AMN Healthcare Services, Inc. (AMN) Earnings Call Transcript & Summary

Good afternoon, everybody. My name is Grant Hesser. I'm an associate here at JPMorgan. Continuing on with the 39th Annual Healthcare Conference, very happy to have AMN Healthcare. With us today, Susan Salka, who is the Chief Executive Officer; and Brian Scott, the Chief Financial Officer. Just for a brief description, for those of you who are not familiar, AMN Healthcare is recognized as the largest U.S. health care staffing firm providing health care workforce solutions and staffing services to health care facilities across the United States. So the format today is Susan and Brian will give a presentation, and then I will come on towards the end for some Q&A. So with that, I will turn it over to Brian.

Thanks, Grant, and thanks, again, for having us here today. I appreciate everybody taking the time to be involved in our presentation and the Q&A. Before I have Susan kick off the formal presentation, and I'll wrap it up, I just want to give a few comments. So various remarks we make during this webcast about future expectations, projections, trends, plans, events or circumstances constitute forward-looking statements. These statements reflect the company's current beliefs based upon information currently available to it. Our actual results may differ materially from the forward-looking statements provided or implied during this presentation and during the question-and-answer session. Factors and other cautionary statements that could cause actual results to differ from those discussed in or implied by the forward-looking statements, discussed in this presentation and question-and-answer session are set forth in the company's most recently filed Form 10-K and Form 10-Q and the cautionary statements included in our most recent earnings release as well as the press release issued yesterday afternoon. The company does not intend to update its guidance or any forward-looking statements provided today prior to its next earnings release. This webcast also contains certain non-GAAP financial information. Information regarding and reconciliations of these non-GAAP measures to the most directly comparable GAAP measures are included in the appendix to the slides that accompany this webcast. Hopefully, you may have seen yesterday that we did issue a press release and 8-K, indicating that we expect our consolidated revenue for the fourth quarter of 2020 to be $623 million to $628 million, which is about 7% to 8% higher than the midpoint of the revenue guidance we provided on November 5. We also indicated that we expect our operating and adjusted EBITDA margins will be at the high end of our November guidance range. The preliminary revenue results reflect strong demand for our services really across all 3 of our reportable segments, and we'll hopefully be able to talk about that some today. We'll also provide some additional color regarding the operating trends driving that performance and some of the other trends that we're seeing right now. So with that, I will pass it off to Susan.

Thank you so much, Brian. Thank you, Grant, and JPMorgan for the opportunity to be with you here today. We'd like to start first by extending our deep gratitude to everyone, all health care companies and individuals, including investors that are working so hard in collaborating to really accomplish so much during this challenging time. We have a lot to share today. But on Page 4, we've listed what I think are the 5 most important things that we would like you to know about AMN Healthcare. First is our values-based and purpose-driven culture that has been a very important part of our success over the years and certainly, how we think about the positive impact that we make every day. Our impact is created by people. And so nurturing and evolving our culture is really the most important thing that we can do. Second is our leadership position as the innovator in total talent solutions, which includes technology-enabled workforce solutions as well as healthcare staffing services. Third is the diversity and strength of our leadership team and quite honestly, our team throughout the organization. I'll share more about this in just a little bit. And then the macro drivers of our ever-evolving strategy that position us well for future growth. A lot of the things that have driven our success today will actually be amplified and continue to pick up steam as we move forward. And of course, we've done a good job of creating a strong balance sheet and cash flow to ensure that we can make the right investments to be the kind of partner that our clients want us to be. Our growth over the years has come from a combination of organic growth as well as synergistic M&A. And this has not only driven revenue growth, but also better margins and more resiliency during any kind of disruption. We began AMN in 1985. I joined in 1990, and it says if we have been working the last 30-plus years to be prepared for this important time to really help our clients serve their patients and to support our clinicians to do their best work possible. On Page 5, you'll get a sense of how our segment revenue breaks out today, which is considerably different and more diverse than when we presented 20 years ago. We started as a travel nurse company, and we've steadily diversified the business in response to our clients' needs and to build a stronger, healthier financial model for our shareholders and the sustainability of our growth. You see 2019 financial figures here. And of course, Brian will share a little bit more later on our current state. But even in the disruption of the pandemic during 2020, we will hit new records and expect to see revenue around $2.4 billion and adjusted EBITDA of over 13%. Also noted is the continued growth of our Technology and Workforce Solutions segment, which was really nonexistent about 12 years ago and today is about 25% of our overall EBITDA. These businesses have been newer to AMN and really reflect the strategy of listening to our clients and continuing to make investments to be a more strategic partner for them as they continue to grapple with workforce challenges, not just due to the shortage, but in a desire to really optimize their workforce to deliver better patient care. Page 6 provides a little bit more detail on the types of solutions that we provide in our reportable segments. I won't go through them all in the interest of time. Our staffing segments of nursing and allied, physician and leadership have changed significantly over the years. Twenty years ago, they were more transactional in nature. And today, as the leader in providing managed services programs, over 56% of our revenue in these segments comes from MSP contracts with our most strategic clients. And again, this has really been very deliberate on our part as we sought to become that more strategic total talent solution partner for them. The second key callout was the continued expansion of our Technology and Workforce Solutions capabilities with our most recent acquisition of video and audio language interpretation services, Stratus Video last year, we've continued to add in both new capabilities but also some size and scale to this particular category. And I think as we move forward, you'll continue to see it be an important focus for us so that we can serve our clients. Slide 7 provides a bit more insight on our transformation in becoming the talent solution leader that we are today. We are the strategic workforce partner to most of the major health care systems. And our top 40 MSP clients use an average of over 4 AMN solutions. We have much more runway on this and many more opportunities to add value and provide other services to them in the future, both existing solutions that we have in our portfolio as well as thinking about adding new capabilities. We are delivering innovative, tech-enabled solutions that are needed in every category of worsening labor shortages. We're rapidly launching digital capabilities for clinicians. I'll touch on that a little bit more later because it's very important that we find ways to streamline the process of navigating their ability to find the right job and build their career as well as onboard into whatever new role that they are seeking. Slide 8 lays out the competitive advantages that we've contributed, that have contributed to our continued growth and our leadership position over the last 20 years. You'll notice our passionate and engaged company culture is #1. It's a very critical part of who we are and our DNA. Hand in hand with this commitment to our culture is our commitment to our communities as well as social issues in diversity, equity and inclusion. These are really important facets of the AMN culture and our values. And while our commitment is stronger today than ever before, it's not a new focus for us but rather, it's just a part of our value system and who we strive to be every day. Slide 9 reflects the growth in our managed services programs, including both staffing-led MSP and vendor-neutral VMS programs. Our gross spend under management is by far the largest in the industry and provides opportunities for AMN and our affiliate vendors to help our clients obtain the critical staff that they need to care for patients. And you can only imagine how critical this is today. But in addition to providing staff, it gives AMN a platform to have strategic conversations with our clients about multiple areas where they're striving to really change the way that they manage their workforce in trying to create, in some cases, a more enterprise view, and that includes having analytics so that they can make better decisions about how and where they're staffing their different facilities. As clients become more diverse themselves vertically and horizontally integrated, it's important that they have a staffing partner that can work across all settings of patient care. Slide 10 provides a glimpse into our leadership team, which very much like our strategy has evolved over the years, resulting in a robust combination of industry veterans like me and Brian as well as fresh perspectives of leaders who've come from other environments, other industries, including other health care services organizations. What hasn't changed, however, across our leadership team is the common passion and purpose-driven culture that we desire to have at AMN and our commitment to innovation. We want to make a difference through our time and the investments that we make, and we want to make a difference in people's lives every single day. This diversity and relentless desire to make an impact starts with our Board of Directors. Slide 11 shares a bit more about the strength and diversity of our Board, and we do continue to refresh our Board with expertise to match our strategy and where the business is going. We also have a healthy mix of tenure, backgrounds and diversity of opinion within the Board. We are one of the very few companies that actually have over 50% representation from women and other underrepresented groups. I'm very proud of that. One of our most recent additions to the Board is Rear Admiral Sylvia Trent-Adams, who is a phenomenal addition and brings such diverse experience and perspective, very impactful and helpful at this time, particularly even in her role as a policymaker and nurse. So we're very grateful that she joined us. Our purpose-driven culture has translated into long-term commitments and sustainable value to all stakeholders, including our communities, our team members and regarding social issues. On Slide 12, we share more about our strong track record across diversity, equity and inclusion and how we use our leadership position and our resources to support others around these same issues. We see our leadership position as a responsibility to help others, but also an opportunity to do things and have a voice. And so I believe you'll see AMN being very present and, where possible, influential around social impact issues. Slide 13 captures the macro drivers of our industry, with an aging population driving more utilization of health care services and the shortage of health care professionals driving long-term demand growth and the need for us to continue to innovate. This also underlines the importance of having a very diverse portfolio of solutions that can help our clients to recruit and optimize their workforce across the entire spectrum of temp, perm and telehealth-enabled workforce offerings. Slide 14 shares some insights on our total addressable market of over $22 billion. The competitive markets that we serve clients in are very fragmented. For example, in the temporary health care staffing market of over $17 billion, we're the largest provider of just a little over $2 billion in revenue. So there's plenty of opportunity for us to continue to grow and expand into our existing markets as well as, as you've seen over the years, we've created opportunities to grow into new addressable markets as well. Slide 15 shares a bit more detail on the competitive landscape of the health care staffing market. AMN is the largest provider of services in 6 out of the 8 categories listed, and we've grown our leading position steadily over the last 20 years. Our industry has thousands of smaller providers who are very important to helping serve our clients. And in many cases, they are affiliate vendors and subcontractors with AMN, helping to serve our strategic MSP clients, and we are very, very grateful for their collaboration and their partnership. We make each other better. And together, we can serve our clients in a more holistic way. We see them as partners, even though in some cases, we do compete out in the marketplace. Key pillars to our long-term growth include continuing to invest in innovation, leveraging our total talent solutions platform and continuing to have financial discipline in our decisions. We're investing considerable resources into our technology workforce solutions, our digital capabilities, automation and analytics. Slide 18 provides some insights into our most recent acquisition of Stratus Video. Stratus is the leader in providing video remote interpretation services for both spoken and sign language within health care. This very entrepreneurial team and the capabilities that they've been able to add to the AMN family have really come at exactly the right time. Not only do they bring great expertise and passion for what they do, we've been able to very quickly pivot and continue to expand their platform and create new innovative capabilities under their leadership. We've also been able to integrate our Stratus platform into our own other telehealth platform of speech language into the schools environment as well as creating interoperability with other telehealth platforms during such a very critical time. This team serves a very, very important patient demographic during their greatest time of need. This business has also been growing very nicely over the last several years, including in 2020, with very strong top line growth as well as profitability growth. And overall, along with our other technology workforce solutions, has been accretive to our overall margins. We're very excited about this team as well as other acquisitions that have joined us in the last few years. It's really continued to enable us to be that total talent solution partner for our clients. Slide 19 shares some insights into the internal investments that we are making in our digital capabilities as well as automation and analytics. And if we look at, in particular, one of those capabilities, AMN Passport, we're very excited and proud of how we've been able to stand up these capabilities so very quickly. If you look at Slide 19, we have the ability to enable clinicians to very quickly navigate the jobs that are available, but also to create an onboarding experience that is much more seamless and able to really get them working and doing what they love to do best, driving great patient care. So I'm going to turn it over to Brian at this point, but I just want to reiterate that while we have certainly a lot in front of us today and the importance of our work has never been more critical than it is during this pandemic, we are also very focused on continuing to evolve our strategy and build out our capabilities for the long term. We have some very important macro drivers that are going to continue to drive demand and growth opportunity, and we need to make sure that we're making the right investments to be the right partner for our clients 3, 5-plus years from now. So with that, Brian, I'm going to hand it over to you.

All right. Thank you, Susan. Yes, I'll just go through our financials a little bit and our capital allocation strategy, and we'll leave plenty of time for some robust Q&A here. If you go to Slide 22, just a summary of our financial performance. It was interesting as we round out 2020, reflecting back where we were 10 years ago and thinking about the incredible progress, not only just the financial progress of the organization, but the significant transformation of our business and how that's been reflected in the numbers. But our ability to serve our customers in a really unique way and deliver more value than ever is something that we're extremely proud of. But looking back at 2010, our revenue was actually a little under $700 million, and our adjusted EBITDA margin at that time was 6%. And we had set a goal a few years after that to get to a 10% margin. And you look today and we're up over 13%. So really proud of the steady top line performance, both through some really strategic acquisitions over the years as well as really solid organic growth. But through those acquisitions and really solid discipline around driving more efficiency in the way we deliver our services, you see the gross margin over time has expanded. And then that really, really solid EBITDA margin expansion and EBITDA growth over the years. So really proud of the continued and consistent performance of our business over the years, and you see that dropping all the way through to our adjusted net income and adjusted EPS as well. Slide 23, just another indication of just our strong track record of not only growing, but really growing profitably and our ability to convert that into a really strong free cash flow, which not only delivers a good return for our shareholders, but it allows us to reinvest in the business as well through CapEx, reinvesting in our team members and ultimately, reinvesting into our industry to deliver more value to the health care community. So you can see here on the EBITDA growing on a consistent basis over the last 5 years, but our free cash flow over the last -- from 2016 to 2020 has more than doubled over that period of time. And that's even as we have invested more in our CapEx over that period. So how we get to that? You've got a couple of different drivers. One is, we are known for having a very scalable operating model. We can drive incremental margins as we grow the business with our fixed cost not necessarily growing. We've run a more centralized -- even though we're in a distributed model, we can run a lot of our operations out of either core offices or today, people working from home. So we get nice scale leverage on our traditional staffing businesses. Layer on top of that, these acquisitions like Stratus, which drive more leverage for us and higher margins over time as well. But our scalability goes both ways as well as earlier in -- middle of 2020 when things shut down, we were able to quickly adjust our cost structure to the environment and maintain a very healthy level of profitability. And that's something we've demonstrated over the years. But even as we've evolved and added more services, we still maintain that discipline and flexibility to really be able to adapt to the market conditions in either -- in whatever environment we're in. You see that reflected in the strong free cash flow. Susan talked about these really critical investments we're making. Even as we look at M&A as a part of our growth strategy, first and foremost, we're investing in our teams and our technologies because that's something we know we can control. And as we invest more in bringing together all of these best-in-class solutions, we want to create a very seamless, integrated relationship with our customers, where they feel like they kind of have one partner across these service lines. More and more want the ability to have analytics, insights to help drive more value. And then we want to have an experience that's kind of best-in-class for our health care professionals each and every day and however they want to engage with us. So these investments we're making in our CapEx are up now at about a 1.5% to 2% range. Historically, they were down a little under 1%. We think these are essential to our long-term growth strategy and really reflect a pretty small percentage of our overall free cash flow. So next slide, 24, just talking about the balance sheet. We feel like we're really well positioned on the balance sheet both from a defensive point of view, if there are uncertain conditions come into play, but also from an offensive strategy if we see acquisition opportunities. You see today, our leverage ratio at 2.6x as of 9/30. So right at the -- in line with our overall target, gives us that flexibility to be acquisitive if opportunities come up, so it really puts us in a really solid position. We also have capitalized on a very strong credit markets over the last year and have moved some of our debt into longer-term unsecured notes. So we have, really, by the time we pay off a very small amount of term loan left here in the near future, all of our debt that we have remaining will have maturities that don't even start until 2027. So it really gives us a ton of flexibility as we look to execute on our growth strategy. Slide 25, just reflecting back on our capital allocation strategy here. A nice balance of making acquisitions consistently over the last decade plus, but then also generating really strong free cash flow to be able to repay debt and keep that leverage ratio. We talked about a target of around 2 to 2.5x. That doesn't mean we'll always stay within that range. We've had periods where if we don't see a really solid acquisition or we don't think the profile matches or the valuation, then we will sit and wait and focus on our core strategy internally. We can also go higher in that leverage ratio as we've done a few times. Even with Stratus Video, we're at about 3.4x on a pro forma, but then we're quickly able to delever and bring that leverage ratio back down again. So like we've got a great track record of being able to capitalize on good growth strategies, delever again, but -- and ultimately, back in the same leverage ratio position. Acquisitions, we do believe, will still be an important part of our growth strategy going forward. But as I said, again, our investments in our internal systems are the things that we know we can control right now and more and more appetite for -- from our clients and our clinicians to have this really digitally enabled solution for them. We have done some share repurchase over the years. We want to leave that as a tool for us, whether there's a -- we feel like there's a really good opportunity with our stock price or if we don't see a good horizon of acquisitions, we can continue to use that if we think it will drive more value for our shareholders as well. And then just the last slide just has some of the criteria. Probably no big surprises here. There's the traditional financial filters that we had used. And I think in our case, looking at acquisitions that have -- that are accretive to our margins and growth profile, I think it helps sustain a higher level of profitability but also the multiple that usually we would trade at as well. I think the one thing I'd really want to point out in terms of the criteria -- two things. One, the total talent strategy that we have, we want to make sure that any acquisition aligns to that. But we've also found that our best acquisitions are when we really focus on the culture and the systems that these companies have built. They're just critical to having a good sustained integration with AMN as we want to really focus on bringing these solutions in as part of our total talent strategy, and having great quality management usually means they have good ethics programs in place. And all those, we talked about having a highly cultural, how they engaged culture that focus on doing things the right way. Those are, for us, have been our best acquisitions, companies that are really aligned to that focus as well. And so with that, I will hand it back over to Grant to facilitate some Q&A.

Perfect, guys. Thank you very much. That was an excellent presentation. [Operator Instructions] I guess just to kick things off, Brian, obviously, yesterday, you preannounced the fourth quarter. So can you provide some additional color on the preannouncement? Where do you see sort of particular strength in the quarter? And what do you think sort of carries forward into 2021?

Sure. Yes, I'll kick it off and then hand to Susan as well. So yes, we -- it's not common for us to preannounce. We thought considering the magnitude of the revenue outperformance to the guidance we gave in early November and just being able to provide some color on the trends that we're seeing that, to your question, are carrying into at least the first quarter, we thought it would be helpful to really provide some of that color today. What's interesting is it's really -- we're seeing the higher demand and the teams are doing a great job executing into that really across all 3 of our segments. We've mentioned in our press release kind of nurse and allied being the biggest impact. That's really from a dollar standpoint. With the very high demand continuing, it's creating continued competition for these really critical health care workers right now on nursing and allied, but nursing even more so. And so that is creating competition in terms of bill rates to offer higher pay packages to fill these critical roles. And so we saw that trend continue. It really started in the third quarter, has continued into the fourth quarter and saw it accelerate even over the last couple of months. And that's carrying into the first quarter as well. So the outperformance in the fourth quarter is partly driven by some higher bill rates for both the clinicians that we had on assignment as well as the new starts that we had in the back half of the quarter, both from a traditional kind of travel nurse as well as some of the rapid response placements we're making as well. That same high demand though related to COVID is carrying through across our interim leadership division, our locums division and then our vendor management technology, which sits in our Technology and Workforce Solutions segment. As we're seeing higher placements and rates, that also flows through for them as well. And then just generally, our teams are doing -- are executing very well. Stratus Video did really well in the quarter. So kind of across the board, seeing that demand. It's a combination of, I think, continued somewhat recovery in our businesses as well as some incremental needs from COVID. I'm not sure if there's anything -- I'd leave you anything there.

I think you know that.

Okay. Perfect. So first just, I want to ask a little bit more about the status of the nursing labor environment. Now into 2021, given a lot of the headlines, we're continuing to see around worker burnout, time-off requests, et cetera, just given the last 9 months and everything that the nurses are going through. So what are you seeing around supply and demand in the market? And are trends worsening now into the winter? Anything there would be helpful.

Yes. You're absolutely right about the impact on health care workers. And so many permanent health care workers, let's say, nurses in particular, over the last several months, decided to opt out and maybe out of necessity even stay home with their children and/or if they were older, maybe retire earlier. So vacancy rates at our clients are at historical high levels from what we hear. There's no real-time data, so it's relatively anecdotal from our clients. And that's driving some of the strong demand that we're seeing. And even when things start to settle down and the vaccine takes hold, there's a belief that many of the health care workers won't be coming back at all. And so we've perhaps lost some subset of the health care workforce kind of forever. We're already on a path for one of the worst shortages that the country had ever seen across most health care disciplines, and that's just really been accelerated. Now some workers may come back, but they may need a break due to the burnout. And so we don't anticipate any sort of sharp end to this. There will likely be longer-term implications. Not just us, health care educators and executives are all talking about the long-term effects on our health care workforce. And that's why it's so important that we're supporting them in any way that we can now. Now you asked about supply, we are seeing more supply of clinicians come into the travel industry to us, but also generally into the industry with competitors as well. And that will also create opportunity for future placements because once someone gets an introduction into a flexible work assignment in an environment, they often want to take a follow-on assignment and a follow-on assignment. And so we actually think it's very positive for the industry overall that we have so many first-time travelers coming into the industry as well as for us, [ lapsed travelers ], people who maybe worked with us previously, went into a permanent job and now are coming back into the industry. So supply is growing, but it's not nearly enough to keep up with the very high demand levels that the industry is seeing.

Got it. That's helpful. And I have an investor question here maybe for Brian. Brian, how do you make sure that you're not overpaying for deals as focus seems to be on the tech side, which in this market tends to carry higher multiples and valuation?

Yes. Yes, that's always something we're extremely mindful of. And it may be the biggest inhibitor we have in being able to get -- make acquisitions even with quality companies when there is so much competition for assets. So we have to be willing to have the discipline like any company in terms of looking at valuation and opportunity. But we've also had to step out a little bit from our traditional comfort zones around multiples, you pay for staffing companies. Stratus Video, I mean in hindsight, ended up being a pretty -- really good valuation for us, but it was a multiple above our own trading multiple. So we're trying to balance those factors. But ultimately, if we feel like evaluation is just far beyond what we can justify, then we'll pass. And we've done that multiple times over the last several years or have been outbid on certain assets as well and felt comfortable walking away. We're in a great position in that we have a lot of great solutions already in our portfolio. And we have not fully capitalized or realized the value from them. And so between optimizing the solutions that we have, whether it's our Avantas scheduling and predictive analytics capabilities or Stratus, there's a lot we can do with the solutions that we have today, and we can continue to add on and build out internally as well. So we'll continue to look for those types of acquisitions and at the same time, recognize that we may not be able to achieve every deal that we want just because valuations are pretty frothy.

Got it. That's helpful. Susan, in the presentation, you discussed selling more capabilities into your existing client base. Can you give some specific examples of these sort of additional services and your strategy for maybe driving more penetration into 2021?

Yes, absolutely. One of the best things we can do for clients is to listen and understand where their greatest opportunities and pain points are and then come to the table with solutions. And that's what's led us to some of the acquisitions we've done like Stratus and other areas, but also being able to bring a portfolio and help them as they plan for their long-term workforce needs. So just as an example, we may have a large MSP, where initially, we're providing nursing and allied services. But over time, as we build trust and credibility with them and have deeper conversations about what they're trying to achieve, then we can look to bring other capabilities to the table, whether it be locums or interim leadership. We've done a great job of adding those in to many of our large MSP clients. More recently, we've been able to add in our credentialing capabilities of Silversheet but also Stratus, our most recent acquisition. Most of the -- our clients are using some form of language interpretation services. They might even be trying themselves to migrate from an on-premise or audio interpretation service to video, of which Stratus is the leader. So as we're renewing contracts or winning new contracts, we can add in these additional capabilities. Just in this year -- last year, as an example, right after the Stratus acquisition, we were able to add them in to one of our largest national MSPs, and we will be rolling that out across their hospitals over the coming months. It will probably take even a couple of years because it's pretty large. But that's -- part of our strategy is we're adding in these synergistic solutions. They can stand on their own and they do have great client talent, are adding additional clients all the time, but we can also add them in to our largest, most strategic clientele.

Got it. That's helpful. Got it. That's helpful. And I guess we've mentioned Stratus a few times at this point. So I guess, can you just take a step back, Susan, and sort of lay out AMN's broader telehealth strategy just given sort of a post-COVID world and the acquisition of Stratus? So really interested in how that business performed over the past 12 months and your expectations for how trends shift in sort of a post-COVID world.

Absolutely. Well, I'll start with our broader strategy around how we add value to telehealth care delivery. So first, we do provide staffing services to several telehealth providers, both those that are maybe within our clients, but also those that are stand-alone telehealth providers. That was accelerated during the height of the pandemic, and I think will continue to grow over time as they're trying to add to their clinical workforce, both on a permanent and temporary as-needed basis. So we can play a very important role as an enabler for them to be able to serve their patients and clientele through the workforce capabilities that we have. Second would be how we also offer our own telehealth platforms. Schools is one area. We acquired Advanced in June of 2019. As part of that, we fortunately brought Televate into the AMN portfolio, and that is a telehealth platform for speech therapists to provide speech and language therapy to students remotely. You can imagine how important that was during the pandemic as so many schools weren't sure whether they would be in person or online. We can add in other capabilities to that over time, school psychologists and other types of care providers. We actually even integrated Stratus into that platform in the last few months so that we could provide language interpretation to those students, which was certainly and important to ask from many school systems. Stratus is another example of how we have a telehealth platform. You might not think of it as such right off the bat, but it provides a device and a technology solution where patients and clinicians can interface with an interpreter, but it can expand beyond that. And actually during the pandemic, we were able to explore ways that we could enable our clients to use the platform for other things where they were trying to get their own clinicians to interface with patients, and they couldn't necessarily be present in the room with them. We've been integrating Stratus into other telehealth platforms, both clients, telehealth platforms as well as other standalone telehealth platforms. So we see multiple ways that we can continue to explore both being a workforce provider as well as a technology or technology and people provider to our clients. A lot of opportunity, our job is to choose well so that we really are adding value and not trying to compete in a space where we don't belong.

Perfect. Thank you very much. That was great. And with that, I think we're out of time. So thank you very much to Susan and Brian and the AMN Healthcare team, and thank you to all of you who joined.

Thank you.

Thanks, Grant.