 years ago, when I was still doing that, I would say, there was always a conflict between which came first, which was primary. Was it mental illness primary? Secondary was chemical dependency? Was chemical dependency first and mental illness came second? And finally, I think we've now started to evolve to the point where we say, let's treat the whole person holistically. And that's now what we call co-occurring. And as I think we've started to share with you all this morning, probably the most challenging population that we treat in the Specialty division is that co-occurring patient. And we have programs, whether it's Sierra Tucson, whether it's Timberline Knolls that really have done a fantastic job in terms of not only looking at how we treat those folks but constantly challenging themselves and their program to make sure that we're providing quality services, at the same time, maintain that operational, fiscal discipline that Chris spoke about, that John spoke about earlier, and really for us in the Specialty division, we feel like the future is bright, and we look forward to continuing to move our programs forward. And before I turn it over to Dr. Nasser Khan to speak about the CTC division, there's a video that you all can watch. [Presentation]

Good morning. My name is Dr. Nasser Khan, and I'm the Group President for our CTC, or Comprehensive Treatment Centers business. Every time I see that video, I'm struck by 2 things. First, I'm from the Pacific Northwest, I'm an avid outdoors person, and I desperately want to drive our mobile van. But -- no, but on all seriousness, it's that patient story. That's a real CTC patient, and that's her real story. It's stories like that that drove me to pursue a career in medicine 2 decades ago. It's stories that -- like that that brought me to Acadia and to CTC. And it's stories like that that inspire our thousands of teammates across our 148 CTCs in the U.S. There's no way to sugarcoat it. We're facing an opioid epidemic in this country. There are 9.5 million people affected by OUD, and only 10% of these patients are receiving evidence-based treatment today, what's known as MAT, medication-assisted treatment. This is a deadly disease. There were 107,000 overdose deaths during the pandemic. The vast majority of those deaths were due to opioids. If you look back prepandemic, this number has skyrocketed exponentially. I'm sure all of you have seen articles about this in the news. It seems like every single day. When you look at the full societal burden, the economic burden of OUD, it's a staggering $78.5 billion annually. So that's a lot. But I'll tell you that we, at CTC, are actually quite hopeful. In the last couple of years, we've seen greater awareness, we've seen the process of destigmatization, and we've seen more patients start to cross that bridge and begin to say, I think I can do this. I think maybe I can change my life and go in and seek treatment. We've also seen influxes of funding, funding to provide patients more access to treatment. In 2020, as many of you are likely familiar, the Medicare program expanded to include coverage for MAT. We've also seen a number of states go ahead and expand their Medicaid programs. And then as I'm sure many of you are familiar in this past year, there have been a number of settlements between opioid distributors and manufacturers and state and local governments to attack this problem. We're estimating currently to the tune of $40 billion to $50 billion in settlements. And while a lot of the details continue to emerge about these funds, I can say that earlier in this year, the single largest tranche, about $26 billion between the 3 largest distributors in this country, Amerisource, Cardinal, McKesson and J&J and state governments, have actually very recently started to begin to distribute funds. I want to point out that this is a gradual process. I know you're all very interested as are we and how this is going to play out. But those funds are going to distribute over an 18-year period of time. Importantly, there's a stipulation that 70% of those funds need to be used directly towards opioid use disorder. I think this is a society. We've learned a lot about how we take these funds and deploy them to public health, particularly from the tobacco settlements. I'll also point out that there are 20-some-odd specific use cases for the funds, of which 7 of them specifically refer to the kinds of treatment that we do in our facilities. Now in terms of being prepared for this, we've actually built quite a bit of muscle. Some of you may be familiar of the SOR grants, State Opioid Response, under the Biden administration. This was about $1.5 billion in funding that was earmarked towards the opioid crisis. We've actually successfully procured a number of grants this year and have started to build a tool kit of solutions that are shovel-ready to deploy as RFPs start coming out. Just to give you a couple of examples. We've been able to take these funds to develop new means of care. For example, the mobile van I referred to earlier. We've used it to create new positions like community outreach and peer counselors. And importantly, we've used these funds to create jobs in local communities. I'll also point out that OUD is not something that we just treat in our CTC facilities. We've already been a successful recipient of funds related specifically to the opioid settlements in order to expand bed capacity in our specialty facilities to treat OUD. We, at Acadia and CTC, stand well positioned to lead the fight against OUD. With $410 million in revenue, we command about 8% market share in a highly fragmented industry. We have 148 centers across 32 states. When you look at our mix, it's about 65% Medicaid, about 18% Medicare. I'll say that this has shifted a bit in the last couple of years, as I mentioned, the coverage with Medicare, but also some of the state Medicaid expansion funds. But by and large, more recently, this funding distribution has remained relatively stable, and we'd expect it to do so going forward. And one of the advantages of being a scale provider is the breadth and the depth of solutions that we're able to deploy. We offer, in our facilities, all of the FDA-approved medications: methadone, buprenorphine, naltrexone. We also importantly offer a breadth of counseling solutions: group, in person, in our clinics and virtually as well. And I think as was mentioned earlier, about 50% of our patients choose to leverage the virtual channel to receive counseling. Now I can't emphasize this enough, counseling is a critical part of treatment. It's in these sessions that our patients develop new peer groups, start to develop new behavioral strategies and begin the process of reintegrating into society. Preventing overdose is critical. But for us, that's not enough of a goal. We're here to rebuild lives. Now we also recognize in this industry that we do have an access issue. There simply are not enough ways for patients to get care. So we've gone ahead and innovated around a number of different solutions to serve patients in rural and remote areas. We've developed things like medication-only units or the mobile vans that you saw in the video earlier. I'll also point out that I've talked a lot about MAT and what we do in our clinics, but it's much more than that. We're providing whole-person care in these clinics. As I'll talk about in a minute, our population suffers from significant physical and mental health comorbidities. When you look at our patient population, 36% of patients have a comorbid mental health diagnosis, typically anxiety or depression, 60% have one or more chronic medical conditions, most commonly diabetes, hypertension or hypercholesterolemia. When you consider the cost to treat this patient population on an annual per capita basis, it's $23,000. So what can Acadia do about that? Well, as a large, integrated and scale provider, there's actually quite a lot we could do about it. Consider, for example, our specialty and our CTC facility. 70% of our patients admitted to our specialty facilities carry a diagnosis of opioid use disorder. When you look at our footprint, 14 of our 37 specialty facilities have a CTC within 20 miles. We're actively working on building linkages across our service lines so that we can follow patients across the continuity of care. And here's an excellent opportunity for us to leverage the breadth of data that we are sitting on and to be able to develop predictive analytics to understand what patients are likely to do well or what patients are more prone towards a relapse, how can we adjust our clinical care models to wrap around these patients and prevent adverse outcomes. So in summary, the opioid crisis is a serious one. There are 10 million people affected in the U.S. The vast majority aren't receiving evidence-based care. But we at Acadia and we at CTC carry a lot of hope. We're starting to see more people take that step forward and cross that bridge and start to seek care. New sources of funding like we spoke about are going to address the access issue, make it possible for people to receive patients -- to receive care, excuse me, who haven't previously been able to do so. We at Acadia are well positioned as the leading provider in this space with our 148 facilities across 32 states and our suite of solutions. And we have a unique opportunity, and I would argue a moral imperative to leverage the scale and do our part to add more facilities expand access to care and meet the needs of our patients across the continuum of care. Thank you very much. And now we're going to transition to a question-and-answer session. I'm going to invite several of my colleagues who spoke earlier this morning to join me up on the stage. [Operator Instructions]

Whit Mayo with SVB Securities. Certainly, a theme that we're hearing is the continuum of care. And I think, Chris, you referenced in your remarks earlier that maybe 85% of referrals want the full span of services that you're offering. Can you maybe just elaborate a little bit more on that, how you calculate that or really what that number was intended to illustrate?

On the 85%?

Yes, the 85%.

Yes. I mean it's -- we would probably have to come back and give you the detailed breakdown on that. I think the thing that we really wanted investors to take away is just the fact that we have been very intentional around all lines of business, not only continuing to build out that capability, but it's really the integration. I mean, Angie, you probably can speak to this best. Angie, having a lot of operational experience, particularly in Philadelphia, seeing our lines of business come together, she's been leading this cross-referral initiative. We're really trying to be more intentional about getting the lines of business to communicate better and to pass patients. Part of this is we're inhibited by the investment in technology to be able to track some of these patients, but why don't you just share some of the progress?

Yes. So our cross-referral initiative is really like -- so we've always cross-referred. It's nothing new to our company. What we're seeing is we're getting more proficient with our efficiencies around operations, and we're adding -- enhancing technology. It's allowing us to do this a lot more and seamlessly. So patients have always moved throughout our system, like they could be in Philadelphia, we can refer them to our Sierra Tucson and then step back down into Philadelphia. So it's something we've always done. But as we get better with our technology, it allows us to leverage and move patients a lot more seamlessly, look at patients through their whole clinical pathway for that treatment episode instead of looking at each encounter. So it's something that we've done. We'll keep working at it. It's a great opportunity for the company. And as we get better with our operational efficiencies, we'll get better at moving people through our system.

And I'd just also add. I mean Andrew Lynch will talk about this a little bit later, but on the M&A front, I mean, we'll be on the lookout for various programs that also enhance the continuum of care and that's something that hasn't been a focus in the past, but I know he and his team are already working on. So more to come on that.

Andrew Mok from UBS. When you sized the total market for substance use, I think you called out $45 billion, does that include the opioid use disorder market? And how do you view the opioid use opportunities specifically, especially with what we know today with the settlement dollars over the next 3 to 5 years?

I'm going to go ahead and take that. Yes, so that $45 billion number that you referenced does include OUD. We're using a number anywhere between $20 billion to $25 billion for OUD specifically. Keep in mind that it's very much a moving target. There's -- it's not as if there's a census person going around and asking people to self-identify. We, as an industry, use a number of different data points to essentially triangulate and estimate what the approximate size of that is. And then to your point about the settlements, the settlement funds are going to lead to more education awareness and outreach. They're going to start to bring more people into care, and we expect then that those numbers are going to increase.

Brian Tanquilut from Jefferies. I guess, John, for you, so as I think about the labor market and maybe for the other folks on the panel as well, how are you thinking about the growth outlook that you've put out versus the growth in the labor pool that will support this? I know you've had a lot of success with HR, but at some point, the labor pool for mental health, nurses and counselors, needs to grow as well in line with what you're looking at. So just curious what your thoughts are on that.

Yes, I mean -- yes, of course, as we increase more patient volume, we need more nurses and clinicians to care for those patients. A couple of things is that we want to lead the industry in our recruiting efforts but, more importantly, be seen as a provider of choice to where if you're a mental health professional or psychiatric nurse, you want to work at Acadia facility. So we will continue our efforts, not in just recruiting to make sure that we are positioned as an employer of choice and then really looking at our recruiting efforts and making sure we're recruiting the right places and have the right affiliation with teaching organizations and nursing schools. And so we're really starting to recruit, not when we have a need, but as someone is going through training or through education, that we're already in contact with those people, so as they join the job market, they're looking at Acadia.

And I could add one thing for you. I think there's a lot of opportunity organically within our facilities. A number of our direct care workers, behavioral health associates have bachelor's degrees, go back to school, work their way up, become master's-level clinicians or even go from being a direct care batches level person into some of the nursing, and we see programs like that. We've had LPNs who've gone on to become RNs. We have quite a few RNs who now are going on to become advanced nurse practitioners. So I think organically, we have a great talent pool and each facility has a certain accountability to look at that pool and trying to increase the amount of people they have work in those disciplines.

That's exactly right, Steve. Thank you.

I think the career development is really important. I've referenced it earlier, but our ability to really impress upon so many of these clinical leaders that there is a path for them within Acadia frequently beyond just the facility. And I think Steve gave some really good examples. I mean we're certainly willing to invest in their training, in their education to take that next step, and I think that's something that will prove to be very important. I think we're always looking to leverage technology differently as we're trying to attract people in. So we're -- I think there's some opportunity there. I think John also referenced the remote monitoring opportunity with patients. And why that's important from a labor standpoint? He alluded to somebody that comes into an acute facility that is dangerous to themselves or to others has to be checked every 15 minutes. That is very difficult to find somebody in various geographies to take that shift at 2:45 a.m., 3 a.m., 3:15, 3:30, constantly tracking that. This remote monitoring bracelet that a patient wears enables us to have clear validation that they're doing okay and that they haven't moved during the night, but also can take their vital signs, which are an indicator sometimes that there can be some clinical challenges ahead. So technology is not going to solve everything, but we're going to look for ways to leverage technology to enhance our core operations. And I think this is a very good example where we have the scale that we can test remote monitoring product like this in a few facilities, learn and then with the lens to expanding it regionally and then quickly nationally, if it makes sense, to all of our facilities across the acute spectrum.

I'm going to cheat and ask two questions since Whit stole my question. The first question is the doubling of revenue by '28, the components of that revenue mix and broad strokes how will that change from the revenue mix today. And then secondly, the company's disclosure, you -- there's a lot buried into the couple of metrics that you provide. Is there going to be some thought given to maybe more expanded disclosure to give some spotlight on some of the businesses that probably aren't as well understood as they could be?

Yes, I'll start. I mean we clearly will look to do that. I mean I know the -- there's a lot of eagerness around the financial presentation that David's going to pull up on at the end. And we're going to clearly go through some of the breakdown. I think the takeaway that I would want investors to come away with is that we're seeing record growth in all lines of business. I mean we're challenging every one of these leaders. That's why we decided to split specialty out. Somebody that comes into an acute facility is frequently coming in, in a police car, sometimes very frequently and voluntarily. Somebody that comes into one of our specialty facilities is sometimes hitting -- frequently hitting rock bottom and finding us through a Google search. Completely different outreach. There's ways for us to leverage analytics to proactively find some of these patients in need more aggressively. So we're constantly looking for ways to enhance all of our lines of business, but this isn't one where there's one area that's going to have disproportionate growth. You saw the industry trends, which I think will be very applicable for us. There's certainly real tailwinds in CTC. The growth rate in acute historically has been a little bit less, but David will go into this in more depth just as we look at our own outreach. Is there anything else that you all would want to add on that?

I think you covered it.

Okay. Great.

It's A.J. Rice, Crédit Suisse. I'll follow John's precedent and ask two questions real quick here, now that we have that precedent set. In your presentation, Chris, you said that mental health is growing 7%. I wondered that's a broad category, it covers inpatient, outpatient. The business that you're in and do you think that's growing 7% or would you come up with a different number there and put outpatient at some other growth rate more? And then you guys have done more M&A in newer areas, more CTC recently. Since we got the whole panel up there, what about the M&A opportunities in the different business lines? Can you maybe people comment on whether that will be part of the story going forward?

Yes. Great questions. I think because of the diversification of our business lines, we certainly think that we can grow faster than 7%. There will be markets and geographies and segments that in any given year will grow a little bit more quickly, but that's part of our job as we look to identify some of these MSAs. We've, as a company, done some initial work around 100 underbedded MSAs, but we think that our ability to work with each of these leaders together to decide where do we want to plant a flag, where does it potentially make sense for us to reach out to a JV partner proactively, where would it make sense for us to do a de novo ourselves? So we're constantly having these discussions on how can we more aggressively deploy capital. And I think that's going to serve us well on the growth front. From an M&A perspective, Nasser, do you want to -- I know that started to CTC, do you want to take that?

Yes. No, we have already, in the 3 months or so that I've been here, evaluated a number of different opportunities. As I think the question referenced, we recently closed an opportunity down in Georgia. And I'll say that the industry is undergoing a transition. There's clearly a gradual lifting of the bar that comes from the fact that this is a highly regulated industry that comes from the fact that when you've got governments through things like settlement dollars putting in funds, there's an expectation of clinical quality. There's an expectation from society for ROI. And so as we're able to go in and demonstrate that we are capable of being successful, it puts more pressure on the subscale participants in this industry. And as I think I alluded to in my talk about our -- we have 8% market share, you start to look at the structure of the industry, and it's quite a long tail of onesie, twosie subscale programs, they simply don't have the resources to make those kinds of investments.

Also thinking in terms of the Specialty division, we frequently talk about where there's unmet need because there are people who will travel to, say, Sierra Tucson for specialty care, just like people will travel to the Mayo Clinic for specialty care. But if you think about other disease states, one shouldn't have to travel to get treatment for their diabetes or cardiovascular care. So we look at areas that I'm thinking of, for example, New England or other parts of the country, where they really need treatment for addiction. So that comes into...

Yes. And I don't want to steal any of Jeffrey Woods' presentation later in the day, but he will speak to MSA analytics that we have developed that not only helps us identify favorable MSAs but also helps us determine how we should enter that. Is it an M&A, is it a JV or is it a de novo? So Jeffrey will speak more to that later in the program.

And just a reminder to everyone, we're going to have another 15-minute, 20-minute panel. Looks like we had -- we're running a little bit ahead, so we're actually tacking 5 more minutes on to this panel. But we have one more panel that's going to come at the end of the day after David's presentation. And there's a little bit of thunder-stealing that's going on already. One of the John's question on the JV front, we feel -- and we'll show you as these committed 18 JVs begin to evolve into the future, we have a high level of visibility into the bed growth that clearly is attributable to our acute line. So that is clearly driving a nice component of our growth. And we have some very specific detail that we haven't shared before that will give everyone a sense for how we get that confidence and what the visibility that we have looks like. So look forward to sharing that.

This is Pito Chickering from Deutsche Bank. A few questions for Dr. Khan on the CTC side. What's the split of the $410 million of revenues between counseling, getting methadone or getting grants? And then looking at the revenue growth, is revenue growth coming from -- I guess if you look at the revenue growth's split, is it in new patients and new centers? Is it building new centers or acquiring new centers? Or is it increasing revenue per patient in the centers?

Yes, thanks for that question. So I'll save some of the financial comments for David's part at the end of the session today. I'll just say that if you're familiar with the Medicaid market, it's almost like working with 50 different payers as opposed to a monolithic one. And as a consequence of that, or particularly in states where you've got a managed model and then there's multiple different entities, you'll see quite a bit of variability. So there's not a single answer to your question. It actually can be an either or depending on how the specific payer has structured the reimbursement. And then just run me on your second question. Do you mind repeating it one more time?

Looking at the revenue growth, what's the split between new patients in the sort of same center growth versus building new centers versus getting more revenue per patient in the centers?

Yes. Okay. Got it. Thank you. So there'll be some data, I believe, in a next presentation, just giving you a sense of the trends and how we're looking forward for adding CTCs. But if you look, for example, in 2022, where we're going to add about 6 or so, and I believe it was the same number in 2021, and you put that under a denominator of 148 clinics, I think you can start to appreciate that driving same-store growth has been kind of the main way that we've grown the business. Obviously, as someone alluded to earlier, we've done some M&A this year, and we expect that will continue to be an important part of our strategy to drive growth going forward.

And another part of our strategy on the CTC front are clearly de novos, and Jeffrey will speak to that as well. But we think there's real opportunity there to potentially accelerate in several different markets. And just given the tailwinds that we think are pretty unique, that's something that, as a company, where we look where we might deploy capital, that's clearly an area of significant interest for us.

Kevin Fischbeck from BofA. I wanted to go into -- it sounded like Steve mentioned that the company reorganized a little bit from a geographical base operationally to the service line base. At a time when you're talking about clinical collaboration, I would have thought a geography-based operational structure might have helped collaboration more rather than service line focus. I'd love to just hear a little bit more about what you get by focusing on the service line, how you maintain the lines of communication to capitalize on the collaboration dynamic? As well as when you talk about clinical collaboration, what business is going to benefit most from that way? Where are you underpenetrated relative to everything else and you see the most opportunity to add an extra service line?

I know that was a question for Steve, but I'll start with that. So for me, Steve moved into this role, although you would think because we were all integrated before and that geographically, it made sense, but it actually makes more sense to have someone who can specialize in the specific area and actually having Steve do that role since he came from the other side, he knows what's best to integrate and how to work better together with his peers and other group presidents. But also what we think with our cross referral, I know this is coming up a lot, I think the specialty market is actually going to benefit most from all of this. So I think because our intake staff workers already know how to think about, okay, we can't meet the need here, where else in our facility in our company we can meet that need? I think with our discharge planners, when people are stepping down and moving throughout our system, Specialty has the most benefit because patients don't have to just step down within their local area, they can step down or step up throughout our whole company. So having someone in our Specialty division who focuses on that and knows the business is going to be really helpful for the company.

Angie is usually so reserved, it's uncharacteristic for you to step in and answer for someone else.

Yes, I was going to say that as Chris alluded to earlier, there is such a distinction between how Specialty and Acute focus. I think it's very important as somebody focused on our Specialty. We have a national marketing team that focuses on nothing but Specialty. We have our digital marketing teams that are focused on the specialty. So somebody who is focused on everything that goes into specialty is very important. But we've also -- this cross-referral initiative has been a huge initiative with the company, and we've actually created a position within the company that they're overseeing that cross initiative and helping build out the technology and the metrics and everything that we can follow and track. So that's -- we have continual meetings. We have a dedicated resource to that, and we're building out the infrastructure. So that's going to be part of the fabric of Acadia moving forward.

Yes, Steve, anything you would add, I mean, just as somebody that has run a really large division over many different states and having acute facilities, having specialty facilities and having RTCs kind of all intermixed, how do you think this focus on specialty?

I think Dr. Genovese, in his presentation, really outlined a big piece of it. Where the patients come from, how they get to our facilities is one of the big differences between acute care and specialty care. So when we really start taking a look at acute is you have a lot of people come from emergency rooms or in crisis, and they don't have necessarily a lot of choices, but when we look at the specialty market, there is a wide range of different providers that people can choose from. And I think some of the analytics that we're starting to look at and [ Brett Bermans ] coming on to take a look at, there's a lot of opportunity for us to really take a look at how we can use that data and provide not only better care, but overall, just continue to grow our business.

I'll just add one thing to that. Steve stepped into his role, and I think I'll let you breathe for about 2 days. And then I said, "Hey, 70% of your patients have OUD and that we sat down together, and the first thing we did is let's pull all of the [indiscernible] data for your patients, where are my facilities, what processes do we have in place to capture them, and where I have those white space gaps, I'm starting to adjust my de novo plan and map. And that really can't be done in a geographical way as efficient as it is when you have a service line owner.

All right. The shot clock has gone off. Standard 5 minutes. We have time for one.

That basket didn't...

Mona Eraiba from TCW. It seems like the large cities in the U.S. starting to recognize that large percentage of the homeless population need mental health, and they cannot seek it on their own. Is there any efforts from Acadia to construct relationships for the big cities for addressing that issue for mental health like New York City. Now involuntary pick the homeless who have acute issues with mental health and try to address -- they are not really homeless per se, but they suffer.

So what I might say is -- to your point, what I'm hearing is they're homeless because they're suffering with untreated mental illness. And to the extent that we can treat that mental illness, we can get them back into a better situation. And we do. We partner with localities. We know the officials in all of our geographies. We work very closely through our local CEOs, through our government relations department. And we are eager to -- we have the resources to help those people, and we're a natural partner.

Sorry, I'll provide one specific example. In 2023, in one of our geographies where we've got significant density, we actually are recipients of SOR funds to go to our patients and to distribute specific funds earmarked for housing. And the [ kind ] has come to us and said, you know your patient population better than anybody else. You know that houselessness is a significant problem. We want you to come up with a solution. So that's something that we're going to be doing in 2023.

Okay. We're going to wrap up, give everyone a chance to head to a break, and we'll come back and talk about our growth strategy. 15 minutes. Thanks, everyone. [Break]

Good morning, everyone. First, I've got to apologize in advance, I was getting ready early this morning, I got up here on the stage, I wanted to see what it would look like. And with all of the lights, the production crew told me, trying to be helpful, that I've got a lot of scalp glare. And so if I'm blinding anyone at some point, give me a little signal, and I'll try to sort of change my angle, try to make sure we're taking care of there. My name is Andrew Lynch. I'm Chief Strategy Officer of Acadia. I've spent the vast majority of my career in health care from a number of different angles, payer, technology, services, provider. And one of the big cross-cutting themes has just been the critical need for behavioral health services, both in their own right and because they're such a big driver of overall health, including physical health. So I'm very excited to be part of this work. I'm going to pivot us from before the break where we looked at our service lines and their track record and why we're so proud of them to talking more about growth and why we think that Acadia can have an even greater impact in future. A couple of reasons we're so bullish. The first is just a very significant amount of unmet need in the behavioral health space. First, it's wild to think that there are more than 100 MSAs that are considered underbedded from an inpatient psychiatric perspective. What we mean by that is that in those markets, there are fewer than 50 -- significantly fewer than 50 inpatient psych beds per 100,000 population. That's a benchmark that's been established by a number of clinical advisory bodies. And one thing capacity issues like that drive, along with other forces, of course, is just the continuing and accelerating degree of mental health crisis in this country. Nasser talked a bit about that on the opioid use side, but it's really across the board. One in 3 of the millions of Americans with serious mental illness, for example, do not receive behavioral health care today. That's one of the big drivers of some of the daunting statistics that you heard earlier around suicide. 30% increase in suicide rate since 2019 and, among adolescents, it's even more daunting. Among adolescents, it's hard to believe, but suicide is now the second leading cause of death. There's also very significant unmet demand in the substance abuse space. Again, you heard a bit about this earlier, but it's wild to think 75,000 preventable deaths a year, that's more than 200 preventable deaths per day. If there are positive trends we can look to, I think it's just a broader recognition across multiple sectors in society that this really is a crisis that we've got to pull together to address it. And so whether that's reduced stigma, bipartisan support, increased commercial payer receptivity. I think all of those things are important tailwinds as we work to meet the unmet demand that I just talked about. We also believe that there is an important opportunity to improve and strengthen market structure in the behavioral health space, both in terms of consolidation and in terms of partnership. On the consolidation side, behavioral health is highly fragmented. We're showing a couple of stats here. I think it's inpatient, psych and CTC, but it's really across the board of the areas where Acadia is focused. And similar to other areas of health care that are highly fragmented, we think there's a big consolidation value opportunity, both through strength and scale economies, of course, but also ultimately through clinical quality, unlocked by some of the investments and specialization that scale can often help provide. We also think that there's an important partnerships opportunity. We'll talk more about this in a little bit. But at Acadia, we're very proud of the joint ventures that we have with medically-focused health systems across the country, we bring just a ton of operational, clinical expertise there related to behavioral health just as they bring a lot of value to us. Out of the more than 600 medically focused health systems that we think could benefit from arrangements like this, only a fraction have joint ventures focused on behavioral health today. So we think there's a significant opportunity there. As we work to meet this accelerating degree of unmet demand, Acadia has a broad and complementary array of growth levers that we have been focusing on and continue to push on every day. I'm not going to go into depth on each of these. We'll do that next, but I'll just hit the high level on a couple of crosscutting themes. So first, joint ventures. This is what we just mentioned, but this is equity partnerships with medically focused health systems across the country. Facility expansions, so increasing capacity at existing sites typically through additional beds. De novo, so standing up wholly owned new facilities from the ground up. Programmatic M&A and then extending the continuum of care. What I mean by extending the continuum of care from a growth perspective is filling in service line gaps at an individual market level. Again, Angie hit on this a little bit earlier, strengthening cross-referral programs and so on. We'll go deeper on that in a little bit. Across these growth vectors, as we think about investment, our philosophy has a few key tenets. First and foremost, ROIC above our cost of capital, of course. And then additionally, we try to strike a balance across core performance metrics related to investment, whether it's upfront capital, time to breakeven, overall projected rate of return. At a portfolio level, we work hard to strike a balance across those. And then we will always take into consideration qualitative and strategic factors, of course. Qualitatively, local market environment is a good example. Health care is hugely local, as you all know, and certain localities will skew more towards some growth vectors than others. And then strategically, just as an example, an M&A target may have specialized clinical programming that we see value in. Next, we're going to go deeper on each of these. And we're going to start with joint ventures. For that, I'm pleased to hand it over to Isa Diaz, our Senior Vice President of Strategic Affairs. And as we transition, we're going to play a short video that, hopefully, brings to life why we're so proud and excited of our work in the joint venture space. [Presentation]

Good morning. I'm Isa Diaz, and I have the honor to lead our joint venture development efforts around the country. And for me -- the greatest satisfaction for me as I'm hearing that video is hearing directly from Dr. Ryu at Geisinger and Bob Riney from Henry Ford Health System, saying, why they're partnering with Acadia. It really validates all of our efforts and all of the hard work of our teams out in the field. For -- as we look at Acadia, we are the leader in behavioral health joint ventures. We have the most of any other behavioral health provider in the country. And as we talk through with different partners, the reason that we are the partner of choice, Acadia has the behavioral health expertise, the quality treatment programs and services, the operational and financial resources. And I think very importantly, we have a proven and successful partnership track record, and that's very important as we talk to different health systems around the country. So what we're hearing from health systems everywhere around the country is that they have a tremendous need for behavioral health services. They have no capacity to deal with what the needs that they're seeing in their local communities. And in many cases, they come to us because they're trying to solve a complex issue in their community. So for example, they'll have patients waiting in their emergency departments, and they just don't have capacity in their units to take care of the volume of patients that they're seeing. In other cases, there's a gap in service in the local community. And I'll give you a perfect example. We just recently announced this summer our joint venture partnership with ECU Health in Greenville, North Carolina. And in that particular partnership, the closest child and adolescent bed programming is 55 miles away. So tremendous need in that community to bring child and adolescent programming. In our new joint venture hospital, which will be a 144-bed campus, we are going to have a dedicated child and adolescent unit, and again, solving an issue that's tremendously needed in that community. As you saw in the video, there's many benefits to Acadia in terms of having joint venture partnerships. And one of the things, and I stressed it in the video, is that with a partner, we're able, to use Dr. Ryu's term, turbo-boost our operations in that local market, we're able to come in with a head start. And there's that brand halo effect from our partners where we're able to access their current relationships with payers, their current relationships with providers and their current relationships with referral sources. So that's a tremendous benefit to Acadia as we're going into a market. One of the things that is also very beneficial for us in partnering with organizations in certain states that have a lot of barriers to entry, there are states that are complicated with a CON process or they have a moratorium for new hospitals, and a perfect example is our partnership with Fairview Health. So we had identified proactively, as Chris has mentioned, Minnesota is a market that was underbedded and we would want to penetrate. But there is a moratorium for new hospitals. To build a new hospital in Minnesota, you have to get legislative approval to be able to build that hospital. So it's a very complex process. Working with Fairview, our partner, we were able to leverage not only the experience of working in that state but also navigating the relationships to be able to go through that very complex moratorium process. The good news is that we were successful in obtaining all of our approvals and that project now is moving forward. So I think that is one of the other benefits of partnering with organizations that have such a strong reputation and knowledge base in that particular community. One of the things and the trends that we're seeing with our new joint venture hospitals is just because there's so much demand. Our hospitals used to range anywhere in the 80-bed capacity range. We're now seeing more 120 to 144 bed campuses. And all of them, as we're building, we're looking at how do we expand those hospitals. So again, a tremendous need out there that we're seeing. And the other thing, I think, from a financial economics that's very favorable to us, having the joint venture partner, we have not only access to their patient stream but also to their staff, and that's been very beneficial in order to break even and reach our occupancy targets sooner. So I think those are all definitely great benefits to us. The other thing, I'll walk over here for a little bit, that is very important to us is that many of our joint venture partners are academic medical centers. And this has been fantastic for us in terms of being able to look at innovative programs that we can train the next generation of clinicians. So we want to grow more of those clinicians internally, and this provides a great opportunity to do that. So we're very excited about that and looking at innovative ways to integrate physical and mental health. A lot of our partners in the academic area have a lot of research and great ideas of how we can do that. So I'm very, very proud of this slide. I can tell you that we have accelerated our joint venture partnerships, and that is something that we've been working very hard on. And I'm very excited that this year, 2 hospitals, joint ventures, we opened our Covenant JV in Knoxville, Tennessee this past summer. We just did our soft opening of our Lutheran Health Network joint venture in Fort Wayne, Indiana. We're going to get our first patients at the end of the month. And we're on target, as you saw in the video, you saw the construction of the Geisinger building, that should open next year, also Bronson Healthcare and Battle Creek, Michigan. This area here I'm extremely proud of because these are all signed agreements, and we are right now in the phasing of the development of those new hospitals, and that represents over 1,000 new beds in the next 2 years, '24 and '25. So very excited about that. I just think the trajectory of what we're seeing and the need is so great, we're going to continue to see more of that. And aside from this, but wait there's more, we also have a very robust pipeline of numerous projects that are under development, in different stages. So there's more to come on the JVs. I'm very excited. We have a great trajectory for years to come. I'm running out of time. So next I want to introduce my colleague, Jeffrey Woods. He's my partner in crime. Once we sign the agreements, we have to operationalize these joint ventures. And Jeffrey and I work very closely together. So I'll turn it over to him.

Thank you, Isa. The incredible work that has been done in our joint ventures is a testament to the strength of Acadia and its growth strategies. It's also an opportunity to demonstrate Acadia's ability to operate nationally with diverse partners, who have diverse interests. In addition to that, it allows Acadia to represent its own vision and mission in these partnerships as we work together in these collaborations towards fully integrated models of care that take care of the whole person. So my name is Jeffrey Woods. I'm Operations Group President with Acadia Healthcare. I have been with the company for about 7 years now. And during that 7 years, I have witnessed and it's been my privilege to really observe and participate in a transformation of Acadia Healthcare. And that transformation is -- it really sets Acadia up for very strong success going forward. So I have the opportunity now to speak to about two additional levers for growth. One of those levers is bed additions and the other is de novos. And when I refer to de novos throughout this conversation, please know that I'm speaking about wholly owned hospitals, acute care hospitals; I'm speaking about our -- in some context, our joint venture de novo hospitals; and I'm speaking about specifically our CTC division. So when you hear de novos, and I'll call some of them out individually, but that's what I'm talking about. So you all as analysts and investors, earnings calls, all the things that you do to keep track of what we're doing, you are aware that we have very consistently, throughout our history, delivered on our bed expansion strategies for the company. And we deliver those bed expansion strategies through organic growth within our existing service lines. One of the things that is a driver for future growth and to ensure that we not only sustain our current bed expansion pathway, but that we are able to expand beyond our traditional bed expansion pathway are our JV de novo hospitals and our acute care and our specialty facilities, and that is to say, our de novo specialty facilities and our JV hospitals and our acute care hospitals. Our ability to -- as we onboard those facilities, as they mature, we are seeing increased opportunity for bed expansions. We have already experienced that across the enterprise with some of our more recently acquired and operating joint venture hospitals. And as Isa mentioned, one of the benefits of having a JV partnership, not only speed the market, but that they often bring staff, they often bring a substantial population of patients who are in need of services, and as a consequence, we see a much faster ramping with those hospitals. So when we think about our bed expansions, there are two things that are probably most significant for us. The first is the economic efficiency that drives bed expansions. Because we are able to leverage against our existing facilities, we're not having to build all of the infrastructure, we're able to bring these bed expansions online quickly and at a cost point that is about 25% less than what it costs us to build a de novo hospital or a JV hospital. So much more efficient in terms of use of capital. And then the trigger for our JV hospitals, for our expansions, bed expansions, is we look towards the capacity limitations of our existing facilities. So when a facility is reaching sort of that 60% to 70% occupancy, that becomes the point where we get very engaged and energized around evaluating whether that facility is the facility that is going to be ripe and appropriate for further bed expansion. And if it is, then we will, of course, assess the relevant bed need in the community and then a very disciplined financial analysis to ensure that it makes good business sense for the company. So we have a very robust pipeline for bed expansions. And I want to talk a little bit about differentiation. So when we talk about the strengths of our company, part of that is both innovation and what the key differentiators are for Acadia as a company. And while there are many key differentiators, I'm really going to focus on three today to sort of give you an idea that I think are important. And the first has to do with our proprietarily developed comprehensive MSA assessment technology. This technology is comprehensive. It's extraordinarily detailed. It gives us very complete visibility instantly into more than 400 MSAs across the United States. And we are looking, of course, very closely at the 100 MSAs that you've heard about earlier, where we know that there is substantial unmet need with respect to bed capacity. And so we're looking at those very closely, but we have the ability to drill down into over 400 MSAs. And some of the demographics or some of the characteristics that we look at involving the 40 variables, 40-plus variables that we analyze include population demographics, socioeconomic demographics, the bed-need analysis, competitor profile. We are looking at the provider profile, the availability of providers to support services within the communities that we are looking at. So a whole host of services. I won't bake the whole cake for you all 40-plus variables because it is proprietary, but it is an extraordinarily strong tool. And one of the things about this tool that we're able to use is that it is advanced to the point that we are able to make decisions in real time in each market about whether the project should be a wholly owned de novo JV hospital, whether it should be a joint venture de novo hospital, whether it should be a CTC clinic, whether it should be an M&A activity. And so we're able to look at those things in real time and make those determinations. And in some cases, it may be more than one of those things. You saw the map of our company a couple of times earlier, and you could see concentrations of our footprint, where we have acute cares and specialties spread across the country. And so we're looking very closely into each of those markets where we have one or more service line to see where complementary service lines make sense to further build out the continuum of care that you've heard some of my colleagues talk about. The second area that differentiates us is our design and construction team, and they are arguably the best in class. And I've been doing this a long time, and I will tell you, we are blessed to have some really terrific folks. They are leveraging within their departments and within their teams, design, construction, architecture, engineering, site selection, real estate, land use, business development, a whole host of things that go into sort of deciding what location makes the most sense, establishing the land for our anticipated or planned project and then being able to execute on that. And then finally, our track record on being able to have a path to rapid profitability. And because of our efficiencies, and I'm going to talk a little bit more about some of our efficiencies that go toward further innovation. Our average time to profitability, breakeven and profitability, is about 12 months on average. So we're delivering very quickly and in part because we also have very strong capacity to build relationships in the communities that we work with, referral sources, providers, et cetera. So knowing that we have a very strong pipeline, both for our bed expansions, our de novo hospitals and pathways for de novo hospitals, you've heard about the JV hospitals in more detail from Isa, we feel very strongly that the outlook for Acadia and its growth in each of those sectors is very strong. Now I want to give specific emphasis, however, on the CTC division. You'll notice that there's substantial growth in CTC in 2024. I'm going to tease you a little bit to tell you that in the years out from 2024 in all of these sectors, but in CTC, and you heard Dr. Khan talk earlier about just how dire the need is, you are going to see substantial additional growth in the CTC space that is going to drive the care of patients and help to preserve life for these individuals who are suffering from substance use and opioid use disorder. So we have substantial bed need. We have substantial capacity to deliver on that bed need. And I want to talk a little bit about some of our processes that are innovative but also that are relevant to the work that we do in the care of our patients and the care of our communities and being good stewards of the resources that we have as a company to ensure that we are making decisions that drive shareholder value but really also meet our patients where they are and support the clinical work and the clinical outcomes that we are driving towards. So you saw in the videos earlier a host of our facilities of all different types. And I hope that in each instance, you said to yourself, those are beautiful facilities. Because we've put a whole lot of time and energy and effort in ensuring that not only are our facilities state-of-the-art, that they are healing places, but that they also respect the dignity of the individual, the patients who walk through the front door of our hospitals and our treatment centers seeking care, that when they come there, that is a place of healing for them, that it's a place where their families can be -- participate in their care and the return home from care. And so a lot of energy and effort is placed around those types of things. And so when our patients enter our facilities, we want to be able to meet them where they are in their clinical process and their clinical need as we work towards treating the whole person, mind, body and spirit. And this is a theme within our company that we're treating the whole person. You heard Dr. Khan, you heard Dr. Genovese talk a little bit about the fact that we are treating the whole person, medical comorbidities, psychiatric comorbidities, substance use disorder, all -- psychiatric disorder, all of the components that make up the total human, including the spiritual health of the individual and the physical and mental health of the individual. So our facilities are beautiful, they're safe, and they are built with the idea of integrity and dignity for the patients that we serve. So we have some very leading design capabilities. Our design team, as I mentioned earlier, works with a whole lot of fantastic experts. But some of the innovations that we have delivered in the design and construction really drive speed to market and value and efficiency in our construction costs. So we have developed about a half a dozen prototype hospitals that we can stand up without having to reinvent the wheel from a design and construction and architectural standpoint, in just about any market in the country. We have built redundancies or efficiencies within those hospitals so that we're not reinventing the internal operating structures of these hospitals each time we build one. So for example, the fire panels that you might see in a hospital, and if you don't know what that is, it's a super important thing, and it's really hard to get, particularly since a lot of the chips right now come from the Ukraine. So to be able to transfer a fire panel from one project to another drives efficiency for us. And so we have that type of built-in redundancy, that built-in efficiency so that we can bring these facilities to market more quickly. We also have developed a whole host of prefabricated materials to help speed construction, reduce some of the costs associated with subcontract labor and to ensure that we have facilities that have consistency. So the picture you see behind me is one of our joint venture hospitals, Bronson Behavioral Health Hospital in Battle Creek, Michigan. And in this instance, you're seeing an exterior wall that's prefabricated that is going on to the hospital. So substantial reduction in construction time when we have prefabricated materials like that that we can deploy in our hospitals. Similarly, we have complete -- we call them boxes, but complete boxes that we can insert in the hospitals. So bathrooms, for example, which are very complicated things to build, it turns out, to be able to drop those into a hospital and know that they are psychiatrically safe and that they meet all of the standards for construction, a very efficient way to be able to drive to market more rapidly. So very excited about those types of things. And then I just mentioned on procurement. So it's difficult out in the market today in some areas when it comes to being able to obtain some of the materials that you need, particularly those critical pathway materials that if you don't have them, the project just stops. And it may be something relatively small, may be a rooftop unit that requires a certain type of chip that again is only made in Ukraine and really hard to get. So because of our scale, because of our size and because of our forward-thinking, we're able to stockpile materials that we know are critical pathway elements that could delay our ability to drive to market more rapidly. Similarly, we were able to stockpile other materials that we know we will need across any portion of our company when it comes to our construction and the work that we do around building new facilities and then be able to deploy those things on a very rapid basis to anywhere in the country that they're required. I think of a project recently where because we had the foresight to stockpile structural steel early in the COVID pandemic, we were able to continue construction on projects where peers we know had to stop construction or they had to substantially delay construction because they weren't able to access structural steel. And by engaging in some of these early procurement activities, we're able to purchase things at bulk and it reduce costs, which further benefits the company in terms of, ultimately, the delivery of these products to the marketplace. We have an amazing regulatory expertise team within our company made up of individuals who are experts in quality, regulatory matters, safety and all things related to survey readiness. And survey readiness, in particular, I'm referring to our local surveys, our state surveys, our CMS surveys and our accreditation surveys. These are all -- this is a very important critical pathway to ensuring that our hospitals open on time. So within six months prior to the opening of a facility, this team of experts is on the ground. They have a hardwired process for every one of our facility types to ensure that when it comes to the time for us to engage in those regulatory activities to actually open the facility that we're able to do so. And at least in my 7 years, I have no personal knowledge of a single facility that we were not successful in opening on the first try in every one of those dimensions. So really proud of that team. And they are regionally stationed across the country, so we have quick, responsive reach to our facilities. So you can build facilities all day long, but if you can't staff them, you got a problem. And so we have built, and I know this was talked about a little bit, but I'm going to give you a little bit more detail, we have built over the last 18 months an extraordinarily robust and well-resourced team of national recruiters for all disciplines that are relevant to the operations of our hospitals. That includes physicians, nurse practitioners, registered nurses, social workers and our C-suite talent for our facilities. And this team has really been a critical partner in bringing talent to us. And as a company, we have relationships with physician, psychiatry, medicine, residency programs all across the country. And many of our hospitals and treatment facilities, our teaching facilities as well, where we are training physicians, nurses, social workers, all of the folks that I talked about as part of the pipeline to ensure that we have talent that is ready, able and capable to provide the services necessary within our hospitals. And then finally, we have a very robust real estate team that is involved in site selection, working with negotiating LOIs and PSAs and all the work necessary if we have any issues that relate to our land use requirements. So I've been doing this for about 36 years in -- both as a clinician and as an operator. And I can tell you that I don't know of another company that is as ready, as able and as capable as Acadia to execute on its growth strategies. And I would tell you also that is the reason why every single day I choose to be an Acadia leader. So thank you very much. And I'm going to return -- reintroduce Andrew Lynch, our Chief Strategy Officer, who's going to take you through some additional information on M&A.

A quick update on M&A as well as make a few broader comments on growth around continuity of care because the M&A piece is going to be brief. I'm going to be giving it on behalf of David Keys, our Chief Development Officer. He is here. He will be involved in the Q&A portion. I'm sure you'll be pleased to hear. So building on all the great organic growth initiatives that we've just talked about, Acadia also has a really strong track record of inorganic growth. Nasser mentioned one of these earlier, but since 2019, we have made three acquisitions spanning 19 total facilities. These span across multiple service lines within Acadia. The most recent one, this is the one in Georgia that was referenced. We announced it earlier, I think it was last month, four comprehensive treatment centers for opioid use disorder in Georgia. Moving forward, we believe that Acadia has -- really is better positioned than ever for continued strong inorganic growth. And there are a few reasons for that. First is just the level of fragmentation of the market that we talked about earlier and the industry consolidation value opportunity that represents. But equally, we believe that at Acadia, we have a differentiated ability to capture growth and value from that consolidation. Part of that is our existing scale and breadth of capabilities. We've talked a lot about that, but it's also about just the richness of our relationships and knowledge at the local market level. It's also about our strong balance sheet. To deliver on that opportunity, we have a strong pipeline in place that's driven by a dedicated team and a clear idea of what we're looking for. On the next page, we're going to talk a little bit in more detail about that M&A prioritization framework. In summary, we have a highly targeted, highly programmatic approach to M&A at Acadia. A couple of acquisition types that we look for. First, and this is by far our biggest focus, systematic tuck-ins, small- to medium-sized providers that meet our investment criteria, of course. I will talk about those criteria in a minute. And then I mentioned our strong balance sheet. That does give us the flexibility to go after larger, more creative deals opportunistically. So we're always monitoring there. And then across both of these areas, there are a number of criteria that matter to us. Three of them are really filters. So again, foundationally, certainly, we will always require a clear path to attractive return on invested capital. We require clinical excellence in the providers that we go after. And then we're focused on a few areas, inpatient psych, specialty and CTC, in particular, from an M&A perspective. And one quick comment on path to attractive ROIC. There are certainly many drivers of that. I mean our scale helps us. Synergies are always going to be in play. But equally, we often will encounter providers where there's operational improvement opportunities and that can be a nice value creation lever, too, when applicable. Then there are a couple of things, a couple of criteria, not always critical, but that can be very valuable. There are certain size thresholds that we look for, for example, and then strategic value. I mentioned previously, an example of that could be an M&A target may have specialized clinical programming. Equally, a target may have technology that could accelerate us or market access that we find beneficial. What this structure and clarity does, it puts us in a position where we don't have to just wait for opportunities to come to us, but we can be highly programmatic and highly proactive. Finally, I want to say a few more words about the role of continuity of care in our growth at Acadia. I hope this is a thread you've seen kind of teased out multiple times today. Chris talked about it, Angie has talked about it, Dr. G has talked about it. Let me hit in particular on what Dr. Genovese said that integration across the continuum of care is at the heart of our clinical strategy because it allows us to meet our complex patients, where they are, step them up in acuity, down in acuity and do it cohesively. But integration across the continuum of care is also a big part of our growth strategy for a couple of big reasons. First, drives referrals into our Acadia ecosystem from the outside. That's because, I think, as you may have seen earlier, when providers are referring into behavioral health, the #1 thing that they look for is the breadth of services that that behavioral health provider can bring to bear. Integration across the continuum also drives appropriate cross-referrals within our Acadia ecosystem because the more comprehensive set of behavioral capabilities that we can bring to bear in a given market, just simply to better our ability to get our patients the care that they need quickly and seamlessly. What can develop over time is a virtuous cycle at the individual market level, clinical collaboration, integration of care, referrals and growth. With all this in mind, we're continuing to focus on a number of areas. Again, some of these you've heard about earlier. Angie talked about strengthening cross-referrals. That's a big focus. Another one is just filling in service line gaps at the individual market level. We're also leveraging virtual care, both to take specialized clinical programming from -- I think Dr. G mentioned Sierra Tucson as an example, take that best of Acadia to many facilities and just, in general, virtual care to take our care beyond the 4 walls of the clinic. That's an important part of continuum of care. When you take all that, you combine it with, again, our scaling capabilities, which we talked about, again, we really believe that Acadia has a differentiated ability to drive value and growth from a continuity of care strategy. With that, I'm going to hand it over to David Duckworth, our CFO, who is going to talk more about how our growth strategy and broader strategy will translate into robust financial performance in the near term and long term.

All right. Thank you, Andrew. Thank you to the team. We discussed our growth strategy. We now want to go into our financial update and really elaborate on a number of points that have been made throughout the day but really want to elaborate on them in the financial update, as we also talk more specifically about 2022's results and our outlook for 2023 and beyond. The first point, our financial performance has been strong. It's been consistent throughout the year, in line with our expectations and really provides a solid foundation for the company financially but also just the strength of our service lines. As we move forward, we have a solid foundation to build upon. As we just saw, we also, secondly, have robust pipelines with a high level of visibility into those pipelines. That does give us all confidence as we talk about the growth expectations that we have. Those are supported by highly visible projects that we have coming on over the next several years. And we will talk in more detail about our 2023 and our longer-term growth that's driven by those pipelines. We are accelerating investments where we think that the company needs to continue to lead the industry forward, where we can make selective opportunities to add value to the company by using technology, adding to our infrastructure. And we think there is a strong benefit to making those investments. We'll spend a minute on that towards the end of this section. Our cash flow and debt position strengthens not only the organic growth pathways that we have but also, as we think about M&A, we have a lot of capacity, we have a lot of flexibility as we think about the right way to grow across our markets and service lines. So let me jump into the detail and start with 2022. We have seen strong performance throughout the year. The trends that we've seen in our business have continued throughout the year. That includes our quality being a strong driver of our volume. We've seen high occupancy rates, as we talked about earlier, strong relationships with our payers that has driven revenue per day growth. And we've continued to add to our beds at existing facilities as well as bring new facilities online. And the labor market has been challenging, but it has been stable and the operations team has managed very well across the company through a very challenging environment. We, this morning, affirmed our guidance for 2022. And obviously, we have 3 quarters in the books and 2 months into our fourth quarter and wanted to just share a few trends relating to the fourth quarter that just give us confidence in affirming our guidance this morning. Our volume growth continues to be strong. We saw in our third quarter 3.1% year-over-year, same-facility volume growth. And through two months of the fourth quarter, we've seen approximately 4% year-over-year volume growth. The bed additions, we've talked some throughout the year about bed additions being needed and being added to our existing facilities. We added a lot of beds in the third quarter and the fourth quarter, and that will continue to be and was thus far in the fourth quarter a key driver of that volume growth. Revenue per day, which has been strong throughout the year, that momentum has continued into the fourth quarter. Obviously, a lot of that contracting that happens with our payers establishes a rate for a year. So we would always expect that to continue from quarter to quarter. We will have in the fourth quarter a higher comparison to the fourth quarter of 2021, where we also, at the time, highlighted a $4 million onetime item that represents about a 1% comparative impact. But even with that, we expect revenue per day momentum to continue through the quarter. And our labor costs continue to be manageable. I mentioned the environment continues to be challenging. But the team is doing a fantastic job on all of our recruiting, retention initiatives, and we'll spend more time in a minute talking about 2023. But we continue to be more optimistic as to the labor environment as we move forward. So we wanted to provide, just hearing the discussion around our growth pipelines across the different growth pathways, an updated view as to how those different growth pathways come together and the combined impact that they have and really the total bed additions resulting from those different pathways to the company in total. So this page would be our inpatient bed additions on a combined basis across de novos, joint ventures and facility expansions. CTCs are not reflected on this page because it's a bed additions metric but has a very similar accelerating opportunity for that business. And what you can see here, we are at the end of the year, finishing 2022 with around 11,000 inpatient beds. And next year, adding almost 700 beds across our 3 growth pathways. And those are projects that we, as you would expect, given the construction time that we have to go through, the survey process that we have to go through, other processes, we have high visibility on that number. We know the 2 joint ventures that we're opening next year. We have talked about it today, Bronson and a Geisinger facility. We know our de novo facilities that we're opening next year, which includes an adult facility that adds to our Montrose operations in Chicago as well as a de novo facility in California. So high visibility around 2023's bed additions. I think, importantly, as you saw Isa's page and she talked about 2024 and 2025, where we have signed joint ventures, those have been announced over the last year, even 1 year plus. Those agreements are in the design and construction process today. Many of those were in the breaking ground phase. And once we get to that point, we actually feel like we have even higher levels of visibility into bringing these beds online. There's a lot of work that goes on that Isa and Jeffrey lead for us between when we make an announcement and when we open a facility. And so many of our facilities, joint ventures and other projects are in that phase, but we have high visibility as to delivering on a growing bed additions number. This growth that we see from ballpark 600 to 700 total bed additions a year to over 1,100 beds a year, that's 7% to 10% total bed capacity growth for the company. That will be a key driver of our growth, as we'll see in a minute. So we do believe with the pipeline that we have a clear path to continued growth for the company. In the near term, 2023, that growth expectation is in the range of 9% to 10%, which includes expansions of our existing facilities and the new facilities we're bringing online. The new facilities that we brought online this year will grow and mature into next year as they ramp up their operations. And we have an ongoing focus on operational efficiencies and cost discipline. As we think ahead to a longer-term period of time, where we do have more bed additions coming online, we believe at this point in our growth. We do now have more visibility into the growth rate opportunity for the company being higher. And so we are establishing a longer-term earnings rate target -- earnings growth rate target of 10% to 12%. And again, this is organic growth for the company. This would include expansions as well as our joint ventures and de novos but not include any M&A, which we believe will be part of our strategy. We will see M&A that's incremental to these numbers, but it is not included in these targets. The growth from the 9% to 10% to the 10% to 12%, we'll talk more about it in a minute, but it's the acceleration in our joint ventures. It's the new focus on de novos that will include substance use and add to the historical focus that we've had on acute de novos. We'll continue to invest over this period of time as we'll look at in a minute. So -- and I want to talk now about 2023 and then spend another slide on the longer-term growth rate. For 2023, we did issue this morning initial guidance for 2023. We normally do that in February, but this is obviously a great occasion for us to provide some initial thoughts around 2023. And we have consistency in our trends, a lot of momentum in our business. So certainly feel confident and are excited to share our guidance today. Our 2023 guidance does reflect, at the midpoint, 9% to 10% EBITDA growth and revenue growth. The drivers of that are the bed additions to our facilities, 300 in 2022. More new beds coming on next year, including, fortunately, a better progression of those bed additions than what we've seen this year, which was very much back-end loaded. And so we're excited to be able to add that capacity and create more of that volume growth opportunity for the company. We do incur start-up losses when we open new facilities. So between the 2 new de novos and the 2 joint ventures, those will spend a year ramping up their operations. But we do believe next year that will continue to be in the $15 million to $20 million range that we've seen this year. So that is factored into our guidance and is a similar level to what we've seen in 2022. We believe that revenue per day will continue to grow for the company. Our payer relationships are very much a local -- a facility to a local payer plan supported by, at the corporate level, relationships that we have at the corporate office with that payer. And the team has done a great job, as you can see in our results throughout the year, driving those increases. And we expect that opportunity to continue. We have a lot of our payer contracting already done for next year as of today, as you think about recent rate increases. We have visibility on Medicare because a rate increase that was effective October 1, 3.8% increase for Medicare will continue into next year. And we have many other recent rate increases that give us visibility and confidence that we'll continue to see success in our revenue per day. As a company, we hope that those rate increases on average continue to be mid-single digits. Our commentary for now at this point in our planning process for next year would be that revenue per day would grow at more than 3%. We have a great opportunity in front of us, especially as we continue to talk to payers about the programs that we provide, the way we're partnering with them in our local markets and then the inflationary pressures that we've seen in our business. That will continue to be a number of the factors that we engage with, with our payers. With respect to our labor assumptions for next year, we have seen higher wage inflation throughout 2022. So the team has done a great job managing staffing, having staffing available to support our volumes and also managing it in a way where wage inflation has been manageable for the business. But it's been elevated. Even despite those factors, our wage inflation this year has been 5% to 7%. The business has historically been more like 3%. So as we move into next year, we do believe -- and we have some early indicators around our recruiting and retention metrics around hiring activities and other metrics that we're monitoring. We are optimistic that next year, we would see some moderate improvement in our wage inflation and believe that over the course of the year, we'll see the business return to less than 5% over the course of next year. So that's incorporated in our guidance, along with a reduction in our premium pay. Our premium pay has been low, but it's been elevated this year. And we believe with our investments and initiatives in place, we can drive improvement there. We also have highlighted here just that interest expense is projected to be higher next year just in case any of you are wondering about EPS growth at 8% relative to our earnings growth. And the company, obviously, is in a much better leverage position now. That 2.1x of leverage means that we have much lower debt. We also have 2/3 of our debt is fixed, so not impacted by rate increases. But that other 1/3, given how rates have moved up this year, is impacted by rate increases and that has about a $10 million to $15 million impact as we think about interest next year. That's a $0.10 EPS impact at the midpoint. Again, as I mentioned a minute ago, this guidance does not include M&A and any transactions that we complete over the course of the year. We'll always -- as we do complete a transaction, we'll add to that and update you as to the impact. Now the longer-term growth drivers, as we think about the bed additions increasing, we would say that the main source of that bump in our longer-term earnings growth would be the volume growth that's driven by the bed additions, as you would all expect, where we are adding more than 1,000 beds a year, which represents 7% to 10% additions to our existing bed capacity. That has historically driven about a 3% to 6% volume growth expectation for the company. That's just what we have at the 600- to 700-bed level. And we see that growing to 5% to 8% longer-term volume growth for the company. You might wonder why is it that 7% to 10%? Why isn't the growth in beds equal to the growth in volume? There's the ramping process that we see. When we open a bed, we are ramping it up to its mature occupancy over the course of a 1- to 2- to 3-year period. But that 5% to 8% is about a 2% increase over the historical volume growth that we've seen. So volume, in us being able to meet the demand by investing and adding to our capacity across our service lines, across our growth pathways, is the key driver to our longer-term growth. The growth in the CTC revenue every time we talk about patient days that does not reflect our CTC business, but we have a growth outlook for the CTC business that's in line with our inpatient projections around volume as well as earnings. And over the long term, we expect revenue per day to continue. We expect labor to continue to be manageable. And with respect to our margins, as we add to our volume, especially as we add programs to existing facilities, and we have efficiency opportunities, we do expect to see same facility margin opportunity. But we also believe over the next couple of years, we will be investing more in technology, and we'll look at the numbers related to that in a minute. And as we have more facilities opening, we may see, in 2024, a step-up in our start-up losses. We would size that today as the $15 million to $20 million that we've seen historically, may grow to a range of $20 million to $30 million. And then once those facilities open and once we invest in technology to drive some of the opportunities that we see from that that we've talked about throughout the day, we think that's actually a longer-term positive as we think about the impact on our revenue growth opportunities and the efficiencies that we'll see in our business. So the key is implementation of these investments and a successful opening of the facilities as quickly as we can and as successfully as we can. Okay. The investments that we are making in technology. I know we've given some examples throughout the day, but we want to just talk in a little bit more detail here about the areas where we're investing, the benefits from those investments and how we're, as of today, framing and sizing what those investments may be. The highest priorities, we have a number of -- a long list of potential priorities and initiatives. But our top priorities today would be on this page. And really, this page also shows where the most dollars would go. Not every investment requires a significant amount of capital as much as just a changing and a rethinking of the best processes that we have in place. But today, the areas where we expect to make short-term investments include our infrastructure, which really involves improving all of our technology capabilities even down to enhancing our Wi-Fi to be able to support all of the other investments that we want to make. And those include electronic medical records. We today have manual, paper-based processes across most of the company and the potential for electronic medical records is a significant opportunity for not only Acadia but also the industry. And then you've heard also today about patient safety compliance technology. There are a number of benefits from making these investments from a clinical perspective and a financial perspective. The quality and compliance from not having the paper-based documentation that is harder to monitor and track and very inefficient will be significant for the company. So the clinical quality benefits will be -- as you can see on the right-hand side of this page, will be significant. The patient satisfaction, the patient experience will benefit from these investments as well as our employee satisfaction, which will lead to benefits in recruiting and retention. The data and analytics capabilities that we will have, which are important across all functions of the company as we engage with payers, as we monitor the business, as we look for operational efficiencies, having more data to evaluate and to use in our analytics, will drive revenue and margin improvement opportunities for the company. So as we're thinking about making these investments, we're doing so in a disciplined way. And I know this page might be hard to read. Hopefully, your deck is not as hard to read, but we included some detail here just because we want to be sure everyone understands the disciplined plan that we have. We do think in 2023, we'll begin to make these investments. There is about a $15 million to $25 million IT capital involved in 2023's phase of the investments and about $5 million of incremental operating expenses that we expect to incur. From there, we will continue to evaluate the success that we're having, the value that we're driving and the investments and believe over the 4-year period from 2023 to 2026, that we could see a total of $75 million to $125 million, again, over that 4-year period of time of capital, and that the $5 million of incremental operating cost would grow to a range of $20 million to $30 million. Our goal today is to just provide some initial framing of that and continue to update you as we implement these initiatives, which we are extremely excited about the value that will be driven for Acadia and as we lead the industry forward that we think all of behavioral will benefit from. A quick update as well on our cash flows and our funding of the investments. In 2023, we are projecting another strong year of operating cash flows. The company has historically funded its investments with our operating cash flows and, over the last couple of years, have had more operating cash flows to have the ability to pay down more debt or have flexibility as we think about other investments that we can make. So for next year, we are projecting $450 million to $500 million of operating cash flows. And we're providing more detail today in a breakout of our technology capital. Historically, that has been part of our maintenance capital. Today, and looking back historically, that's been around $20 million a year just based on the spend that we've had. And so as you layer in that $20 million to $30 million for next year, that IT capital is broken out on this page at $40 million to $50 million, again, $20 million to $30 million of that would be incremental to historical levels -- or actually, that's $15 million to $25 million. The $40 million to $50 million is our maintenance capital, which has been consistent for the company, and that's included in our projection for next year. We will continue to fund our organic growth investments. Those are projected at $350 million to $400 million for next year. We'll continue to fund that with operating cash flows generated by the business. On a longer-term basis, we have talked historically about a ramp-up and an acceleration in our capital spend. And just as the bed additions number becomes greater in those outer years, we do think our expansion capital will continue to grow moving from 2023 into 2024. And where we have a $350 million to $400 million estimate for 2023, we do think that that expansion CapEx investment for our organic growth opportunities will grow to $500 million, ballpark $500 million, at which point that's where we think it would be depending on the timing of projects, but that's the level of spend that we would expect relative to that 1,100 bed additions that we're projecting for those years. That will continue to be funded by operating cash flows, which will continue to grow as we project forward for the business. The balance sheet capacity that we have and the growing cash flows that we're projecting continue to give us capacity to make further investments as we think about M&A capacity and flexibility to make other investments as we move forward. So significant support from the balance sheet and our projected cash flows for the investments that we want to make. So to recap, we've seen strong financial, operating, clinical performance. We have robust pipelines that we believe give us high level of confidence in the growth targets that we've shared. And we have a plan to invest in strength in Acadia, continue to differentiate Acadia and that supports and enhances the growth opportunities that we have. And we're doing so in a way that sustains the operational performance that we've seen recently. And we have the capital to continue to support our growth and accelerate our growth. And we are now going to move into the second Q&A panel of the day. I'd like to invite my colleagues up. We're going to have Isa, Jeffrey, Andrew and Chris all join us on stage. And I believe we have around 15-ish. We're going to get you to lunch on time and out in time. So we may have 10 to 15 minutes.

Kevin Fischbeck from BofA. In your growth projections, it's just really interesting, I guess, the pricing this year has just been so strong, and it seems like a lot of us struggle with exactly what was driving that? And it seems like you're saying this year's high, it's going to come down next year. Most other providers seem to be saying the opposite that it was low this year, but it's going to be going up next year, over the next few years. So can you talk a little bit about why down is the right way to think about it for next year? And what to maybe help this year's pricing be so strong?

Yes. We -- so I made the comment more than 3%. I didn't put an upper end of the range. And we have seen strong revenue per day growth this year, which we attribute to many years of engaging with our payers across our facilities and markets. On the importance of the services we provide, there's, at the same time, greater focus on mental health from those payers across those markets. And we would attribute those initiatives to the recent drivers of our revenue per day growth. And we expect that rate increase level to continue and that focus to continue from both our local operators and our payers. And that we would now introduce what many providers are talking about, which is the impact of inflation on those discussions. And we do believe we will continue to see positive results with the payers. We're being cautious as to the weighted average impact across all the different payers that we contract with. So we might be slightly conservative with our target of saying more than 3%. We certainly believe, in most markets and even in specific markets that we've identified, the opportunity is greater than that. But we, of course, want to be cautious as we think about how it all comes together and the weighted average impact of it for the company in total.

When I hear EMR conversion, a little part of me gets a little bit nervous just given the track record of operating disruption. So maybe just provide a little bit of context around how you landed on the number that you did about the 4-year investment time frame, either how you're preparing for operating disruption or how you're trying to avoid it altogether.

Yes. We, of course, have heard many stories as well over the last many years. And we've, for many years now, we've thought about this as a company. And we have already -- I think we've mentioned this in the past. We have looked at pilots for a solution that we're piloting right now at 4 of our acute locations. And we really want to take our time to look at those pilots, look at the results, look at the impact of it, make sure that we have the team and that we know how a facility can successfully implement it in a way that not only provides the value that we expect but also is not disruptive to the work that we're doing at the facility. And so we do -- as we think about prioritizing that investment over the next few years, we do think that we would start with our acute facilities. They are treating and have more of a workflow because of how complex and how many patients they're admitting on a daily basis and just the level of acuity of those patients. So our plan is to start with our acute facilities and also look at our other service lines as we go through the next few years. We're sharing total numbers, the $75 million to $125 million of total capital that I mentioned. That includes all of our initiatives, of which EMR is potentially a large part of that. So we're certainly aware that we need to do this in a way with the right resources internally that's not disruptive and that evaluates as we go whether we're delivering the value that we think is there.

I'm going to -- I would just add, we're going to do this in a very measured way and not go too fast. I would tell you, spending a lot of time in the field over the last several months, that these facilities are literally fighting to be next on the list, like this isn't something that the corporate office is pushing upon them. They see the merits. They want to move towards an EMR. And so that's something we're going to do cautiously. I talked about the remote monitoring technology and how we started that out in a few facilities, then moved regionally, then went more broadly. We're going to have stage gates in place. We obviously, when we went into the market to look for a CIO, very clear that we wanted somebody that had experience in rolling out significant system changes, working through transformation on a multisite basis, and that's something that we're going to be, from an operational standpoint, highly, highly focused on.

So continuing on the focus of the EMR, have you selected a vendor and is the -- are you going to wait for your CIO to [ bless ] that? And then secondly, just at a high level -- same EMR, just one question, come on. Is the strategy just to do a neutral third-party deal? Or has there been some consideration into maybe becoming an equity holder and incubating some scrap [indiscernible] company or you could pay Epic $1 million or hospital, whatever you want to do?

Yes, I would say, John, you're very well versed that there are a number of solutions out there. We've done the initial pilots with one party that we haven't disclosed that's done a good job so far. But it is important when you're bringing in a new leader that those relationships matter. And anyone that's been around technology world for a long time has certain points of view. So we will clearly wait. We're not going to slow things down because there was some expansion that we were going to do anyway. We're just going to be very, very measured and continue to be very deliberate, but we've been very pleased with what we've seen so far.

It's A.J. Rice at Crédit Suisse. I'm noticing a pattern here that I seem to be following John today, but anyway -- on the questions. You guys have a lot of volume to be had. You've got pricing gains. So in the current world environment, you're doing really well. But there's a lot of discussion about value-based care and new and exotic arrangements with managed care in your discussions with them and given the continuum of care that you address, do you see that creeping into the equation in any way? And how might that manifest itself?

Yes. Great question, A.J. I would say it is already starting. Some payers and recall, I came from the payer background, I have an extensive experience in value-based care, it's still very early. We would love to see more payers want to put forth value-based constructs. We have one right now. These in the early days are very much akin to what you saw in primary care in the early days there, where it's shared savings initially or they're upside-only contracts. There's not a situation where we're being expected to take downside risk immediately or certainly to go to a fully capitated arrangement. So I think we will work through it. We would like to do more of this with more progressive payers that are willing. But the constraint is not on our end, it's really finding the right payer partners in the right geographies. And I think there will be a lot of interest there. I think this is one where you have to have when you're working through your strategy formulation, you have to have a point of view on the pace of change with respect to value-based care. We don't think this is going to accelerate rapidly in behavioral health because it's very complicated. But we want to be ready. If there is -- if there are payers that want to move more quickly, we are absolutely going to be at the table, and we're going to move at the same pace.

Do you see more opportunities on Medicaid managed care, Medicare Advantage or commercial or it's all fair game?

I'd say it's all varied right now, probably a little bit more so on the commercial front initially, but continue to hear that there's interest on the Medicaid side and, certainly, CMS is used to this on the Medicare side.

Just to build on that, I think Chris is right, it's all about doing at the right pace and the right time and doing it thoughtfully. But over that long term, I just think the increasing recognition clinically among payers of the causal relationship between behavioral health and overall health, including physical health. I just -- I think it's a powerful story, and we'll just have to see how it plays out.

Yes.

Andrew Mok from UBS. When you laid out your 10% earnings growth target initially in early 2021, you initially planned for 6% to 10% CTCs expansion a year, you're now expecting 14% in 2024. When we think about that, is that a catch-up from deferred projects in 2023? Or is that a step function increase that you'll be able to maintain going forward?

Yes. In my view, we don't have Nasser on the stage, but you could, hopefully, hear his -- I mean, you heard some about his perspective on how he's thinking about meeting the incremental demand in some of the access issues that are out there today and how that educates our de novo strategy and how we're using mobile units. And so it's more of a step function in the opportunity today compared to when we initially thought about the opportunity. Obviously, a lot more funding that's going to be available that we think will drive a higher opportunity there. And this may have to be our last question before we break. But...

I want to ask a two-part question.

Okay. Another one.

[ Thai Chau ] from [ Auger ]. First for David, I believe your 2023 bed addition target of 670 is a slight reduction from the outlook at the beginning of this year. Can you give us some color as to why that is? And probably more importantly, when you look out to your longer-term guidance, should we think that there's more constraint to the downside or more opportunity upside in terms of the opportunity to add beds beyond your targets? And the second question is for Chris. And maybe you can close with this. Can you just share with us your thoughts about differential pricing in the industry? Is that already starting to happen in longer term? Is there opportunity for better operators to get better rates across the payer classes?

[indiscernible], thank you for your question. Good question. The outlook that we provided very early this year, we talked at the time about needing to break ground on some of our joint venture projects. And we have talked throughout this year about bringing down our expansion CapEx spend because of some delays in the very early stages of a project where we are trying to get all the local, zoning and environmental approvals that we need. And so we did see some delays this year that pushed some of those projects from 2023 into 2024. We'd like to think that some of the agencies that we've been working with are maybe now caught up, and we obviously have our techniques of driving and accelerating the opening as much as we can. And our projects today, fortunately, are now further along in the process in a way where we have more visibility. Once we break ground, we feel like we have more visibility. So some of those early delays were the reason for that. And then I like the second part of your first question around -- there are more -- it was 3 questions. But around, do we have more of the downside, the upside? We talk a lot about that as a team because the opportunity is significant, and we do believe and hope that we will beat some of the numbers that we shared today because of how significant we believe the opportunity is. It's there for us to execute on.

Yes. On the differential pricing question, which is very fair. I would say that it's early there as well. But I firmly believe it's not a question of if but when. I just increasingly think like all of the history in health care and all of the trends would suggest that we are eventually going to have to compete on the quality of our health outcomes. And I just -- we may not have to contract on that right now. We're getting very good rate increases today. But I just think there is a point in time, I'm not sure exactly how far it is, I can tell you we're going to be ready for it when we're able to put our clinical outcomes out in front of a payer or a JV partner and we really want to compete by having the single best outcomes in the industry. And so that's going to take investment, certainly, in technology in terms of tracking our data. They're just going to require investment in analytics. These are some of the things that were in the technology bucket that David referenced. But we have to position the company for that eventuality. And it's coming sooner versus later, I think.

And that concludes the Q&A panel. We'll exit the stage and leave it to Chris for some closing remarks.

Thank you.

Thank you, all. Okay. I'm going to wrap this up really quick, and I just want to thank so many of you for not only being here in person at Carnegie Hall, but all of the folks that are dialing in on the webcast, I know we've had a really significant turnout. This is a big commitment of your time, and we recognize that and just really appreciate it. First Investor Day that we've had in 11 years as a public company, such an opportunity for us to tell our story, our excitement about the industry growth, but also hopefully, you can see our confidence in the future, the depth of our service lines, the strength of the operators that we have today and that our commitment to continuing to grow going forward. And I would just go all the way back to where we started, this is a pivotal time in behavioral health given the record demand that you're seeing across the board. And I think it's a defining moment for our industry. I think we're a company that wants to meet that moment. And I think we are highly positioned to do it. We're going to make the investments to make that happen. I think we have the talent to pull it off. And we have a very strong balance sheet, obviously, to execute from in a very tough economy, which I think is also a real differentiator for us. So we're excited about the future. I think the last thing I would say is it all comes down to the quality of our care. I was at Timberline Knolls, our specialty facility just outside of Chicago a few months ago to see a teenager who has a significant eating disorder, like reunited with parents is -- it's just so compelling to see those families reunited. I mean the quality of the care that we're able to provide, I just think it's going to set the company up for real success. So I'm just -- I'm so grateful for our 22,000 employees and just the quality of care that we're providing every day. We've got to get them the tools from a technology standpoint to provide better care. It's just way overdue. And so we're committed to that. We're going to make it happen. But as I said in the video, I truly believe that our best days are ahead of us. We have so many tailwinds as a company, and we're just excited about the days ahead and so much appreciate each of you and your just support of the company. So thank you for being here. We're going to have a great lunch from here. I think Gretchen or someone will give the details on how the lunch will work. But thank you all, again.