Claritev Corporation (CTEV) Earnings Call Transcript & Summary

Thank you, everyone. Thanks for -- I guess, first and foremost, thanks for everyone for joining us at the conference. Really appreciate it. And we especially want to thank, I've said, the management team starting with the team from Claritev Corporation. Doug Garis, Chief Financial Officer is with us. Doug, a lot of great things to talk about. I thought maybe we'd just start by general introduction. Obviously, it's been a good year, a big turn. So, I thought maybe we'd just walk through the dynamics that and then the level set, and then we can go from there on question.

Yes. Great. So, good morning, everybody. Maybe to start to show off here. My name is Doug Garis, Financial Officer of Claritev. I've been at Claritev for a little over a year now. Been a fast year. 2024 for us was the foundation, which we've talked about in external markets. 2025 was the turn, which we announced that we successfully completed. And now we're focusing on the way up, which is creating a sustainable growth company. And so, a lot of friendly faces in here. Glad to see a packed audience. We're so early in the morning. But by way of background, I was formerly at Cerner. I was part of the team that sold Cerner to Oracle. Travis and I ran Oracle Health for a period of time, done a lot of interesting things in my background, kind of multiple disciplinary. And I think the opportunity with Claritev, what really attracted me to Claritev was the asset base, and we keep talking about the strength of the core business. And part of our stabilization plan this year was making sure that we had a core business that we could refinance the company against. And I think what we've discovered is, by and large, all of our businesses are growth businesses, and we have five kind of internal P&Ls that we manage and we've opened up six new market segments. And so, we're really excited to be able to give some color as this business has stabilized and recovered. And as Travis and I really think about the way up, there is an interesting problem that we have as we're going through our internal planning process. There's too many things we could do. And so, we're really focused on discerning the critical few. And the two or three big things that we're focused on are very well aligned to our core business and our core markets. And I know we'll get into it and talk about it, but that's what we're really excited to share.

Great. And I hope this was coming across, but can you walk us through -- you talked about the six new market segments, kind of your go-to-market strategy, which has been particularly relevant in the past couple of quarters. Can you talk about that strategy in a way kind of compare and contrast to maybe what wasn't there in the past or how it's different from the past? The way we think about the company.

Yes. Yes. And so, the market segments and the kind of the beautiful thing about the business, is we spend quite a bit of money on R&D every year. So, about half of that is to support the current products and then half that we get to choose, we want to invest in. And so, the former multi-plan was known as an affordability and cost containment, payer services company. But what's underneath the company was an incredible set of technology assets, albeit a little bit aged, but extremely well kept. And serviceable to new markets. And so, over 90% of our revenue is still in the payer and TPA space. So, we do business with the 700 largest payers and TPAs. You pick a payer or TPA, we either sell them a network, either primary or complementary. We have payment revenue integrity, prepay and post pay. And then we have a whole range of out-of-network solutions that focus on affordability and cost containment. That's what Claritev was known as. The new markets that we've opened up, starting kind of left to right is the provider market. So, we've developed a couple of new products, one of which is a transparency product called CompleteVue, that focuses on all the publicly available data, uses a little bit of our secret sauce and our data asset and provides pricing transparency to providers so that they can better negotiate their network rates with payers and/or TPAs. So, that's a nascent area for us. What's really interesting, too, is that our Advanced Code Editing, which is our second pass payment revenue integrity product has application for providers in international market. And that's where our expansion into the Middle East has been pretty incredible. And so, our Advanced Code Editing focuses on denial management for payers. So, it catches a claim before it gets paid and something ostensibly went wrong with the coding. We fashioned the Advanced Code Editing with very little R&D and put it right in a provider's RCM, so that they can manage denials and reduce their denial rates in an international market. And so, when you think about providers in international, we think that the problem of affordability is a global problem. We started in the Middle East because that's where a lot of the money is. But as folks need private health insurance or better health insurance and coverage, a lot of the kind of international community is procuring doctors. You look at the Middle East, the denial rates are 30% in some countries. And so -- and you get one chance to manage a denial and then you have to resubmit it to next year. So, that's the kind of provider in international markets. We also opened up a government segment. So, we're selling our core products into federal agencies. We had a nice win that we'll probably broadcast on Q4, that's still going through the process. But no new sales motion other than to put folks in the federal and state and local bidding systems. We think there's incredible opportunities in state local markets. And then, we also think there's some incredible opportunities doing things like selling our network through federal agencies. And so, this one in particular was through the CDC, and we're the subcontractor on a pretty large fit at a prime one. But that is -- the next market is a government market, and it's very nicely attached to our core business. And then finally, where we think that there is a incredible opportunity is in the employer space and through the broker channel. And so some of our new solutions, namely Benefit Insights or BenInsights, is a health intelligence platform that basically takes a look at an employer, self-insured employers data and helps you manage the risk of your population, native within a human capital management solution. Why is that important? As a CFO, my second largest expense item is my carrier cost. So, what I pay to United or Cigna is number two behind my W-2 wages. So what I pay my people is number one, what I pay to an insurance carrier is number two. The buying behavior for health insurance has been, "Oh, gee, what's going to happen next year?" I'm going through the renewal process, and I get a 10% increase coming. That's what's happening right now to all CFOs, Chief People Officers or self-insured companies who are looking at the '26 benefits renewal cycle. We're able to use BenInsights to make sure you buy the right insurance that you can go through and look at if you're doing an RFP process, look at the additional carriers. And what's really important is, we're embedding our technology native within human capital management. So, we think the next 10 years, as people talk about AI, we are an AI company as well, and we're embedding our technology right in the workflow for human capital management. That's important because somebody can make -- a CFO can make a decision to buy or BenInsights software if they have Oracle human capital management, and it's not a 6- or 9-month sales cycle. It's right there in the solution. And so, those are the six channels and verticals we're thinking about, and we're activating against. And you'll see when we report earnings, we're going to start to give more color. A lot of the new verticals outside of the payer and TPA space are still nascent. But some of the velocity we've had on the bookings front, it will eventually turn into revenue. But we're highly encouraged, because we didn't have to do any shady or lures or any tricks. We just had to put a go-to-market strategy with a bartering sales force and activating the channels, and it's worked out pretty well.

I follow the company for a number of years. I mean, historically, the international footprint that you're talking about is something that was absent from this platform. I mean, how opportunistic is the international platform within the kind of the six channels, if you will?

Yes. So when we -- actually, when we refinanced the company, we didn't even have an international strategy. It's something we kind of stumbled into. But from my previous life, Travis and I, when we were at Oracle, we -- Cerner and then Oracle, we were in 32 countries. So there are 32 countries out there with U.S. coding standard, CPT-10 or near U.S. coding standards like CPT-11 and Australian coding standards, to have a U.S.-based EHR and who have a revenue cycle function. And so, the opportunity was there to add value. I think we used and leveraged some of our previous relationships to start exploring use cases. And what we found is applications through denial management for providers. And I think we'll be exploring other areas. There's probably some business to do with either national or private insurance and new markets. But what's clear is there's about 3 dozen countries who have kind of exported some of the inefficiencies of the U.S. healthcare system into their markets. And when you look at the U.S. healthcare system, we spend about $5 trillion a year on healthcare, and it's probably 5x to 6x more than the next most modern country. But when you total up those 3 dozen countries, there is a huge addressable market, but you have to plant your flag, you have to show up, right? And I think we've been asked by investors, is it a distraction? It's not, right? It was a great idea, and I think we're going to moderate our growth. I don't need that business to be a $100 million business to be successful. But when we get kind of proof of value and we start getting some major concentration with some nation states and some local providers and payers, we are going to accelerate investment, because there's nobody else out there approaching the market the way that we're doing, especially connecting our solutions through RCM, focusing on the direct to provider.

And to that end, what is the competitive balance on international front?

So there's not really a good compare. So providers, kind of like in the U.S., right, that their smaller providers are doing a whole bunch of exotic things to try to manage denials. And so, they'll typically put an army of folks to try to manage the denial rate. When you look at a few of the countries that we're either in or going to and I mentioned the denial rate is 30%. Our first customer, Burjeel Holdings, about USD 1.5 billion, a little over 100 provider systems. We put our Advanced Code Editing in our first kind of simulation. We took their denial rate from 7% down to 3.5%. So 3.5%, so we reduced their denial rate by 50% on a $1.5 billion business. That's $40 million of economic value to Burjeel. Burjeel is a Abu Dhabi listed company. They're a public company in their local markets. That is an incredible value proposition, for a strategic partner and a vendor. To our knowledge, we're the only folks out there approaching the market this way other than just kind of the old-fashioned way of hiring an armada of folks and a provider-to-provider level.

Is that product -- denials will become a greater issue for providers in the U.S.? I think, we're hearing it across the board. Is that a product that you could be deployed here in the U.S. that is...

Absolutely. Yes. So, we announced that we've made a couple of kind of small investments and partnerships as of late. One was with a company called Klaim, which we made a small seed investment and another one was a company called iO Health. We envision healthcare eventually moving into the left through the clearing house into the RCM and potentially even into the EHR. And so, our Advanced Code Editing and denial management and our claims intelligence work even better as you go closer to the provider. And so, the conversations that we're having and the first thing Travis did when he got here is he formed a strategic alliance with the National Rural Health Association. I can't think of a better population or a more target-rich environment than national rural health providers. They are in the cusp of bankruptcy, most of them, even the most well-run providers have maybe 4 to 6 weeks of cash on hand. And so, when you look at our provider solutions, and the ability to manage denials and catch bad claims before they go out, it's not just a payer problem of managing things that are miscoded, up coded or addressing things like fraud, waste and abuse, right? Those are there. Our products were incredible for that. We're highly interested in catching the issues much more close to the point of care. The value of doing that accelerates cash flow for the entire ecosystem, right? Payer gets right claim paid immediately, provider gets more infusion of cash flow, not having to go through the dual loop of arbitrating or having a lot of abrasion with the payer. But when you look at some of our newer partnerships, we're looking at building cash flow optimization solutions much more closely aligned to provider markets.

Okay. Great. Thank you. Is there any questions in the audience, please raise your hand at any point in time, feel free to. In terms of -- I guess it was on the third quarter call, you mentioned the ACV of $40 million, I think it was $45 million year-to-date, and you thought about $60 million for the year. How does that -- how do we think about it if we're looking into '26 and beyond without getting into specific guidance? But how do we see that kind of maturing in terms of what you start to report on a go-forward basis?

Yes. So I think ACV is very well received. Some sort of indication that we can run a growing business, I think, from some of our current and legacy investors is really helpful. We're going to expect to book at least $60 million of ACV. And if you're familiar with the way kind of software and technology bookings work, it typically takes anywhere from 1 to 3 quarters for those to turn into revenue. And so, there is a huge mix of deals that we've signed. We've actually closed 491 deals year-to-date at an average ACV of approximately $80,000 to $90,000. And so, the deal velocity is picking up. We expect a good portion of the revenue to occur in 2026 and beyond. But obviously, the closer you get to the end of the year and the more that you book, the more you would expect the kind of revenue to slip into the next year. I think on our Q4 earnings call, when we provide '26 guidance, we'll do a very sock-puppet simple walk on how to think about our bookings to revenue conversion. But a good -- a decent chunk of the $60 million of ACV will start to turn into revenue in 2026.

Perfect. And within the new product context, is there any one particular product or customer or a landscape that is -- that comprises that $60 million? Is there any one notable?

So, I think, what we have started indicating is our pipeline and the strength of our pipeline. So, our pipeline is approximately $200 million, .55% of our pipeline is within our current installed base. And so the payer -- and so we joke and say, sometimes people view customer concentration as a risk. We love having Fortune 100 customers and solving their problems. So, my top 10 customers are approximately 70% of our revenue. A lot of our opportunities are in the BUCAs and the large payers. And they are kind of longer, more strategic term engagements, highly concentrated, highly accretive deals. And so, when we look at our funnel, our expansion areas, which are reference-based -- our downmarket reference-based health plan that we've rebranded Vistara, some people might know it as HST. Some people might know it as BDHP. But our downmarket solution, Vistara has gotten incredible traction in the smaller self-insured category given the rate of healthcare inflation that employers are seeing and then our data and analytics business, formerly known as Data Decision Sciences, is where our true kind of software and technology solutions are starting to pick up. And so, we do risk analytics. We sell our BenInsights solution to brokers. We announced our strategic partnership with Oracle. And Oracle Badge folks are starting to sell our BenInsights solution. So we think about BenInsights as the health intelligence platform. We think that, that will get sold like an enterprise piece of technology and we're excited to share more information. That is 40% of our funnel, just the Vistara and the data and analytics. So, there is a lot of interesting opportunities. But make no mistake, the core business is the strength of what we offer our payment revenue integrity, our network and our analytics pipeline is very robust.

Okay. To that end, the Oracle relationship, how -- is there more to come from that relationship? Obviously, you and Travis' backgrounds, the teams background as well.

Yes. So we had -- we were at Oracle AI World, which is their big kind of conference, and we had six presentations. So that our Chief People Officer, Carol Nutter, and I gave kind of a keynote speech on BenInsights. We actually had a testimonial on the rapidness of the deployment of Oracle Cloud Infrastructure. We deployed OCI in 9 months, and we kind of joke and say, when I was at Cerner, it would be like until 2035 that we're fully on OCI. Because you're dealing with large health systems and multiple EHRs -- kind of a mess. Our -- the foundation of the opportunity with Oracle was one of the technology relationship. And so, most companies that have to go through a digital transformation when they embark on the journey, they spend a ton of money, and it takes many, many, many years. We are able to affect our lift and shift to Oracle Cloud Infrastructure for most of our applications in 9 months. That is incredible. So incredible that Oracle even mentioned us on their Analyst Day as one of their strategic enterprise customers. And so, there is significant relationships kind of at the executive level at Oracle. But if you just kind of, if you didn't know anything and you looked at our technology infrastructure, you would see a tech stack that is running 2x to 4x faster at a 40% cheaper rate to support than our own data centers or AWS, Microsoft or Google. And so, the impetus behind the relationship started out with getting our technology ready for the future, getting out of the data center business, right, and then being able to affect our products and our go-to-market with different channels in different markets. And I'll give you a perfect example of the power of the relationship with Oracle, we were able to deploy our Advanced Code Editing to Burjeel Holdings and UAE in a couple of weeks. Historically, if we wanted to put a technology product in a new market, you have to go through all the data sovereignty, you have to find a data center capacity. You got to work with -- it would have taken 12 to 18 months. We're able to do it in a couple of weeks. So the kind of what's next with Oracle -- now that we're in their partner network and we're live within human capital management, we think the direct-to-employer channel is any self-insured company that has Oracle human capital management that's looking to optimize their benefit plan is a potential customer of ours. So much so that there's about 3,000 badged Oracle cloud reps that are now starting to enable to sell our solutions through their sales and distribution channel. On top of that, we have strategic partners like KPMG, some other SIs who are also enabled to sell as well and implement our solutions. We're actually thinking it may make sense for us to open up some advisory services to capture more value. But the partnership with Oracle started as a technology partnership has evolved into a much more staunch go-to-market relationship. It's going to take time to build, but we'll go out to other human capital management providers too, and we'll embed our in technology within ADP, within Cronos, within Workday and some of the other HCMs. But the foundational and the blueprint with Oracle was one that was built on a technical infrastructure that's world-class, and runs way more efficiently than comparable clouds.

Is that what has enabled you effectively to open up those 32 markets, Oracle relationship?

Yes. And so the interesting thing, too, is where Oracle doesn't have -- so Oracle has about 5 dozen public cloud regions. And they're out raising capital to open up a few more mega data centers. I think they're raising like $38 billion of new money to do it. Where they don't have a public cloud region, they can do what's called Oracle Alloy, which simulates their public cloud at a location. And so, some vendors even resell Oracle's Alloy as a managed service and make money on it. And so, just -- even if Oracle doesn't have a public cloud region in a market, we can kind of open a cloud in a box with the Oracle Alloy, and offer cloud services to some of our customers.

I'm not going to lie to you. I didn't understand that. A public cloud strategy by Oracle in international markets. You lost me. It could take a couple of weeks to me to figure that out.

It's going to take a few years for us to figure out, well the AI and cloud investment was actually worth it. But we're happy to use their balance sheet to grow.

Yes. That's great. Congrats. Looking into kind of 2026, and how do you kind of put -- and maybe you could frame this well in that conversation. Obviously, you stabilized the organic or legacy business, if you will. Can you walk us through how you did that and the relationships and what was necessary to kind of stabilize that business? And kind of how do you -- that and the new business opportunities, how do you kind of puts and takes as you get into '26?

Yes. Since Travis isn't here, he won't be mad at me for saying this, like I view a well-run business works for finance. We did not have a finance function. So the first order of business was putting the emphasis on accountability with how we allocate resources. So when we went through our 2025 planning process, we came out and said we are going to plan the business as if the business is going to decline next year. So, when we went after our cost structure, after my first few months, it was pretty clear, even though that we're an incredibly profitable company, we weren't run efficiently. And so, there is a lot of -- when you look at our Q2 exit rate, we grew our business with 3% less head count. And so, the tree trimming that needed to happen and the infrastructure to have a general manager over a P&L with accountability and then a market segment leader where they could shake hands and commit to business and results was like the first ingredient. So part of the stabilization was coming out and saying the thing that we probably should have said before were like, hey, our core business is doing fantastic except one issue. And so, we came out and we addressed that with a ton of transparency. And then, we went on a full kind of top 10 client executive-to-executive mission to make sure we could shore up any relationships. And so, a lot of our large clients are made up of a portfolio of companies. And so, one of our large client has 10 brands. Some of the brands are up, some of them are down, but the executive-to-executive connection was the kind of the second step behind getting an actual financial foundation that we could plan against. And then, I mentioned discerning the critical view, we made a big focus on our core business and making sure that we could have hygiene around activating a pipeline and making sure a pipeline was credible. So, we -- for folks who use technology, we have sales force, we didn't use sales force. And so, how the heck can you plan a business if you don't have a pipeline that you can run metrics off of. So, all of the stuff that you would expect, we call it, mastering the basics wasn't there. The foundation was there, the opportunities were there, but we didn't have a scorecard and we didn't have an agreeable way to keep score. So, those were kind of the foundational elements of 2024. 2025, I think we are highly encouraged by the ability for our new Chief Growth Officer to activate the sales force to go after some of the opportunities. And we were in a position to give -- the Street a forecast on bookings. We weren't necessarily confident in doing so. But our internal planning for bookings this year was $60 million. Right? And so, it's about $15 million a quarter, guess what, we're going to hit or exceed our forecast. And so that type of discipline allows us to go do something like accelerate an investment and see if an international market play is a great idea. And we don't need five things to happen in order for us to achieve our medium and long-term growth plans. We just needed the clarity alignment and focus to say if we're -- if I'm going to spend $170 million on capital, where the heck am I going to spend it? And who am I going to hold accountable and when can we accelerate things, for instance, right? We accelerated a little bit of investment this year. Like when do we know when to pull the joysticks, where is the green light, yellow light and red light. But foundationally, that was important for us in '25. And then, I think we found that a lot of our large clients -- if you exclude the one client issue, a lot of our largest clients are up mid-single digits and even high mid-single digits with us this year because our purpose is to make healthcare more transparent and affordable. The large customers who are seeing significant margin pressure are using our solutions more and relying on us more, and that's what the basis of a strategic partnership is, which we enjoy with all of our 700-plus and especially our 10 largest accounts.

Do you view the organic business as a growing business per se?

Yes.

Like with organic growth?

Yes. And we talked about kind of the core business and the expansion areas. Our entire business is a growth business. And so the importance of having segment leadership and then having a general manager who owns a P&L, when we originally cut our Vision 2030 plan and we refinanced the company, Travis and I looked at the network business were like, it will be maybe -- it's a $200 million business, maybe it's a $150 million business. We have almost 9 figures of pipeline in our network business that we can see in the windshield over the next 3 years, because we've done things like open up the government sector. We have three incredible networks that the BUCAs use, the TPAs use, that we can resell and we need to think about how the strategy evolves, but you actually need a general manager who you can hold accountable and say, "Hey, man, you got a $200 million, you have $200 million of revenue, you have this much of cost, you get this much of capital." And that's really the, how we think about the core business, and we think about all of our businesses as potential growth factors.

Okay. Great. Thank you. I think -- unless there are any questions, we have time for -- we have a little time. But are there any questions in the audience? Okay. Well, thank you, Doug.

Awesome. Thank you.

Thank you for joining. Thank you, everyone.