BrightSpring Health Services, Inc. ($BTSG)

[Presentation]

Good morning, everyone. Thank you all for joining us here at BrightSpring's headquarters in Louisville, and welcome to those of you who are on the webcast. Today's agenda will start with a company overview from Jon Rousseau, Chief Executive Officer; followed by detailed reviews of the pharmacy businesses from the leaders of specialty, infusion and home and community pharmacy. Following the pharmacy overview, we'll bring up the leaders for question and answers before we take a break. After the break, we'll go through the provider businesses, starting with home health, hospice and rehab and personal care, followed by a Q&A session with the provider leaders before breaking for lunch. After lunch, we'll hear from the leaders of government relations and business development teams, followed by a discussion on the company's financials with a wrap-up discussion and Q&A with Jon and the other leaders. Our goal is to end the day around 2:00 p.m. Eastern. Before we begin, I'm going to read the company's forward-looking statement. Today's discussion will include certain forward-looking statements that reflect our current assumptions and expectations, including those related to our future financial performance and industry and market conditions. Such forward-looking statements are not a guarantee of future performance. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our expectations. We encourage you to review the information in today's presentation as well as in our annual report on Form 10-K that is filed with the SEC including the specific risk factors and uncertainties discussed in our Form 10-K. Such factors may be updated from time to time in our periodic filings with the SEC, and we do not undertake any duty to update any forward-looking statements, except as required by law. During today's presentation, we will use non-GAAP financial measures when talking about the company's financial performance and financial condition. You can find additional information on these non-GAAP measures and reconciliations of our non-GAAP financial measures to the most directly comparable GAAP financial measures to the extent available without unreasonable effort in the company's 10-K. This presentation is being recorded and will be available for replay on our Investor Relations website. And with that, I will now turn the day over to Jon Rousseau, Chief Executive Officer.

Thanks, David. Good morning, everybody. Is this thing working good? You guys can hear me? Good thing I can't see so well. Good morning, and thank you for being here. I appreciate everybody traveling. And for those that were able to get to walk through last night over at Onco and CareMed, hope [indiscernible] the great things that the organization there that. All right, with that, I know we've got a packed schedule, we will dive right in. I'm going to hit just an overview for about 20 minutes, then we'll hit pharmacy the provider side, and then we'll wrap up with some core debt and finance, if that sounds good. If I can figure out -- the clicker. Okay. Well, look, I think a lot of you are very familiar with the story at a high level, but I'll reiterate it. We are a leading home and community health services company, full stop. Whether it's pharmacy services in a closed door manner directly to the patient or whether it's provider services, going where the patients are, we are a solution for the future of health care, where we deliver very high-quality products and services at a lower cost for a very high ROI. We think that's a very good place to be aligned with long-term health care trends. And we want to ride that out as far as we can and continue to be an innovator and a solution provider within health care. So again, we primarily take care of seniors and specialty populations, providing them with very needed solutions, which are also lower cost. In doing so, we really focus on the platform and our quality and operational capabilities. That's really been a hallmark now for 9.5 years that we've invested in, process, people, operational excellence wherever we can, and that drives our growth. The quality of reputation and our ability to get services out the door quickly drives our growth. Ultimately, we also have a lot of scale advantages with this platform, which I'll talk about more, sometimes I think that's a little bit underappreciated. Yes, we have a lot of service lines that are doing well, and we are defined by broad-based growth with a few superstars in our portfolio from a growth perspective. But I also believe that the reason why we've been so successful, we're in the top 5%, 6% of public companies in the last 3 years on EBITDA. In the Russell 3000 for companies over $5 billion or $10 billion in profitable, we're second on revenue growth over the last 3 years, right? I think the reason why we've been able to do that is because we have the one enterprise platform. So a little bit on our history, ResCare, our predecessor company and brand goes back almost 50 years founded here in Louisville, taking care of individuals with intellectual and developmental disabilities in group homes, just an unbelievable mission. That company has grown its revenue for about 30 or 40 years in a row consecutively an incredible quality that leads that industry. When I got here about a little over 9 years ago now, we started more heavily investing on the clinical side. We also had a pharmacy business, taking care of those individuals in the home very smartly. We had a rehab business, personal care, but we really started building out more of the clinical side with some of that -- with some of my background in a earlier in the areas, that went really well. Had been in the company for about 15 years, taking it private. We recapitalized to KKR about 2.5 years into that, a little bit sooner than we wanted to, but Onex literally had to exit. KKR has been incredible and wonderful partners throughout. I mean, their focus on quality, their focus on mission was just ideal for this company. So that happened in early 2019, and it's just been an incredible run. Our thesis then was to combine a large pharmacy company of scale, PharMerica, which they had bought about a year earlier with our provider scale and create a very unique platform within health care, a very unique, scaled pharmacy and provider platform that could more comprehensively serve patients. And that has gone extremely well. Fortunately, that headquarters was about 4 miles down the road on the PharMerica side and very seamless for us to all come together. So after that, it's really been about 7 years at this point of just execution and building out the platform. We had the service lines we largely wanted to be in, and it's been growing in those service lines on the back of our quality and operational skill set, which has been the focus for the last 6 or 7 years and has resulted in those growth rates that I spoke about before, CAGRs of around 20% at this point on both the top and bottom line. We've had some events now in the past couple of years. We went public in January of 2024. So it's been about 26 months now. And that community living business, which we started with about 50 years ago, we decided late January of last year to divest that business to have a strategic focus on more clinical services in the organization, also helpful from a deleveraging perspective and a cash flow perspective. So again we expect that to close here in the next few weeks. We've also selectively done some acquisitions, with these home health assets here more recently, which we think that will be very favorable for the company. So our model today, the circle, the top half is pharmacy. The bottom half is provider. And we think those fit together extremely well. It is a comprehensive in what we believe to be a very differentiated model for home and community health care services that better addresses required patient needs for improved outcomes, it creates market and integrated care opportunities, and it leverages our scale. So I think everybody is probably pretty familiar with some of the challenges and opportunities in health care. I think the left side of this slide is very self-evident. But there is a smaller percentage of the individuals in our society that make up a larger proportion of the spend. It's individuals on -- with chronic conditions, seniors and specialty indications. One of the markers of these populations is that most people is typically on 6 or 8 or more medications. When you look into health care and you see an individual who's on 6 or more medications, in particular, that's referred to as polypharmacy, mean that is a pretty clear indicator of where your biggest risk is going to be and where your most complex patients are. A lot of these individuals could be served in lower cost settings, very logically. And a lot of ER visits and hospitalizations could be curtailed with more proactive and more proximal care for these patients where they are. So our solution to that has been the integrated care model. These services are delivered in lower cost settings. We've been able to deliver very strong quality results. The comprehensive model does give us a lot of integrated care opportunities, whether it's cross referrals across our service lines or ultimately managing patients in more value-based care models. This model, we believe, again, is the future of health care in many ways in what we need to keep driving. So what constitutes that model more specifically from a product perspective, on the pharmacy side, we have 3 key service lines. On the provider side, we more or less have 3 key service lines. So I always keep it straight in my head with kind of a 3 x 3 framework, if you will, on pharmacy. This is closed door pharmacy, okay? And that is the big difference. This is not you and me walking into a retail pharmacy. It is the polar opposite of that. There are a myriad of settings and locations in our society and neighborhoods every day where people need their medications where they are more chronic, more acute where they can't walk into a Walgreens for one script. That doesn't work for a large chunk of our population. So we go to them. That's what closed door means. You cannot go in, we go to our customers, we go to our patients wherever they are. The first patient population that we do that for are individuals with cancer and individuals with rare orphan diseases. That's our specialty pharmacy business under 2 brands, Onco360 and CareMed. Onco360 as the name might indicate is our focus on oncology. CareMed is our focus on LDDs and rare and orphan therapies outside of oncology, and that continues to grow. That is a leading quality business in the United States with excellent service metrics, Net Promoter Scores of above almost 95. And on the backs of that, the team has developed incredibly deep and trusted partner relationships with pharma over the years, and our sales team really pulls through as a partner in the offices every day, prescriptions, working with patients and families. Our infusion business, this is going to the home or sometimes in a suite or in the clinic in providing needed infusible therapies. We really do everything there. It can do everything in infusion, except oncology. Specialty business I talked about before is oral and injectable. This is infusion. And we do most things except oncology, which is primarily done by the hospitals and the doctors in the buy-and-bill model. So in infusion, there's 2 key areas in patient population types that we focus on. It's our acute patients, antibiotics, nutritional therapies, et cetera, and then the chronic specialty population, IVIG, a lot of neuro and gastro indications et cetera. Wonderful business, large market growing. Our home and community pharmacy business. This is more or less the biggest legacy business of PharMerica. So this is where we are getting drugs and medications to hundreds of thousands of people every day wherever they may be. These are individuals, again, that are more acute with chronic conditions in skilled nursing facilities and assisted living facilities at home on hospice, at home on home health in behavioral group homes. This is a good example of where we have integrated care in our company. All of our hospice patients, all of our behavioral IDD patients also receive all their pharmacy services from us. But collectively, across these pharmacy businesses, we dispense over 40 million scripts a year, I think that puts us in about the top 10 of the country as a pharmacy after the retailers and after the big PBM mail order houses. Scale is very important in a lot of industries. It is absolutely vital, as Scott will talk about, in the pharmacy industry for purchasing, for payer contracting, for leveraging your OpEx for driving automation, pharmacy is just critical. We can be anywhere in the United States on the ground within 3 hours. That's our coverage, and that's our footprint that's been built up over the past 40 years, and it's a huge advantage. On the provider side, home health care, rehab care and personal care. Home health care, that's home health and hospice, and we're building out our home-based primary care business. We'll talk more about that. We're integrating presently the home health assets that we acquired in the United divestiture of Amedisys. That's going very well, but we love those businesses, huge ROI of home health, produces hospitalization rates by 20%, 30%, reduces cost the same for hospice. These are wonderful services with very mission driven clinicians who are out there every day, taking care of people in their home so that they don't go to the ER unnecessarily or they don't go to a hospital more than they have to. It seems incredibly intuitive that the more you get to somebody proactively in their home, see their setting and make sure they have a customized care plan, like that works. I remember like 15 years ago, somebody told me there's not a lot of new ideas in health care. It's just the implementation and the execution of it. And a lot of these things are very clear in terms of what you should do. It's the ability to actually do it, and it's making sure that you have a reimbursement model that supports it. On the rehab care side, wonderful business with incredible clinical quality. Here is where historically, we have taken care of individuals with severe neuro conditions, either a brain injury or a spinal cord injury. It's mostly a workers' comp and in a commercial funded business, where we have a footprint across about 30 states, very predictable, nice double-digit growth business. It's about a 7% growth market. We are more recently leveraging that rehab and therapy expertise to also move into the senior setting, adjacent to our home health hospice primary care and pharmacy and be the rehab provider in conjunction with home health in places like assisted living in the home for seniors under the Part B benefit. Personal Care, very, very steady business for us, 2% to 4% grower, but operationally, very consistent, very steady, it is not the easiest thing in the world to hire caregivers to go deliver personal care, the lesser clinical home instead type services in the home. Our team does that very predictably and in a very consistent manner with really good quality results. I really think that personal care and med management are the 2 ways if you look at the data, that keep people out of the hospital the most. If you just think about it, when somebody is in the home, you don't have to necessarily be a doctor or a nurse or a therapist to do common sense things at the home. What are you eating? Are you able to get around? Are there fall hazards in your home? Are you getting companionship? Are you taking your right meds? Any of us can do that. That's personal care. And it has an incredible impact on also keeping people out of the hospital. Our markets are large and growing, and they're also incredibly fragmented. So we think that creates a lot of runway for us in the future, both organically and from an acquisition standpoint. If you look at our markets, they all have favorable demographic trends. Everybody, I think, knows the growth in the seniors population. I think people over 85, that population is supposed to triple in the next 10 to 15 years, people over 65, that's supposed to double in the next 30 years. So a lot of long-term growth trends here. Specialty indications are generally growing at about 5% to 7% or 8% in the country. On the pharmacy side, a lot of these specialty therapies have been growing more in the 10% to 12% range. Ultimately, these markets, we believe, are very attractive. They're also very fragmented. We believe scale is going to only be more and more important in the future. You need scale in these industries to invest in HR, to invest in technology. I mean, Charlie and Viji are going to talk for a second about how we're investing in AI to drive operational efficiency through the organization. Our ability to deliver really good operational services and sound practices should be so much better than a home health company in 3 states than an infusion company in 2 states. We try to leverage our expertise. We think scale will only be more important in these large and fragmented markets while we also try to partner with the government and with payers on needed solutions. The prevalence of chronic conditions, unfortunately, continues to escalate as well. These are all factors that are fueling the growth in these markets where we want to continue to be a standout provider. We want to not only benefit from addressing the demand needs in these markets, but also through a differentiated model and better operations, take market share as well. There's just some growth stats here for you. I won't go through all these. It's going to be in your deck. But on the pharmacy side, we see infusion and specialty pharmacy generally growing in the 8% to 12% range. There are some therapies and indications there that are growing higher than that. There are some that are growing lower than that. Acute tends to grow at 3% to 4%. Other chronic conditions and infusion tend to grow in the double digits. Within specialty pharmacy, oncology is not only one of the biggest segments of specialty pharmacy, it's one of the segments growing the most quickly because of all the innovation and the new therapies coming out of the pipeline that are literally extending life in saving people's lives. And obviously, we have the largest position as the independent pharmacy in that very interesting growth market. On the provider side, personal care tends to grow at the population growth rate. But home health hospice and rehab are growing in that 5% to 7-ish percent range depending on which one you look at, very healthy growth rates. And the way we think about that is, look, if the market is growing at 5% to 7%, and we need to try to double that, we're taking market share, and that's our approach to try to get to double-digit growth in all those businesses on the clinical side of provider, rehab, home health hospice. Everything is based on quality, as I talked about before. I think one of the things that collectively our management team is most proud of is what we're doing from a service perspective and from a quality perspective. Again, a lot of pretty obvious comments today, but you literally can't almost do anything if your operations aren't very stable and predictable and if you're not getting good quality outcomes. For us, really importantly, we try to benchmark everything, and we try to track everything. So we know how we're doing. We try to do that in real time as much as we can with investments for the past 7 or 8 years in all of our data warehouses and reporting suites, so we can see in real time how we're performing and then also how do we go get benchmark data in the industry to really hold ourselves accountable. On the pharmacy side, I could pick any one of about 20 metrics really that would show really strong and consistent performance, whether it's the predictability of getting our meds out on time, the accuracy of those meds or Net Promoter Scores that literally can be world-class in the mid- to upper 90s. On the provider side, in hospice, we've been ranked the top 5% hospice provider. Our home health branches, I think about 94% right now are over 4 star our hospice branches are well above the industry average on 4 star. In hospice, we see our patients a lot more, right? If you're a mom or dad or somebody you knew was on hospice. Would you want somebody coming once every 2 weeks? Or would you want somebody come in 4 or 5 times? It makes a massive difference. We invest in quality, and we invest in service levels. And we think that's ultimately manifested in our ability to reach more patients and make a bigger impact and grow the organization. We've had over 30 articles and abstracts written about our outcomes in leading journals and publications. I would be surprised if I knew of another company with 1 or 2 or 3 of those. It just really shows and I think, a tangible demonstration of how focused we are on wanting to drive quality and service through the organization. Slide here on some of our advantages as a one enterprise scale platform. I think some of these things do go underappreciated oftentimes. But there are real reasons why these businesses collectively and why our company together as one does better. First and foremost, probably stating the self-evident here from procurement and contracting perspective, we're able to be much more effective in terms of how we buy across the company. We are able to leverage IT spend and drive best practices in technology and data and analytics throughout the organization. It's not only the ability to buy that more effectively and save money as a bigger company. It's to make sure that's being deployed through the organization the right way. So each one of the businesses has the right technology profile. Clinical quality and compliance. We invest heavily, we've got some 250 people that sit topside at corporate, even above the quality personnel in the businesses that are constantly auditing. They are constantly out there teaching and educating across all of our branches and locations. We have a greater ability to invest and deliver those results on the prior slide because we leverage the organization. Sales and marketing. We try to drive best practices in sales and marketing across every one of our businesses. How are we hiring sales reps? How are we onboarding and training them? What is our sales analytics for how we target our referral sources? What kind of compensation plans do we have in place, rewards and recognition. Just down the list of Sales 101, we try to make sure that, that's very consistent across our businesses. HR is an area we have been focused on, along with IT, along with sales and marketing at the corporate level, we always aspire to be an HR "academy" company. How -- what is your experience like when you're recruited? How are you onboarded? How are you trained? What is the intranet, what is the internal systems that you're able to use? What systems do you use every day for your EHR? Is that an easier system to use. Are there career pathways here? What can I do? And these are all reasons why our retention and our turnover has improved every single year for the last 9 or 10 years. And if you look across our businesses, we are typically in the top 10% to 20% of retention as you benchmark us across our industries. The PMO, that's something that I was very familiar with going back to my Medtronic days, that is a program management office. The way that I like to describe the PMO is they just help make sure stuff gets done. And you have people that are in charge of everything in a business, there is always the need for follow-up no matter what, and things can always fall through the cracks when you're executing on cross-functional initiatives. The PMO team, we've got about 20 people on that team right now. They are working on over 100 initiatives at a time in this company, helping to make sure those projects are on time and getting moved forward. We have evolved that to take probably some informal process around smart lean process over the years. And in the last 1 or 2 years, in particular, make that much formal in our company. So we now have individuals and leaders in this company who drive Lean Sigma training, whether it's a white belt or green belt or a black belt, you can get that here at our company, just like at your Medtronic or just like you're a GE in the old days. You can get that here, and we have something like 300 projects going on right now in this company initiated by people on their own in their business, working on how to do something smarter. So we want people to organically think about what we're doing every day. I've been taught about what Lean and smart process looks like. Now how can I go execute that as part of this training because I need a live project to get through graduation of this training, and I have to demonstrate the execution of a project. So really, really cool stuff that we get excited about, that's in the bowels of the organization every day, but it's literally how things get done. Really last from an acquisition perspective, we are able to leverage a lot of our size in terms of being able to be selective about our acquisitions, right like we don't have to just pick from home health assets. We don't just have to pick from infusion assets. We can look at infusion, hospice, rehab, home health, LTC, pharmacy, and we have the luxury of being able to sit back at any point in time and say, which one of those do we like the most, right? And think about what makes the most sense right now in our company for an acquisition to do. Most of them have been small tuck-ins, but we have the ability to execute on really almost any deal out there with our team and with the synergies that we bring to bear. In some of the pharmacy deals, day 1, day 2 after close, boom, that financial profile looks very different because of the contracts that we have in the revenue and the cost synergies that we can bring to bear. These are all strengths of the organization that we believe we have advantages of scale driving best practice through the organization that I just am not sure a local or regional provider of one business alone would have. And so we want to continue to push the pedal down on this as we move forward in the future and just drive more and more scale and more and more advantages of scale with really high-quality services. Just a slide here a little bit more on the lean process. I mentioned it before. There are over 700 projects in the last 3 or 4 years that our PMO team has completed in procurement or process or technology implementation separate now from all of the organic on-the-ground Lean Sigma projects going on as a result of the Lean Sigma Academy training in the company. This is in our DNA, and this is what drives operational service levels and the quality results that you saw. Charlie and Viji, did you just want to take 1 or 2 minutes to talk about, we can't talk about all the things we're doing in AI for a few reasons, but we're excited about it, right? And we feel like with a company of our size, a $15 billion company with our resources and our people. Sure. There's going to be some things we go buy, right? There's already some projects we've partnered with paid for with outside AI vendors to get going. Home health intake is a good example of that. But we feel like we should have the sophistication and the ability to get these AI projects done. And if we can do that, we're the ones with the workflows and the businesses that the vendors want to get their hands on, so we're doing this every day. We know what the problems are. We know what the opportunities are. If we can develop and leverage all the great work we're doing in tech on the AI side, we think that's probably an advantage for us going forward, probably saves us a lot of money ultimately is more predictable. If we have the team to be able to do it. And so that's what we've been building out.

Thanks, Jon. My name is Charlie Wardrip, I'm the Chief Information Officer here at BrightSpring and thank you all for coming. Like Jon said, we've invested a lot in technology over the last couple of years. We've been able to establish a very sophisticated integrated data and technology platform that not only supports the needs of each individual line of business, but also supports the needs across the entire enterprise. It gives us the ability to provide integration where we need to and share data across the organization as we feel fit. In order to do that, we've done a few things. We really focused on establishing a very operationally focused platform. We work closely with our operators to make sure we can identify things and solutions they mean and that we can provide outcomes that they need to operate their business. Also, we focus on hiring the best people. And as Jon said, AI is a big focus that we have in place right now. So we went out and found Viji. I let her introduce herself. She's our Chief Technology Officer, who joined the company about 7 months ago now. So Viji, why don't you just introduce yourself for a second?

Good morning, everyone. I'm my -- I've been here for about 6 months. And my remit is all things technology advancement, including AI, ML and intelligent automation. My background is before joining BHS, I was with CoreWeave, which is a GenAI hyperscaler. And prior to that, I was leading the machine learning fleet for Alphabet, working with 23 internal stakeholders, including deep mind research and ads. My patient -- my passion is driving innovation to drive better quality outcomes for our patients, while improving revenue and reducing cost and simultaneously improving employee productivity. And we have several AI initiatives across the care continuum that will drive that scale that Jon was talking about.

Yes. And Viji has been able to actually bring a lot of people from the industry into the organization. So we focus on a couple of key areas: hire the best people, to fill the gap. So we have the ability to service these things internally. And at the same time, in order to accommodate scale and time to market, partner with key strategic partners. So we've engaged like with several partners now that will allow us to drive these AI projects in the organization. We focus on, like Jon said, on about 3 areas. We try to keep it simple at. I didn't realize we were all going to get to 3s today, but we did get to 3s today, and one is we got to provide clinical outcomes, great clinical care. We got to support our clinicians and how they provide the services through the technology. We focus on revenue generation and how can we support the company and revenue growth through referral management, through effective M&A integration capabilities and other strategies. And at the same time, we focus on like Jon was alluding to, how can we get rid of overhead burden so how can we automate processes that's where we think AI has a tremendous amount of opportunity in the organization to automate those functions for us. So thank you all.

Thanks, guys. Charlie basically hit on it, but these are the fundamentals in the building blocks for IT that we've been very focused on I would call out cyber as well. It's a tricky world out there. And Charlie's background, in particular, deep on the infrastructure and cyber side, it's a huge focus, but really excited about how -- really excited about how technology can help us drive forward from not only an operational perspective, but quality in growth as well. Look, these are our growth drivers at a high level as we go forward. Each one of the businesses obviously has their top 5 or 10 growth drivers. But when you look in broad strokes, number one, as I mentioned before, we're fortunate to be in markets at growing where we can provide more needed solutions in participating in that market growth rate. Number two in those markets driving market share through a differentiated capability set and focus on quality and growth. Number three, we continue to try to expand geographically, that is a big opportunity we have in this company. I would say more on the provider side and in infusion and especially in LTC pharmacy, we're pretty much everywhere. There are some markets we can be deeper in home and community pharmacy. But on infusion, home health and hospice and rehab I mean there is still a good ways to go. I mean I don't even think we're 50% of the way there in terms of where we could be geographically in the next 10 years. And one of the ways you do that is through just opening up new locations on a regular basis, which we've done, continuing to expand your geographic footprint. Continued platform efficiencies, that's a form of core growth for us as well, continuing to drive the organization as efficiently as we can, reinvesting in IT and in our people and process. So that's core growth. And that's -- these are literally words we use in the company, core growth and strategic growth. Core growth is how do we take the service lines that we have today and just continue to scale them as best we can. Strategic growth would then be getting into more and more investments, some of the newer AI initiatives that we've talked about before to hopefully continue to transform the company and support scale. Adjacent provider in pharmacy, patient and payer markets there are numerous patient types and payer types that we could address with what we are doing today. A good example of that is in rehab, where we took our rehab platform in workers' comp and commercial and now we're growing into the Medicare side into ALS. There's quite a few more examples where we could continue to extend our services into certain patient customer and payer partners, driving additional integrated care opportunities. I'll talk about that on the next slide. But how does the business work together as effectively as possible to provide more integrated care, and then ultimately, from an M&A perspective, continuing to drive really accretive M&A. So Integrated Care, we're sort of getting to the end here of my section. Again, our focus every day is on core growth, and how do we continue to provide great services in these attractive markets and scale our core service lines. But there are a lot of other interesting opportunities available to us because of our platform. Some examples I talked about before is on the provider side where we provide a lot -- most of those provider patients with our own pharmacy services. That's just an obvious example of where we are a bigger company from a financial perspective because we are able to offer multiple services to that patient and individual instead of just one, but we think about integrated care in 2 buckets. On the top of the page, above the dotted line is really how do we better integrate care for patients within our service lines, right? And so as we look forward, some areas that we're most focused on, more and more integration of home health with palliative and hospice, more integration of hospital and SNF discharges into our other service lines. Our skilled nursing customers in our Home and Community Pharmacy business, we're not the SNF, the customer where we are a pharmacy in that building, they will discharge about 250,000 people a year into the home from those buildings that we service on pharmacy. Some of those buildings we're getting into with primary care. Those are all individuals, 30% to 40%, that will need home health rehab and hospice. That's a huge opportunity from a care coordination and continuation standpoint. One-stop service solutions into ALS. ALS need home health hospice, rehab, primary care and pharmacy. ALS have to have that. We do all of those. So our ability to be that service provider instead of saying, hey, we're just a hospice over here. Or hey, we're just a pharmacy in these buildings over there. We have the ability to go in as a one-stop shop, and we are really starting to do that more, really led by our home health and rehab business going in and offering one combined rehab solution to that building. And then really last home-based primary care integration and patient management. We have been building out the house calls model. Wilford Brimley, this is old school, going back to the 20s. Doctors, largely NPEs going into the home or a SNF or an ALF, and they are your doctor. 50% reductions in hospitalizations in that model by the doctor coming to you, right? And so the doctor is the holder of the pen, they are the ultimate care coordinator, and they can prescribe for the patient what they need. And if we're better integrated with that doctor and if that doctor exists under our organization, that's a nice opportunity to provide services for the physician and for the patient in a better way. And then there is integrated care from the perspective of value-based care. For us, this would be managing patients in a quality focused manner under a different payment model, where you are compensated for the incredible work that we do in quality and the cost savings that we drive in the organization. So we think there's 3 fundamental things you need in order to treat a complex high-cost, high-risk patient who's out in the home on their own. How do you do that well? We think, number one is home-based primary care. You need to go to them in their home as the doctor as the NP see their environment and proactively care for them on a regular basis. Number two, you have to put the meds on lockdown with a medication therapy management program that works. One of the top 2 leading causes of unnecessary hospitalizations and ER visits is medication issues. So our continued care program is a customized program where we can do this for anybody in the United States where they have a 30-day cycle fill with compliance packaging. They get phone call check-ins, where we provide this service in conjunction with home health, a JAMDA study 2.5 years ago showed a 70% reduction in hospitalization. Like that's just a staggering number. But it's because we really focus on the medication issue, which so often goes unnoticed and underappreciated. And number three, what do you do with the in-between time? It's great if a doctor is starting to go into the home, but you can't be there all the time. So you need a clinical nursing hub or a way to monitor and be in touch with that patient in all of the in between time. And so we're building out the hub with 8 specific use cases as well. If we can deliver those services in that comprehensive model to patients, you can have the confidence to be able to go and get paid in a different way or at least be able to appreciate the savings you're generating in an ACO model. So we have an ACO today that's been productive. It's been an EBITDA driver. It hasn't been overly significant. We've got a couple of thousand patients in it, but that's a huge opportunity to scale in the future. That is a shared savings model with no risk whatsoever. It's literally getting the savings, a piece of the savings that you're driving with your better clinical model. And then what we're trying to do is be an effective partner with the payers, hey, payer, you have 5% to 10% of your members that are 70% to 80% of your cost. We will deploy this model for you with those individuals and get them a much better quality of life, better experience and get you better outcomes, let's please partner together. That's what we're trying to build out. Wrapping up here from a financial perspective, Jen will hit these numbers in a bit later. But on the revenue side, we have a 3-year CAGR of about 20% now. It's almost the same from an adjusted EBITDA perspective. We were up to $13 billion of revenue at the end of '25, $618 million of adjusted EBITDA. I think one of the things Jen and I are most happy about or pleased with, in addition to a lot of the quality stuff of the organization over the years is we went public at about 4.6x leverage and that number is now down below 3x. It will be about -- it's 2.6x now pro forma, should that community living transaction close. In addition to that, we generated about $500 million of operating cash flow last year. You take community living out this year, you put in growth for this year. We expect that OCF number to be about the same in 2026 but we just feel like that gives us a lot more optionality and flexibility as we move forward into the future. So that's been something that's been really pleasing for us. Jen will talk about how we're thinking about the next -- this year and the next couple of years later in the presentation. But as we look out to 2028, in our range that we see today, with what we know today, we think this company can grow off of '25 anywhere between 70% to 85% in terms of EBITDA as we go from the end of '25 to the end of '28. That's what we're really excited about. And that would be from an organic perspective. And so you look at the balance sheet and you look from a leverage perspective, that would be additive. And just very pleased that we've been able to grow into our leverage level and cash flow continues to perform with continued increases in working capital and the CapEx-light nature of our business. That's really it for me. If I were to sit here and just talk to you for 1 minute about what I think makes us different, it's this slide. I'm going to spare you the details, but I'm sure you'll rush to pull this out after the day and read it for yourself. But really, this is why we think BrightSpring is the difference. And it goes back to what I said before. We are a home and community health services provider, full stop. We think that is a very good place to be, and we think doing that at scale with the operational quality and sales focus that we have is hopefully going to continue to allow us to grow and move forward in the future importantly so that we can continue making a bigger and bigger impact for so many patients that need these services in the U.S. So with that, that's it for me for now. And I think we're going to go right into the Onco360 and CareMed team. So Ben and Robert you guys come on up. I probably ate into your time by 5 or 10 minutes. So Robert Thomson is our Chief Commercial Officer for the business. Ben Fernandez, runs Trade, Chris Urban runs all things operations, that is forward. These guys do a tremendous job with the business and the focus on our patients is always evident and the creativity and the ingenuity in this business, the partnership mentality with everybody in the system has been phenomenal, and we're excited to continue to scale this business not only in oncology, but in a lot of other areas that are defined by rare and orphan disease and LDDs. So guys take it away.

I met many of you yesterday, Ben Fernandez, Chief Commercial Officer. I've been in health care over 20 years, here with Onco360 for about 14, really with a focus on driving access to therapies and our limited distribution portfolio.

Good morning, everyone, Robert Thomson, Chief Growth Officer; I'm in charge of everything, sales and business development included in that is payer sales, physician sales, which is an outside and inside sales team, hospital sales and then also sales operations. And I've been with the company 13 years now.

Nice to see everybody again. Chris Urban, Chief Operating Officer, been with Onco360 for just over 10 years. So for those that participated in the tour yesterday, thank you. Hopefully, you found that just as valuable as we did. So for those that were not there, we are going to start this meeting, like we start all external meetings, and that's to really talk about our mission, vision and values. Mission, vision and values are not just words on the screen, but they are what we truly live day in and day out with our employees and extended to our patients. So our focus is to improve the lives of patients living with cancer, rare and orphan disease. How we do that? Through our vision, we will clearly demonstrate that in our presentation today. The values. Values are truly embedded in the DNA of each of our employees. Now one of the really neat things that we do on a quarterly basis, we encourage our employees to nominate each other when they see our mission, vision and values being demonstrated. We review hundreds of nominations a year. And then every quarter, we choose a winner or multiple winners in some cases, when you're reviewing 100. And we put publications out both internally and externally, celebrating that. And then that winner gets to choose a charity of their choice, and we make a donation to that charity and their name. It's something that we truly believe awesome, and we really celebrate as an organization. I think we'll see that we're there yesterday, I saw that. So we have had the unique ability to grow both organically with Onco360, but then also capitalize on opportunistic adjacent markets in rare and orphan. Back in 2014, we had 12 sales reps. We had 39 limited distribution drugs. Today, 275 sales rep strong and now over 149 limited distribution drugs. We also took our accreditations from 2 up to 4 with the key being designations in some of those accreditations for rare and cancer. This execution has really allowed us both Onco360 and CareMed to become the largest independent oncology rare orphan pharmacy platform in the United States.

Thanks, Chris. As you all can see, we've been very intentional and purpose-driven with really an unbelievable focus on driving clinical and operating superiority across specialty with the focus on cancer, rare and orphan disease. All of our focus has historically been around driving an optimal therapeutic experience for patients. It sounds simple in its message, pretty complex in its delivery. How have we done that? It's been through really investment in infrastructure and oncology. Today, we have the benefit of going to market to support manufacturers across new pipeline innovation through 3 really defined businesses. In our specialty pharmacy at Onco360, which is really our largest, most mature business within the rare cancer and orphan space. We have CareMed which has been a solution to partners looking to get that same service, quality, performance, innovation, ingenuity out of that they saw in oncology at CareMed. In addition to specialty pharmacy, separate from the pharmacy business, we have ConnectMed360 that looks to partner with manufacturers and really provide support and services. And all of the programs coming out of ConnectMed360 are really fee-for-service driven through clinical programs, innovation, really providing a lot of bridge free drug support as an extension of the manufacturer partners we support. If you go to the next slide, we're going to talk you've heard the theme of quality today throughout every interaction, but the compassion really drives all that we do across our care coordinators internally, our account management teams, our sales organization, from a manufacturer perspective, we built a reputation and credibility based off consistency. While we partner with manufacturers, we're consistently first to market, that's because Robert's team is driving pull-through. We leverage those 250, 275 sales reps in the market to create awareness and access whenever we launch new limited distribution. Chris' team is operationally ready to launch on day 1, consistently once a product gets FDA approval. That product is not generally in the channel for a period of time. That could be 48 hours, sometimes that can be 2 weeks. A number of our programs, partners' products on the shelf that same day, we're sharing the success, getting patients under treatment. That speed to market really means a lot to patient, a caregiver could be a pediatric neurology patient that we're servicing. We sell that success of our partners. That continued focus and support really is what fuels our pipeline. We're going to talk a little bit about pipeline and our LD access in a little bit. Our people are an extreme differentiator for us, right? We have seasoned leaders within the business that have really position us for continued growth, whether it's through new access, our sales organization and our operational leaders.

So guys, this is how we view the business in simple terms. Ben acquires the drugs, thereby creating a differential advantage in the marketplace for Onco360 in CareMed. In doing that, he turns over the opportunity to us by leading sales force around the country, 200 plus. And what they try to do is create awareness of access with the physicians, educate the physicians create a first mover opportunity and then also just in simple terms, garner referrals. In doing this, one key aspect of Onco360 and what we've built by design is that our sales force is built into Chris' operational workflow, this literally means that they can see the prescriptions as they come in minute by minute by minute and start educating the physicians as it relates to prescription status. Of course, inclusive of this is the ability to troubleshoot. Should there be any prior authorization issues, medical issues or just more information needed. And then lastly, upon final dispensing of the prescription, they educate the physicians to ensure that the patients who need this therapy in an urgent manner go on therapy and start their... The last part of this is, of course, to have payer access. So we've got a team of fully dedicated sales folks dedicated to relationships with payers so we can service and have broad network access for all the referrals that the hospitals send to us and the physician send to us because a high percent to fill is absolutely critical in this industry.

And then all comes back down to the patients. Our high touch, white glove service model is really delivering few call-outs here. Obviously, Onco360, Jon mentioned it always in the high to mid-90s. I do not want to steal any thunder, Jon, from when you're upcoming calls. Well, in Q4 2025, CareMed our rare and orphan pharmacy received a 100 Net Promoter Score, okay? That's absolutely phenomenal. That is their third perfect 100 in the past 5 quarters. So we are so proud of that team, and we're so proud of the service that they're delivering for our patients.

We're going to expand a little bit about what we see on this page here is really the diversity of our manufacturer partnerships, right? You can see a mix of biopharma as well as big pharma. Some manufacturers that are solely focused on oncology, but also others that have a healthy mix of oncology, rare and orphan pipeline. As we look at the market, we still feel very excited about the growth in the pipeline in oncology. But these partnerships really set us up for success, not only from launching of manufacturers new drug. But oftentimes, when we launch the first new drug, we're getting the next 2, 3, 4 drugs of the manufacturers portfolio. As you know, there's a lot of consolidation in the marketplace, you'll see pharma acquire different organizations, consistently, our platform is the go-to from a partnership standpoint. We're coming off our most successful year in company history with 2025 new product launches. And what we're seeing in the delivery in network selection of these drugs is compared to 2019, 97% of the products we're launching today are an exclusive [ royalty on our ] network. The value for that from our team and our program is in those networks, we're driving larger market share. Robert's team has an extensive portfolio of products that they have as an availability for the offices. Some of the reasons why manufacturers want to select Onco360, CareMed and also ConnectMed in that platform is really driven by the consistency in the operating model. The ability to know near real time, the status of all of our prescriptions not only empowers them with access and visibility, but ensures we're driving speed to market and confidence in the model. The volume of new products were launched on an annual basis also fuels new patient start growth and volume growth right? So compared to the earlier part of the decade, we're launching over 1 new drug a month in '25, it was 24. We expect that to be very exciting again this year. Not only are they new molecular entities coming to market, but you also have examples of manufacturers that have broad limited distribution networks or open access drugs that consolidate that. And we had a number of examples of that in 2025. So ultimately creates a more captive market share in audience. As I look at 2026 and beyond, we're already working the pipeline, 12 to 16 months out, 20 months out in terms of near-term opportunities. A lot of those decisions are already made. We feel very excited about the future and the pipeline of the portfolio. Robert's going to talk a little bit more about that.

So as you can see, over the past couple of years, the momentum is increasing with Ben's ability to garner drugs. Well, we believe the future bodes extremely well for us. Over the next 7 years, you can see on the left, about $100 million -- $100 billion of new product is expected to come to market. And our leadership team feels very, very confident that we'll be within network, if not preferred or exclusive with all of these products. In addition, there's a unique opportunity in the market. On the right, a significant amount of brand drugs are going generic over the next 7 years, approximately $20 million or -- $20 billion of drug is going to go generic. And of course, our physicians rely on us and our hospitals rely on us due to our capabilities and access, they rely us -- on us for brand drugs, LDDs but also generics due to our capabilities. So we're really excited over the next several years of that conversion cycle. Next slide. So this is a really important slide to understand how the sales force is configured. Our sales force is configured of approximately 60 teams across the country. I think field sellers and inside sellers combined in a partnership model, where we use data and information, both external and internal to focus on the biggest opportunities in the biggest markets and make sure that we're targeting the right physicians. Although Onco360 has a significant sales force, we pride ourselves in speed to market. If you think about it, we try to get to the marketplace when Ben wins a drug over the first 24 to 48 hours. What that allows for is first mover advantage, where we're educating the physicians on these needed drugs in the marketplace, but equally as important, it establishes that we can garner any pent-up market demand because these physicians are waiting for these unique therapies in the market. Lastly, on the right-hand side, we can never forget our existing patients. So our sellers truly are a seller sales and service model. So we focus a significant amount of time working with our physicians on their current patients to ensure that they stay on therapy, talking about new patients that they've referred to us, and so it's really a white glove service model for the physicians in our hospital partners. Next slide. One aspect of this due to our unique market positioning with Onco360 and CareMed, we formed deep and long-standing direct relationships with PBMs around the country. This allows us to ensure broad network access in both their commercial networks, but also their Medicare networks at the appropriate rates. In addition to the PBMs, we're focused on -- we have a team focused on smaller payers around the country who want to establish a direct relationship due to our product access, but also our operating model, and in many instances, will carve an exclusive out or a preferred relationship where we get to manage all of their patients, inclusive of LDDs brand and generics due to our capabilities.

Okay. So just one more time, I just want to summarize our value proposition for our patients in the industry. So for our patients, it's the reassurance that they're receiving the best quality, the best care based off of the protocols that we have built with our Board-certified oncology pharmacists and also our certified specialty pharmacists. Access. I think that pretty much speaks for itself, 149 key products key LDD products and growing. Compassionate Care, I mentioned it yesterday, we have 30 what we call onco advocates that are dedicated solely to helping bring down that co-pay and help with funding for our patients. And last year alone, they service 27,000 patients and help them get their medication. So if you really think about that, if they were not able to do something to help bring down that co-pay, they may have to cut another expense. It could be a utility bill or maybe their food bills. So it's really something that we're very proud of. Time to first fill, the North Star metrics in specialty pharmacy. We're really proud of our 4 days, approximately 4 days for 2025. And then that is all wrapped together with our IT and enterprise data services team so that we can provide, one, the highest quality data to our pharma partners. We can also provide to our sales and to our physician partners the most actionable updates and at the end of the day, deliver the highest quality care and customer service to our patients. Thank you very much. And I think we are going to hand it on over to Rich and infusion.

Thanks, guys. Great job. Thanks. All right. Rich, thanks for being here today. So Rich?Denness is the President of our infusion business. Rich and I connected pretty quickly with our shared pharma background. And you don't see that a lot in health services, but Rich has been a seasoned leader of a lot of pharma organizations in the past and Rich had been the Chief Commercial Officer at Option Care as well. It just has a passion for infusion and bringing these products to as many people as possible. So Rich, thanks for being here today.

Thank you.

Green button, that would help, the big one.

Well, thank you all for being here. Welcome to Louisville. I don't live here. So I hope your journey here was as eventful as mine. That said, Jon raised something. It's -- we did share our pharma war stories back in the day. But when I look at infusion and when I look at Amerita, I think of the opportunity to truly build a brand and to build a brand within an industry that is truly evolving every day. As the pipeline comes out and Chris and team referred to it, the amount of infused drugs in this pipeline, the amount of drugs that have to be administered by a health care professional just continues to grow. It's evolving. It's changing. But I go back to the pharma days when I'll age myself, I was at the Claritin launch meeting, which was about 1937, I think, somewhere back then. And we became the official allergy medication of Major League Baseball. And I didn't know that Major League Baseball really needed an official allergy medication, but apparently they did. And over time, you saw the pharma industry get more and more heavily regulated because of things like becoming the official Major League Baseball. We have the ability to build our brand here. Super exciting. And I would argue all of infusion has that ability to do it together. So let me get into a little bit -- here we go, about who we are. Amerita. I would call us a super regional infusion provider. We're not fully national at this point, and I'll get to our footprint in just a minute, but a super regional infusion provider focused on both the acute and the chronic business. I'll probably use the term chronic and specialty interchangeably throughout the course of the presentation. But at the end of the day, we are involved heavily in both. That is significant because for those of you that follow the infusion business, you know that over the last 3, 4 years, a couple of large providers have backed away from the acute business. Last year, a regional provider do the same, and we are still heavily involved in both. So we take both of those patient responsibilities very seriously. And at the end of the day, we are committed to the acute and the chronic or the specialty pieces of our core business. I don't need to probably explain to you who we serve in both of those markets, but I always like in the acute business to riding the tour de France in first gear. You have to be present to win, your feet are moving and the legs are moving 1 million miles an hour, you get home, you rest, you come back to next day and you do it all over again. That's kind of the acute market. If you're not present to win, if you're not providing world-class service. If you're not timely with great nursing in the home that day upon discharge, you're probably not going to be nearly as competitive. Chronic little bit different. You have fewer patients, high revenue and basically an annuity business month after month moving forward. We focused, Jon mentioned it earlier, on the neurology and the gastroenterology markets. We're not unique in that section. And frankly, it's our ability to provide world-class service best-in-industry service that makes us competitive in this market. When we look at the overall size of the business, you can see the market is growing quite well. The 9% really includes the HOPD, the hospital infusion pharmacy department books of business. And then the 11% is the home and the alternate site infusion business. The -- when you look at the acute business, the TAM is going to be less than your chronic business. That should be no surprise to anybody. And then the alternate site where we are actively engaged and have a full-scale expansion strategy set up is also growing at 9% -- excuse me, $9 billion on a TAM scale. Where is our footprint? I mentioned we're a super regional. We're not everywhere in the country, but we are strategically located in many key markets around the country. We have a plan to, as Jon said, organically grow where we currently exist and then expand our footprint into new markets. So this footprint, I think you can see will evolve over time, and we are actively engaged in M&A. Now let's talk about the acute opportunity. This middle section, I think, is the most important on this slide. We currently have the ability to cover 1/3 of the geography in the United States. So 33% is where we have the ability to compete. So clearly, growing our geographic footprint in the acute business is a significant opportunity, and we are currently actively looking in markets throughout the United States where we can grow our acute footprint. The one thing that I will say when we look at the acute business, we are currently #2 or 3 in most markets where we compete in the acute business. Our market share in acute is growing every day. Our market growth is a very healthy double-digit growth. So we're very pleased with that. And again, 2 out of 3 in 16 of the 18 major markets where we currently compete. On the chronic side, we focus on about half of the market, the geography in the U.S., the difference is in chronic, as you guys know, you can actually service into other states from pharmacies that are not necessarily located within the state that the patient resides. So we cover or have the opportunity to compete in half of that geography on a national basis. In pharmacy, our growth strategy is to basically be the fastest, most efficient in terms of getting benefits through the system and getting patients on service. Chris and team talked about a white glove service. We are doing the same with IG. IG is the holy grail of the chronic specialty business. So we are treating that with kid gloves white glove, no pun intended, and we expect to be market leaders within the chronic business. Reasons to expand. I mentioned the underserved population, the pipeline, our scalable strategy, we have excellent payer access. We continue to work with payers on what we can do to further differentiate ourselves. But the opportunity for us to provide service above and beyond with payers is extremely significant. And you think about it, we spend 40 to 60 hours a year with patients. How many other providers do that? How do we create value and extract value out of that? When we look at where the clinical innovation opportunities are, Amerita, our infusion services business is very heavily involved in Alzheimer's. We are one of the key providers of LEQEMBI in the country. And Amerita has been selected by Eisai to participate in the Alzheimer's Advisory Board. We're certainly collaborating with both Eisai and Lilly on opportunities to expand our Alzheimer's franchise. When we look at IG, I talked about our clinical focus on IG, our concierge services on IG and that is underway right now. Our growth in IG has been quite significant, and certainly proud of where we see our franchise going -- moving forward. And then other limited distribution drug opportunities. We currently have access to around 20 that we are working with manufacturers on in the pipeline. So I'm very, very encouraged by where we're going to go with our LDDs moving forward, and we've got new leadership that is heavily involved in the LDD franchise for us. Now if you look at -- pardon me, operational excellence, we're really focused on our turnaround times with both the acute and the specialty business. The acute turnaround times are running 30 to 45 minutes, specialty 12 to 14 days. And Chris mentioned a heck of a patient at NPS score, ours are running at 94% right now. Very proud of that. So if you look at -- pardon me, where we have the ability to invest people, process, technology, Charlie and Viji spoke about our technology opportunities earlier. But we have put in an entirely new executive leadership team within infusion. And excuse me, I'm very, very pleased with where we're taking the business. The last thing I'd say, is our -- basically, our overall growth drivers, I mentioned several of them, but we're excited about where this business is going to go between the current growth we're seeing in the acute market, where we're going to be taking the chronic business, what we're doing with LDDs, where we're taking technology and what our new leadership team is doing, the ability to build the Amerita brand within BrightSpring is massive. We look forward to it. And with that, I'll turn it over to Scott?Greenwell.

Thanks, Rich. Yes, the acute business, and Rich, thanks. I know you're coming off of a case of pneumonia. Thank you. Most people would not have been able to do that with your last week or 2. But thank you. Scott, thanks for being here. So Scott joins us most recently from Humana, Scott ran all the pharmacy operations at the PBM there. I think among many, many things over the years, really building that pharmacy operation out over there in a highly, highly automated way, driving something like $5 cost per script reduction over a period of years that is very hard to do also with exceptional quality. So Scott, we're thrilled you're here. And just like Rich, I wanted to say, Rich has done an incredible job in the last year at infusion really building out a broad team. If you look at the top 10 leaders in our infusion business, everybody is essentially new in the last year and just a, caliber individuals, whether it's sales or operations or rev cycle or specialty and LDDs, et cetera. So Scott has done the same really across the business. I would say just building on a lot of the strength we have, but going out and getting the people and the resources to build this out into the biggest and most efficient home and community pharmacy in the country. So take it away, Scott. Thank you.

Thanks, Jon, and appreciate all your time today. And by the way, happy St. Patrick's Day. I we said that. When I think of St. Patrick's Day, I don't think of snow and sleet in the Kentucky market, but unfortunately, here we are. And I understand some people had some travel issues getting here. But again, Scott?Greenwell pharmacist by training. I've been with the company now for about 9 months, has certainly been an exciting time to join the organization around the Home and Community segment. And we're going to get into what that looks like here in the next couple of slides. I am going to try today with some time. I'm used to batting clean up. So hopefully, I'll get us back on schedule. As you can see, BrightSpring and PharMerica has really built a really, really powerful pharmacy platform to serve really all kinds of transitions of care as people navigate through the course of their life between the work that we do in the group home setting and servicing our IDD members to Senior Living under the Senior Living brand, and then one point patient care, our hospice, pharmacy and PBM provider business and ultimately into the traditional skilled nursing business under the PharMerica brand. But I hope you gather from today, is really around how this business has evolved over the last couple of years, how we're thinking about it going forward and kind of pivoting from a SNF-focused long-term care pharmacy business to really tackling each one of these individual business segments in a unique way. To do that, take scale, right? We have 4,700 heart beats every single day, working to take care of over 4 million patients across 120 pharmacies servicing 6,500 facilities across the U.S. Those 4,700 heart beats every single day waking up to take care of the nation's most vulnerable patients is our bread and butter. It is what makes us different. It's what makes us unique. And I'm really proud to be part of an organization driven by such an incredible purpose. My father passed in 2020 of frontotemporal dementia. So I personally know all too well what our patients and their loved ones and caregivers have to navigate as they navigate through the long-term care setting. And one of the reasons why I'm here today is to help make this a meaningfully better process and to offer a different level of care and focus that comes along with that. As we think about our quality deliverables and metrics, Jon has been incredibly passionate around this. But for me, it's simplified around right patient, the right drug at the right time. We have to get those things right every single time. It is not something that is ever allowed to be off. And as you can see, by delivering across all 3 of those right patient, right drug, right time, you ultimately get your attention with your customers. And we have an incredibly strong retention across each of our 4 business segments within Home and Community and continue to grow and expand that. All right. So this is the footprint. Jon's referenced scale, scale, scale. Frankly, this math speaks for itself. 120 pharmacy locations spread across the country. We most recently entered into the Alaska market with pharmacy there. And we are capable of servicing coast-to-coast, any patients need within 3 hours delivery to door. So I think that is a competitive advantage for us, especially in this market right now with the disruption that we'll speak about here in a little bit that has been the long-term care pharmacy space. Next, strategy. And one of the things I really wish you to take away from this slide in our conversation is that this is not the PharMerica of old. This is a new PharMerica. This is a PharMerica that is not trying to stick a round peg in a square hole of skilled nursing facilities and capabilities into the IDD, a senior living/assisted living marketplace. We are focused now around core general managers for each one of these businesses, focused on the unique sets of needs and skills for their respective businesses and aggressively targeting growth across each of those. We have a leading sales team across each of those 4 business segments, aggressively targeting, leveraging our sale collectively to figure out how can we continue to grow double-digit growth across each of those 4 segments. This is a new PharMerica that's backed by a tech stack that Viji and Charlie referenced earlier that it gives us the ability to leverage our national scale and footprint, but to deliver a local unique customer service model that makes it feel again very local by leveraging our account management teams and capabilities powered by the analytics and data that come along with that. Ultimately, to get to a $24 billion addressable marketplace. We are trying to rethink how we service these customers. Again, unique to each individual business segment. Part of that comes to also rethinking our clinical capabilities through formulary management, utilization management, particularly in the skilled setting, trying to think through how do you take traditional PBM tools to leverage total cost of care and optimizing clinical outcomes at the most appropriate cost. This is not something that as an outsider coming into the space that we've seen with the collective industry and one that we believe there's a very real opportunity to differentiate strategically for PharMerica against everyone else and to power the growth that we've been referencing. One of the keys, again, is around our focus and kind of a new way of how we're thinking about long-term care pharmacy and in the Home and Community segment, is really standardization of processes. How do we take and create a consistent standard process and onboarding experience for each and every one of our customers within their respective segment that allows us to partner with large regional players and national games to make sure that whether it's in a skilled facility, whether it's an assisted community or whether it's an IDD that they experience a consistent onboarding experience again and again and again. And we have done that through leveraging technology in a way specifically things like robotic process automation and machine learning to make the onboarding process smooth and streamlined as humanly possible. We have a lot of investments today, trying to automate a lot of the historic legacy clerical tasks that a pharmacy have to deal with, whether it be member load, prior authorization requirements, billing capabilities and order entry within the pharmacy proper -- pharmacies candidly, benefits from having a lot of structured data as a way for us to feed off of, which is highly adaptable to a lot of these new tech capabilities that we're partnering again with Charlie and Viji to deploy, which is going to create a differential experience for each one of our customers that we've not yet seen across the industry. So incredibly excited about that. And by leveraging those things, we can get to a different operating model in terms of how we think about our operating cost and cost to fill, as Jon had referenced, which is something that I'm incredibly focused on right now is how do we get to a differential to drive truly a world-class experience and operating model. We're getting close here. Okay. Investments can clearly be kind of summed in 2 different parts. One, again, I've been referencing it automation, automation, automation, how do we leverage automation in a way to streamline and take advantage of the scale that this business offers across our 20 pharmacies and then ultimately to our customer and clinical experiences for our customers. Way too often our clinical counterparts within our facilities are dealing with being historians of a patient's care navigating through a very bureaucratic process on ordering meds, getting meds, wears my meds, et cetera. I think everyone today is very familiar with the pizza tracker analogy of trying to figure out how do we leverage technology in a way to improve the -- our partner experiences. So they know exactly where the meds are when they should expect them and ultimately giving them back time to spend it where they should be spending it most, which is caring for the patients that they ultimately are tasked to do and not trying to figure out where their medications are. So we're spending a ton of time specifically in that realm in terms of improving those experiences, again, with Charlie and Viji's help. And then ultimately, I think we'll probably spend some time at a future meeting talking about the outcomes of the deploying of these lot of these machine learning and robotic process automation tools and how they're evolving our cost structure and how we're thinking about the advantages that will create. And then last, it's all about growth. I mentioned earlier, we are expecting and trying to drive to double-digit growth across each of these 4 segments, again, backed by the national scale that we have backed by the clinical capabilities that we have backed by the technology and deployment, enabling these things, and ultimately related to a best-in-class sales force that can go back and articulate this value prop, a differential that we're offering to each and every one of our customers. We are now seeing over the last several quarters meaningful growth across each one of these business segments, and we expect to continue to see that. It's an exciting time. All right. Five keys to our success really is around this high-touch, reliable, and dependable partnerships with each one of our customers. It's a best-in-class clinical capabilities that we have built in the LTC model. It's operating at scale and driving efficiencies, both for our pharmacy operations as well as our clinical counterparts. And how do we return again back operational efficiency time to them in nursing especially when they're dealing with high turnover, nursing environment as well as constant training needs. And then ultimately bring stability to a very disruptive market that currently is the long-term care pharmacy space, as we look across the market and see some large players and the legacy players having filed bankruptcy in the last year have been very public. We believe that, that disruption creates a very real tailwind for us given our stability, market position and scaled footprint to really take advantage of all of that disruption. And couple that with some of the things we'll see with the IRA, particularly focused on the small regional independent pharmacies who are going to have to navigate some of the complexities with the IRA that do not have the strength of BrightSpring or PharMerica's balance sheet is going to create another very real tailwind for this business as we think about growth going forward. Jon referenced this earlier. This organization has curated a leadership team over the last 24 months that takes advantage of the 40-plus years of traditional long-term care pharmacy expertise, but has now coupled that with PBM, clinical and cost containment excellence, modern pharmacy practice at very large scale and highly efficient, coupled with providers and partners that have historically been on the provider side and operators that have a very unique perspective and point of view into the real -- very real pain points that our customers and providers deal with every single day that can help reinform our products and suites and services and how we're showing up to the market. And really again, this has been a very real change over the last 24 months, and I'm really excited about what this team is starting to produce and how we're starting to think differently about this as a product and a service offering within the suite. Okay. At the end of the day, it's about winning. We are here to win. We love to win. We are focused on winning. That winning comes because we have 4,700 heartbeats showing up every single day, taking care of the patients, the over 4 million patients that we serve and doing so as if they're caring for their own loved ones and family members. That is the differential. Every single day, every single meeting that we kick off kicks off with a patient story and a patient persona. So we can continuously remind ourselves why we are showing up what is our purpose every single day. We're here to win to help our customers manage their overall drug costs. We're here to help them win related to making them more efficient and operationally effective. And ultimately, we want to win, so we can win for our shareholders, and the investor community at large, which is why we're here. And that strategic differentiators that I referenced earlier, I think positions us incredibly well to do that here over the coming quarters and years. I think Jon wraps me up. And yes, Q&A.

Scott. Yes. So I think everybody comes up for Q&A. Okay. hey, while they're coming up, I'm just going to just sort of -- there's a lot of slides there. So I'm just going to recap some of the growth drivers for the businesses. Onco, again, this is helpful, everything starts with quality, deep relationships with pharma. There's a very deep innovation pipeline that still exists today, coming to market the opportunity to partner and bring these new brand LDDs to market, they ramp up over a period of years. So you have this LDD growth that kind of stacks upon itself with launches every year as prior launches are still growing? Those drugs are pulled through by a sales force that we've heavily invested in. And then over time, in addition to the brand side, you have some brands going generic. And then the team has built out a really strong and rapidly scaling fee-for-service business of data and service agreements with pharma and hub programs. So a multifactorial growth model there in specialty on infusion really got to run those businesses from an acute and chronic specialty perspective. We are investing in the sales force on both sides of those. We're investing in turnaround time and service metrics to build those businesses out. We have a lot of geographical expansion opportunity, and we're building out suites over time to give patients and prescribers more alternatives on where their patients could be seen in addition to just the home which should give labor efficiencies as well. You look at home and community pharmacy building on 40 years there and the scale that we have today, it is all about scale and continuing to scale that business as efficiently as we can. There's a lot of attractive end markets in that space with ALF, with behavioral, with hospice. PACE is emerging for us and then you've got the historical skilled nursing channel, which is very healthy today. Look at some of the skilled nursing pharmacy companies out there today, and they are very healthy. So a lot of very attractive growth markets for home and community health care and how do we further penetrate those with leading services in a very efficient model with automation at its bedrock. So that's our pharmacy business. Again, we go to where people are hundreds and thousands and millions of acute chronic individuals every day, helping to take care of them better and to try to keep them out of the ER or the hospital and give them the better quality of life. So with that, happy to take any questions on the pharmacy side. Brian, maybe you want to go first, I saw your hand quickly.

Brian Tanquilut from Jefferies. Ben, just for you. So when I think about the successes you've had with LDDs and bringing those in. How do we think about translating that to the opportunity in generics? Or maybe asked differently, how do you drive market share with these new generic introductions coming out?

Yes. I'll take the first part and then Robert will probably expand on it through the sales force. So our focus really is multifactor, right? So we want to launch -- be a part of the pharma when we're launching new therapeutic products coming to market. When we do that, and we're 1 of 1, 1 of 2 multiple SPs, we're consistently driving larger market share than our competitors. That creates really an advantage for us as we think about the pipeline. As organizations manufacturer looking at getting in the space. Onco360 is embedded in a lot of those relationships. Robert seems focused on pull-through. We want to drive new patient starts and then retain them over the life cycle of that brand when that product brand goes generic, the larger the market share we have when that product spread, the bigger the opportunity is in that respect.

When you think about pharma, I would just add, you think about when the drug was generic, the pharma sales force and the detailing just completely goes away. So that's where Robert and his team becomes very effective working with prescribers and patients to still be there as a supportive educational resource for the offices at that point in time.

Erin Wright at Morgan Stanley. With the IPO, there was that significant opportunity to also kind of better integrate the businesses in terms of pharmacy provider. You talked a lot about that in terms of that one-stop shop. But what has surprised you? Where does that stand relative to a couple of years ago? And I guess, for an analogy, like what inning are we in on that front in terms of that sort of overlap? And then one more pharmacy specific question, just on the $100 billion of new products that are coming to market that you mentioned. I think that was just oncology, if I read that slide correctly. What about rare and orphan. Can you talk a little bit about that size? And then also the relative growth rates across our rare and orphan and then versus your or your Onco360 business?

Yes. So maybe I'll go first and then Ben or Rob speak to the rare and orphan and the LDD or Rich chime in, if you want on that? And maybe just characterize some of the rare and orphan growth in the portfolio. But as it relates to integrated care opportunities and care coordination opportunities, that continues to be a really big opportunity for us. It continues to evolve in new opportunities present themselves seemingly on a regular basis. We have tried to be careful not to let that distract from the strength of the growth in the core service lines as well because I think, Erin, as you're saying, and it was a question that we got repeatedly in the IPO. I think people look at the uniqueness of the platform and the integrated care services that we have and the immediately say, well, that's different and that's unique, and that seems like a really obvious opportunity to combine all these services, that's a good idea. We wanted to make sure that we also didn't lose the attention on, well, hey, the core services themselves are in great markets. They're executing really well. So we view the integrated care opportunity, what I referred to here today is strategic growth as just really additive to the core growth. And hopefully, it's a lot of really interesting upside in the future, which would be great for patients and the system. So I gave a few examples of those today. I mean I do think we are in the second inning. And what we have found is that -- you really do need to and like this is not rocket science, you really do need to resource things in an organization for them to move, particularly when they're sort of in the gaps in between service right? Ben Robert, Chris, Rich, Scott, I mean they have a day job, Elizabeth, Rhonda, Jay and Hospice Home Health, they have a day job to grow their business as much as we can. Now they're also thinking from an enterprise perspective. But what we've done in the last really 6 months or so, we're starting to build out a team. We hired a gentleman, Scott Hawkins, who's terrific. We're starting to build out a team that just focuses on these integrated care opportunities more. We're also continuing to resource that primary care team. There's a new leader there in the last year. We hired a CMO there in the last 7 months. We just hired somebody to drive payer contracting. We're continuing to resource the payer, private the primary care team. So with that focus from a resource perspective integrated care and growth in primary care, we expect to see these opportunities continue to present more growth and then more revenue and EBITDA as we go forward as well. So a ton of opportunities. And frankly, I think sometimes it's a situation for us where there's a lot of good stuff going on. And we don't want to shortchange growth in infusion, growth in home health and get distracted too much. So what we've tried to do for these strategic growth areas, which I think are really unique to our organization, we've tried to resource them appropriately in the last year and be really sober and thoughtful about needing to do that, so that hopefully, in 5 to 10 years, you're getting 9 figures of EBITDA from these areas, and that's what we're focused on now. So maybe, Ben, you can start with the second and third parts of that question.

Absolutely, yes. As we think about the pipeline, from our perspective, oncology still kind of over the next 5 years, still remains probably 70% of where the innovation and biggest opportunities are going to be from a growth opportunity perspective, we're out there 16, 20 months in advance. If you think about the life cycle of when they start to make pharmacy network decisions, distribution decisions. Sometimes that doesn't start until about 16 months when they're really thinking about access. And so we're typically right there. A lot of those same manufacturers that are launching products in oncology there's a segment of the portfolio of very targeted therapies with like rare cancer, patient population, that's in that number that we described. And then rare provides really a lot of opportunity as well, probably 30% of the other segment of the market comes from a rare orphan disease. A lot of the activity today that we have around non-oncology products. It reminds me of where Onco360 was maybe in 2018, 2019, right? There's a lot of conversations around our support system and transferability from oncology to rare. If you think about the programs that we've developed with pharma to support cancer medications. They're not only product specific, they're product indication specific, but then implemented, we talked about the infrastructure, the technology that overlays our operating model these are really patient dedicated programs that the business is managing at scale. That transferability into rare disease, which is a more fragmented market from a physician perspective, from a product perspective, a lot of the work that we're doing there early on is whiteboarding with pharma to create and develop solutions for those patients and caregivers across the pharmacy space but also as you think about the Amerita team medical benefit and being able to provide support and services in the home.

A.J.?

Just maybe a couple of questions about PharMerica. There's been a lot of disruption on the competitive landscape over the last few years. Is that mostly done? Or are there still chunky opportunities for you to gain share vis-a-vis players that are struggling? Additionally, I guess, when we talk about AI opportunities, it seems like to me, ambient listening with consulting pharmacists is they're going around doing charting. Are you doing that? And how big an opportunity might that be? And then I'm going to throw one more in there. In terms of your other businesses, is there leverage because you have access to a unique population in the PharMerica. Is that a selling point for you in these specialty pharmacy businesses that you're able to use?

Scott?

So great questions, A.J. So -- so first, PharMerica and opportunities there. We do believe that there are very real opportunities in the traditional PharMerica SNF space for us to continue to take advantage of given the disruption that you referenced. I'd love to have a crystal ball to try to figure out within the IRA for other pharmacies that do not have the same size and scale and, frankly, ability to contract with PBMs to offset that, that there'll be continued offset of that. But I think we're all kind of watching waiting lens of where that ball ultimately drops. But we do expect there to be opportunity there for us for as well as we're also trying to think through a repositioning of SNFs, almost this lens like a Part A PBM and how do we really think about drug cost management in a different way for the SNFs during that Medicare Part A stay and help them inform their budgets and spinning projections for months and quarters out like a traditional PBM model would in the commercial market space. So I do think there's a very real opportunity for us to continue to deepen our penetration in the SNF side. On the -- I think AI was the next piece of it. So incredibly excited about that space, especially using AI as an enhancement to our clinicians and to really do a couple of things. One, help us operate at scale and to think differently about how we can solve complex Medicare problems and challenges in a more efficient way by leveraging AI capabilities to help offset just the traditional reading the charts, finding medication opportunities, classifying those types of things. So those are all things that we are actively working on today to help enhance our model, and we'll make into more detail around that as that comes to fruition. But I do think that's a space across, frankly, all the medical landscape that's really going to be a powerful tool for clinicians to take advantage of and an appropriate safe manner truly as an enhancement tool.

Your third piece, maybe talk about Blake, how we're...

Yes. So on the specialty piece. So we do have -- we picked up an acquisition a couple of years ago called Blake Rx. Blake is really focused today in a couple of states, literally a handful of states, but it's trying to solve for this unmet need of specialty within an institutional care setting. It's an interesting space. We do think there's a lot of opportunity leveraging the CareMed in Onco special capabilities within that, within the PharMerica customer base already as well as expanding beyond the PharMerica customer base because it's a -- it's a bit of an unmet need across the industry that no one seems to have taken advantage of just yet.

So Yes, I didn't even mention that before I talk about it....

We actually -- we currently have a process built out amongst all 3 businesses where if Scott's team gets a referral, has some questions. We have it all worked out where it would come over Onco360 or to CareMed to service that patient where we can based off of the payer associated with it. And then it's the same thing. We get an IVIg or a hemophilia patient from -- that is also on an oncology medication, that is automatically going over to Rich and the Amerita team and then both of those products are delivered to the patient.

I think within the Alzheimer's space, just given where that product is likely going in terms of the impact of that across all 3 of these platforms is a really, really an interesting opportunity we're going to continue to take advantage of.

We really didn't even touch on that before. I mentioned ALF, behavioral, hospice, skilled nursing is the end markets and home and community. The specialty part of that business growing. The team is doing a nice job of focusing on the specialty drug needs of individuals in those institutional long-term care settings. And it's interesting. I mean, you look at behavioral, hospice, specialty ALF pharmacy within that home community business, skilled nursing compared to those 4 is much smaller. It's been a really interesting -- and that was a business that 10 years ago was all skilled nursing. It's not -- it's a good market. It's just that the business has continued to evolve in really interesting ways, but all of those markets present an opportunity to be much, much bigger.

Charles Rhyee with TD Cowen. Two questions. Maybe first a follow-up to Brian's question on generic opportunity. Obviously, it's a bigger -- everyone's kind of focused on it. Maybe talk about how you are -- you talked a little bit about how you are working to gain share as these drugs go generic, but particularly, can you talk a little bit how you work with or around big PBM-owned specialty pharmacies that obviously would also want to capture some of this generic conversion opportunity? And then secondly, Jon, in one of your slides earlier, you're showing sort of the ramp of the LDDs. And it looked like, in particular, the '23 and '24 cohorts, were ramping very nicely. And then it looks like the 2019 cohort is now starting to ramp up. Anything particular about those years of LDDs that you'd call out or what's interesting about those and why they're ramping so much better maybe than some of the others?

Robert and Ben, go ahead.

I can take the generic question. If you think about cancer, which we showed the pipeline of the cancer drugs going generic, generally, it's a disease of the elderly. And if you think about the network configuration and the way the industry works, there's any willing provider regulations. So long story short, as long as you can meet the PBM criteria is for access and participation and agree upon rates, which we've got into a good place. It's then about service. It's service and support and your physicians by choice, have the ability to use whoever they believe services the patients in a better manner, whether it's assisting with funding like Chris said, turnaround time, communication because this is a crisis diagnosis. So absolutely, we compete against the PBMs, but we compete on service, we compete on relationships and support for the patients.

Ben, like different cohorts, different growth rates, all the pens, what's the drug, what's the market?

Yes. So on that side, you're -- we're seeing just an acceleration of new products coming to market from an innovation standpoint, right? So -- but it's not only new molecular entities, as existing products that may be of open access or we call it broader limited distribution networks. And let's call it, 2013 through 2020, most of the limited distribution networks may have been comprised of over 7 pharmacies. Today, we're seeing 97% of those be 3 or less, right? The 30% of our launches in 2025 having been exclusive. So that creates, obviously, that opportunity from a growth brand perspective. The products that are coming to market oftentimes have longer durations of therapy, because we're 1 of 1, 1 of 2, we have greater market share in those limited distribution networks, the longer durations of therapy also benefit us from a patient retention standpoint.

And those networks shrunk over time, too, some of those early ones, I think?

There's a number of examples. In '25, there was 2 significant products that were open access and now we're 1 of 2 SPs.

And Charles, I mean, we really try to partner with everybody out there as productively as we can. We've had really long-standing and positive relationships with all of our PBM partners, just really aspiring to serve their members and as high quality of way as we can. And again, we've invested in a clinical liaison team over the past 15 years, that's close to 300 folks every day right now, aside from the hundreds of individuals we have internally interacting with patients every day, but really invested in a field force and team over the last 10 years that we've been growing every single year to be there in prescriber accounts with patients every day, just helping them through their decisions.

This is Joanna Gajuk, Bank America. So Rich, actually, I want to switch to home infusion. So a couple of things there. So first, on the -- over 20 LDDs in home infusion that doesn't sound like you were involved in those. So can you give us a little bit more color in terms of what exactly you need to do to make it, I guess, your presence shown in those LDDs. It doesn't require investment in pharmacies, people, technology or anything else? And the second question on that map on the regions, are there some markets where you have like your eyes on set and why? Like is there some priority were you looking at this and like, okay, we got to get that market mix?

First off, thanks for all of you putting up with me with my flare on Slide 5. I appreciate that very much. I wasn't expecting that. Two very good questions. I'll answer the last one first, if I may. We have a two-pronged growth strategy that we know is real in infusion. The team is absolutely excited about it. I mentioned earlier, my entire leadership team has turned over. So nobody has been here for more than a year outside of my HR person and our finance person, everybody else that touches the outside world is new. The markets that we want to compete in, where we don't currently have a footprint, while I won't get into specific markets, think of the states that are highly populated, that aren't on our map, full of health systems, and I know that you are very familiar with the infusion business, where we will be able to take our competitive strategy and compete against other players. That said, too, there is the chronic and the acute side of it. I mentioned earlier, we are the #2 market share now nationally in acute. We are absolutely convinced we can compete with anybody in that book of business in any state whether we're in it now or not. On the chronic side, on the specialty side, same thing. So the best answer I can give you without giving you specific locations. A, we are very, very active in looking for acquisition opportunities. We are focusing on high population states. We are focusing on states where our combined experience. Jon mentioned where I came from. We have -- our operations leader is from Coram, our sales leader is from Option Care, we have a trade leader, which I'll get to the other part of your question, who has experience from Orsini, KabaFusion and Sileo. So we know where the opportunities lie, and that's where we're going. On the first question that you asked, we have access now to 20-plus LDDs per se by definition. Access is one thing, having a relationship with the manufacturer where you're actually working with them is another thing. That's where we need to be. So part of the strategy moving forward is to get heavily involved using some of that experience that I just mentioned from past companies where my leadership team has evolved, getting strategically involved with manufacturers. In some cases where we have access to drugs, we are rekindling those relationships, because for whatever reason, historically, Amerita did not take advantage of that. So that's a lost opportunity in the past. But moving forward, I think it's a big opportunity for us. Because as you know, with LDDs, there is an opportunity for us not only to successfully service patients, but there are data monetization opportunities. There are outcomes opportunities and there are ways for us to help build our brand, which is our overall strategy. So there's the existing portfolio that we're pursuing. My head of that business, my -- the gentleman that works for me that's responsible for that comes from a specialty pharmacy background where particularly the lifeblood of what his business did. He came from Orsini. So he has had a very, very good track record historically and he has been very successful in his early tenure here. He's been here about 4 months now, 4.5 months, where he has reestablished I think, our image, our brand, our experience, our approach with manufacturers. And there are a number of I think, novel, very interesting molecules where BLAs are filed and we expect approvals coming, and you guys probably know a lot of these drugs, I won't get into the details. But therefore, cardiovascular disease or for diabetes, they're for other things that we are going to have to become involved in as is every infusion provider because the specialty landscape has changed so much on the GI front, which used to be a huge piece of the business. So I hope I've answered your question, but a two-pronged approach on that.

The company was just so focused on acute with its history, historically, and what we're doing today is trying to focus on both acute and chronic and specialty. And you just -- you need to operationalize those 2 markets very independently within your organization. And I think that's what the team is doing a good job now trying to focus on.

Dave Larsen with BTIG. Can you talk a bit about a day in the life of your sales rep, like you got specialty, you've got infusion, you've got home and community pharmacy. What is this sales rep doing all day? Is that person representing all of these different business lines? How is their commission determined? Are they calling on dock offices or hospitals or SNFs or all of the above or health plans. Can you just describe that, please?

Can I hit that just upfront real quick to set the table, and then we'll just go to 1 to 3. So Dave, I would just say 2 things upfront. Number one, I've been at multiple organizations, leading health care companies over the past 15 years. It is always a question as to whether or not you have a sales rep sell the whole bag or a suite of services or just their own service line or a product. Let's say, we have 4 reps in Boston, and we have each selling -- and we have 4 products at the company. Should we have 4 reps that are selling each product? Or should we have 1 rep there selling 4? Our experience time and time again, has been unique focus. You are always going to have something that's left out. If somebody is selling multiple pieces, and so we have made the decision, again, which I think is the right one, is to have focus sales reps, focused sales reps in our businesses to be much more productive. Now if we can share relationships, if we're swinging by another doctor's office, when we're at that hospital, if we're passing along referrals that come up, that's fantastic. But number one, principally, we want focus I would say, number two, in our company as you look at the call point, it's either B2B or more of a, call it, pharma medical device sales point, where it's a hospital case manager, physician or a doctor's office. So home and community would be a good example, where it's all B2B. We are working with the assisted living facility CEO management team to win that contract for the chain. That's the way it works largely across home and community. In most other parts of our company, you have an individual clinical liaison going out there every day, whether it's home health, hospice, infusion or oncology and they are individually meeting with a case manager, a physician in the hospital or in an office to pull that individual referral through, and it's more of a "retail" model. So Robert, and Rich and Scott, maybe you can just hit anything more about what the sales reps are doing, who they're calling on.

So I can go through the specialty side of the house, Onco360 and CareMed. We have 2 different types of sales salespeople, a field rep, which think about traditional pharma. They're going into doctors' offices, educating the doctors, the nurses, the oncology coordinators of our drug access capabilities giving potential patient updates and they're going to see in certain metro areas, various hospitals around the country or actually around their region and then they move on and they do that all week long to go interact with the physicians. The inside sellers, which are partnered at a regional level with the field sellers. So the strategy is aligned, the message is aligned the targeting, they're behind a computer. They start the day with data and information, literally the night before. They have information on what referrals came in the day before, so they start to follow up. They start the education, they start the troubleshooting if necessary, and then they're working in conjunction with the field sellers, to make sure that they're on 1 page as it relates to physician offices, next step, strategies, opportunities, long story short, over the past couple of years, we've shrunk territories. Chris showed that we've gone from 12 reps to 275. In shrinking territories, you can service more accounts. You can touch more accounts more frequently. You can provide better service updates. So in the past, we might have had very expansive regions. Right now, they're smaller regions, so we can see the doctors in the offices more frequently, and generally, with the relationships, the sellers that are there most often providing real value to the doctor's offices when as it relates to where the doctors choose to send referrals. And then as far as the comp plan, we have a comp plan that rewards mix, making sure that there's a healthy mix of both brand and generic drugs, but then also you're comping as it relates to growth. New patient acquisition because that turns into prescriptions and those who have the highest success rate as it relates to growth and mix are rewarded accordingly.

Okay. So in infusion, we have 2 sales forces. We have an acute sales team and a specialty sales team. We have data that allows us to segment our customers and quintile them, Quintile 1 through 5 based on where we see the potential. So the data is heavily utilized in terms of call planning and things of that nature. We go with a 4-week call plan, that doesn't mean we just see somebody every 4 weeks. We may double down. I may see you every week if you're a quintile 5. I may be there so much that if you repeat back to me what I want to say to you, I feel like I've done my job. So that's the way that we operate with the acute and the specialty team. The acute team is focused on health systems, hospitals and getting referrals for those patients that are discharged from hospitals on a daily basis. It is -- I mentioned earlier, it's like riding the tour de France in first gear. You have to be present to win. Because if you're not, the case manager needs to get that patient service by somebody, and you've got to be there. Now the better job we do at providing service, the more we are front of mind and that case manager knowing and building a relationship with our seller will reach out to them and say, I've got a patient who we want to discharge a day, they need daptomycin, blah, blah, blah, right? So that's the way we operate on the acute side. There are 2 roles in the acute business. There's the account executive whose job is -- we just use the analogy of the hunter and the farmer, the account executive is the hunter. They're building business in health systems or in hospitals. We may already exist, and they're expanding that business, but their job is to grow the business. We have clinical liaisons that we refer to as the farmers who are there to maintain the relationships, to put out any fires if there are any but they really are the liaison between the patient, the referral source and our pharmacy. So that's how the acute business works, and I'll get to how they're paid in just a second. On the specialty side of the business, our folks there are calling typically on large neurology and gastroenterology practices. In some cases, there are other specialties that are involved, rheumatology, if you're dealing with gout or KRYSTEXXA or some of the chronic inflammatory diseases. Ophthalmology, if there's an opportunity with TEPEZZA and our partnership with Amgen, which goes back to your question earlier. So -- the specialty team has a very, very clearly defined target audience that they call on as well. Again, 4-week call cycle. Their job is to be the frontline representation of the Amerita brand and to get referrals from those physicians for basically the target opportunities that we showed on the slide earlier. So in neurology, it would be IG, it would be multiple sclerosis. It would be drugs that have to be administered by a health care professional. A lot of those are for the emerging market in generalized myasthenia gravis. You see the TV ads all the time on TV. So we're involved in neurology in a heavy way. And in gastroenterology, with all of the drugs that you all know. The REMICADE, the biosimilars, the SKYRIZI is no longer the STELARA, but at the end of the day, there's plenty of opportunity there as well. We are seeing a shift in our focus is becoming more neurology-focused than gastro-focused quite frankly. How they get paid? Everybody has goals and quotas and on the acute side, we get paid based on the referral or the admin -- not the referral, but the admit, the start, whatever terminology we want to use where a patient is actually put on service. Our focus is on antibiotics and TPN as is pretty much every other acute providers focus. So they get paid on their ability to attain goal or exceed goal there. Same thing on the specialty side. It's a start-based compensation plan. We don't make money on referrals, right? So that's -- the other -- the last thing I'll say on that is the sales team's ability to partner with our pharmacies to make sure that referrals are as complete or clean as possible, so we don't have to keep going back and forth to the referral source. That is critical. Those criteria that we put on the slide earlier, we show 12 to 14 days to get benefits through on a specialty patient. That's pretty darn good. We want to get it below 10. We show 30 to 45 minutes on the acute business. We'd like to get that way lower as well, but it's progress and it keeps us competitive. Our ability to partner between the sales team and the pharmacy is what keeps the service levels good. And frankly, referral sources don't want you to keep coming back to them. They don't -- they want you to take this case and go get the patient service. So the better we do that, we always say good service begets more referrals, good service with more referrals begets growth, and that's where we want to be. So I hope I've answered your question on infusion.

And then lastly, in the Home and Community space, Jon referenced it. For us, it's mostly B2B as we think about it. I would say, and this goes back to my reference related to kind of the new way PharMerica's kind of approach this Again, we think specificity is a differentiator in how we should think about growing the home and community space. I think historically, we had more of a SNF lead in, and we got sold against by some of the other larger assisted living companies say, "Well, they're a skilled company, wow, would you bother? That's not the case anymore. And we are showing up in a very specific and unique way and how we're servicing the assisted buildings as well as IDD. It was a specific sales team focused on that. And we're investing on the assisted side in the retirement right, where a lot of these assisted living communities are growing and expanding exponentially. That is where we are doubling down our efforts to focus our growth in those populations. We do have as you can imagine, some large vertically integrated customers, right, that have skilled assisted living and some IDD communities. We have very clear ways to hand off those referrals as they may hurdle across multiple different settings for an institutional-based customer client. In terms of pay, it's -- again, we're very focused on profitable business, growing profitable business and making sure that we have customers that can pay us, pay us on time and are good partners for the business, and their comp plans are structured to take advantage.

So even within a home and community, we have dedicated individuals resources by those end markets that are focused on those. And I would say, Rich, the -- with what Rich said about, think about the hunter versus the Gardner, the Hunter being more of an account manager per se, the Gardner being more of a clinician per se who's kind of settled maybe in one location versus hitting many different referral sources. That's a model that we employ broadly in home health and hospice as well. And I mean, as you step back and look at our company, I mean, we're probably in over 10,000 different offices today across the country with our liaisons. And so that's where thinking about the benefits of our organization, we do try to drive best practice consistency of sales methodologies and techniques throughout all of our businesses, but a lot of folks out there educating a lot of accounts and patients every day.

Jon, can I say one more thing.

Sure.

One of the really unique things about our service providing business is the interaction that our sales team will often have with patients, caregivers and the ecosystem that is treat it. If you're in pharma, you're not dealing with a patient if they get prescribed your drug. You're not. I mean I am blown away at how professional our sales team is as they interact with patients and caregivers on a regular basis to make sure that everybody understands what's happening next. You get discharged from a hospital and you get told, oh, you're going to be on TPN for an indefinite period of time for your nutritional needs or you're going to need this chronic drug possibly for the rest of your life. People need professional, I think, compassionate but very knowledgeable folks to support them because our company shows up at their door. And I think that's one of the cool unique things that makes our business very, very special and very, very different from other sales jobs, if you will, that are out there in health care.

Yes. I say this a lot. In pharmacy, I think a lot of people just think about I grab my script and go in closed door pharmacy like we do, serving these populations where they are, there are easily over 30 things we are doing on an ongoing basis, interacting with the patient and with the family. And that is a huge part of why you can differentiate yourself from a service quality perspective and from a loyalty perspective because you are very involved with so many things along that patient journey and we are who they call. Break time. Well, thank you guys for that flew, about 3 hours already -- 2 hours. But thank you, guys, for your attention this morning, and I think we've got a little bit of a 20-minute break or so right now, 5 minutes. We got to do some work in these breaks. But yes, it looks like we got about 5 or 10 minutes, and we'll continue the agenda after that. So thank you, guys. [Break]

Here we got most people back. And we will continue the presentation and discussion. We're going to shift into the provider side of the business now. Elizabeth Robinson, our President of Home Health. Rhonda?Sanders, our Chief Commercial at Hospice, Kim More, Rehab and Personal Care, they are here for the next provider section. So I wanted to say 3 quick things about the provider side of our business. Number one, it has been a really steady and nice performer for the company for a really long time, double-digit revenue, EBITDA CAGRs going back 5, 6, 7 years now. And I think that's based on the fact that we're in markets that provide a really great service, and they continue to have a lot of demand. And so it's a really steady provider business with an attractive growth profile. Number two, really underpinning that is a these are good businesses, like these are really good businesses in the company. They're stable, they're consistent. We have really good people in them. I guess it's been almost like 13, 14 years for me in the health services provider world. And I can tell you, being at some pretty good companies that were industry leaders we have excellent people at the top and down through these businesses that we're thrilled about. And we always have people knocking on our door wanting to come and we're like, well, how do we find a place for that person because they're an A, but we have really good people in the businesses delivering really good quality results. These are just good businesses that we need to keep serving more and more people with these great services. And number three, there's really a tie-in between the provider services and the pharmacy businesses that our company. Home health is a good example of that. I think we have a slide in there that shows like 8 different tie-ins of home health to all of our different businesses. So there is really a lot of cross-functional work that goes on at the company and they really fit together nicely. So with that, Elizabeth, you've been a little busy lately integrating...

A little bit.

About 100 branches here recently, but it's going really well and Elizabeth, maybe you can spin us through home health. Thank you.

Thank you so much, Jon. Thank you for that warm introduction. And I am really excited to tell you about what we do in home health. We provide compassionate patient centered care designed specifically for the older adult and the comfort of their home. Our teams treat a variety of illnesses, injuries, chronic conditions, and we definitely want to progress the patient toward a higher level of independence and produce better quality of life for them. Our primary focus in the home is to make sure that patient can remain safely in their home. At the same time, we want to reduce avoidable rehospitalizations. We provide skilled nursing, occupational therapy, physical therapy, speech therapy, home health aides and social work in the home. Now in this division, we provide home health services and private duty services in the home. They are different. Home health, we provide intermittent care primarily to seniors. We treat multiple types of patients with a multidisciplinary approach. We are paid episodically and per visit. On the private duty side, we can be in that home up to 24 hours a day. We treat both the pediatric patient and the adult patient. We are paid hourly, we're in the home for long-term care for chronic conditions such as ALS, cerebral palsy, Parkinson's disease and other neurological disorders. We provide skilled nursing and certified nursing assistants in the home. So why would one choose home health? Every patient receives a customized plan of care built around their personal goals, preferences and needs. We believe if the patient is heard and involved in their care, they're much more likely to stay committed to that plan of care, thereby improving patient outcomes. We provide support not only to that patient but to the families and the significant others in that home. It can be overwhelming navigating illness and recovery. So our clinicians, our teams are in that home providing reassurance, guidance and care every step of the way. They can call us 24 hours a day, 7 days a week, 365 days of the year. We also focus on continuously improving our policies and procedures, investing in our staff, education and training and also using the latest and greatest technology to provide effective efficient care. Our quality is the core of what we do. We strive every year to improve our performance scores. We use database -- we use data. We use feedback, we use best practices to elevate our plan of care and to elevate the care we give. We are committed to innovation with this innovation, we can rest assured that we are producing and delivering the best standard of care available in the industry. We partner with companies such as Homecare Homebase, Mosaic, PatientPing, CareFlow, Element5, et cetera. Our goal is to improve that patient's outcome with every episode of care. We believe BrightSpring is poised to meet the demand of the rapidly aging population in this country that will need high-quality, low-cost care. We believe as individuals -- more individuals choose to age in place in their homes, the demand for convenient accessible care is going to rise. Right now, the home health industry is valued at $119 billion, growing annually at 7%. We believe by consistently improving our quality, we're going to be trusted partners with ACOs, post-acute networks, preferred provider partnerships and also managed care organizations. We are right now 12 out of 22 states are CON states. We have 181 branches and growing, and we're serving 27,000 patients. 81% of the branches acquired from LHC and Amedisys are in CON states. It is difficult to enter a CON state. You can do so two ways. You can apply for CON and compete with other competitors trying to win that seldomly open CON. And at the same time, the people that have the CON already within that area is going to oppose you. So it's a long and drawn-out process or you can acquire branches within that CON state. We are very fortunate in the fact that LHC and Amedisys have achieved some of the highest quality scores in the industry. So we have branches coming over with the same quality mindset as we do. We have new CON states that have been added to our portfolio, Arkansas, Kentucky, Illinois, West Virginia, New Jersey. We're currently progressing through a very detailed and thorough integration process. Each branch has a growth action plan assigned to it. We will be bringing over $30 million in additional EBITDA. We expect longer upside through additional operation efficiencies and also additional growth. As I said, quality is front and center. Right now, our 60-day readmission rate is 15.9%. We are improving and being invited into additional post-acute networks. We have developed our own internal OASIS certification process. We're putting every branch manager and clinical manager through this certification program where we pay for their training internally and pay for them to take the national exam. We currently have a 90% pass rate. After all of our leaders progress through this program, we will then begin to invite professional clinicians to go through this type process. We compare ourselves to the industry using our shared platform, SHP. We are constantly striving to improve, like I said, our quality scores. Right now in patient care, we're 96% versus a national average of 90%. In the rating of the agency, we're 94% versus a national average of 86%. And in specific care issues, we're 94% versus a national average of 85%. We will continue to focus on our episodic payer mix, we always have. We'll continue down that path. We have been very successful in negotiating stronger payer contracts. We'll continue that path forward. Right now, our integration and stabilization of our newly acquired branches are of most importance. And we're pleased with the progress to date, which should be completed -- that integration should be complete by year end we are also putting significant efforts towards further automation of our referral and [ central ] intake departments. and we are pleased with their progress. How do we grow? How do we continue our growth? Of course, we're going to continue to pursue organic growth by leveraging our ability to gain market share in our new and existing territories, and we have strategic plans in place for that. We will also continue to grow through this acquisition. We have strategic action plans and growth plans assigned to every branch. We will continue to grow through leveraging our ability to successfully stand up locations through de novos. We will continue to build on our de novo strategy. And then after we complete the successful integration of the LHC and Amedisys branches, we will continue to grow our M&A activity with particular focus on CON states. Thank you so much for your time and attention today.

Thanks, Elizabeth. I'm going to jump in here on primary care. But it's interesting about our home health and hospice business, and we'll hear from Rhonda in a second. That business, when you think about LHC and Amedisys, when they were so public companies going back a number of years, our home health and hospice business is pretty much right at the doorstep of where they were from a size perspective back then. If you think about the significance of this business, there's really only 2 companies out there, Genesis and their most recent reincarnation in hospice, [ Genesis ], Gentiva and their most recent rebranding back of the Gentiva focused on only hospice and VITAS. Those companies have been around for 40 years in hospice and have very, very large censuses. That's probably out of reach. But other than that, we will be the biggest home health and hospice company in the United States, and we're essentially there today, and we'll keep that going. But thank you, Elizabeth. Elizabeth is one of the best, most accountable operators I've ever been around and has a ton of history in the industry going back to her Amedisys days. But primary care, we just have a couple of slides here. For reporting purposes, we keep that within the home health care segment. So that's why that's here today. I think about this more as that strategic growth area, one of them, in addition to our core growth areas. But why have we been doing this for a couple of years, getting this up and going? Number one is just simply we have access to so many patients, hundreds of thousands of patients a year through our pharmacy and home health and hospice businesses that need better primary care. So there's an opportunity to introduce that into the service lines that we have to provide patients in their home and in ALS and SNFs with a better primary care experience. The other one is, as we just want to leverage our really strong quality outcomes into value-based care, we felt strongly that having the primary care capability set was important in that. They are the quarterback in terms of the experience and the journey of the patient. And so we wanted to build out that primary care capability, move up the value stream, if you will. And that's been going pretty well the last couple of years. It's been a grind getting this going, it's been really all organic, but we've continued to bring good people into this business, including, as I mentioned earlier, a new CMO, a new Head of payer partnerships just in the last 6 months, and we're really excited about further scaling this out. Home-based primary care, either in the home, but mostly in assisted living and senior living and assisted living and skilled nursing; has incredible outcomes, typically a 35% to 40% to 50% reduction in hospitalization, depending upon what you're looking at. And so what we are trying to do is enter as many assisted living and skilled nursing facilities as we can and service people in their homes to scale this business, both from a fee-for-service and increasingly ACO opportunity perspective, but then also, as I mentioned before, the opportunity to partner with payers and manage their high-risk members. We can do that by combining primary care with our Continue CareRx model in the home, med management in the home and having an effective clinical nursing hub in the in-between time, and the in-between space, helping to keep people out of the hospital stepping in front of it. We're in 10 states today. As I said, we're -- we also recently hired a new sales leader for this business. We keep investing in this company and in this business. So we are looking to enter into as many skilled nursing and assisted living facilities as we can as the primary care provider. We want to partner and share leads with our home health and hospice and rehab teams as much as we can to gain access to these buildings, and we want to provide great care. If you're a skilled nursing facility or an assisted living facility, that primary care capability in your building has a huge outcome on your patients. And so that is vital for you. It's how you market yourself in the community. Do I keep people here longer? Do I keep them in my facility longer, less in the hospital? So primary care is really important for all of these operators out there in the industry. And then we're leaning into the ACO as well. So our definition of value-based care is really threefold. One of them would be having your own ACO, right? So if these are our own patients that we are the doctor for, right, they are assigned to us. If we're driving really strong outcomes for them, how do we see the benefit of that? So what we're in today is a no risk, all upside shared savings model with Medicare. There's going to be some new ACO models coming out in '27 and '28. We are going to be joining those and continuing to try to grow the percent of the patients we see that are in a shared savings model. The second way, as I said before, is to go to payers and use our care management model here to better manage their members with an innovative contract with them that reflects the value that we're delivering. And then the third way is we have a really small [ I-SNP ] today. That's a special needs plan. That's a managed care plan. It's in 2 states. You have to get these things approved state by state. So we think we can move much faster on the ACO and payer partnership side. But this is a managed care plan in a couple of states where we have a couple of thousand patients in it. So if we're in a skilled nursing facility or an ALF, for example, we have the ability to treat Medicare patients under the ACO. Or if not, we have the ability to see patients under a managed care plan construct like this [ I-SNP ]. We just want to have a comprehensive solution in alternatives from a value-based care perspective. So I hope to be talking about this business and this build-out a lot more with you in the coming years. Our goal is to serve over 100,000 patients and more in time. And doing about 300,000 encounters a year today, but we want to rapidly grow this business and we think it has a dramatic impact on improving quality and reducing cost, and it's very, very closely tied into our other service lines as well. So with that, we will then move over to hospice, and Rhonda Sanders is going to come on up. Rhonda knows the hospice sector about as well as anybody I know. And not only Rhonda, are you terrific from a day-to-day referral generation and sales standpoint, but also one of the best strategic thinkers and partnership-oriented type individuals I've seen in hospice before. So take it away.

Thanks so much, Jon, and good afternoon, everyone. Again, I lead the growth for our hospice division. It's one of the most compelling divisions in our portfolio. Every single person in this room will need hospice at some point in their life, right? So it's a very compelling service, and I'm excited to talk with you about our growth potential today. So just hospice at a glance, I want to make sure and paint the picture of who we are today and really what sets us apart as an organization. So from a broad geographical reach, we're in 21 states and 93 locations across the U.S. That sets us up really coast to coast. So we have a great opportunity to go deeper in every market that we're in. Very exciting about the growth potential in the hospice division. From an integrated service offering, Jon's talked a lot today about our integrated model. It really is a continuum of care. It's making sure that we're servicing patients in a very fragmented health care world. It's very complex. I don't know how many of you have navigated the health care landscape lately, but it can be incredibly challenging, especially for a senior. So our ability as an integrated service organization to create a less fragmented model is a differentiator for us. So we have our hospice, which we service patients that are terminally ill. Typically 6 months of life is what we're focused on. Our palliative service offering is even more broad. So we're really partnering around advanced illness patients. That's a broad scope. Today, we service over 3,000 patients with palliative, with about an 80% conversion over to our hospice at some point, really focusing on right care, right time. We focus with our palliative patients around goals of care, where are they in their decision-making, where are they in their disease process. And then we work very closely with our OnePoint pharmacy. They do provide pharmacy services for our hospice patients. We've seen a lot of efficiency and enhanced customer service and working with OnePoint. It's really been a differentiator for us. And then from a home health perspective, Elizabeth shared a lot about our home health. They have some of the highest quality in the industry. And again, we're really focused on getting patients upstream. So not only from our home health but other home health in the country, right? They have patients on service that need advanced care. And it's really using the data that Elizabe talked about SHP data to really identify triggers for these patients and ensure that they're receiving that care at the most appropriate time. And then our home-based primary care services which Jon talked about our partners. I'll just give you an example about the type of scale that hospice has opportunity and working with them. And Ohio market last year, our [ board ] partners actually made 400 hospice referrals. So just a tremendous opportunity there. And then from a focus on quality and operational excellence you've heard a lot about today, but that's rally what we lead as organization, ensuring that we're delivering a highest quality of care. I'm pleased to say that over 2/3 of our hospice branches are 4 stars or greater. That's like a hotel, right? Many of you choose a hotel based on 5 star rating. CMS actually gives an opportunity to rank our hospices based on quality on a star rating scale. So the consumer actually chooses a hospice based on overall quality. So many consumers in the AI world, they will use AI technology to choose their hospice. They choose us because we have the highest quality in the industry. So as far as an average daily census standpoint, as you can see by this slide, we've continued to move up and ending Q4 at 6,925. That's how many patients we have on service daily. I'm pleased to report that we're over 7,000 in our core business as of today. So great opportunity. As far as our market growth trends this hospice sector in the health care world is a fast growing one. As you can tell, $31 billion and growing 4.6% annually. So the reason because -- the reason for that is 65 and older demographic is projected to nearly double. So 10,000 people a day turn 65. That's outpacing births in the U.S. So it's really a fantastic time to be in hospice. And routine care is actually over 90% of that revenue generated in the hospice industry. And 98% of the entities have an annual revenue of greater than $50 million. So again, our margins are really solid as well in the industry. This is just a great opportunity to outline our scale and our reach. So again, we're coast-to-coast as far as a hospice and palliative care division, so a great opportunity. As far as why BrightSpring? Why are we different than other organizations and how are we well positioned in the U.S.? A lot of the sector in the hospice is either a stand-alone hospice with no continuum of care or they're small operators. Given the fact that we are a large organization, we really can provide economies of scale in working with our own pharmacy to also ensuring that we're putting best practices in place across the country. This differentiates us from other organizations. From a referral competition standpoint, we get to lead out there with quality. So I lead the sales force. Everything that we do in the communities that we serve starts and ends with quality. In a narrow network, which is what most organizations are moving to, they want the highest and best quality at the lowest cost. And fortunately for BrightSpring that makes us an obvious choice. And then from a workforce shortage standpoint, that's something that the industry is certainly facing. And without [ SN ], without caregivers [ DNAs ], we can not continue to grow our business. And so at BrightSpring, we are really focused on workforce shortages. We're very competitive in terms of wages and benefits. But we're investing in our workforce in terms of skill sets. We're also -- we just finished our legacy awards which Jon presented a couple of weeks ago, really recognizing top talent within the organization. All of those are the reasons why people continue to choose BrightSpring. Jon mentioned people really linning up to work with us. it really is our culture that drives the difference there. And then from an operational and administrative complexity, we have some of the best operators like Elizabeth in the country, really leading efficiencies. We are data-driven, so we have proprietary data that we utilize to enhance our overall offering and certainly drive quality results. As far as our hospice differentiators, we could really break that down into three categories. So strategic positioning, expanded palliative care model and then health equity strategy. So we've talked a lot about the strategic positioning. We're best-in-class from a quality perspective. In addition to that, we offer the lowest cost care out there. So we're an obvious choice for payers, ACOs and value-based care. And then expanded palliative care reach. We already talked about the conversion of our palliative care patients at 80%, ensuring that we're delivering the right care at the right time. This is an obvious opportunity for us to really expand our platform to help more people who have advanced illness and are suffering from pain and symptom management. And then as far as integrated care model we talked a lot about that today, health equity is strategy we have at our hospice because 50% of people that are in need of hospice care get it today. That means we're focused on taking share from our competitors, number one. And number two, we're focused on the 50% of the population that don't get the hospice care that they need. So many times that because of health equity, challenges whether it be cultural, whether it be socioeconomic. So we've developed a proprietary strategy internally to really focus on that population and bringing education to the communities that we serve. And then just to talk about our performing metrics to brag a little because this is really a fantastic slide, as far as -- we provide more visits than the national average by 30%. This is a really impressive number. Average discharge length of stay, again, we're focused on patients upstream. And so 99 days is over 3.5 months of care, right? So that's been a focus for us. We've been able to improve our margin year-over-year by 140 basis points, also another impressive statistic in the hospice division. And this is one I'm incredibly proud of. We're bringing access to care to 22,808 patients. That's 19% year-over-year growth. We're slated again this year for double-digit growth in the hospice division. So -- and we've been able to do that for improvement in our referral conversion rate. So trending last year at 74.2%. We were able to improve that to 78.6% really through education and training of our clinical teams. And then from a hospice building through clinical quality, I want to walk you through clinical quality because it truly is our #1 differentiator, as I've talked about. So the HVLDL is our hospice visits last days of life. This is a measurement that CMS has put out to measure our impact on patient care. And so we're at 76.1% versus the national average of 48.3%. That is very impressive. And then 98% of BrightSpring hospices actually exceed the national average. That's almost 100% of our locations. And then the CAHPS survey, this is something from a consumer standpoint. We talk a lot about consumerism because people have a choice there. So the CAHPS survey actually goes out to patients, and it's their way to really evaluate how we did with their loved one. It goes out to patients that discharge their families, and they basically grade us on the overall care that we provided. Also pleased to say 87% versus the 81% national average, so outpacing our competition. And then from a continued improvement in our hospice care index, another CMS measurement, we're at 9.4 average scores versus 8.8 nationally. All these reasons set us apart as an obvious choice in the hospice industry. And then skilled nursing visits. We talked a lot about our workforce. It is imperative for us to have a strong workforce and strong retention so we can continue to build on our skilled nursing visits. We're currently at 8.1 versus the national average of 7.8. So some really nice stat. And overall, this is just a review of our star ratings. Over 74% of our hospice agencies have a 4-star or better. That's almost unheard of, right? And we really focus on timely help, enhanced communication back to our patients and families and then certainly help around pain and symptoms. And then we do this through really a culture of eligibility, really teaching and training our teams on what eligibility looks like, specialized care that is patient-centered. And then certainly, we have a protocol. And then from a growth lever standpoint, we want to expand our reach and patient impact. That's our whole goal. And so we really do that through four strategies: organic growth strategy, de novo and CON strategy, integrated market and strategic focus on growth. So just to talk a little bit about organic growth, we are focused organically and going deeper, as I mentioned, in the markets that we're already in, taking market share, we want to drive to be 1, 2 or 3 in terms of overall market share in every market that we're in. As far as defined dementia strategy, dementia is one of the fastest-growing disease processes in the country. We have clinical pathways that we're focused on around dementia and cardiac. And then expanding our liaisons. We use claims data today, we use proprietary data to basically ensure that we're in the right areas to drive access to care. And then last but certainly not least, ensuring that we are expanding our high targeted referral sources. And from a de novo and CON strategy, I just wanted to talk about de novos as an opportunity. So we were able to launch 5 de novos slated for this year. So really excited about what that brings to the bottom line from an EBITDA perspective as well. And then as far as the CON strategy, again, applying in 5 locations throughout 4 states this year and certificate of need. And we've talked a lot about the integrated market strategy, I think a key differentiator for us and then certainly a growth area. We've defined core KPIs across the continuum of care. We've actually selected multiple integrated markets to pilot. And so we'll be going deeper in each one of our integrated markets this year. And then from a strategic focus on growth, which we talked a lot about ACOs and value-based care. They truly are narrowing the network, they are wanting to work with 1, 2 or 3 companies. They are not wanting to work with 7 companies out there any longer. So we're positioning ourselves for top choice for accountable peer organizations and value-based entities. We signed multiple preferred partners of agreement with ACOs this years as well as going deeper with payers on unique opportunities. And then just in summary, this really sums it up. Coast-to-coast services, integrated care mode and then certainly our quality and operational excellence make us an obvious choice. And we want to continue to grow in this segment. So thank you so much for your time today, and we'll certainly be around later for questions. Thank you.

Thanks, Rhonda. Terrific, terrific hospice business that's been built up over time, and thanks for all the strategic direction in that business today. Well, Kim More, Kim and I go back about probably 12 years. Kim was probably our top operator at rehab care back in the day, which was the biggest rehab company in the United States by sites of service and skilled nursing facilities and ALF. So Kim has done a wonderful job with our very highly clinical neuro rehab business. And now as we look to extend that into the senior space as well. So take it away, Kim, thank you.

Thank you, Jon. So nice to have you all here with us. As Jon shared, my name is Kim More. I'm the Senior Vice President, leading the Rehab division at BrightSpring. And I've had the honor of being part of this organization for the past 8 years now, and I look forward today to sharing the integrated care platform that we've built and that we continue to scale across rehab and personal care services. So let's dive in. All right. Every year in the U.S., millions of people survive brain injuries, they survive strokes and neurological trauma. But the challenge isn't just survival. It's in the recovery that follows. Our highly trained and skilled clinicians are dedicated to this recovery, focusing on restoring critical functional abilities, including communication skills, basic physical independence, activities of daily living, mobility, cognitive skills recovery, executive functioning and emotional regulation. Rehab's continuum of services span post-acute transitional centers of excellence, home and community programs, day neuro and outpatient clinics and now Rehab in Motion senior living outpatient, which is embedded directly within the assisted and independent living communities. Beyond neuro rehab, we also provide complementary services that leverage that same clinical infrastructure and care coordination capabilities, including pediatric ABA, which is applied behavior analysis therapy for children with autism spectrum disorder. In 2026, the prevalence of autism today is 1 in 31 children. We also provide state-contracted foster care support programs focused on providing a safe home for children in need counseling and wraparound services, supporting stability, life skills development with the ultimate goal of family reunification and sometimes adoption. Again, another statistic to show you this as a chronic demand is 250,000 children enter the foster care market in the U.S. each year. That -- the thread that really ties all of this together is that coordinated multidisciplinary approach that is designed to help people recover function, to regain their independence and reengage in their communities while delivering the care in the lower-cost settings with the best-in-class outcomes. Now next, to fully appreciate the opportunity that we have in rehabilitation. It's important to understand the structural problem that we have -- that we are solving today in the U.S. The U.S. health care system was designed to treat episodes of care, a surgery, an acute illness, a hospital stay. Traditional rehab models assume a linear recovery, fixed lengths of stay and volume-driven reimbursement, but neurological recovery does not follow that pattern. Recovery from a brain injury is what we call nonlinear. Patients often progress, they plateau and they improve again during that critical window of neuroplasticity. Patients with complex neurologic diagnosis are frequently underserved in home health and skilled nursing facilities because they were not designed for their needs. The results, as you've heard hospice speak and home health as well, is fragmented care, inconsistent outcomes, unnecessary hospitalizations and higher system-wide cost. BrightSpring's rehab model, on the other hand, was purpose-built for that nonlinear recovery. Our model is designed to follow patients across that full continuum. Upon discharge from the acute care setting, our patients may transfer to our post-acute transitional living centers to our home and community services and through our day neuro and outpatient therapy services. And what truly separates and differentiates us is our clinical specialization and longitudinal engagement. Our teams deliver neuro specialized therapy, cognitive rehab, behavioral integration and community reintegration, including return to driving. We have a specialized return to driving program, return to school, return to work and meaningful life recreational activities. This level of care requires specialized neuro clinicians, highly coordinated multidisciplinary teams and regular engagements where the patients actually live. It also requires sustained investment in quality, in compliance, in clinical infrastructure and IT advanced solutions that you heard Charlie and Viji mention earlier. Each year, approximately 1 in 60 Americans sustains a traumatic brain injury. Over a lifetime, 1 in 4 U.S. adults will experience at least 1 TBI. 1 in 4, that's incredible. Traumatic and acquired brain injuries affect individuals through pediatric through geriatric populations. Examples include for our youth population during sports injuries and trauma, for our working adults from motor vehicle accidents, workplace accidents, falls, assault, violence and extreme recreational sports. And then for our seniors, most often from falls. The U.S. neuro market alone is estimated at $6 billion, growing at around 7% annually. Payers and referral sources increasingly want scaled providers that can deliver predictable cost, standardized protocols, seamless care transitions and consistent outcomes across markets that creates that clear advantage for national platforms like we have at BrightSpring. All right. Next, I'd like to introduce our most exciting growth platform this year, Rehab in Motion, which is our Medicare Part B therapy model that is embedded directly within the assisted and independent living communities. This program serves our seniors where they live with dedicated on-site multidisciplinary team delivering physical, occupational and speech therapy. The focus of our Vitality program is on reducing frailty, preventing falls, improving their mobility and maintaining independence while also reducing that important hospitalization risk. A key differentiator is our proactive fall recovery training. We teach residents how to safely recover after a fall, building confidence and reducing fear through our trauma-informed care model. Rehab and Motion is highly integrated with our home health partners, primary care, pharmacy and care coordination services, creating that true continuum of care within our senior living environments. Today, we operate in 20 communities across multiple states, with expansion underway through de novo growth through our partnerships and through targeted acquisitions. As many of you already see and see and experience in our health care environment in the U.S., it has completely and fundamentally shifted. And that shift has created opportunity for us at BrightSpring. Aging in place is no longer optional. Acute care capacity constraints and cost pressures are pushing us to provide that care in lower-cost settings. And at the same time, value-based models are increasingly focused on functional outcomes, fewer hospitalizations and predictable cost. BrightSpring combines that national scale, integrated care delivery and deep clinical expertise to deliver rehab services across home and community, senior living environments and align precisely with where the system is going today and into the future. Most providers have pieces to that solution. BrightSpring operates the platform today. So let's next spend a moment on our geographic footprint and the structural advantages of our rehab model. One of the unique strengths of our platform is that it is not dependent on a fixed base of real estate. We deliver care directly in the home and community. Our model is inherently capital-light and flexible, allowing us to scale efficiently as the demand grows. Another important advantage is our ability to enter new markets quickly. Since our model is built around clinical teams rather than brick-and-mortar, infrastructure expansion can happen much faster than in traditional rehabilitation settings. Brain injury and complex neuro referrals frequently cross state lines, and many of our referral partners operate on a national basis as well. Our national clinical infrastructure allows us to combine that local care delivery with enterprise-level support, quality oversight and operational discipline. So we -- when we talk about growth, we pursue it through three primary strategies. First, again, de novo expansion. We enter approximately 8 new markets each year focused on proven geographies and referral relationships; second, payer contracting, diversifying payer mix, strengthening reimbursement with our government and commercial and workers' compensation contracts; and third, through disciplined strategic M&A, enhancing geographic density, scale efficiencies and value-based alignment. Together, these levers support sustained capital-efficient growth. Now our clinical outcomes, we are also proud, and I've heard my peers as well speak to this, but this is absolutely the foundation of our rehab program. Our programs deliver measurable results, including an MPAI score of 9 compared to a national average of 5. This reflects a robust clinically meaningful improvement for our brain injury patients. More than 50% of our patients achieve 8 or more hours of independence in the home environment, which is a critical milestone in brain injury recovery. Customer satisfaction also remains exceptionally strong. In the fourth quarter results, we had 100% in our outpatient and 98% in our home and community services. These outcomes reflect the expertise again of our clinicians, our focus on quality and compliance and the effectiveness of our integrated care market. So when we step back, the opportunity should be really clear. Brain injuries and neurological conditions are cumulative, they are chronic and they are increasingly prevalent as the population ages. Facility-based episode-driven care models were not built to accommodate this reality. BrightSpring's rehab platform meets patients where life actually happens, delivering that specialized care in post-acute settings designed to keep people out of the hospital and support long-term recovery. That's the model that we have built, that we are expanding and we are proud to offer at BrightSpring and why rehabilitation will remain a meaningful driver of growth of impact and value creation. All right. Next, I'm going to shift on to our personal services platform. Recovery, here's a key point. Recovery doesn't end when therapy ends. That's where personal care becomes such an important part of BrightSpring's continuum of care. It allows us to extend that support beyond the clinical treatment and into daily living, helping individuals maintain independence, avoid unnecessary institutional care and continue living in the environment they prefer most their home. From a health care perspective, this work is also extremely valuable because it helps to lay the need for that higher-cost institutional care such as skilled nursing facilities. Today, our personal care platform operates over 21 states, serving more than 16,000 individuals through over 160 locations nationwide. Supporting that care delivery is a workforce of more than 12,000 employees, including 10,000 caregivers working directly with families in their homes. In total, our teams deliver 13 million hours of care annually. This geographic footprint allows us to combine that scale with local opportunity expertise, which is critical in the service model that depends on those strong community relationships. Today, the business generates approximately $402 million in annual revenue, serving more than 16,000 individuals across the markets. When you take a step back and you look though at that broader landscape, the U.S. personal care market alone is estimated at roughly $80 billion and continuing to grow. The underlying drivers of the growth are super clear. First, demographics. Nearly 90% of adults over the age of 65 say they want to remain in their homes as they age, and personal care services makes that possible. Second, economics. Home-based care is significantly more cost-effective than institutional alternatives, which makes it increasingly attractive solution for our payers and for our government programs. And third, our ability to expand through multiple channels, including VA programs, commercial payers, private pay services and strategic de novo expansion. Importantly, this business also creates natural synergies with other BrightSpring services, including our rehab services, home health, hospice and pharmacy, allowing us to support individuals across the full continuum of care. Quality and compliance are also foundational to how we operate this business. Across personal care operations, our overall quality score currently stands at 87%, representing a 2.7% improvement since 2023. The scores reflect rigorous oversight of regulatory requirements, including supervision, care planning, documentation of service delivery, emergency preparedness and infection control protocols. Our client record compliance score is 92%, demonstrating that strong adherence to state-specific regulatory documentation standards. And ultimately, our focus is simple here, delivering high-quality evidence-based services that align with what patients and families value most, independence, safety and dignity at home. What makes this platform particularly compelling is how all of these services work together across BrightSpring. Rehabilitation restores function. Personal care helps individuals maintain that independence over time. Together, they allow us to serve patients across a much longer period of their care journey while strengthening those referral relationships, improving those outcomes and expanding market opportunity. Thank you for your time today and your partnership and the belief in the opportunity ahead.

Thanks, Kim. I was wondering if you were going to try to read that huge quote.

I know. No, definitely not.

Do you guys want to come up here for a little Q&A?

Yes.

Hopefully, you guys are getting a sense of the broad-based quality of a lot of these businesses and the broad-based growth in the organization. So really some terrific provider service lines here that we're fortunate to have in the organization. Any questions on the provider side? Joanna?

Larry Solow, CJS. First question, just from a high level, it seems like acquisition opportunities is more on this side of the business. So as you look out 5, 10 years, where do you see geographically? Do you see yourself expanding a lot, especially on the home health side, where you're only in the Southeast? And then as part of that, do you look for -- most of your properties are obviously very high provider scores, high-quality service. When you look for acquisitions, are you -- will you only look for that? Or will you also look for somewhat distressed assets where maybe service levels aren't as good, but it gives you an opportunity to expand geographically and also improve those service scores and financials?

Yes. Thanks, Larry. Maybe I'll start and you guys can add any thoughts. But clearly, I think we will continue to try to expand geographically in each one of our hospice, rehab and home health businesses. Our focus in home health will largely be integration over the next year of those acquired assets. I think after that, we will continue to look at certain target markets. Hospice, we are very open to the right partnerships there. Hospice, like infusion, has seen extremely elevated multiples in those industries. Most of those businesses in both of those markets can trade at 15x or more. So we've been very patient there with more of an organic focus. And wherever we've done a rehab tuck-in, it's worked out extremely well. So -- but I would say across the company, it's really balanced from a pharmacy and provider perspective, Chris was going to talk about this in corp dev a little bit later. But our focus on M&A will remain balanced across pharmacy and provider. So hospice rehab, home health here, but then also infusion and some very hopefully low multiple tuck-ins on the home and community pharmacy side. That's been our history. It's worked for us. It gives us a lot of optionality. We get a lot of selection preference by being able to look across those service lines. And I think that you'll see that posture continue into the future. On home health and hospice, there's probably ultimately 35 states in each that I can see us participating in, and we're roughly a little over 20 sort of around in each today. So whether that's de novos or CONs organically or whether some tuck-ins, that's where we'd like to build to ultimately. Any other thoughts from an acquisition standpoint?

I would just say we meet with business development on a regular basis and are looking at M&A opportunities. So we have a team that is focused on a core strategy and making sure that these deals meet that strategy.

I would just say the last piece there, too, is, and it's -- these are just things that are meaningful every day for us that we see, there's a lot of operators in this incredibly fragmented set of markets that are looking for a long-term home. And we are regularly approached from owners about "I see BrightSpring, I see what you guys are doing, public company public stock. I would love for that to be long term home for my people." A lot of the sellers that you come across, the good ones, really care bout what happens in their organizations, their people. Like they don't want to see their company dismantled. But change is inevitable. and so if there's going to be change, hopefully that change is focused on best practices within a company with a great culture. So we routinely, and that's one of our drivers of M&A that we'll talk about, see proprietary access to situations. I can think of three right now that are going on, smaller deals, where the owner has literally said, we want to go with you, no offense, versus private equity or versus some other massive company. We win those like 80% of the time on preference. And so we look forward to being that long-term home within these ever-evolving industries. Joanna?

So Rhonda, a question for you on hospice because that business in the provider segment has been growing very nicely and I guess, prior to this recent acquisition, was the largest piece of that segment. But I want to ask you about reimbursement because that piece of that business, I guess, is driving some of the multiples, as Jon talked about. So a question here or two part actually. The reimbursement is stable there, right? But there's been more focus on fraud and abuse in certain markets specifically, but also at the federal level, more audits and things like that. So do you expect this to kind of put some pressure on reimbursement? Is there any indication that there could be some changes to reimbursement in hospice? And the second piece on the Medicare Advantage [ carbon ], right? So CMS kind of gave up on this idea, but do you guys expect this to eventually become reality where you have to actually contract with Medicare Advantage payers in hospice?

A great question. So I would just say, to address your first question around fraud and abuse, I think it's very well known that California and Texas are looked as states that there has been a lot of fraud and abuse going on. Here at BrightSpring, we have a very detailed compliance process. We also work with an amazing accreditation organization actually, too. We work [indiscernible] hospice site as well as [ HDHC ]. So I feel like that really prepares us as an organization. We are doing the right thing. So I am not as concerned at BrightSpring. But from an industry standpoint, I do think that will continue to be a focus, but -- I actually sit on the Board of [indiscernible]. So this is something we look at on an ongoing basis. But I do feel like we're very well positioned as an organization there. Second piece of your question around -- refresh my memory, I am so sorry, Medicare Advantage. I do believe that at some point, Medicare Advantage will become a reality. Right now, over 90% of the care that we provide is to fee-for-service Medicare patients. However, we have had carve-in examples, they did not -- they were not highly successful in the past. But M&A does seem to be still very focused on this as an opportunity. We meet with payers all the time, and they're very quick to ask us many questions about the business. So I do think it is in our future. And we continue to prepare ourselves for that with some unique value-based agreements with payers today.

Hospice has such a strong value proposition from a quality and a cost reduction standpoint. So Rhonda is right, those pilots or demos did not go well. So I don't think there's anything going on, and Daryn can speak to this in the GR section in this world of significance today. So not on a lot of people's radar screens. I would just say back on the fraud point, we have actually over 900 third-party accreditations in our company across all of our service lines. I mean almost 1,000 different accreditations from third-party accrediting bodies, which are very difficult to get. They come in and audit you very deeply. And you only get that gold star, if you meet all their criteria. So we focus on that extensively. I would say we absolutely support the administration and what they would be doing around anything in this area, of course. I don't know the percentages. I would venture to guess that 99% plus of the providers out there in these industries are very well intentioned, dedicated, committed clinicians and individuals. And if there's fraud in any industry whatsoever, we should attack that and root that out. Hopefully, we can continue to collaborate with the government in this area to make sure that the right targeted solutions are implemented in the future. You would never want to throw the baby out with the bathwater as there are -- the vast, vast, vast preponderance of providers are very compliant. So we would look forward to dialoguing with the administration as they continue to try to go after any individuals who might be abusing the system.

Jon, I just wanted to the comments on MA carbon. There's nothing imminent on the horizon there. Certainly, industry has been very vocal about that, but we'll watch it closely. And if it is inevitable, we'll certainly be ready for it. And then from a rate perspective on the hospice side, it's been very incredibly consistent because the statutory structures of those rates force it to be incredibly consistent. So yes, we feel very good about where that sits.

Thanks, Daryn.

Question for Elizabeth. So when we think about these Amedisys or former UnitedHealth assets that you've taken on from a previous coverage of that company, these are, from our understanding, that you've picked up some of the best assets within that portfolio. So as we think about areas for potential improvement, whether that's margins, clinical outcomes, where do you see that? And then I guess the second part of my question is, what are you seeing in terms of the competitive environment as United is seemingly like losing focus on home health and then Elara Care just went to DaVita, so that they're probably going to take on some of that capacity in-house? So just curious what you're seeing on that front.

Yes. I see significant opportunity in the home health space. Like you said, I have had a long history at Amedisys and definitely knew how that company operated. And they are strong branches. They have a metrics-driven mindset, a culture-driven mindset. And I have been out visiting those branches. They're excited to be here. And I think because of the acquisition that was taking place and they had kind of been on hold for a little while and now we are there with specific growth action plans, the teams are excited to grow. So I definitely think we have opportunity with this acquisition. Same for LHC. LHC has -- we competed with them over and over who's going to knock each other off the top spot for quality. Great quality mindset. And we brought that team here right after the acquisition and really had introduced and welcomed them to our company, showed them what our culture was. And all we hear they're excited to be here and ready to grow. So we think there's definitely upside.

The margin we acquired was a little bit lower than our margin. And so over time, we would expect that to even out. So I think that's an opportunity. And then also from a growth perspective, it can be challenging when people are in a situation where there's a pending acquisition for a year or 2. And so we're excited, as Elizabeth has said, to really drive a patient reach and growth focus in that business. I think as you look at the bigger industry, Brian, I think what I said before is I just think we have a real opportunity there with some of the biggest independents having been acquired over the years. Enhabit has now been taken private. That was a little bit of a challenging situation with Encompass over the years. And so we see a really attractive runway. As I think I mentioned before, there's probably only 2 companies who've been around for 40 or 50 years in the hospice space where that's out of reach. But other than that, we absolutely want to be known not only as the biggest, but the best operator in home health and hospice and rehab in the industry. And I think we have every opportunity to do that, and we are well on the way down that path. But I think those dynamics in the market have probably created more opportunities. And we've been trying to work with MA and payer partners over the past year or 2 to partner with them just around outcomes and what is a fair rate, given better outcomes. And we've had some success there, and we would look forward to continue to do that. I remember several years ago, one of the CEOs of one of the biggest payers in the United States said that we've looked at everything over the years. And it is our opinion that home health impacts outcomes in a positive way more than anything else. And so we just want to continue to try to scale that business. When there's something like 40% of the people today written for home health who do not get it, which we just cringe when we hear that. So hopefully, you'll get rate stability. I think CMS showed some real understanding in the final rule back at the end of last year. And we're optimistic that the support will be there, given the outcomes, and we want to continue to scale in that market. A.J.?

A.J. Rice from UBS. You commented on personal care services and what the market growth was. I wonder on home health and hospice, I may have missed it, but I didn't see where you said we think the market is growing this. We think we can pick up through geographic expansion or through de novos additional growth. Do you have any way to size the metrics on growth around hospice and home health? And then I might pivot over and ask about the primary care initiative. Is that MDs? Is that nurse practitioners? Are they your employees? Are you contracting with people? How are you structuring? What you're doing there?

From a market standpoint, we see home health and hospice is about 5% to 7% market growth. Obviously, you get some of the demographics at play there. Hospice also, I think there's still only about 50% of the individuals eligible for hospice actually receive it. So there is -- on top of the underlying population demographics growth, if more people start utilizing hospice as they should, that's what makes hospice a little bit of a higher growth rate than home health. We want to grow in that industry double digit. So our internal goals every year are going to be around 12% to 15%. And so obviously, we have to be taking share, and we want to do that through our volume, continuing to enter new markets and invest in sales. On primary care, about 80% of those clinicians are NPs. The there is not an unlimited supply of PCPs and doctors who want to be making house calls versus perform neurosurgery. And so you have to augment that with very skilled NPs, who can very capably be the primary care provider. And for nurse practitioners, they love it. The pay is very good, and you are your own clinician, you're the doctor. And that's empowering. And we see that NPs are very excited to have their own panel of patients in these various buildings and across homes. So we've been investing a lot in those individuals with training and making sure they feel appropriately compensated. It's a great job. I go to that assisted living facility today and spend all day there treating their patients. I go home at 5:00. We've got centralized on call. It's a great job where they can make an incredible impact.

And they're your employees?

Absolutely. All [ FTEs ] . Across our whole company, we're FTEs [ 10 99 ].

Yes, Raj Kumar from Stephens. Maybe just kind of focusing on home health and the preferred provider arrangements, maybe what's kind of driven initial success there? What's kind of the ongoing conversations around payers in terms of what they're looking for? Is it just capacity, higher acuity focus? And then maybe any specific targets as we go through the year? And maybe just any color on the economics of those arrangements relative to fee-for-service?

Elizabeth, you'll probably keep the economics out of it.

Okay. Yes. So we have had a lot of focus on that, but quality drives everything. That's what they're looking for and reduced hospitalizations, keeping those patients out of the hospitals. That's where payers really have an advantage. So we're getting phone calls now wanting to partner with us in post-acute networks. And managed care organizations wanting to create some really, I guess, value-based care arrangements. And so -- but I'm going to stick with quality. Quality is what makes that phone ring for people to want to partner with us.

Yes. It's -- look, they have access to all the data. And across all their members, across all home health providers, what we hear is we do better, so we want to do more with you, right? And look, there are some payers out there in the past more so, but still even today that don't -- aren't willing to pay a breakeven rate, which is ridiculous when this service is so incredibly valuable for their members. That has really improved over the years. You've seen a supply-demand imbalance in favor of the providers. And what we've seen in the last 3 years is progress with rates. But where we like to have preferred partnerships, send us more of your patients, and we will try to prioritize them, there has to be a fair reimbursement rate for that. And in these arrangements, we've generally moved in that direction to a level where we're willing to engage.

Yes. Jared Haase from William Blair. I guess maybe just a couple of quick ones on the primary care business. So I'm curious, from a go-to-market perspective, are you primarily leaning into the existing relationships that you have on the pharmacy side in the home and community space with SNFs and assisted living facilities? And I guess, as we think about your growth initiatives on pharmacy, are you sort of leaning into almost a joint go-to-marketing where it's, "Hey, we can manage both pharmacy and medical for this particular community"? And then I guess the third point around this, just if you are thinking about this as sort of a joint go-to-market, how penetrated is the primary care business relative to your existing book on home [ pharmacy ] side?

Yes. Where we are today, it's going to lean more towards your second comment, which is as we move forward, we see a lot more opportunity to work together in these buildings and in these communities as one organization, cross-selling, as you will, but really presenting yourself as one organization. I would say, historically, we certainly have examples of where we are in settings and locations because of a handoff, warm handoff referral from pharmacy or even home health already being in the building. That's not the majority of how we've entered into our home-based primary care buildings today. I think as we go forward, to use just a generalization, 50-50. That -- just like all of our businesses, that primary care team will be responsible for their own growth because you can't, in our view, be solely dependent on another service line and relationship for your growth. You have to own your own growth as well. But the other 50%, we should be growing through relationships and partnerships that we have in these buildings in pharmacy, in home health and rehab and hospice, and that is a much bigger opportunity. So to your third point, I think we're 5% down the road on that. That strategic growth area, including this cross-sell integrated care. We're hesitant to talk about it too much and distract from core growth, but that really could be a very large opportunity for the company over the next 5 to 10 years, but -- and it makes all the sense in the world, obviously. Well, thank you, guys, for your attention. As we've gone through our provider business here for the last 1.5 hours or so, I think we're going to take a break for lunch. It's about 12:10. We'd like to be back by 12:30, 12:35, 12:30. So if we could shoot for about 20 minutes, that would be terrific. And then we'll touch on government relations, M&A, finance with Jen, and we'll wrap up by 2:00. So thank you. [Break]

Welcome back, and you guys are doing a great job of adhering to the time schedule. So thank you. But welcome back. I really do hope this is being an informative and enjoyable day for you guys here in Louisville, where our headquarter is. So thank you again for joining us. I wanted to also say they're not even in the room really, but Natalie and Lisa and Lee and a whole lot of people who helped put this event on today. I really wanted to thank them for everything they did. Really last, these little bats here at Louisville Sluggers. So sometimes when we close an acquisition, Louisville is home to Louisville Slugger. We'll do baseball bats as kind of the deal toy. So in my office, you would see like 15, like really cool bats, different colors every time with the name of the deal on it. So you're not probably able to travel or you don't want to travel with a full-size bat. So we just got you some little ones. It just says BrightSpring Investor Day. These are safe to stick in your bag. They won't stop you. So if you want to grab one, there's a basket of them below the stairs before you leave. And with that, we will wrap up the day over the next hour and 20 minutes, get you out of here on time. Daryn is going to talk about government relations efforts, and then Chris Consalus will be here in corp dev and then Jen on some of the numbers. So Daryn, take it away.

Thank you, Jon. Good afternoon. The political guy loves the podium and loves the pop and circumstance of the podium, feel like I got to get my hand gestures in. And I did want to take a moment to announce my candidacy for Governor in Kentucky today, but just can't help that political side of me. It is an absolute honor to lead our government relations function here at BrightSpring Health Services. I've been in the leadership role for a decade, essentially as soon as Jon had come on with us. And I just really -- I've been asked to kind of get straight to our issues pretty quickly today. But I did want to say a couple of things upfront that are just really words that are -- if you have any takeaways from what I say because I know you all have a lot of familiarity with the issues I'm going to talk about. Two words are outcomes and visibility. Outcomes. So proud to hear all of our operators today and when Jon and Jen do their earnings calls, investor meetings, the outcomes that we drive as a company are just incredibly impactful on our efficacy as advocates. It is just a really great thing, and it's also incredibly important to just our credibility as advocates as well. So we use all the numbers you're hearing about for our specific divisions all the time. And this is a super, super important thing, super, super important for the company as well. And then on visibility, I'd like to speak about that in 2 ways. One is visibility within my team and the visibility for the company and relationships for what we do, visibility on issues and visibility that's changing as we continue to grow as a company, a lot of regulators and lawmakers are coming to us proactively through preexisting relationships, through knowledge of the company opposed to us going to them and introducing ourselves who the company is, what we do. And so that's just a great piece of our growth. Here on this opening slide, I would just note that we have a very experienced, very consultant-heavy team on the GR team. That's very purposeful. We're heavy with consultants, so we can be flexible. If we need new issue experts, if we need to move resources in a different state where we're not that strong and might need a lobbyist, we can do that very, very quickly. And on the resource side, one of the great things about partnering with Jon over the last decade is he's never said no to me on anything government relations related and have asked for additional resource. I'd say no to him sometimes, but he never says no to me for just kind of [indiscernible] approach and just spend that we have availed to us. We just are always well heeled for what we need to do and to do it effectively. And our focus is really -- we're in education and [indiscernible] function. We're out there talking about all those great outcomes that I mentioned before. And really everything from rate, workforce issues, structures of our programs. We're just using all the facts and everything we have to educate and drive good outcomes for our programs. So with that, I'm not going to talk to you -- you all know the environment is difficult. The stuff on the other side about just team approach. I'll skip that in the -- but as it relates to just the environment, it is a complicated environment. As we look at the federal agenda for the balance of the year, there are not many legislative vehicles left that we'll be able to move our items in. The upside of that is there's not many legislative vehicles left to move things that we're not excited about. So we'll be working really, really hard for what is most likely trying to get 2 or 3 bills into a year-end package in D.C. We fully expect the Trump administration to continue to be very aggressive with their executive orders and rule-making, and we continue to have just good visibility on all of that. And I would say everything we worked on in 2025, the first year of the Trump administration, there were some things that required heavy lifts. Those heavy lifts afforded us good access to leaders in the Trump administration. So we know who they are, they know who we are. And as we go into '26 and beyond, those relationships will be there. So jumping into just the key issues of the day for us. I'm going to hit on 7 different issues. Left side of this slide, references stuff that happened in '25. The other side is what we're going to be focused on in '26. I'm going to co-mingle the 2 issue by issue. First is the Inflation Reduction Act. We're going into -- the first 10 drugs going live on January 1, we did work very hard on parallel tracks with CMS and the Hill, introduced legislation in both the House and Senate, excellent momentum for our House legislation. But the other side of the track was working in the White House and CMS. And we did have great success there with 2 different memos that went out to Part B plans and payers specific to our long-term care pharmacies that had the most impact from IRA. Those directives to say to be fair with pharmacies on IRA were very effective in mitigating the ultimate impacts. And as we move into '26 with IRA, our focus is going to be very much on taking it another step further. We think there's more that CMS will do as they see the impacts that are happening in the field, particularly with some of the smaller pharmacies in the space. And we'll be moving to continue to gain cosponsors for our House and Senate bills and hopes that we're well positioned to pass at year-end if we need it, absent additional CMS action. Drug pricing, whether it's most favored nations, tariffs, implementation of the IRA, certainly 1 million things out in the ether last year. Our singular focus and all those things was to make sure, one, are there impacts? And two, is anybody thinking about the impacts on pharmacies. And I think we did that very effectively in 2025. And I know early off in '26, we're doing that effective again and will continue to be our focus on all things drug pricing this year. Next, PBM reform. We were very, very excited to finally see PBM reform pass the federal level earlier this year. It took a very, very long time and our specialty pharmacy association was particularly effective with our partners and their efforts to make sure that our most important element that was passed in their contract changes that finally give CMS some teeth in working with pharmacies and PBMs on contracting disputes. So over the next 2 years, CMS will be working to establish reasonable and relevant contracting terms. And then CMS will have some -- once that goes live in 2028, CMS is going to have the authorities to implement some civil penalties when those aren't followed. On the home infusion side, and just going into this year with PBM reform, certainly, our focus is going to be working with CMS to make sure our voice is heard and the right things are implemented in that process. On the home infusion side, going back to the Cures Act of 2016, there has been a real deficiency in the fee-for-service payments and infusion. We've got legislation focused on Part B that had a hearing a few weeks ago. It has a great group of cosponsors, and we are very optimistic that this is a year that we get that fixed after many years of lawsuits and legislation and otherwise. This year, our folks get it. It's a no-brainer, needs to get done, very optimistic that will get done. Home health rate, you've heard about that already from Jon today. We never celebrate a cut, but to go from where the administration started in the proposed rule, to an 80% mitigation in the final rule, we felt exceptional about as an industry and felt very optimistic about the stuff that's in the -- that was in the final rule going into rule-making for calendar year '26 or '27. And so we're excited about that and meeting with CMS, working the hill and just really pleased that we have good strong champions and really expect to be fortunate to have more predictability and stability in that rate going forward. Medicaid, people have asked a lot about just kind of what does the One Big Beautiful Bill Act mean to states. In 2025, we were net positive on the Medicaid side. We have just an incredible historic run of being net positive on the rate side in Medicaid. We certainly expect that to be the same in '26. We're hearing a lot of conversation at the state level about the One Big Beautiful Act. We're talking to them a lot about it. And post the behavioral transaction, obviously, our Medicaid footprint will be smaller, but we will not be any less visible in states on that. And the one thing that there were many positives in the One Big beautiful Bill Act, including positives in Medicaid. And what they did in Medicaid is they just really signaled to states and the legislation that the populations that we serve, the must-serve populations in Medicaid must be protected as states implement elements of that bill. And we've seen that so far, and we expect to have a solid net positive rate in Medicaid this year. And last, my team supports all things in growth, certainly, the transaction -- home health transaction closed last year, working in partnership with Chris and his team on the behavioral transaction getting closed, tuck-ins, CONs, anything organic. We're constantly in communication, providing intel, opening doors as needed and just have a really great partnership with both operations and the M&A team on that front. And Jon, that's it for me, and I'll be up a little bit later for the Q&A. Thank you.

I think as Daryn said, one of the things that we take very seriously is just given our scale and our scope and given our quality, we are routinely asked by individuals, offices on the hill and at CMS and HHS for our views on things, just given what we're out there seeing every day in our relevance. And so we're always honored and glad to be a part of conversations as they're occurring to be able to provide our input and try to always be making decisions that make the most sense at large for society. So with that, Jen and Chris are going to join. And Jen, I think we're starting with you. And then we'll get into corp dev and then you'll go again. So everybody knows Jen Phipps. She's our Chief Financial Officer, what has it been? Over a year? I think over a year. Yes, you're over a year. And -- but Jen has been here for almost my entire time, almost a decade in a lot of different positions in the company, including Chief Accounting Officer before being the CFO. So Jen has just done an incredible job in this seat over the last year, but she had already been doing a ton in this capacity for years and years before that. Chris and I had worked together at Kindred. Chris has been here probably 7 or 8 years as well. Chris was one of the corp dev leaders at Kindred. He's our corporate development leader here, SVP at the company and a critical role as we have obviously done a lot of M&A. A ton of it's been small, accretive tuck-in, but have even more opportunities going forward. So Chris, I appreciate you walking us through that as well. So go ahead, Jen.

Thanks, Jon. So as Jon mentioned earlier today, we are just very proud of what we've done from a leverage and our balance sheet position with the company. Post IPO, we were at about 4.5x levered. And at the end of 12/31/2025, we were at 2.99x. When you pro forma the balance sheet for the Community Living transaction, which we expect to close by the end of the quarter, we would be at 2.6x. Before any uses of capital, we expect to be under 2x for 2026. So if you just think about the EBITDA growth and the cash flow generation that we would have. We continue to increase our EBITDA conversion to cash, and we've done that each of the last several years. We expect to be at greater than 60% conversion to operating cash flow in the coming years. Our CapEx requirements, as a reminder, are very light. And so we are typically well under 1% of revenue from a CapEx standpoint. Ultimately, that position has allowed us to make significant investments in technologies and systems, de novos, automation equipment in our pharmacies and has allowed us to obviously still generate really positive free cash flow. Our balance sheet and free cash flow generation, our leverage position provides us with what we expect to be significant, and we'll talk a little bit more about it later, flexibility to fund additional deals through M&A. So I'm going to turn it over to Chris to spend a little more time talking about our M&A capabilities and our focus for '26 and beyond.

Thanks, Jen. Thanks, everyone, for joining us today. One slide here to go through and then my part will be done. I know a lot of this has already been discussed during today. So hopefully, I won't be too repetitive, I did want to drive a few things home. Since the beginning of 2018, when I arrived here at BrightSpring to partner with Jon and Jen and the rest of the team, we've completed approximately 79 acquisitions. 76 of those 79 are in a better place from an EBITDA perspective than when we acquired, looking through the last 12 months ended January 26. Over that time, our approximate multiple we paid on a TTM versus pro forma basis now is approximately 50% decline, which we're very, very proud of as an organization, the M&A team, everybody involved. Obviously, we would love it to be 79 out of 79, but 76 out of 79 has been a pretty good record. Average -- the median purchase price is approximately $5 million, lots of tuck-in M&A. We have done some bigger deals throughout the years. I think there's probably 5 or 6 that we've done north of $100 million. If you adjusted that for the average, the average price is probably closer to 20 than the 5, but median being what we look at, the deals range anywhere from $300,000 of spend that we've done to almost $0.75 billion. So we really run a full gamut there of acquisitions. When we start thinking about like why are we successful, there's a variety of factors. Mainly, it's largely the teamwork here and the buy-in from the collective organization, whether it's the executive committee, whether it's corp dev, whether it's our operations leaders, there's people that really have an M&A growth-focused mindset where we're able to go and find proactive deals or get involved with various bankers and brokers in terms of sell-side processes that are out there. That's probably square one of how we've been able to do so many accretive acquisitions over the years. The other, probably #2 on my list is disciplined investing. We're not just out there buying EBITDA. We're making sure it makes sense, and we're getting sign-off from not just Jon and Jen and Chris and the rest of my team over there between Doug, Nick and Thomas. We're getting sign off from the operations team. We're getting sign off from the person in charge of payroll and HR. I mean, it really takes a village to do an M&A deal here. And we have between the 10 to 20 people you've talked to today, there's another 50 behind the scenes that are helping make all these acquisitions work. So it's really an incredible team effort to get to that point. I know it's come up a couple of times today, but we also have been successful in some deals in the past using more variable structures in terms of how we would finance or buy a business, whether that's offering equity, seller notes, a portion upfront. We did an acquisition in Q4 of '24 down in Florida in the hospice space, where we got very creative in terms of the capital that we're willing to put together for a nonprofit system because of how their foundation worked. It was incredibly attractive to them, and they got a sizable chunk of BrightSpring stock, and that's worked out very well for them and it was obviously a great transaction that we did. I would be remiss without mentioning our integration management office. So they're kind of the quarterbacks behind everything once we get to a signed letter of intent to closing a deal and then integrating the transaction, running the show. We meet weekly with them, with our 40 or so functional leaders and make sure that everything that we're doing is being done the right way and any issues that come up are being addressed in the correct fashion. And then last but not least, we obviously leverage our economies of scale. When we started doing this back in 2018, we were largely a Medicaid company that now has one of the largest home health and hospice businesses in the country. And as we've added those assets, each individual acquisition thereafter has gotten a lot easier to integrate and source. Generally, when we're looking at transactions, we're looking to do 10 to 15 deals a year. You can do the math. It's about 10 per year that we've averaged. Ideally, with where we are now, the team that we have, the investment that BrightSpring has made in corporate development, we would love to be at 15 transactions a year. We think we have the team to get that done. Another thing that's come up, we're very balanced between pharmacy and provider. Historically, you're going to be looking at, depending on the year, somewhere 60-40 split between transactions allocated to provider versus our pharmacy business. It's one of the unique positioning factors for us as a company to be able to do transaction in both spaces, which also leads us to the sheer number of acquisitions we've been able to be closing over the last few years, largely focusing on everything that we're investing in today, whether it's the provider side or the pharmacy side, home health, hospice, hospice pharmacy, rehab, home infusion, tuck-in, lower multiple transactions in the LTC space in the IDD, ALF and SNF space as well. And then also looking at select opportunities. We've done a couple of these acquisitions over the last 12 months in both the technology and home-based primary care space. Lastly, and I know Jen's mentioned this, and it's been mentioned throughout the day, but one of the other things that makes my job a lot easier than it otherwise could be is just the general performance of the company and our capital structure, IPO deleveraging, the sheer amount of operating cash flow we threw off last year helps us fund deals. It's a lot easier than having to go out and finance every transaction if we were in private equity. And then also generally just the low CapEx. I know Jon mentioned our time together at Kindred, that was a much more heavier facility-based CapEx industry. We don't have that here, 1% of revenue, very low, allows us to generate more free cash flow and be successful. So thinking about the past, the future, I think we're set up very, very well to take what we've done and grow on that in the next couple of years. And I know we'll get into that a little bit more in terms of the capital that we have to deploy, but I appreciate everyone for listening to my tech talk.

Thanks, Chris. Well, you can go sit down and bring it back up for questions. Perfect. So we're going to go ahead and just go through some of the financials. And I'll move through some of these slides a little bit quickly because you know most of our historical numbers. So just as a reminder, we have a really strong track record of historical growth in revenue and EBITDA. If you look at our revenue CAGR from 2022 to 2025, that is really a 26.6% compounded annual growth rate, and it's over 18% on adjusted EBITDA. That has largely been organic over this time period, although it did have some M&A in there. Pharmacy's adjusted EBITDA CAGR was about 17% and providers is about 15%. So really good, strong balanced growth across both of our segments, as we've mentioned in many cases. Our total company CAGR being larger than that has been because we've been able to leverage our scale and really get an opportunity to drive down our corporate costs as a percentage of our total enterprise. We've done all of that. We've talked a lot about this in calls and other Q&A that we've done historically. But we've got a chance to really make investments. And that is something that we continue to do every single year. We've talked about a lot of the IT investments, the people investments. You've heard a lot about new members of teams that exist today that didn't exist sometimes earlier in this time period. We are very focused on making sure we're balancing our growth for today with long-term growth as well. So we've been able to continue to do that and still achieve these numbers. In 2025, we saw margin expansion, in '22, '23, '24, you did see some compression of margin as our Specialty Pharmacy business was growing at an outsized pace to the rest of our -- rest of the growth and [indiscernible] our businesses. And with that growth, obviously, we talked about from a mix standpoint, there was a compression in margin. We expect the continuation of margin expansion. You saw that in our guide which we'll talk about in a minute for 2026, and we expect that to continue to grow as the underlying factors in all of our businesses, we expect margin expansion in those businesses. Just a few stats to note about our revenue and EBITDA growth. Jon mentioned a couple earlier today, but for the Russell 3000 companies greater than $5 billion of revenue, we were second in 3-year revenue growth. So if you were to compare our growth, obviously, to the 3000, we were second. For public companies over $10 billion in revenue that were profitable, we're in the top 6% in 3-year EBITDA growth. So really strong performance across various different companies and different industries. We're really proud of the work that the teams have done. I'm not going to spend time on the KPI slide, you have all this information we wanted to provide it to you against just for ease of reference, but ultimately we continue to grow volume above market, we're focused on that in each of our different service lines, and we're focused on doing that underpinned by our high-quality services. So maybe I'll just move on to the next. So on February 27, we initiated our 2026 guidance. This guidance, just as a reminder, excludes the Community Living business, and it excludes any acquisitions that have not yet closed. Revenue is expected in the range of $14.45 billion to $15.0 billion, including Pharmacy Solutions revenue of $12.6 billion to $13.1 billion and provider services revenue of $1.85 billion to $1.9 billion, reflecting growth of 11.9% to 16.2% over full year 2025. Total adjusted EBITDA is expected in the range of $760 million to $790 million for full year '26, which reflects a 23.1% to 27.9% growth over full year 2025. This guidance does include $30 million expected contribution from the Amedisys and LHC branches as we had mentioned in our call. So maybe on to the slide that most people probably care about. So as mentioned, we have a historical track record of 18% CAGR over the last several years. So we talked about from '22, but you could actually do it from 2018. You could do it from 2020. It's a very similar number. That does include M&A. We have seen acceleration of that growth in the last 3 years, which you can see reflected from '23 to 2025. Just another stat, if helpful for public companies in health care, over $5 billion, we rank fourth in 3-year EBITDA growth. As we've had the opportunity to discuss in each of the business units, the underlying drivers of the growth that we have seen remains intact and underpins our view of '26 through 2028. Today, we are hoping to provide a framework for growth over the next 3 years. As we look forward, we have provided, as we just talked about, a guidance range of 23% to 28% EBITDA growth for 2026. And as we look beyond 2026, off of the high point for '26, we see the opportunity for 15% to 20% organic CAGR from the end of '26 to 2028. That represents, as Jon mentioned earlier, a 70% to 85% growth from 2025. Please note, the spots on the graph are not actually intended to depict actual point estimates, but rather a framework for the CAGR and the visualization there. So I had been informed that people might use protractors to like measure. So that is just representative of what -- not necessarily intended to depict a point estimate. This does not include -- to be clear, this is organic and does not include additional growth from capital deployment. So as we discussed earlier, Chris talked a little bit about it as well, we have a really strong cash flow generation and balance sheet position. And as we think about the opportunities to deploy capital, we really think of this as at least $2 billion worth of additional incremental capital availability through 2028 to provide opportunities for growth in M&A. And so while again, we're not putting that -- that's not a guidance number, but that's just really as we're thinking about the deals, we are going to get the opportunity to be very strategic about the acquisitions that we do. Our balance sheet position gives us a place of power as we think about the deals that we think are very important and can provide value to BrightSpring. So with that, I will turn it over to Jon to wrap it up, and then ultimately, we'll move into Q&A.

Thanks, Jen. And so what I had alluded to earlier, as you look at Jen's numbers that she just went through, I had alluded to point-to-point aggregate growth numbers that we believe are achievable as you go from the end of '25 to the end of '28, that 3-year period. And so at the 15% scenario for '27, '28, that CAGR at the low end of the base rate, that produced about a 70% 3-year aggregate total growth. And at the 20% end of that range for '27 and '28 CAGRs from the end of '25, that produces about 80% total growth over the 3-year period. So hopefully, that's helpful. On M&A, that's about half of the [indiscernible] on the M&A on the wall over there in terms of our team. And we've got about 8 people or so on that M&A team today. So it is a really highly capable group of M&A professionals that we've invested in and have at the company. And I think one of the things we really try to do well is to really spread that M&A around in terms of the type of deals we're doing to create as much value as we can and to balance things out in terms of certain deals that look like this for size and multiple and then other deals that look like this. And things have really balanced out in a very healthy way over the last 7 or 8 years. I get fairly involved in those deals. And so maybe it's like 7.25 FTEs we have on the team. But I think with, as Chris said, the ability to find proprietary deal flow, being a preferred next destination partner home for the sellers has worked in our advantage. And I think as we go forward, having capital available in the form of public stock is only something that's been helpful for us, too. So Jen mentioned $2 billion of capital available for M&A, that would even be without using stock. That number is probably in the [ 2% to 3% ] range, while still staying within the 2x -- 2 to 3x leverage range of theoretical capital deployment potential that we see to the end of 2028. That by no means indicates that we would go do that amount of M&A. But as you just run the very simple math on our base case, that is what the math produces in terms of that several billion dollars or plus of capital availability outside of stock currency. So as we get into the last slide here in Q&A, I did just want to reiterate some of these historical numbers one more time. Jen just touched on them. But you're sitting in the room of a company that has had 7-, 5- and 3-year revenue CAGRs of 22%, 25% and 27%. Adjusted EBITDA CAGRs over 7, 5 and 3 years of 18%, 18% and 19%. And if you look at that 3-year CAGR actually move forward a year, including '26, so '24, '25 and 2026, that 3-year EBITDA CAGR, if we hit our guidance this year, would go up to 26%. Again, as you look at all of the Russell 3000 over $5 billion, that revenue CAGR over the last 3 years puts us second to Eli Lilly. As you look at all of the Russell 3000 for companies over $10 billion within health care, we are again second to Lilly. From an EBITDA perspective, for all public companies in health care over $5 billion of revenue, we're fourth in EBITDA CAGR. And for all public companies in health care above $10 billion, we're second in 3-year EBITDA growth again to Lilly. So really just want to thank the team at this organization for what they've been able to do over the better part of a decade now, driving these results. So hopefully, this has all been constructive, a good use of time today. We've obviously focused on some of the bigger themes as we encapsulate the organization, again, large growing markets that still clearly have unmet needs. Within those markets, we're providing high ROI services to very complex populations who benefit greatly from those services. Everything is based on our outcomes and our capabilities, which has been driving market share gains on top of the healthy growth rates in those markets. We believe that our scaled platform, our one company platform has many advantages and has been one of the reasons why we've been successful. From a financial perspective, we've been proud of what we've been able to achieve in our growth profile, particularly comparatively. And hopefully, we continue to build on a very experienced and proven leadership team in the space. What you've seen here today is just incredibly tip of the iceberg. We're going through bonus time in our company. In every year, we literally go through every single person's name in the bonus file, bonus-eligible employees, and make a final determination on their outcome for the year as we do with the annual equity grant file. In the bonus file, there's some 1,800 people that we literally go through every single name every year, making sure that bonus makes sense. And the last couple of years have obviously been -- that's been a fun exercise. The question has been how can we do more for our best people. But when you go through that exercise, it is incredibly humbling to just see the amount of people in the list of names that we have in this organization that are just stars. So just even in the last 6 months, I can think of 20 people that we hired that would be worthy to be up here today speaking in front of you guys. And so we will just continue to add to that depth in the organization, and we are investing as much as we can this year to try to continue to position the company as best we can in the future. So I'll wrap it up. I just -- I am going to read sort of that prior slide that from this morning. If I was talking to my neighbor or one of our equity analysts, friends and colleagues or somebody at KKR or one of you as an investor or any employee, this is just in layman's terms, how I would describe our company, and this is on Slide 18 or something like that. So why BrightSpring is different? BrightSpring focuses on home and community services to a large and growing population of complex patients with services that all improve outcomes and reduce cost and thus create great value. That's everything we do in each business. We prioritize attractive markets. We leverage scale and create efficiencies in meaningful ways and drive our best practices through each of these home and community pharmacy and provider businesses, delivering to them the resources they need to succeed and grow. We execute at a high level on acquisitions and our scale, leverage ratio and cash flow position allows us to further capitalize on accretive and geographically expanding M&A. We still have many additional integrated care opportunities across the complementary service lines to drive more coordinated care and patient volume and impact. And we have a large opportunity to leverage our care management capabilities and further develop our ACO scale and payer partnerships to grow in value-based care payment models. Moreover, we have related attractive service lines doing well and gaining share in growing high-need markets. And these service lines all do better and are better together within the BrightSpring platform. We're on the right side of health care trends and needs with a unique enterprise and set of assets from which to deliver solutions to all industry stakeholders. That's what this company is all about every day. So with that, thank you, guys, for your time. Make sure to pick up your bat if you want on the way out, and we are available for Q&A. Jen, I wasn't going to forget Q&A. We've got a healthy amount of time here, about a half hour for Q&A if we happen to use it all.

Jon and Jen, thank you for hosting us today, really valuable use of time. Maybe, Jon, as I think about just the runway for growth, when you lay out these things, large growing market, high ROI, we think about generics, LDDs, the demographic trends. I mean I appreciate you've given us through '28, but is it right to think that these trends should continue past '28?

I guess I would answer that in 2 ways. Number one, and chime in wherever you guys see fit, really, really hard [indiscernible] things, I think, in business and in life beyond a couple of years. And we see it today, obviously, business and trends and disruption has never moved more quickly. So hard for us to think much beyond the several year time frame. I would say second, and maybe this is going to be a 3-part answer, we don't see anything necessarily other than the law of large numbers in math that would impact our growth in the future. And we will continue to lean into that as much as we can. I would say the third point would be we are very passionate here about continuing to leverage what we think is a unique and differentiated platform to continue to drive that growth. There will obviously be twists and turns in our markets this year and over the coming years. But I think with our complementary diversification, I think with our scale, and I think with the operational quality and growth themes and priorities that we have in the organization, I think there's a resiliency there that is better positioned probably than anybody else in health services to continue to work through any changes as constructively as we can. But I would say we've never been more excited about the company. And I think I said that last year, and I think I said that the year before, but it's really true.

Jon, I would just add from a public policy perspective, our diversification has really proven to be a high value for us. If we've got one division that's had a challenge that we're working through, we've got others that are flourishing with opportunity, and we expect that to stay the same. A.J.?

Just a follow-up. I think since the IPO, the company has generally talked about 10% to 15% tuck-in deal -- 10 to 15 tuck-in deals a year, about $100 million of acquisition spend. With the capital that you have available now, do you see yourself leaning into maybe picking that up a little bit? I know also on secondaries, you've now started to buy, when some of the distributions have happened in stock. What's your thoughts about that going forward?

Yes. On the latter, I mean, I think we take secondaries as they come. Clearly, as we look out into the future on the last 2 secondaries, we were eager to acquire that stock back at those prices and think that will -- that's very value accretive. So we'll take those case by case. I think our base case would remain the same is that we would lean into those. From an M&A perspective, our pipeline has never been stronger. And we just always have to be and try to be as judicious as we can around prices and valuation. There's quite a few of our businesses that have been seeing 15, 20x plus EBITDA multiples in the M&A world. And some of our businesses are in very highly valued markets. So I would say that's something that we're very careful about. But we will continue the steady stream, almost to use a cliche, sort of the string of pearls approach to M&A, where we continue to do really good deals, probably more modestly sized or smaller size and just stack and stack and stack those on top of each other. And that really adds up. That is our base case. But the fact is that today, our balance sheet is in a different position, and we think a very good position as well as our cash flow generation capability. And I think we would be -- I think we would assume that the aggregate EBITDA acquired, particularly, I would say, as we get into 2027 would pick up. We are not under LOI right now on any significant deal. We need to see the Community Living deal, in fact, close, and we needed to get through the home health asset acquisition. And then we would reevaluate from there based on what is at hand. But I think as we look into the later part of '26, and I think, in particular, as we get into '27 and '28, I would be probably a little bit surprised if that activity doesn't pick up.

When we look at -- and maybe this is for Jen, too. So but when we look at that 15% to 20% consolidated or enterprise-level EBITDA growth, I guess, I don't think you're giving explicit components of that. I guess, to what extent -- how should we think about the trajectory in terms of any sort of change in the trajectory that we should anticipate across the 2 different key segments in terms of pharmacy versus provider? Or should it just be more of a continuation of the same on that front? Or any nuances to think about as we think about particularly like '27 and '28? And then from there, you're adding, I guess, 2 to 3 percentage points potentially from M&A, I guess, is kind of how it pans out. You mentioned the 60-40 split. Is that a little bit more weighted than historical on pharmacy? Should we read in between the lines there on the potential around pharmacy deals, I guess, going forward?

Yes. Going in reverse order again. So 2% to 3%, that's your number. We'll see what happens on M&A, but I think we're in a really good position from a balance sheet perspective, I think with a very unique ability to execute against successful M&A, and we're optimistic about that. I think we'll continue to be opportunistic in terms of where the deals are. Barring larger chunkier deals, 50-50 is a good assumption for how the provider and pharmacy deals would shake out. If we happen to do 1 or 2 more chunky deals, that would skew things based on whatever industry that was in. On growth as we go forward, I mean, we expect a lot of consistency there for sure. But if I -- if we had to probably note a little bit of a change, just given some of the growth on the pharmacy side of our business, maybe does that moderate a little bit. We're very optimistic, though, about infusion and home and community pharmacy stepping up their growth rates. And we're optimistic about provider in terms of relative growth contribution in the company continuing to be more of that. So there could be a little bit of a tilting more towards the provider business and within pharmacy infusion in home and community, really just as a function of, hopefully, a lot of focus and execution in those businesses and those businesses doing well versus anything else pulling back. But we continue to see what we've seen historically. Our view is that we should expect to see and are attempting to drive a lot of consistent broad-based growth throughout the organization that we have historically.

I would just add 2 things. The first is that really what we were trying to do in the '27, '28 is to provide a framework and not specifically any guidance related to our expectations. The second thing that I would say is that we would expect to continue to leverage all of our infrastructure that we have from a corporate standpoint as well as we grow, which will be beneficial from a growth rate perspective.

Can I ask a question to a government guy, please? So on -- for home health reimbursement, the proposal was minus, I think, 6%. It came in at minus 1%. I think that they were considering what they call like a clawback to implement in '26, which did not happen. Is that risk now past us so that will not happen ever? Or what are your thoughts there? I thought there was a certain time...

Yes, there's a time period where it had to be revenue neutral, and we're getting at the end of that. And really, what they signaled, which is we use the word signal very carefully, is just potentially no more permanent cuts going forward and just temporary cuts. So we would expect to see something in end of June, early July with a proposed rule that has maybe a little element of a temporary cut in it. And then you always have the dance between the proposed rule, the final rule, and that's where the market basket stuff with your inflationary considerations come in, and we're very optimistic that we'll end up somewhere net positive at year-end. And then going forward, there is an industry -- because we had a good reception from the Trump administration this last year, we're really having some deep conversations about what the most appropriate ask is. Now -- and I'm not going to get into what some of those are, but it's pretty exciting to be asking for something that's really positive instead of just playing pure defense.

So you would expect an increase, a modest increase with minimal risk of...

We're optimistic about where things sit before a proposed rule. And like every year, we could see a proposed rule that we're not really excited about. We see a final rule that feels pretty good.

Okay. And then just with IRA and drug pricing, Jen, maybe this is more for you. Do you collect rebates? And is that part of your negotiation process, your sort of standard negotiation process with manufacturers? Are rebate discussions part of that?

We have very little rebate exposure or benefit in our company.

Okay. And just one more quick one. What kind of margin lift can we expect to see for generics? Just any color around that when it goes from brand to generic?

Yes, we would not be addressing that. But generics are ultimately positive for everybody in the -- positive for payers and positive for everyone in the generic environment.

And when a drug goes generic, there's just the manufacturing side with the participating manufacturers on a drug goes from one to many, many, many. And so even though that there is a dramatic price decline in a drug when it goes generic, which is helpful for the system, you see the cost side improve as well because of the change in the manufacturing landscape.

Jen, you've talked on the call last time right there, the IRA headwind that you're facing, you talked about $15 million of mitigation in terms of working with PBMs for improving sort of the dispensing fees. Daryn, I think on your slide, you're talking about '26 focus areas, engaging with CMS for these kind of rules and implementation and also seeking additional protections related to IRA. What is the necessary component to then further kind of mitigate some of these headwinds because of the changes? Is that rule-making from CMS? Or is that the direction that they've given to PBMs and you just have to negotiate with PBMs?

So maybe before I turn it over to Daryn, I just want to clarify, $15 million is our expected net exposure post mitigation. I just want to clarify that.

So yes, going forward, CMS has signaled very clearly to us, and that's not even a signal, it's direct to our base. So I'm just using the careful cautious words here today. But they fully appreciate that particularly our long-term care pharmacies had a very niche impact with IRA, given how they're paid, reliance on brand drugs, all of that. So we have full expectation that CMS is going to listen as we're a couple of months into this. There will be good data after the first quarter from industry to take the CMS and talk about what the realities on the ground have been. And we expect a positive response from them if additional mitigation is needed. And we do have just -- we built exceptional bench of champions on the hill that are supportive of us that will communicate both to push legislation forward if we need it and just related to CMS that we need additional help if we need it.

Great. And just to follow up maybe on Erin's question. Maybe if we think about pharmacy, could you sort of maybe rank order the components of growth, maybe which ones have more contributed to growth in the coming year or the next couple of years. And so if we think about LDDs, generics, prioritization of infusion, home and community, like if you were to rank orders, which are the bigger contributors? Could you do that?

Yes. I think we'll have to see to a certain extent around the edges in each one of the businesses. But I think we're -- I think we like our position when we look at each one of those pharmacy businesses as being in a solid growth position as we look to the future. We think that's a good place to be. We have a lot of aggressive initiatives going on right now in infusion and home community pharmacy. So we have to see how those play out over the next couple of years. And there is the potential for those businesses to really step forward from a comparative growth perspective internally. I think as any specialty pharmacy business continues to scale, that degree of growth from a percentage perspective just becomes more difficult. But we like being in a position where we are pushing businesses as much as we can for growth leadership in the company. I would just say, again, sort of related to the IRA question or policy, in pharmacy, we absolutely believe that scale and efficiency and quality wins the day. And that is what we are pursuing as much as we can in each one of those businesses. And then we'll see what happens in the external landscape. I think everybody views pharmacy as the white knight in the value chain, providing a lot of value to everybody, interacting with the patients every day, driving generic utilization, driving patient services. So we get a lot of support out there, rightfully so, as Daryn said. But regardless of what happens, we think that very differentiated scale, quality and efficiency is the name of the game. And so that's where all our efforts are -- remain focused on.

So a question, Jen, I want to follow up on your comment about the margin growth that you expect the margins to continue to expand. And in the past, I want to say you talk about your kind of long-term target of 6% EBITDA margin. So the question is, is it still on the table? And how are you going to get there? And sort of kind of walk us through the thought process there in terms of margin expansion, what's driving that?

Yes. So 6% was what we had said really at the time of the IPO, and we really saw very significant growth in specialty. That obviously, we talked a little bit about in '24 and '25, what that did in terms of the margins. We have very focused -- we're focused on each business, expanding their margins based on -- and ultimately up to what we think is an appropriate margin for that business. And so we have action plans at each operational team that are focused on lean process improvements, leveraging the scale we have in each business, focusing on driving volume in the right areas. That is ultimately going to be official. And so I think we do believe that we have additional opportunities. We've talked about home infusion, home and community pharmacy, home health as being areas that we definitely see opportunities for merchant expansion. And then as specialty is growing, and we definitely see opportunities for real scale as well in that business and leveraging the infrastructure. So I would say 6% is probably a little bit further off in terms of a margin, but just given the growth of specialty and where we're at today, but we definitely expect margin expansion as we noted in the guide as it is related to 2026, and we'll be working to achieve some incremental in '27 and beyond.

Just following up on Brian's question. Just as you look out long term, be it next 10 years, what would you rank as like the biggest risk in terms of continuing this growth, competitive, macro, regulatory? What do you think -- just from a high level, what could kind of interrupt this trend?

Yes. A little bit difficult to conjecture. But look, I think these markets are so large, so fragmented and provide such clear value, that gives us a lot of motivation to just keep our heads down and to try to just keep grinding away and provide as many of these services to the people that need it as we can in each and every one of our core businesses. So we see a decade-plus runway in doing that. You know it's health care, reimbursement, right? And so -- but there, again, I think if you look at the value of our services, if our services are not utilized as much as they could and should be, if you squeeze that balloon, the rest of that balloon is going to explode and costs are going to go way up. It's just math. I mean the ROI for our service lines one by one by one is dramatic. And the answer is to provide more of these services and to keep funding them more. We put all of these 700 projects that drive efficiency across the company in the last x years. It all goes back into people. We've -- 5 years ago, nobody in home health, hospice or rehab had 401(k), right? Everybody is screaming about it. Now everybody has 401(k), right? That was not $1 million. That was very, very much more than that. But these are the things that we are making sure we fund internally to have the clinicians to be able to deliver the services to grow. And so it makes all the sense in the world to fund individuals and to fund services that are delivering needed solutions at a high ROI in health care. So we have to continue to educate and advocate for all of those services. And our view is that they should all be funded more because that's part of the solution in health care. But when you're, in concept, a price taker, you have to make sure that the external landscape is assane and logical as possible. At the same time, I think our scale, our quality, our efficiency, our growing automation and AI initiatives put us in a unique situation as we advocate and as we negotiate with payers around fair rates. And if there are disruptions, I think that creates opportunity as well. So our base case is a lot of continuity and a 10-plus year runway on just continuing to grow these services in these big core markets and advocating as much as we can to utilize these services even more given their value.

One little specific. On the -- I know '28 is not guidance, but in that number, that value-based piece, I assume it's still probably not significant? Or are you some kind of -- it will grow, but are you assuming actually a material driver from the next 3 years in that piece in the value-based?

We are not. That would potentially be upside depending on -- I think related to the framework, which is not guidance, we would have the same philosophy regarding how we set guidance, which is high confidence in our views based on what we see today.

Any more? Well, thank you for coming today, everybody. It has been -- do we have one? [indiscernible] under the water.

Can you talk a little more about the efficiencies opportunities like what you've done so far and where you see incremental opportunity in AI?

Yes. So we've got -- and we're making pretty careful buy versus build decisions because we don't want to sit on the sidelines for a year while we try to internally execute against some of these opportunities. So there's been numerous examples of where we've already deployed AI in our company working with an external vendor. A couple of those have been in home health, in particular, a few in Home & Community Pharmacy. "And it's not always AI, I mean, automation in and of itself is great." And there's automation that has less AI to do it with it, and then there's kind of classic AI automation. But we are leaning in. We don't -- while we want to partner with great people out there, in 5 years, we don't want to be held hostage by 20 AI vendors, right? And so we're leaning into that. And we're making the necessary hires and resource investments to do that. I would say there's probably 7 or 8 key focus areas of initiatives going on right now in the company, spanning intake, rev cycle, clinical, patient care management, and the hiring and onboarding process, those are some of the central ones now. And we're making good progress. I think by the end of the year, most of those should be getting out to the other side of that work stream and going live. So -- and then I would assume next year, we'll have 15 more. But we'll keep driving that as much as we can. We've been able to generate a good amount of savings here pretty much every year going back the last 5 years. And while obviously, that net somehow finds its way to profitability, but we are using that to make continued resource investments in our people and in our processes and in our technology. And I think that served us really well. But we will keep the focus on operational best practice as much as we can. I mean there's a lot of us that really get a lot of satisfaction and enjoyment out of just how do we run the tightest ship possible operationally. I mentioned before, we aspire to be an HR academy company per se. I think we're pretty close to that even today, but there's even more things we're doing from a career management perspective internally and automating a lot of the HR process that I think gets us fully there. I think we feel the same way about IT and lean and process. I remember going back to my first days in the company world after banking and private equity. And at Medtronic, not only were they very buttoned up around lean and Black Belt, you could be sent to companies that were known for this. They would train you, even other companies that were just known for their lean in their best practice operations. We want to be that company. right? And I think within health services, at least, we're way out in front. But as we talk internally and with Charlie and Viji every day, I don't know if it's realistic for us to be the most advanced technology company in the world, that's probably not possible, but I think it is possible within health care. And I think it is absolutely possible within health care services in the next 3 years. So that's where we're going to continue to push and try to be. All right. Well, thank you guys for coming today. It's been really enjoyable for us to meet with you. I hope you had a nice quick trip, and it's been great seeing you, and I'm sure we'll be talking to all of you very soon. So hopefully, that was informative today. I did want to thank all of our employees out there across this organization. I mean there are tens of thousands of people taking care of your family members and people in our communities every single day in a very mission-driven way. And so this company does an incredible amount of good. And with that mission, we just tried to run the company in a good way as well. So I think we had well over hundreds of people viewing in on video today. And so we appreciate everybody's time. And hopefully, it was an afternoon well spent. Thank you.