Alignment Healthcare, Inc. (ALHC) Earnings Call Transcript & Summary

Good afternoon, and thank you for joining us here at the Credit Suisse Healthcare Conference. I'm Jonathan Yong and will be moderating today's fireside chat. Today, we are pleased to have Alignment Healthcare, a tech-enabled health insurer, focused on Medicare Advantage. From the company, we have John Kao, Founder and CEO of Alignment; and Thomas Freeman, Chief Financial Officer. Again, this will be a fireside chat, and you can e-mail questions to me at [email protected], which should also be on your screen as well. So with that, welcome, John and Thomas.

Hi, Jonathan.

So for those who are less familiar with Alignment Healthcare, it may be worth having you take a few moments to speak about the company, what makes Alignment different from other MA entities in the marketplace and just a recap of your third quarter earnings, which were reported last week.

Perfect. First of all, thanks for having us Jonathan. I think the way to describe Alignment Healthcare is that it's different than a tech-enabled Medicare Advantage health plan. We really like to think of ourselves as a Payvider, meaning that we have all the competencies really of a Medicare Advantage health plan, but we also have the culture and the Care Delivery capability to serve seniors needs. And specifically, the best way to describe our operating model is through what's -- what we refer to as our virtuous cycle, which is our version of a flywheel, which is really to identify who of our membership is in that 10% to 20% of the population that account for 70% to 80% of the spend in health care. And we think those individuals are the most vulnerable. We think they're the polychronic, they're the frail. And then when we deliver Care Delivery, both virtually and at the home for that population. And so we do that in concert with our provider community primary care doctors as partners. And that model has allowed us to bend the cost curve consistently. Now by betting the cost curve consistently, we can reinvest the savings into richer benefits and better coverages, more supplemental benefits and do so in a way that maintains high quality in terms of STAR ratings and Net Promoter Scores. So that virtuous cycle, do the right thing, bend the cost curve, take care of those individuals that need it the most, reinvest savings in richer benefits and then take care of the members that you have is what differentiates us. And so at the core of it is technology, but we think that technology plus a very proprietary care model, plus the ability to create innovative products, that's the recipe for success. And then Thomas, do you want to take the Q3 update?

Yes. Sure. So great to get everyone today. And I'll be brief on the Q3 results. But the third quarter of the year was also the third quarter of our public company life. And so we reported strong results across the board. We typically focus both investors and analysts on 4 key metrics, which are: our health plan membership, our total revenue, our adjusted gross profit and our adjusted EBITDA. So for the third quarter in a row, we exceeded both the high end of our external guidance as well as analyst consensus across all 4 key metrics. I think the one in particular, we're proud of is not just the continued top line growth, but also just some of the data points around kind of improving profitability and really efficacy of that clinical and operational model, John was describing. So in the third quarter, our MBR, our medical benefit ratio, was 85.7%. We obviously are particularly proud of that given some of the -- I think, just kind of general noise and a little bit of confusion across the market and some of the COVID concerns heading into the third quarter. And EBITDA for the quarter was a loss of just $5 million. So we're really proud of sort of the kind of balanced notion of growth and marching towards profitability as opposed to kind of overly emphasizing one versus the other. So another good quarter, and we're excited for the rest of the year outlook.

Okay. Great. Kind of -- I know you talked about you're more of a Payvider, it's not necessarily all about the technology, but I do want to ask a question on the technology. So you have a tech platform AVA. Can you talk about what makes it different from the technology of some of your peers and how it interacts with your provider partners?

Yes, of course. I would say one distinction is it's not a point solution. It really is an enterprise-wide core system that touches all parts of our company and provides the ingestion of data with limited latency. And so what I mean by that is we ingest lab data real time, pharmacy data real time, encounter data real time, hospital emissions discharge and transfer data real time. We get this information. It feeds into AVA. It gets cleanse and we make decisions that are actionable based on this information. I think that's different than some of our peers or certainly some of the legacy folks out there, where there's typically a 30- to 45-day data latency because you get a lot of back-end claims information. That information needs to get reconciled, needs to get cleanse and scrubbed and then it's pushed down to the globally capped providers. That's a 30- to 45-day kind of latency problem. We don't have that. So that's the first thing I would say. Second thing I would say is it's built around and for Medicare Advantage, meaning we know what the key value drivers of the company are in Medicare manage, both on the revenue side and on the cost side. And so every part of the system creates centralized sources of truth. So we have consistent data, core information that is used throughout the entire company. And so we know exactly -- we have -- we know how to influence kind of compliant risk adjustment. We know how to close gaps with STARS. We know how to use the data to build our products through our bid processes. Of course, all of it starts with being able to have high quality at low cost. The low cost is -- and making sure, again, that you know who that 10% to 20% of the chronic frail are and provide outstanding care as if they're your mom or your dad to those members and you just take care of them, take care of them at the home that reduces overall hospitalizations. The hospitalizations, we do have -- we do have them. We're partnered with hospital systems to get a lot of that volume. And so the whole system is designed to be aligning for everybody. And I think the main thing is once you have this data, you have to organize the data into actionable information. And then that actual information is both used internally by our clinical and operating people as well as externally with our provider partners. And so we work with them, helping them close gaps on HEDIS, CAPS, STARS, risk adjustment. And then we partner with them also on the utilization side. And that part really is we're saying to the primary care communities and the IPA and Medical Group partners, we're not trying to add another brick in your backpack. We'll do a lot of the lifting. We are a team to support you and your primary care physicians. And it's a team-based approach that supports you for basically no incremental cost to you. And that's a recipe for success.

And kind of building on that, you talked about the live data and being able to make decisions faster, get to the patient faster, intervene if they need, help versus the legacy of waiting for a claims to come in before you take an action. What allows you to kind of get that data so much faster than the legacy players? Is it your you plugged in directly with your partners? Or kind of how does that work?

Yes, direct interfaces into the lab vendors, their PBM and the hospitals. And I'd say we have about -- we have last count, over 1,000 interfaces with hospitals and institutions. We have live feeds from the big lab vendors. Our PBM, we have live feeds. And it's not to say claims data is not useful because it is useful for administrative functions, closing some of the STARS and RAF gaps, I think, are important. You use that kind of information. But by definition, claims data is 30 to 60 days old definitionally. So what you want is you want much more current information to be able to make clinical decisions. And then organize it in a way that you can push it to your clinical teams and push it to your provider partners to take action. And that's -- the transparency of the data is what's allowed us to be successful.

Okay. Great. So as you kind of think more forward-looking on your tech platform, are there any areas where you think there could be improvement? And then are there other areas where you think there needs to be a little bit more investment in your perspective overall?

Yes, absolutely. I mean we're -- we made significant investments this year in the AVA platform with respect to our inpatient admission prediction model, which is really our first foray into machine learning. And I'm amazed actually what the team has done with respect to the accuracy, the precision and the recall associated with that investment. We reported in the Q3 call that we think that 50% of the -- our members that were hospitalized were predicted. I mean, that's like amazing. So that investment is starting to pay off. And we had recall increase from 30% just a couple of years ago to 50% right now. We also made investments in what we refer to as a patient panel management system, which is really a workflow tool that helps our case managers be more efficient, managing the individuals that we've identified to be in that 10% of the chronic frail and make sure that we're caring for them in an organized manner, and that's going to help us scale more. We made investments in virtual care and we had to. We started that really with COVID in the second quarter of 2020, and its paid off. And so we're interacting with our members virtually and training them to use technology. And still, I'm proud to say 60% of our interactions are still virtual with our members. So that's -- so we're leveraging that without any declination in kind of engagement with our members. So I think we're going to continue to invest in what we refer to as care navigation, which is essentially a member experience workflow. We're going to invest in more consumer-facing front-end self-service applications. And as we get more and more of this back-end automated and our ability to kind of get MBR lower and lower and lower, I think we're going to look forward, like, okay, if you can get very aggressive MBRs, if you can translate that into very aggressive products, and so the next evolution of that is putting that into the hands of the consumers. And while that might not be entirely adaptable right now, I think in the next 3 to 5 years, people that are aging in the becoming seniors are going to be much more tech savvy and expect and demand that kind of capability. And so I think that you're going to see us invest in that. And then also, you're going to see us invest in kind of the buzzword these days is whole health, and we've been talking about that for a long time in terms of having supplemental benefits that are going to be incorporated in some of the coverages and benefits, and that's going to be more and more important to kind of serve the entire senior. And you're going to see more kind of investments in that with more choices, more selection, more personalization, if you will. Those are all the things we're thinking about making investments in AVA.

Great. So kind of given all that, one of the questions that always comes up with any successful technology that a company is developing is can you monetize this in the future? Kind of what's your view on that? How do you think about that?

No, that's a great question, Jonathan. We -- a lot of our management team has experienced in a former company that we were part of, called TriZetto, which is a software and services business. So we know how to do that. I would say it's a very different business. And I think the word for us is focus and discipline. And so we're focusing on being our own best referenceable client right now. Once we get to a certain scale, and we've got pretty much -- and right now, we've got whatever it was, 18 out of 18 our markets working. I want that to be 30 out of 30 or 38 out of 38 markets functioning and working and then 50. Once we get to kind of that range and all of this is functioning and working where we have the workflow processes, very tight. Our applications are very tight. Our management systems are very tight. Once all that's kind of in place and we get to a certain size, it's a lot bigger than we are now. Then I think we will contemplate kind of monetizing, as you say, the software and the services. But there's no better thing than to be your own best referenceable account, where you can then productize your learnings and then help others achieve that. And so that's clearly option value. We're thinking about that. But I don't want to distract the company just right now. We want to focus. We want to execute. We want to just do what we've done in the past, which is when we do that, you'll see that we'll have proof points to support that and clients to support that. And we're not going to just come out and say, "Gee, we're going to do this." We will then be in a place where we said, we have done it, and we're going to grow it and expand it. That's how I think about that topic.

Okay. Great. That's interesting. So turning to the Medicare Advantage. The company operates in relatively few states compared to some of your peers. How do you think about your approach to what makes a state a good state and whether you will choose to operate in there or not?

Yes. That's a great question. Really, there's 3 kind of -- if you just think of a funnel that serves as a filter. First and foremost is what I think most people do. They look at the pure raw demographics, where are the seniors, first of all, number 1? And number 2, is, what is the rate of Medicare Advantage penetration? And so -- and then what is the typical benchmark rates? And everyone is going to conclude the same kind of -- there's a handful of markets you've got to be in if you want to be taken seriously in Medicare Advantage, Texas, Florida, California, Illinois, New York, I mean just Boston, and we saw all the big MSAs essentially. Now I would say that those states are markets that we will be in. Where in those states is a little bit more nuanced. And so that's where kind of where is the competition and where are the right provider partners that we can work with that have the same philosophy as we do. And I'm happy to say we're having very little kind of pushback at all. People love the model. They want transparency of the data. They want access to AVA. That's really one of our biggest selling points to create partnerships with the delivery systems and the provider groups as we expand. And so the third piece really is we believe we have a kind of sustainable competitive advantage with respect to this virtuous cycle that I just talked about, where we can get our kind of high-quality and low-cost model deployed and like consistently have a better mousetrap in each market. And so if you're going into a market and some of the legacy players have increased market share for Medicare Advantage vis-a-vis fee for service, I think people are going to buy our mousetrap over their's. I mean it's just a better product. And you got to remember the people buying these products are seniors, which are very value-oriented, smart, savvy shoppers that will move typically for a $5 co-pay, let alone a 5% benefit advantage. So we're kind of mining for that information in every single market that we're talking to.

Okay. Great. And then kind of as you think about expanding intrastate to different counties, et cetera. What's your decision point for saying, "Hey, now is the time to expand into other counties?" Is it you hit a certain level of growth? Or what makes you move into a different county?

Great question. This year, for example, in California, we made the strategic decision to expand our provider partnerships and expand our product diversification inside our geographic footprint. So we didn't add additional counties in California, for example, but we added PPO products, and we announced that we did PPO products with just the top tier delivery systems in the state, including Sutter, a couple of years ago; Cedars-Sinai, this year with our PPO product; Hoag Memorial, this year; Scripps Health. These are big branded health systems that we're doing partnerships with that I expect to take a couple of years, I think, for us to really get the growth from those partnerships, but I'm very happy about that. We also announced we're entering the Arizona marketplace both Phoenix and Tucson. But I suspect for 2023, you're going to see us do more intrastate expansions in California. Now what we did also do -- I mean, the strategy is very clear. It's out of the California playbook, which is get the beachhead set up, do contiguous county expansions that we refer to it. So you get a nice broad geographic diversification, build partnerships in each of those geographies with providers and then just grow. And the model has basically been get to EBITDA kind of breakeven by the end of year 3 and get to about 10,000 members in that market by year 5. Now there may be some anomalies. Just for example, our Northern California expansion we just did 2 years ago, and we see 2 years, we got over 10,000 members. And our San Diego expansion we launched last year. And then again, 2 years, we got over 10,000 members. So those anomalies, I think, will exist in positive anomalies, I would say. But we do keep an eye toward our ability to have profitable long-term growth. There's not just growth at all costs. It's profitable long-term growth.

Okay. Great. And then when you do expand into a different state, different county, what resonates most seniors that you're capturing? And then alongside that, what's the competitive response? And then how do you respond to that response?

It's a great question. We enter a new market. We'll work with our global cap partners. We have global cap partners. We'll work with everybody on a global cap basis. But typically, the global cap partner doesn't have the full network adequacy capability. So we enter into, say, a market -- you can't just go with 1 global cap partner. It's not enough. So we have to build the network around and we like that because we're comfortable taking risk. We're comfortable engaging with providers directly, IPAs directly. We're comfortable with all kinds of risk and value-based contracting methodologies depending upon what the provider is comfortable with. They want fee-for-service, we'll pay fee-for-service. And we'll help them with value-based incentives. They want PCP cap or professional cap or kind of professional cap with no downside kind of moving toward global cap, all structures we're comfortable with. And so the key for us and the value proposition that we offer the providers is just moving market share. In other words, the model allows us a high degree of confidence to productize our AVA and our Care Anywhere operations. And we productize into very innovative products that are sold directly to the consumer. And we work with the providers to get their input on it. So we're like aligned with -- everybody's aligned working toward the benefit of the consumer. And so if we can do that consistently and aggressively, it just -- it's always work. It's just always work. It takes a couple of years. You're not going to get it right out of the gate because people -- if you're in the new market, they haven't quite heard of you yet, but you invest in the market and you take care of it and a lot of the grassroots marketing usually takes off. And really, that's what's gotten us the confidence to be able to deploy this across the expansion markets that we're focused on.

Okay. Great. Kind of turning to pricing for 2022 in MA. Can you talk about your thought process on bid development for 2022. Obviously, there's a lot of moving pieces of the COVID, non-COVID utilization. How are you kind of thinking about that? And any early signs in the annual enrollment period so far?

Yes. So we sort of commented from 2 different ends in terms of our 2022 outlook and pricing and forecasting. So the first is, I think, very similar to what you've heard from some of the other large players in terms of taking a very actuarial and quantitative approach to trying to train our pre-COVID data forward in 2022. The challenge with us is we had less than 50,000 lives back in 2019. And given the growth of the overall business in California, as an example, where we have about 83,000 members today. And so given that significant mix shift of members from pre-COVID to today, we really are trying to supplement a lot of those more actuarial-based methodologies with a much more, I would say, operational and really clinically oriented bottoms-up build in terms of how we think the next 12 months may play out. And so what that means for us is going category by category of spend, both utilization assumption and unit cost assumption and taking that input from our local clinical resources that are responsible for the local market care in our local market network resources that are responsible to the local market P&Ls and using that input in order to inform our overall outlook 2022. And so we sort of approach it in a, I'd say, very granular and operational way. We supplement that with a very kind of actuarial methodology. And that's what gives us confidence that when we think about our overall 2020 pricing, we hope to not miss anything, obviously. And so with respect to next year, I think we've taken a very continuously prudent approach on that notion of growth versus profitability. Some have said to us, why don't you guys go pursue 95% or 100% MLRs in order to try to accelerate growth faster, go buy the market. And we've, I think, kind of stayed away from that approach. We think we stay more disciplined with respect to margin. And so I think we feel good about the cost trend in some aspect than the pricing. I think we do have some flexibility for COVID built-in somewhere to how you've heard for others. And with what we know today and what we've seen in the past, as most recent wave of Delta, I think we do feel really comfortable with our sort of pricing that's baked in versus the cost trends that and our ability to manage those expectations next year.

Okay. Great. Just in terms of new products, you're introducing more virtual options, PPO options. Can you talk about the general success of those products? And what's working? What may not be working? And is this -- are these products seniors are clamoring for? Or is this just giving more optionality for the market?

Yes, I can take that one, Jonathan. I'm really excited about the PPO products. I think the value proposition for seniors is huge, particularly relative to a fee-for-service offering that they may be having now with the supplemental insurance gap coverage that they're paying $300 or $400 on each month. They basically can have a PPO with a provider, let's just call it, Cedar-Sinai, which is again, a preeminent Tier 1 health system in Los Angeles County. They can -- there's no gatekeeper. They can kind of work and see whatever provider they want within that delivery system. And it's so kind of comprehensive in terms of their offerings that it's just the value proposition is huge. I think it was a $22 premium, but there's a cash component reward that is $50. So net-net, they're paying $28 -- they get $28 back, and they have no gatekeeper in a PPO model with a tiered -- top-tier delivery system. Honestly, I think there's a little bit -- I mentioned this on the call, I think there's a little bit of -- this is too good to be true, we don't get it. And so we have to do a better job of saying, no, it is true. And it is a great offering and so -- and I say that because we've experienced this in the past where you have such good benefits, people are scratching their heads and go, how are they doing this? And so -- but after a couple of years, 2 enrollment sets usually the thing takes off. So we'll see. I think that's going to be the future of this. And it's priced a little bit differently than HMO nature of products. It's a little bit different sector. On the HMO side, I think we're going to continue to get good receptivity. And -- but -- and then I would say on the third side is, we have communicated DCE is kind of -- so if you think about HMO, PPO and the DCE. I think DCE is still a little bit early for us to make any long-term conclusions. We need another couple of quarters. Just look at the EBITDA profile, look at the gross margin profile, et cetera.

That actually kind of goes into my next question, which was on direct contracting. How has your experience been there so far? And I guess if you were to contrast that to your beginnings in MA kind of how has the experience been? And how do you think about that?

Yes. So from an operational standpoint, we've been really, really pleased with the recent trends. And as a reminder, our philosophy here is we're taking a lot of the things that will be proven effective in Medicare Advantage, and we're trying to apply that same toolkit now to the traditional Medicare population through our JV partners with the local clinicians. And so what that means for us is we're still stratifying members. We're still proactively outreach and engaging them. We're still developing that high-risk, more chronic complex population in that Care Anywhere, Care Delivery model we talked about in the past. So there's a lot of, I'd say, similarities operationally speaking, and we're starting to see some kind of traction with that similar to what we would expect based on our Medicare Advantage ones. I think from a more financial less operational standpoint, it's been, I think, just challenging to give some kind of real transparency and visibility early on is how we're really doing. As we sit here today, I think we have a high degree of visibility now to the second quarter when we initially launched the program. And I think the good news is that it is probably starting in a better place than we originally thought. But having said that, it's still probably slightly north of 100% MLR out of the gate in the second quarter. And so I think with the next quarter or 2, as John said, we'll hopefully be able to see how we're able to improve that financial profile and therefore, what we think the long-term margin opportunity looks like. But our expectation is that even if it's potentially lower gross margin, that actually could still be pretty favorable from an EBITDA standpoint because the SG&A required is so much less significant than Medicare Advantage, where we don't have the sales and marketing, the commissions. We're not paying claims. We're not doing UM, a lot of these more variable expenses are not required to be successful in DCE. So we'll see how the financial side plays out over the next couple of quarters. As John said, I think we're starting to become kind of cautiously optimistic about it. But we are pleased with the operational trends that kind of inform our thinking.

And when we kind of come out with clarity on it, we'll do it the same way we did on MA, which is with proof points. So this is the data. This is the outcomes. Here's what we've been able to do. Here's the MBR trends. Here's -- I mean we'll give everyone lots of proof points as to why we would be kind of optimistic before we start baking it into our numbers.

So I mean you're not taking a kind of a longer-term view of what the potential margin profile could be. But I guess if you think about from just the top line perspective and the potential, is this a bigger revenue driver than MA from your perspective, kind of all things considered, how do you think about that?

I would not make that statement yet. I think the possibility is really -- I mean, today, if you think about MA's TAM, about $300 billion, growing to $500 billion. If you throw the DCE on top of that, it basically doubles it to $1 trillion. If you add on the regional DCEs, which we really liked because I think there was actual benefits that would accrue to the beneficiary and a lot of -- so it becomes very similar to MA in many respects. If all of that starts playing out, like I said, we would come out with proof points. And with those proof points, we would begin to incorporate those numbers consistently and report on them consistently. It's just still a little bit early to -- for us to say, gee, this is long-term -- a long-term successful program. We're just a little bit more cautious than others, I think. But we're looking at it potentially as a potential driver without a doubt. But the MA TAM is just so huge as it is. And I think there's nothing we're going to change that. I don't think DCE is going to replace the growth of MA, is this the value equation is clearly better than fee-for-service, but clearly less than MA.

Okay. So I think you've previously talked about the possibility of M&A. I mean, when you think about that, what type of assets make the most sense for you? And philosophically, would you look for an asset or a plan that gives you a good starting access to any particular market? Or is it one that's established where you can improve upon what's kind of there already? How do you think about that?

Yes, great question. I mean we have to be good at organic growth, which is what we've been doing thus far. But we also have to be good at inorganic growth. And so we've been spending a lot of time making sure that not only we've been wrapping up our business development capabilities and our M&A capabilities, but our diligence, our integration and our operationalization of M&A. So we've been spending a lot of time focused on that, and I'm really happy with the progress that we've made. A typical profile is -- and we're looking at bankers are bringing deals to us. We're looking at them. And as you said, Jonathan, I think it's getting us into a beachhead with the core operations that we can add to is the way that we're looking at it. We've looked at a lot of different assets. We're also very sensitive. If we do 10,000 whatever kind of member acquisition that needs to work. I mean we know -- again, same thing, we have to prove to the street, we're going to -- we have to be good at M&A. So we have to prove we can do that. So we've taken a very disciplined, thoughtful approach about that. And I think if I have my way, we're going to be reasonably active in it. And overlay AVA, overlay Care Anywhere, overlay our systems and enter markets and get these beachheads set up faster than just what we would otherwise do as a pure de novo, which we're still moving forward on pretty much each one of these markets that we talked about during the IPO. We're moving forward on getting the de novo set up. The other thing I would add to it is provider joint ventures. There's a lot of providers out there that like what we have to do. They like the ability to have some influence with us designing products as a plan. And they really like AVA. They like the technology. And many of the groups that we talk with are -- have very capable and competent systems within their 4 walls of being a provider. But as they expand and start managing IPA physicians, community physicians, they really like our tools. And so that's something that is also out there in terms of getting growth.

Okay. Great. I guess we're almost out of time here, but I just want to ask the last question. COVID has obviously been a major swing factor for you, the industry as a whole. Hopefully, next year, we're not talking about anymore. But what are your learnings from the COVID environment? What are you taking away? What do you think can be improved? What worked, what didn't work? Any color there?

Thomas, you want to go first and I'll share some other...

Yes. So I think maybe a couple of thoughts would be I think our -- first and foremost, our clinical teams, any operational areas that support those clinical efforts to envision to our provider partners, external provider partners did a fantastic job. And I think the result of that, you can see not only in the financial outcomes over the last year where we've kind of navigated that volatility, but you can see it in the kind of continuously high NPS scores for Care Anywhere members, our most recent NPS for Care Anywhere was 82. And you can see it in other evidence such as our STAR ratings, our HEDIS metrics and a lot of these proof points that we've shared in the past. And so I think a lot of what we've done in the past that made us successful, we were able to continue over the past 18 months. And probably more specific from a financial standpoint, our lack of data latency. Of course, differently or kind of data transparency as John described earlier, I think allowed us to be pretty nimble and flexible, both with respect to operationally how we navigate COVID, but also how we, again, forecast our business reserve from an IBNR standpoint at the end of the month or the end of the quarter. And so I think you've seen us kind of manage the business successfully in that regard. John, do you want to maybe add on.

Yes. Yes. Just at a kind of a macro level, I think it's highlighted the fact that technology is a social determinant of health. That concept is something that we're advocating, meaning we've had to make investments in virtual care -- our virtual care platform, which is part of AVA. I think seniors have had to adapt to using technology or their iPhone or their computers to engage in virtual interactions. And so I think in a very ironic way, the whole last 18 months with respect to COVID is catalyzing the adoption of technology is going to, I think, force kind of a lot of the Gen-1 tech vendors out there to accelerate their rate of improvement, it's going to force us to accelerate our rate of investment in front-end consumer self-service tools that will leverage the investments that we've made on our back end. I think you're going to see a lot of that. I'm actually very excited about that. And I think that while today's 89-year-old is kind of using technology, but not particularly proficient in it. I think the 89-year-old and 10 years from now is going to be very proficient in technology, and it's going to demand much more real-time access to care, much more self-service, I think it's going to catalyze change faster. And that's what I think is going to happen.

Okay. Great. Well, with that, we're out of time. So I'd like to thank John and Thomas for joining us today and for the rest of you, enjoy the rest of the conference. Take care.

Thanks, Jonathan.

Thank you.

Thank you again. Appreciate it.