Astrana Health, Inc. (ASTH) Earnings Call Transcript & Summary

Good afternoon, everyone, and welcome to the Apollo Medical Holdings Company Presentation. My name is Ethan Taylor. I'm the associate in JPMorgan's Healthcare Investment Banking Group. It is my pleasure to introduce Brandon Sim, Co-CEO; and Chandan Basho, Chief Strategy Officer and CFO. A quick note on housekeeping. There will be some time at the end for some audience Q&A. So please have some questions ready. And with that, Brandon, please take it away.

Hi, everyone. Good afternoon. Thank you for joining us here today, braving the rain to get here and thank you to the JPMorgan team for having us. We're really appreciative of the opportunity that we get to tell our story as well as some of the exciting kind of latest updates on what we've been up to. With that, I'll get started. I'll kick it off by explaining for those of us who are less familiar with the business, a bit about what we do, how we're looking to transform the health care ecosystem and help us get towards a state -- a future in which everyone has access to high-quality, high-value and accessible care, regardless of your age, where you live or what your insurance looks like. Chan Basho, my CSO and CFO, will also talk through some of the levers we have for growth that we're seeing as we go into 2024 as well as chat about, give an update on 2023. And then finally, I'll conclude with some additional news that we'd like to share with the public here today. And we are looking forward to questions at the end. So please keep those in mind as Ethan was talking about. So to get started, ApolloMed is a value-based health care platform. The business is meant to organize and empower physicians, entrepreneurial providers, whether they are third-party providers or fourth-party providers, into coordinated health care networks that are able to deliver high-quality, high-value and accessible care to all Americans. We operate this business in 3 different reportable segments, which I'll go into a little bit later, but we truly feel that the 3 segments are very complementary with each other and have the opportunity or allow us the opportunity to not only serve patients across all stages of their life, but do so effectively and with great patient satisfaction. The platform is one we've built over decades, one which now has a lot of scale, over 900,000 members in value-based care arrangements, again, across all payer types, across all lines of business, over 10,000 affiliate providers in the ApolloMed network today across 30 MSAs and with over 20 payer partners. It's one that demonstrates consistent and repeatable clinical outcomes, both in terms of inpatient utilization as well as in a timely manner also as well as Part B utilization as well. And it's a business that has continued to grow at a rapid clip, while remaining profitable. We've grown at a 27% revenue CAGR approximately the same clip for EBITDA as well over the last 4 years. At the end of the day, the mission of the company is to -- is threefold. It's to improve access to care for our patients, again, across all walks of life, across all stages of their life to power high-quality outcomes based on our -- not only in our affiliate model, but also in our employed clinic model, supported by the infrastructure and technology we've built. And finally, to drive high-value care for our payers. And the way we do that is by transforming what we view is the status quo, which is individual providers that are loosely aggregated, loosely coordinated, sometimes not coordinated at all, depending on the market that you're in, and transforming that status quo into a highly coordinated and effective health care system that, like I said, is accessible, high-quality and high-value in nature. And the way we do that is via the three reportable business segments that we talked about earlier, which are Care Partners, Care Delivery and Care Enablement. The Care Partners business is the largest by revenue. It's over 85% of our revenue today. And what it is, it is a risk-bearing entity that operates in a multi-payer, multiline of business fashion. It's contracted with all the large national payers that you all have heard of before. The logos at the top of the page, it's contracted of the local health -- nonprofit health plans and everything in between. And the idea is that we can serve as a single payer that aggregates payment streams across managed Medicaid and Medicare Advantage, original Medicare and commercial and upside/downside arrangements in order to truly be accountable at the end of the day for the types of results that we're driving in terms of our care model. The Care Partners business contracts, not only with our first-party employee provider group, which is the care delivery model that we'll talk about on the next slide, but also with a large affiliate network of over 10,000 primary care and multi-specialty providers. Today, around close to 600,000 patients are in value-based contracts in our Care Partners business, and that continues to expand as we grow across California, Nevada and Texas. The next part of the business is our care delivery model, which is our employed physician model. Today, the Care Delivery segment operates across 61 practice locations across 3 states, California, Nevada, Texas. In fact, there are 2 locations not too far from here, that we have the pleasure of visiting quite soon. And this is not only primary care but also certain multi-specialties that are in high demand, such as cardiology, women's health as well as some ancillary businesses such as laboratory and diagnostics and imaging. The point of the Care Delivery business, unlike some of our -- unlike other models that exist is not necessarily to systematically build hundreds of clinics across the country in order to fill those boxes with patients. The way we think about our care delivery business is really to augment the risk-bearing Care Partners business that we just talked about. And what I mean by that is there are often geographic areas where we'd like to partner with an affiliate provider and empower them to take on risk in a value-based contract, but it's a little bit difficult sometimes depending on the region, to ensure that supply and demand are well matched in that region to satisfy the demand of our patients. And for example, sometimes we see that patients are often waiting weeks, if not months, for a mammogram or for an appointment with their cardiologists. In those instances, we will flexibly deploy our Care Delivery model and either build or acquire and integrate clinics so that we can alleviate some of the supply/demand gaps that exist, and therefore, allowing our Care Partners entity to operate with a higher level of quality, value and access as we talked about earlier. And finally, all of that -- both of those segments are empowered by what we call our Care Enablement platform, which is a technology-enabled services business that supports, not only our first-party risk-bearing entities and clinics, but also non-affiliated with Apollo risk-bearing entities and clinics. And I really split the Care Enablement business into 2 different large segments. The first is a provider-facing offering, which essentially is a tech-enabled physician practice management business. We offer services such as offering an EHR integration and analytics engine. We offer a centralized billing service for our practice providers. We offer opportunities for them to use us for a central call center to take appointments and schedule, we do their websites, we do their social media. This is kind of meant to take away kind of the burdensome parts of running a physician practice today and allow them to focus on what they do best, which is taking care of the patient. And the revenue model there is really a percentage of practice collections. And so in some ways, it's similar to other -- some of our peers. The other large sleeve in the Care Enablement business is a little more unique. It's a business in which we're enabling other risk-bearing entities to actually take risk in a delegated environment. In California and now increasingly in other states, payers are often encouraging us to not only take financial risk on the patients that we serve, but also take on additional capabilities around care management, around contracting, network building, credentialing, utilization management and ultimately, even paying claims, which we do for essentially all of our patients in the California market today and increasingly, as Chan will talk about later, also in the Nevada and Texas markets. There are often a lot of risk-bearing entities who don't have the infrastructure, the scale or sophistication to be building their own networks or to analyze actuarially what those networks look like to credential those providers effectively, to perform utilization management, referral management or care management, to pay out the claims and our entity in terms of our Care Enablement business is able to charge a percentage of revenue -- capitated revenue or practice collections in order to do that as well. Of course, the Care Enablement platform also empowers a lot of what we do in-house in our Care Partners and Care Delivery businesses, and we'll talk about a little bit later about how that actually ends up working out operationally and why that leads to some of the outstanding clinical and financial outcomes that we're able to create with the ApolloMed model. At the end of the day, like I said, the 3 businesses really work in concert to create a coordinated, high-quality and high-value system that serves a very diverse member base across all stages of their life. Of our 900,000 members in value-based care arrangements, you can see there's a very diverse mix in terms of ethnicity. All of them -- or very close to all of them are in some kind of risk-bearing, value-based care arrangement, and there's a lot of opportunity embedded in the populations we already serve today to accelerate the path towards for risk as well as the economic benefits that might follow. The providers love using the platform, around 98% provider retention. And the providers are very experienced and high quality, on average, over 11 years of experience inside of our risk-bearing entities. What that means is that we can -- when we take care of a patient, we take care of them longitudinally across their lives. And to me, this is something that's super important when thinking about value-based care, it's often not talked about enough because in order for you to justify, from an economics perspective, making an upfront investment in the patient and their well-being, doing the preventive care necessary, investing in the social determinants and addressing kind of what issues they might have in terms of accessing care, you need to be able to believe that, that member is going to be in your risk-bearing ecosystem for a long time. It would be a shame if you added -- if you spend a lot of money upfront, a lot of dollars on CAC in order to have the patient churn to your competitor the very next year. What we're able to do because we serve a patient across Medicaid, commercial, exchange, Medicare Advantage and across all of the large national payers, is that regardless of their walk of life, their stage of life, their age, where they move to, they are able to stay in our risk-bearing ecosystem and the investments that we've made historically, we're able to reap the benefits of in terms of better patient outcomes later on in life. We saw this in a big way, unfortunately in COVID, for example. Many of our members who lost their jobs, unfortunately, during that time period, turned -- or moved from one of our commercial payer partners into, for example, into Medicaid or they might have bought coverage via the exchange. Because we are contracted with our payer partners across Medicaid and exchange and commercial, they were able to keep their PCP, keep their specialist network, still work with the same care teams and nurses and navigators, social workers, whatever the case might be for a given patient, even when they moved to a different plan. And on the back end, our infrastructure was able to handle that change with no issues. When -- as the economy recovered and they got -- they found a new job or they moved back to a commercial plan or they aged into a Medicare plan, this exact same thing happened. And because of that, we're able to keep a longitudinal -- take a longitudinal approach for a patient that actually makes economic sense for us to do, not only from an obviously moral perspective. Powering all of this is the very flexible and fully in-house proprietary technology system that we've developed over the last 4 or 5 years. It'd be challenging to get through all of it, but I kind of want to get through 4 major buckets of what the technology does, and it's really integrated with the operations and the clinical services that we provide as an organization. The first large category of technology that we've built in terms of empowering our providers is a point-of-care tool that either is integrated with the EHR, if you're on a supported EHR or it sits outside of the EHR in a separate application that is provided free of charge to the providers in our Care Partners network. This integrates more traditional point-of-care tools like Pop Health, gaps-in-care analysis, HEC and risk adjustment to payer-like functionalities such as being able to check eligibility with a plan, being able to submit claims directly to us. As I mentioned earlier, we act as a single payer in the delegated environment as well as being able to submit and receive prior authorization across -- in a very automated fashion so that there's no delay in terms of patient care. And over 90% of our members are aligned to a primary care provider who uses our platform on an active basis. The second large category of technology we've built is around care management and really managing patient outcomes. Along with our very talented clinical team and some of the clinical protocols and heuristics that we've built up over decades of operation, we've built tools that really codify and allow us to scale the clinical pathways that we've learned work in a certain market and across different demographics into Nevada when we enter it or different parts of California or Texas or even beyond. What that means is fully proprietary software that stratifies our patient population based on all of the data that we have. And as I mentioned earlier, because we are the ones actually processing claims, processing prior authorization approvals and denials, we have a great amount of visibility into the data even faster, frankly, than our payer partners do. When we pay a claim, we first pay the claim out of our bank account and then forward the receipt essentially to the payer that we have done so, so they know that we're doing something with the dollars they gave us and not just holding on to them. But at the end of the day, we know that, that happened as soon as it happens. And in fact, sometimes, we know that, that happened even before it happens because for an elective procedure, we're the ones approving the prior authorization. And so we're able to see that prior auth, understand that we may not know exactly when the claim is going to come in, but sometime in the next 30, 60, 90 days, that claim will happen, the date of service will happen, and we can match that up and very clearly understand what our IBNR or claims triangle, et cetera, looks like, that's step one. Step two is taking the data and actually doing something with it. And so we've got a team of data scientists, machine learning engineers that's my background as well, to analyze all the data coming in, that's very real time, that's very high fidelity and take it and figure out not only how to stratify the patients, but what we should do in terms of our 300 to 400 -- close to 400 clinicians that we -- that are employed kind of at the corporate level in order to keep an eye on all of our population and actually act on the data that we're getting. And that's kind of our suite of our proprietary care management applications that we call pathways. Next up, we have a full suite of tools around population health and analytics and really what I perceive to be a risk management problem. As a former financial trader of delta ones, I always got calls from Risk whenever any parameter of my trading or my portfolio went outside of the acceptable norms for any number of hundreds of different factors, right? I either hit my fees on P&L for the day. I had too high of an exposure to European bonds, whatever the case might be, I would get a call from Risk, and we had to address it and fix the problem so that, that wasn't an issue anymore. And that's how we run the business. At the end of the day, we are a payer. We are a risk manager. And we have the ability to drill down because of the data fidelity we talked about earlier and the real-time nature of our data to look at on a per provider, per ZIP code, per geography, per specialty basis, what everything is looking like in terms of utilization, in terms of claims trend, alert the appropriate medical director for that region whenever anything is out of bounds and then have the medical director go and figure out what's wrong, talk to the providers, whether it's primary care or specialty and do something about it. For example, after this chat, if you were to ask me, what is the cardiology PMPM that you spent over the last 3 months in San Francisco County, we could tell you right away with this platform. And finally, being able to do -- knowing the data and being able to alert the data isn't quite enough. It's a lot of the way there. The last thing that we need in order to make the model work is to actually have the clout with the providers, the understanding of how to work with independent primary and specialty care providers to actually change their behavior once we know what the problem might be. Because we are a multiline of business, because we serve, not just 10% of a patient's panel that is, let's say, Medicare Advantage, if we're a Medicare Advantage-only provider or Medicaid if we're a Medicaid-only provider. Because we have such a large percentage of a provider's panel, we are able to go in and make a suggestion and have it be heard, maybe not the first time, but over some time, we're able to genuinely change provider behavior. Because we have the ability to actually essentially drive revenue as the payer -- as a "single payer". And so really all these tools together allow us to continue to -- and you will see some of the clinical results on the next page, allow us to have a lot of confidence around repeatably going into a market, reducing medical costs and other side of the equation is this last fourth column, which is not clinical in nature, but having the operating leverage in order to effectively scale in a sustainable fashion. A lot of our business is about automation in terms of things that providers don't want to do or shouldn't have to do in their day to day. 94% of our claims, for example, are automatically adjudicated. I think close to 2/3 of our prior authorizations are automatically approved. All of these things mean that the provider gets paid faster, gets paid on time. And it means that we don't have to spend millions of dollars on operating teams in order to make that happen. Together, when you look at that holistically, what that means is that our provider network, our value-based care platform is able to affect real outcomes. We keep patients out of the hospital when they don't need to be there. We keep them from being readmitted once they are in the hospital, and we keep them out of the emergency room when they don't need to be there as well. On average across large hundreds of thousands of members, we're able to reduce medical cost ratios by around 400 bps a year on average. And that, combined with operating leverage we have in the platform allows us to feel comfortable with a proven path to profitability in new markets, on average, in around 2 years. Together, that's led to a really strong financial profile for the business. 25% revenue CAGR over the last 4 years, even at a faster clip in terms of adjusted EBITDA which means that we've actually had slight margin expansion over that time period. And we continue to have really strong visibility into 2023 as well as 2024, which Chan will talk about a little bit later on. With that, I'll let Chan speak to the group around how we're going to take what we've built and scale that into new markets even beyond what we've done historically. Chan?

Thanks so much, Brandon. So as Brandon was highlighting, as we're scaling and growing into new markets, there's a common theme in terms of how we choose markets how we're targeting our growth and really executing on our vision that we started almost 25 to 30 years ago. We're first in terms of our core and existing markets. We've had a steady record and success in growing. And almost 30 years ago, when the group was first formed in Los Angeles County, the group initially was very much focused on the middle-income demographic. That hasn't changed in our 25- to 30-year history. We continue to grow and execute on that vision, from Southern California to expanding into the Inland Empire further growing into Northern California and now Central California recently. As you can see in terms of our demographics served, we have a high ethnic population, and it's something that we are proud of. We want to serve our community. We want to continue to strengthen bonds and we really want to help our community through our unique care model that's focused on access as well as quality. Being a provider group, quality always comes first, but we also have a very unique access model, which starts from access hubs, which consists of urgent care, lab pharmacy on the ground floor, member navigator that assists members when care is needed as well as core specialties on the -- in the core surrounding geographic area. And in terms of core results from this model, as you can see from each of the markets that we've entered, we continue to not only improve quality, but also reduce the overall medical costs. Most recently, we've taken this model and we've moved into 2 new geographies in Nevada. We actually entered with an employed group with 6 original clinics that are 12 today. With that same scale of primary care growth, we have built out an IPA risk-bearing organization and are now taking delegated full risk in that state. Similarly, in Texas, we grew with risk-bearing organization, which is an affiliate-based model. We slowly expanded that affiliate-based model to more and more include network adequacy in Houston. We are starting to deploy clinics and like Nevada, we'll be moving into a fully delegated environment. Now in terms of our growth in California, Nevada and Texas, there's a 40 million members that are addressable in this marketplace, and we expect to continue to see very strong growth over the next 3 to 5 years. Now when you look at our financials today, the majority of our financials are on a partial risk basis. What that means is, today, we are recording the professional risk of our overall care model that's highlighted in blue on the left bar. And over the next 12 to 24 months, we expect to move from a professional risk basis to a full risk basis. We've done this through acquisitions in California of various entities that allow us to take full risk as well as applying for similar licensure in Nevada and Texas. What that means is we have the capability, and we have been managing the full risk spectrum today, and we will now be further moving up the risk continuum. And continuing to deliver high-quality care to members. Further, this highlights today about 6% of our members are comprising of that full risk today. And we, today, are already delegated for UM functions and various other functions. So we have a -- and our teams are already doing the majority of the functions today. So we see very little change as we move into this new risk enablement setting. Key item that we wanted to highlight is we continue to execute on our strong M&A pipeline. Most recently, we partnered with an entity, Community Family Care, 4 years ago as an enablement client. At that time, the entity had about $5 million to $10 million in EBITDA over the last 4 years. That EBITDA in our joint partnership has grown to $25 million. And we chose at this moment to have them join the ApolloMed set of organizations. During that time, we also helped and partnered with that entity for them to receive a full risk Restricted Knox-Keene license, which allows them to take global risk on their Medi-Cal population. And synergistically, this will allow us to move our Medi-Cal population into this full risk enablement setting. And also to take their Medicare Advantage members similarly and move them into our full-risk basis. We think this is a deal that we will keep replicating over and over. It makes sense, and it enables us to first get to know partner and build capabilities jointly with them and then really jointly scale together in the future. I want to take a second to reiterate 2023 guidance. We see continued strength in our model. We see a bright future ahead in terms of '24, '25, '26, and I'm going to hand it back over to Brandon.

I just want to make some quick concluding remarks, and then happy to get to questions. As Chan mentioned, we've been doing this for quite a long time. The company has been around for many decades. It's an experienced mix of clinicians, certainly, as well as operators, financial folks as well as engineers, and we think it's a mix that really has worked in terms of generating actual revenue and EBITDA growth over the last couple of years. At the end of the day, what I want to kind of emphasize is that ApolloMed is really a pure play, over 95% -- around 95% of our revenue is value-based care in nature, upside/downside, accountable for the results that we say that we can actually engender. It's flexible. We're able to enter regions, as Chan mentioned earlier, by building or acquiring clinics. We're able to enter via partnership with existing -- so the example is Vegas, for example, or partnering with existing providers that are independent in the community, such as Houston. And we're able to have infrastructure that serves as a command hub to flexibly and in a very coordinated fashion, integrate both of those together so that patients don't even know or care, frankly, nor do they have to, whether something is owned by Apollo, is partnered with Apollo, first-party third party, all that patients know is that they're getting a quality, high value and accessible care at the end of the day. We have a proprietary technology platform that we built completely in-house that allows us to empower and enable providers so that they can operate and succeed in our integrated Care Delivery model. We have pretty clear levers essentially a X by Y matrix of let's grow members. Let's take more risk on those members. As Chan described, and in fact, in particular, with California regulating -- regulatory approvals that we recently got in terms of the restricted Knox-Keene license have some pretty near-term catalysts in terms of the latter, which is growing the risk that we're taking per member. And I want to make it clear, Chan mentioned this, but just one more time. These are not new members that we're taking risk on that we don't know who these members are. They just joined our ecosystem. As I mentioned before, we take a lot of pride in serving members across all stages of their life, and these are members that we've already been serving for a long time. These are members that we already see their utilization from both an inpatient and outpatient perspective. These are members that really all we're doing is changing the financial cash flow of where the dollars go and not so much anything operationally or clinically, for that matter, for these patients. Both of these drivers together, population growth, geography growth in our value-based contracts as well as increased levels of risk are going to combine together to give us a very comfortable and we're very confident in kind of the long-term growth outlook in the mid-20s. We've had a proven track record of continued profitability, been profitable for over a decade and over the last 4 years, in particular, have grown EBITDA by around 27%. And at the end of the day, this is a mission-driven company. We're positioned, we think, really well to create a system that is going to serve all patients that's going to deliver high-value, high-quality and accessible care to all patients, and do that in a way that is sustainable financially and can continue to grow. The last thing I wanted to quickly touch on before we get to questions is we've given a lot of thought to our identity over the last couple of years, especially with all the changes we've made, transforming from a more regional entity in California to a national player in value-based care, continuing to grow the business and prove out the codification and the scalability and the portability of the model. We think about -- what's actually important to us and what's important to us are our providers, our teammates, both clinical and administrative, they're all stars to us, right? And really our business, as I mentioned earlier, is about taking all of our provider stars and stitching them together, empowering them to be a really strong group constellation that will deliver high-quality care to all Americans. And so with that, starting in the very near future, we plan to change our name from Apollo Medical Holdings to Astrana Health. We're here and excited to reach for the stars, we're going to change how health care is delivered in America, and we hope that you guys are all there with us, by our side as we do that. Thank you.

Thank you, Brandon and Chan, for the great presentation.

So to kick off our Q&A portion, could you talk a little bit about what differentiates your business model from some of your public peers? And what has allowed you to achieve a long history of profitability, unlike others in the market?

We touched on it a little bit earlier in terms of the very flexible types of delivery that we're able to provide, right? It's partnering with physicians that already have the trust of patients in a given community, not trying to force a new box into that community, if it's not necessary, but also having the ability to acquire build centers to fulfill or to fill any gap in access that might exist in a given community. And so it's a flexible approach, first and foremost, that allows us to do that. Secondly, it's a really deep integration between primary care and specialists. Our company was founded by 2 physicians, specialists who actually are sitting in the back there. So thank you for joining us. And that focus on specialty care and its integration with primary care has not changed a single bit in the 30 years that we've -- 30-plus years that we've operated. And it's not just having a primary care provider gate-keep or refer or a quarterback, which is certainly an important part of the model. But even more than that, it's having the amount of data that we do, the visibility, the real-time nature of that data then even more importantly, taking that data and being able to go to the specialist and try to offer up -- with our medical directors and our clinical teams try to offer advice and have a discussion around what are the best practices on a clinical basis on an ongoing basis so that we can truly manage things like part B drugs or Part B specialty spend. Again, these are not conversations where you -- someone has a conversation behavioral changes overnight. It's a combination of the amount of hooks that we have into the practice. We are carrying a moment -- process. It's about the amount of the panel that we represent for a provider because we're a multiplayer and multiline of business that we're able to, over time, really influence specialist behavior and have a good sense of kind of integration between primary care and specialty care to avoid some of the challenges that maybe folks in our industry have been seeing lately. And then finally, it's our ability to go into independent and individual practices on a onesie-twosie basis and not necessarily rely on big game hunting and finding large provider groups that are already, quite frankly, successful in their own right, albeit in that maybe fee-for-service setting instead of a value-based care setting. But we have shown the ability over time to not only work with a large existing established groups, but also with the independent practices where otherwise without us in a status quo setting, they're all going to be optimizing for themselves, but not necessarily for the risk-bearing ecosystem as a whole and certainly not necessarily for total cost of care. And so a lot of differentiating factors between what we're doing and kind of what others are doing, and we look forward to continue proving that our model is the one that actually works and executing on that in California and beyond. Chan, did you have anything to add to that?

No.

So as you start to shift members to the full risk, what would that mix look like in the next 2 to 3 years? And is the Restricted Knox-Keene license that you recently got kind of the last barrier to making that shift?

Sure. Yes. So over the next 2 years, we do expect the majority of our members that are Medicare and Medicaid to shift into a full-risk setting, either through the Restricted Knox-Keene in the California market, or the various other regulatory-equivalent ecosystems that exists in Nevada and Texas. And in terms of the last step, we're -- we've been operating in this way for -- historically, our teams are prepared, our data systems are in place. We already have members in a full-risk setting today. Now it's really working with the regulatory bodies to move that membership over.

Great. And then thinking about the new providers that you bring into your network, how do you pick those new providers that you want to bring in? And then can you discuss a typical provider profile for us and why they might choose you to partner with?

Yes, I can start high-level. There are a lot of reasons that providers might join one risk-bearer over another, especially in past years, there have been proliferation of models that all maybe on surface, look and sound the same. I think at the end of the day, the value prop is pretty clear. It's can a provider get paid more? And can a provider have the freedom and the time, frankly, to do what it is that they want to do, which is take care of patients and not have to worry about other things. And that's really where our care partners, Care Delivery and Care Enablement businesses really work in concert to be a very compelling pitch for a new provider that might join our network. On the Care Partner side, because we're able to have a large percentage of the panel, we're able to get a lot of -- or convert a lot of their patients into a value-based contract. And that generally, especially with the performance that we've seen leads to additional shared savings, higher capitated rates for them and quality incentive bonuses that they might be able to earn as part of -- as a participant in our Care Partners business. From a Care Enablement side, we talked about the kind of 2 avenues that we try to enable practices or groups of practices. They don't have to worry about any of the risk-bearing stuff, the reporting, the MIPS, credentialing and the contracting all of that. And from a practice management perspective, we also offer, as I mentioned, EHR access, billing, social media even, website, scheduling, et cetera. So the point is to have so many -- at the end of the day, after they've onboarded to the ApolloMed platform in full, a provider practice only has to practice essentially, they don't have to do any of the administrative. They don't have to worry about their value-based contracts. All of that is administered rather in a very effective and, frankly, profitable setting that allows us to pay the providers top of market. So at least high-level to me, that's a lot of what gets providers in the door. And then of course, there are a lot of on-the-ground things to understand about each community that are idiosyncratic and we do that as well.

Great. Any questions from the audience? Yes. There'll be a mic coming your way.