agilon health, inc. (AGL) Earnings Call Transcript & Summary

All right, good afternoon, everyone. Welcome to the agilon session. I am Bob Jones. I cover health care services here at Goldman. I'm joined by my colleague Jack Rogoff, really excited to have agilon with us today. Joining us from the company, we have CEO Steve Sell; CFO Tim Bensley; and Matt Gillmor, who heads up the IR effort at agilon. So obviously, the format, we want to keep it pretty conversational, folks, but I thought, Steve, maybe to kick things off, just given the recency of the IPO, we thought it could be helpful for you to give just a quick pitch on the business model and maybe specifically help us understand how you see agilon fitting in to this evolving world of clinical practice focused companies.

Yes, sure. Thanks, Bob, and thanks for having us this afternoon. So at agilon, our focus is on really enabling primary care doctors to be the agent for transforming health care in the communities they serve. And I think we do it in a really unique way by partnering with leading independent physician groups, people who've been in their communities for decades. And we enter into exclusive long-term joint venture agreements that focus on their senior patients, so we're in that over 65 markets in Medicare Advantage and most recently in terms of direct contracting. And as part of this kind of unique approach, our partnership that we operate side by side with these groups moves existing patients, doctors and health plans from a fee-for-service arrangement into a long-term value-based subscription model. And it has incredible alignment in terms of outcomes from a cost, quality and experience perspective. And we're really focused on giving these doctors the information, the resources and they -- the time they need to really meaningfully improve their patients' health. And when they do that, there's great alignment with their own personal economics and the practice economics, along with improving patient outcomes. I guess the last thing I would add before we kind of dive in is I think what's really unique is we have a purpose-built platform that was really enabled to focus on that over 65 market and focus on full risk care. That's really all we do. We think we do it extremely well, and the results in the business have really shown that. So the company is just under 5 years old. We're in 17 diverse geographies, 11 of which are live and 6 of which in implementation for 2022. And we have nearly 275,000 senior patients on the platform, so it's been a rocket ship ride. And we're excited about our momentum and what's ahead.

That's great. Yes, I guess, maybe just to follow on there: I mean I think obviously one of the key drivers or the keys to continuing to drive the momentum that you've seen is finding those anchor partners, as you mentioned. You mentioned having 17 kind of already partnered with. How would you describe the pipeline of future anchor partners? It's probably the -- one of the biggest questions that we got during the investor education period of the IPO, so just curious on how you describe the pipeline. And then any differences that you'd flag within the pipeline of potential anchor clients as it relates to geography or size or familiarity with taking risk? Just a better sense of the pipeline, and it'd be really helpful.

Yes. Well, I think the forward visibility in our model is one of the real differentiators. We have 6 groups that we're bringing online for January of 2022, and 49,000 patients. And those groups have been in implementation since the beginning of this year and were signed up at the end of last year. [ You're really ] asking about the class of 2023 in that pipeline, and our business development team has been doing an incredible job around that. I think we're going to have a really robust class of '23. They're going to match up with the criteria of our first 17; and just to remind you, independent community-based groups, leaders in their community at sufficient scale, really well governed, a commitment to transparency both in terms of kind of performance across the practice and shared economics and a real strong interest in terms of the move to value. And so I would say we've got -- we identified 160 groups like that, that match up going forward with that. That number has grown as we've done more work on that and other people have reached out to us, and our team is doing a great job qualifying that, so we're going to have a very strong class. Where we'll go from here is we will sign up letters of intent in the second half of this year. We'll immediately or as quickly as possible move them into implementation. And then we'll announce that class as one class on our Q1 call in May of next year, as opposed to sort of talking about them one at a time, but last thing I would say is that, these conversations, there is just an awful lot of interest. And some of the folks that we'll bring live in the class of '23 were folks that we were talking to a year ago. And we mutually sort of said, "Hey. Let's take another year. Let's get this community to the right place in terms of moving that entire community risk," because it's not just the group or the doctors. There's multiple health plans that need to make that move. And some of the folks we're talking to right now will end up in the class of '24, so there is tremendous forward visibility. I think there' is an awful lot of strength that's there, and our biz dev team is doing a great job.

That's super helpful. I think kind of what lends itself to that growth and -- the fact that the anchor partners are in fact in high demand from agilon model and obviously others'. As we think about the competitive landscape, Steve, I guess, a, help -- can you help investors think about just how competitive it is? I think there's a view coming out of the IPO process and others that have come to market recently and again your large competitors also kind of chasing after this end market, that it's a highly competitive market. Could you just maybe help us understand a little bit where you see agilon fitting in relative to some of those other models that are out there?

Sure. I mean I think you have clinic models out there that are building clinics and recruiting doctors and patients. I think you have people that are providing technology and services that help these groups make the move to value. There's obviously health plans in the over 65 space that effectively could become a partner of agilon because we partner with multiple payers in a community. I think what's really distinctive, Bob, [ and ] what we hear is just the nature of this partnership model. I mean we truly jointly operate this as a business 50-50 co-located with these groups. We are removing the friction that's going to prevent them from making that move. So we bring all the capital, the technology, the people, so we're making those investments. We're taking all of the downside risk so they can move into this comfortably. And then we're sharing in a very transparent way 50-50 on the upside, and we're discussing it every day. And every quarter, we're in these governance and Board meetings. We're talking about how we can get better. And so I think, from the group perspective, our groups are the best sources of referral and the best [ closers ]. Having a doctor talk to another doctor about why did their group made this decision, as this other group is thinking about that, there's just no better way to grow your business. And it's compelling, so I think that's what really differentiates. And then once you're in these communities -- you've seen us grow in sort of our hub-and-spoke approach, where you land in a certain city within a state, Columbus in Ohio as an example. And now we're in 5 cities within Ohio. And we have 4 other states where we've executed that same approach. In many of those cases, our partner introduce us to new groups that weren't originally in our business development pipeline. So our team does an exceptional job, but having the strength of these partners, it's just a great combination.

That makes sense.

Great. I wanted to ask relating to your 2021 revenue guidance. Based on the membership guidance you provided and the PMPMs we saw in 1Q, unless PMPMs decline meaningfully in the back half, it seems like the math leads to you getting above your guidance for revenue, so I guess, broadly speaking, is this just conservatism? And what factors might drive PMPMs lower in the back half relative to 1Q going forward?

Yes. No, thanks, Jack. I'll probably just take that one real quick. First of all, yes, I think, as a public company, we have some level of conservatism obviously into everything that we talk about, but generally speaking, you would expect to see revenue PMPMs decline as you move through the year, a couple of things driving that. One is obviously patients move off the platform or expire during the year. They tend to be the higher-revenue, "higher burden of illness," so higher-revenue PMPM patients. And as we move through the year and that -- of course, we're growing patients. The patients that are coming on tend to be younger, lower BOI, lower revenue PMPM, so sort of as we move through the year, we do expect to see revenue PMPM move down. That's happened to us historically. It's a normal seasonalization. I think it's probably pretty similar for other companies that are generally in this space as well, but yes, we would expect revenue PMPM to move down versus Q1 as we move through the next 3 quarters.

That's very helpful and makes a lot of sense. And separately, can you help us more tangibly understand what contributes to the same-store primary care physician additions to your base? Where do these doctors come from? And what do the mechanics look like when you're adding a doctor from a financial perspective?

Sure. So we think our same-geography growth is a big differentiator. In our first quarter, we reported 15% in terms of year-over-year growth same geography. And just real quickly: There's organic and then there's adding physicians. Organic is kind of bread and butter, people turning age 65 choosing Medicare Advantage or patients that are on Medicare fee for service who choose Medicare Advantage. And we do very well on that, but once we're in a community and we've implemented a partnership and a platform and created this vehicle for risk, what we find is a number of other physicians decide to join in. And those physicians come in a variety of ways. So we have people coming out of residency programs. We have smaller groups, 1, 2, 3, that are deciding to join into our anchor partner. We have larger groups that decide to come in. We also have the opportunity for acquisitions. We were very intentional in the language we used in our Q1 call that said effectively, through agilon, our medical group partners are now some of the best-capitalized physician groups in the country. And so they have the ability to use that capital in a really smart way to accelerate that process that I talked about. And so I think it comes, Jack, in a variety of ways that groups come in. Our groups know their geographies incredibly well. It's another strength. They're leaders in their community. They're really well respected. We bring a business development team that works with them and does that on a regular basis, so they can introduce to the group. They can get comfortable with that group. We can help structure that for them, but ultimately it's their choice, right, about these groups coming in to join their practice and it being a good fit. But back to that partnership, just like everything we do, it works very well in terms of adding physicians in these communities.

Very helpful. And I guess, just off of that: You talk about the 15% growth year-over-year in the same geographies that you're seeing in 2021. I guess, is there anything unique to 2021? Obviously that level is well above what the national MA population is growing at, so how do you achieve that level of growth above the national trend? And what -- how can you sustain that in future years, right? Like how can you grow faster than the national rate of MA population?

Well, I think we've pretty consistently grown faster than the national average. And it's really a composite of the local averages, right? We have some markets growing at 4%, some markets growing at 20%, but then we want to grow over and above that. The organic growth I talked about typically has us at or above that local average, and then the physician adds take us well above that. I think that there is opportunity in both of those, but in particular, adding physicians on the platform is an area of tremendous opportunity in which we think there's upside for us. As Tim said, we're new public company. We're going to be kind of cautious as we talk about this, but tremendous opportunity there.

Very helpful. And then, I guess, like taking a step back around this theme, I believe you have a 25% long-term -- or medium-term membership growth target or something in that order of magnitude of 40,000 members annually from new markets. I guess, can you talk about how you arrived at this target? Recently we've seen Oak Street Health accelerate their growth trajectory. And you have a sizable amount of capital that you just raised. I guess, is there an opportunity to accelerate the pace of new partner additions over the medium term?

Yes. I mean just to level set on that: I mean we grew 50% last year. We grew 42% in Q1. I think the analyst consensus out there has 37% for '22 and, I think, 32% for the following year. So I think that's sort of those data points that are out there, but I think it's a combination of what Bob asked about at the beginning, that new geography pipeline and increasing interest within that. But I think the real outsized lever is in the same-geography growth and so the ability to grow that up into the teens and beyond. So those are the areas that I think can really drive that. The capital really helps to accelerate. I think we believe our TAM is broadening in terms of new geographies that we can serve. And so all of those things, I think, lead to that.

Great. Steve, just to go back to something we touched on earlier around direct contracting; a lot of focus across the industry, across Medicare and MA participants; and different ways of thinking about [ driving ] direct contracting program. Could you maybe just give us your view on how you see this opportunity, how you'd frame this opportunity for agilon and your partners specifically? And what's the approach here in helping some of your partners think about participation in this program?

In terms of direct contracting, Bob...

Direct contracting, yes.

Yes, okay. So from a strategic standpoint, we think direct contracting fits just incredibly well with this idea of having the primary care physician as the quarterback in managing total care. And primary -- direct contracting new government program went live on April 1. It takes patients that were in Medicare fee for service and moves them into a globally capitated full-risk relationship, similar to how we contract with the health plans today on Medicare Advantage. We -- regardless of whether the patients come in through direct contracting or coming through Medicare Advantage from a health plan, they're going to have the exact same experience. So we have that consistent experience for the patient, the physician and the office staff, and that produces really great outcomes. They don't have to worry about different incentive programs, different quality programs. We're able to deliver 90-plus percent of seniors [ and ] 4- and 5-star plans and Net Promoter Scores in the 80s because of that consistency. And the more concentration you get in an office, the better. So MA might be 15% fee for service, maybe. And direct contracting could be another 15% of the patients, but in terms of visit volume and time, it could move you to over 50%. And so that leads to really powerful outcomes. And so from a cost perspective, from a quality perspective, from an experience perspective, we can meaningfully drive improvements within direct contracting as we have within MA. Having said that, it's a brand-new government program, and so our take on it is to be cautious. Tim can talk about kind of how we're treating this from a financials perspective, but we're not consolidating revenue. We have modest expectations from an income perspective within 2021. And it's a program that will evolve, as all new government programs do over time. And we've spent time with the innovation center talking to them about ways maybe from a visibility and a stability standpoint that they could improve the program. I think we're encouraged that they talk about it as a -- an important part of their portfolio of programs, to move to primary care-centric value-based care. Now it's just how can you do things to improve it. And they obviously have paused the second class for 2022 coming [ online ], but they have said to folks like us who have approved direct contracting entities that you can add in other participants underneath those direct contracting entities. And we have not announced what we're doing for 2022 as of yet, Bob, but we think it's a meaningful program. And it aligns for all the reasons I talked about. It's just it's new, and therefore we're going to be cautious about it. So Tim, just...

[ Yes. I was going to say ], Tim, it might be -- maybe it would be helpful, Tim, if you could maybe at a high level even break down kind of what do the economics look like if you have a new partner and they have a Medicare patient or a Medicare population and you have the option of trying to push them towards MA versus push them towards participation in the direct contracting program. How different would the economics look for both your partner and for agilon?

Yes. So -- and that's not exactly [ what we're about ], of course. So we're in these partnerships with MA and now we're attacking -- we're bringing direct contracting into it. So each of these partners that have -- that are in our direct contracting entities, we're already partners with them on the MA side, so it's more a matter of what Steve said. There's an opportunity for us to bring those direct contracting lives onto the platform, impact them with the same elements of the platform that we do MA and essentially increase the surplus that we're generating through direct contracting for what were previously those fee-for-service members. We do think that the economics for direct contracting are going to be probably not quite as strong as they are on the MA side. We're more capped on the risk adjustment side. We think the models are going to be very effective in terms of driving costs in the direct contracting side because again it's the same model. It's the same physicians coming into the same office. We're just basically bringing this new group of Medicare lives onto the program. So all of that should be positive in that the model should positively -- have a positive impact on the surplus that we're generating, but I think, the economics, we anticipate that they'll not quite be as strong as on the MA side. I think one of the other things, as Steve mentioned, though, is we see direct contracting as kind of a way station to MA. So we'll still see members that are coming into the DCE in future years, during annual enrollment cycles, et cetera, select to still move on to the MA program. So we'll still -- we still expect that, that will happen going forward as well.

Is that also true, Tim, for the actual provider? Is it -- for the provider, is it generally more economically advantageous to participate in MA? Or...

[ It is, yes ], because if it -- for the provider, meaning the physicians, is...

The physicians...

Yes, yes. It's we're in a 50-50 -- we're in a surplus-sharing mode, so if we're going to generate more absolute surplus in an MA program, it's advantageous to get people into the MA program. Obviously it's also advantageous to just get fee-for-service members, Medicare fee for service, on to the DCE program as a first step. And that's what these DCEs are doing, and actually increase the surplus that we're generating and therefore what's flowing through to both agilon as well as the physicians or [ provider physicians ] for DCE as well, but yes, there is -- everyone is incented to -- just because of the makeup of the program, I think everyone is incented ultimately to say, yes, people are going to convert to MA. "That's still a positive thing for us going forward." And I think both agilon and our partners look at DCE as a great opportunity to get these folks on to the platform Steve was talking about, but there's still an opportunity going forward. [ That would just be ] a way station in movement to MA.

No, that makes a ton of sense. Maybe just to go on to use of proceeds, Steve. I know we touched on this a little bit, as far as like, obviously, the ability to go faster now that you have more on the balance sheet to do so, but could you maybe talk about some of the other areas as you think about use of proceeds from the IPO?

Yes, sure. No, happy to do that. So I -- we're going to invest in our platform in a really meaningful way. Our platform has done an incredible job for us getting us to 11 live communities and delivering kind of the improvements in cost, quality experience that we've talked about, but we're going to do 100-plus communities. And so we need to have a technology platform that's really going to enable us to scale, and that means a few things, right? We've taken an incredible amount of data today. We've gone from 9 to now 16 health plan relationships. Every time we go in, there's different EMRs that we're integrating with, so the data growth has been logarithmic. And our job is to provide that in a clean and actionable way to the primary care physician, where they can have really kind of a scaled total care model type of relationship with their patients. And so what does that mean? We have to focus on things like data ingestion and normalization and provisioning. We want to focus on getting speed to value in terms of clinical insights. So on the Q1 call, Bob, as an example, we talked about this clinical referral insight program for specialty care in Akron. Cardiology is the first one that we've rolled out there. And the ability to move from 37% to 60% the referrals to top-tier cardiologists. And we talked about, for equivalent or better quality, you can save $100 per member per month for those cardiology patients who, by definition, are going to be with their cardiologists for a while. That comes from providing really clean and actionable data, working with your partner to get them comfortable around that. And then the primary care doctor has that ability to really meaningfully move where that care is occurring. And all of that comes from our technology investments. I mean, if -- from a -- specifics around technology, we're going to have a new data lake that's going to really allow us to bring in data and use it in a meaningful way. And we'd like to have a data lake that's as clear and transparent as Lake Tahoe where you can see down 100 feet. You have the ability to add in a lot of other data. We're going to be relying much more on open source. We're going to be using artificial intelligence and machine learning to provide those precision insights to that primary care doctor. So that's kind of the road map of what we're working on, but it's really about putting that primary care doctor in that quarterback role for what happens in the office; and then being able to connect that cardiologist; and the example I talked about, being able to connect folks who are in the hospital, [ hospitalists ] as part of our program or people doing ER diversion; and closing that loop back so that a primary care physician continues to be able to monitor that for a senior who, by definition, the complexity of their care goes up as time goes by.

Just to build off that. You're talking a little bit about the care pathways that you drive medical costs down with. Is there anything you could do to make that a little bit more tangible, I guess? Does it end with a referral to a higher-quality doctor that you have a relationship with? Or is there more integration beyond that? And I guess, is there any sort of financial relationship with these downstream specialists like the cardiologist that you described?

Well, so a couple of things. One is we work with multi-specialty players, to begin with, right? So in some cases, that cardiologist in that example is part of the group. What we look for is really kind of a lead specialist who helps us to kind of oversee that and is a core part of that, but the other thing about [ channeling ] volume is that it's easier to have connectivity with those groups from a platform perspective and then to close the loop back. And you can really refine, Jack, that care pathway over time. And it's not just cardiology, right? I mean oncology, GI. You can kind of go down the list of the areas that you can work that with, but the platform is really about connecting it and creating that information that allows sort of the most impactful visit and getting people to the right place.

Right. No, that makes a lot of sense. I guess, is there ever an intention to do more physically, whether it's in the home, maybe using technology in remote patient monitoring or using a specialty care management vendor?

Absolutely. So we do that today in some of our geographies. If you think about -- we've got year 0, 1, 2, 3, 4 now because we're just under 5 years, as I said. And so some of the things we're doing in the year 4 and even 3 markets that we'll be accelerating down in 2 and 1s include having home health teams that go in, having nurses, having social workers that are providing that, all right; use of telehealth, palliative as a really meaningful program. So I think that all of those big cost areas that are -- occur in senior health and the transitions which are really the critical piece in terms of where decisions are made that impact the quality and experience and the costs of that, those are the areas that we're spending time with, Jack. And the fact that we've got sort of the total care dollar and management responsibility gives us the opportunity to do that. And the fact that we've got a network in 17 communities makes it really attractive. And we can pilot it in 3. And then our peer-to-peer, our doctors talk to our other physician partners about what that might look like in their communities. Again this is not agilon sort of forcing it, but it's the learning that goes on in this network and the portability from one community to another. It's just a real strength.

Good. It makes a lot of sense. Shifting gears a little bit, I wanted to ask on medical margins. For 2021, there are a few factors that are affecting medical margin percentages in your outlook and maybe driving EBITDA dollars lower in 2021 versus 2020. I was hoping you could provide a little bit of a breakdown on what those factors are and how that's impacting the medical margin percentage this year.

Yes, absolutely. And I think you can get a pretty good indication of the size of the magnitude of these things obviously from the guidance that we provided of like $38 million to $41 million EBITDA loss for the full year, with each progressive quarter in the year being a bit lower than Q1 where we actually had a positive $4 million of EBITDA, but most of that loss happening in the second half. Most of that is going to be driven by the medical margin progression. We can talk about that in a second. I did just want to say upfront that there is a little bit of that that's being caused by the increase in platform G&A costs that we're experiencing because of just the costs of being a public company. I mean we mentioned a few things like [ one of the biggest drivers was ] just the increased costs of directors and officers, insurance, for instance, but the biggest driver is definitely going to be progression of medical margin as we move through the year. And we do expect, even as we're moving through Q2 now, to start seeing some migration back towards sort of a more normalized baseline of utilization, with 2019 kind of being the definition of a baseline. And so we'll start to see that happen a bit in Q2. And then by the time we get to Q3 and Q4, we would expect that we're -- utilization generally is kind of normalizing back to that 2019 baseline. We may even have [ some period where it's ] a little above it as you see some utilization, pent-up demand for utilization kind of coming back into the system. And then the kind of seasonality of that, you can get an impression from the guidance we've given on overall. And of course, that's going to be overlapping significantly lower utilization last year. So those things combined will bring our EBITDA number into that kind of guided range, with the bulk of that downside, of course, happening in the second half.

No, that makes a ton of sense. I guess, what are you seeing real time? I know we've heard 2 factors, right? There's the pent-up demand, where volumes come back to normal. And then there's some have talked about higher acuity because people weren't interacting with the health care system as they normally would last year. So on that second piece, on that acuity of the population, have you seen evidence of that? Or is it more an expectation of what we're going to see more in the back half of the year?

Yes. No, it's funny you ask that because we were just kind of going through this over the last -- late last week, over the last couple days, looking at the data coming in. And I would say at this point obviously there's still a year in front of us, but at this point we're not seeing an increase in acuity, meaning that people weren't going to the doctor and therefore they're getting sicker. I guess it's kind of what you're -- so we're not seeing that right now. We did see, of course, a pickup in COVID-related utilization kind of late last year and early this year. That's dissipated quite a bit already as well. I'm [ not a bit ] surprised when you think about the vaccination rate. It's pretty high among seniors. And that's our population, so you would expect that COVID-related illness would kind of start to drop off. We definitely saw that as we moved through Q1. So we really think that the primary driver is not going to be increased acuity because they come in through COVID as much as it's going to be just a return to normal utilization; and maybe a little bit of [ some blip, some pent-up ] demand from just people waiting for things that needed to get done and procedures that needed to get done that they put off during the COVID time period.

Very helpful. That makes sense. A little bit more topical: We saw the Alzheimer's approval yesterday. We have been getting a number of questions from investors around how that might impact medical costs in 2021 and beyond. Curious if you could describe how -- one of your patients being prescribed this therapy, how that might impact your P&L given your contract structures. I know there's some debate around whether MA plans will be on the hook through these costs this year or if it might shift to Medicare fee for service, but overall do you think this development of the approval could impact your guidance in a negative way? And just generally how the prescription of aducanumab might impact your P&L.

Yes. I mean it -- to your point, it's pretty early, but I think our take is it's pretty manageable, Jack; that as you said, it's just been approved. We go through a process every year to sort of factor into budgeting kind of new drugs coming out. I would say this is a big one and kind of a breakthrough on that. We don't know if it's going to be Part B as in boy or Part D as in dog. Just to give you perspective: About half of our contracts, we do not have risk for Part D risk on that. It's -- kind of varies from health plan to health plan in terms of how they approach that. And then just this national coverage decision and when that will come, assuming there's a lag between now and then. And health plans will be sort of looking at it and doing that [indiscernible] criteria. We have 16 that we work with right now, and -- but I think our take is that it's manageable. It's not the first time kind of going through that. So that's -- that will be my comment.

It's -- in the time we have left, Steve, I was hoping maybe we can think about the future a little bit more. And we got this question quite a bit as people learn the agilon model. I think the obvious place where the model gains traction and sees success is clearly with MA. I think direct contracting, for all the reasons you highlighted earlier, makes a ton of sense, but clearly your partners have many other payer markets that they're participating in, commercial probably not the least of which. Can you talk about what needs to transpire for agilon to really kind of replicate the value approach across the other payer end markets that your partners are participating in?

Sure. So I -- let me start by saying I think one of our great keys to success, Bob, has been this exclusive focus on over 65 and the exclusive focus on the move to full risk value and a purpose-built platform for that. And we do incredibly well around that for those reasons, but having said that, the commercial business that our partners have is incredibly important to our joint venture today, right? If you think about the feeder of lives that come in every year with people turning age 65 and choosing MA, that comes from their commercial relationships. They're able to keep that relationship and move into senior care, so that's a very big part of it. The second thing is -- I would say is our ability to impact costs downstream, some of the things that Jack was asking about, is really amplified by virtue of the share of the adult market that our partners have. It can be 15%, 20%, 25% within a market, which means when they make a call to a specialist about a program we're trying to do, people will take that call and be very responsive because they're such a meaningful part of it. So the commercial business today is super important. Three is the programs that we're implementing like the cardiology program that I talked about. That gets utilized for cardiac patients that are 55 and 60 as well as for those that are over 65, so getting all of that benefit today. So those are kind of the things that I would say really leverage that commercial business in a really super meaningful way. And our partners today do really well within that commercial business in a fee-for-service relationship with them today, so it's not as much of a sort of a today topic, but down the line, we can talk about that. But I think, today, we just are so focused on that over 65, and it's super impactful.

Yes. No, it makes a ton of sense. And obviously you can see it in the results, so far. And definitely we look forward to watching the company progress from here. That's about all the time we have for this session, but definitely wanted to thank Steve, Tim and Matt for being here, really appreciate it. And thanks for everybody who was on the webcast. I hope everybody enjoys the rest of the conference.

Thanks, Bob. Thanks, Jack. I appreciate it.

Thanks, Bob. Thanks [ for taking the time here ].

Thanks, guys.