Enhabit, Inc. (EHAB) Earnings Call Transcript & Summary

Ladies and gentlemen, the program is about to begin. At this time, it is my pleasure to turn the program over to your host, Joanna.

Good morning, everyone. My name is Joanna Gajuk. I'm the Equity Research Analyst at Bank of America covering Healthcare Facilities and Managed Care and together with Andy Bressler and Allen Lutz. It's my pleasure to welcome you to our second day of the BofA Home Care Conference. So we hope you enjoyed the sessions yesterday and that you will find some valuable fireside chat in panels today as well. So I'm happy to start the day today with Enhabit, one of the largest home health and hospice providers. And today, we would ask -- we have Barb Jacobsmeyer, President and CEO; and Ryan Solomon, who's the newly minted CFO; and also Jobie Williams, who's the Senior Vice President of Strategic Finance and Treasurer. So maybe -- and thanks so much, the team for joining us. So I figured out we should start with Ryan. I know -- first of all, welcome to Enhabit. And I know this is your really second day on the job. But I figure we should have you give any comments you might have this morning.

Yes. Good morning. Thank you, Joanna. I appreciate it. I look forward to bringing my broader experience to the group, including industry experience to Enhabit, and we're viewing things with a fresh set of eyes. As you mentioned, it's only day 2. So I look forward to more interaction with the investment community in the new year, but thank you.

Sure. Thank you. So yes, I guess we'll go into Q&A, but just a reminder to the audience that if you have any questions for the speakers, please use that Q&A section next to the webcast, and I'll be happy to pose the question on your behalf to the team here.

So I think that we should start with the couple of different disclosures in the last, I guess, week or so. So first, the 8-K that the company filed last week, a couple of slides in that as well. But I guess the disclosure that was of note was that the company reached a new multiyear agreement with UnitedHealthcare. So can you share a little bit more details about this update?

Sure. So yes, we've been kind of in the works with United for quite a while, and we were pleased to be able to get into an agreement. I will say that while the contract is not going to be considered a payer innovation contract, the contract did allow us to have accretive benefit considering the size of UnitedHealthcare. And so 3 main reasons that we did end up executing on that agreement is it does allow us to be considered that full-service provider to our referral sources. It also allows us to now turn full attention to growth versus replacement. As you know, the efforts had been going on to replace the census that we had. And the third reason is we do still have some contracts, more regional small ones that are not considered payer innovation. It does now allow us to be more on the offense with those to be able to negotiate either at a payer innovation level or at some point, term those contracts. So again, pleased to be able to initiate this new agreement effective January 1.

So just a follow-up. So you said this is not a -- I guess, a fully innovation contract, but can you give us a little bit of sense of the rates? I mean, it sounds like if you agreed to renew this contract, the rates must have been much better. So just a sense of where you are on these rates, if you can give us -- without maybe disclosing the details, but how close, I guess, it's to kind of the episodic type rate versus the per visit rate.

Right. So as you mentioned, we cannot go into actual details about the terms of the contract, but I did feel that the terms were in a place that were very agreeable to us to allow us to continue to be in contract with United. They are still at a per visit rate. But again, that's about the most we can share as far as it relates to the terms.

And also in the slides, I know you had them here up here, but you talk about the $11 million to $13 million pricing increase in '25 in Home Health. So it sounds like you're not willing to share the details, but that number includes, I guess, you previously talked about Medicare rate out there, right, that's going to be about $2 million, $3 million increase year-over-year. And this $11 million to $13 million assumes some continued improvement in some of these contracts. So because of the United size, is it fair to assume that they are a big chunk of that number? Or is there some other numbers that we should consider here? What's included in that $11 million, $13 million?

Sure. Well, first, you're right, on the third quarter call, we talked about $2 million to $3 million benefit from the final rule. That was for the industry impact of the 0.5% improvement for Enhabit. Now that we've been to evaluate our patient mix and our geographical because wage index is a large piece of that, it is about a 1% benefit to Enhabit. So that's the updated information here. As well as you do have that impact, your episodic payers, so that same 1% would go across to our episodic payers as well as, as you mentioned, the rest of that would be the non-episodic improvement in rates.

Okay. That's great. And I guess maybe staying on the slides because there's a couple of other comments, which I guess you had made previously, but on the hospice volumes, right? So clearly, there was a nice improvement in the third quarter, and you talked about the expectation for the growth to be mid- to high single digits. So I just want to clarify, is it organic? Or does it include de novos and maybe acquisitions? And also to that end, can you talk about what gives you confidence that you can grow mid- to high-single digits hospice?

Sure. So it does include the de novos. It does not include any acquisitions. So it is organic and de novos that are included. And the confidence really comes from when you see -- and if you don't mind, I'll just go back to this one really quick to show that sequential monthly growth that we've experienced in our census for hospice that continued into October and November. So if you really looked at, well, sometimes there can be a little softness around December and January because if the patients not wanting to elect over the holidays, you can see though that the way we will potentially exit the year versus coming into the new year, it is a nice bump above where January was. So we're confident that we'll be able to continue that growth and really enter the year in a better place in 2025 based on how we're exiting 2024.

This is great. And thanks for that color as well. And I guess similarly you have this disclosure here on Home Health, right, admissions to grow mid to high single digits, and I guess on the third quarter call, you talked about revenues to grow low to mid-single digits. So that still implies some negative mix shift that's going on. Is that the way to think about it?

Well, I think it's a couple of things. We will, I think, continue to see some payer mix shift. So that I do think we expect some of. But I would say that, that is also related to the fact of only getting a 1% pricing update, so that's kind of why you have the variance there versus on hospice. You just don't have that sort of market basket rate update that one would need to see those revenues grow in line with the admissions.

And I guess another recent disclosure, I guess, outside of this 8-K was around the opinion that was issued, I'm going to say, maybe more than a week ago from Delaware Chancery Court. It was regarding the litigation that involved VitalCaring and then to private equity firms, right? So can you walk us through the decision as -- because like it sounds like plaintiffs are entitled to 43% of ongoing profits, but also there's reimbursement for legal fees? So how should we think about this? And specifically, any help you can give us in terms of the breakout because obviously, Encompass and Enhabit were part of that lawsuit, I guess. So how would this -- how we should think about splitting, I guess, the 43% of ongoing profits that was disclosed here?

Sure. Well, I think a couple of things. One, obviously, the opinion was a very important milestone in this litigation, but the court has not yet entered the final orders. So pretty far back into the 116 pages, there is some information about the work that needs to be done over the next 30 days between the plaintiffs and the defendants. That work has already started. And what I would say is that really there'll be a lot more details that will come out once there is a final order, but as you mentioned, Joanna, I think it is important. If you look at Page 5 of the opinion, Dr. -- I mean, Judge Will did write on there that whenever she was talking about Encompass, she really was including all plaintiffs. So as you mentioned, it does include Encompass and Enhabit, and it was -- that was filed after the spin. So a lot more will be forthcoming because there's a lot of work that's still to be done over these next 30 days.

Okay. So I guess we should ask you a little bit later, but I think I should ask now, but thank you for that. But going back to fundamentals, I don't think it's in this slide deck, right, because it's very short. But on the call, right, you also -- so we talk about the volumes. You touched on the pricing, but you also talked about cost savings, right? So you continue to make very nice progress there. So you talk about for next year, right? I would say, $3 million from overhead, and there's $1.5 million from outsourcing, and I guess we can see in third quarter, G&A ratio came down. So can you talk about a little bit more about these different cost savings areas and how we should think about heading into next year and going forward in terms of the G&A ratio? Because obviously, the ratio came down very nicely. So is it a good starting point that we should think about?

Sure. So a couple of things. For third quarter, there was a bit of that, that was impacted by lowering the incentive comp for 2024, but I would say, as you mentioned, we have put a lot of efforts forward and anticipate the $3 million that we've already made decisions on, $1.5 million of that, we've not experienced at all yet, that will be as we roll out the outsourcing of the coding. So we'll experience that in 2025. And I will tell you, as we have -- are going through the budget process right now, we are taking a hard look at every area of G&A. So there will be a lot more information to come when we do our full-year guidance in early 2024. But one of the things that we really are focused on is how can we use technology and AI to help us in those repetitive, redundant, more back-office type tasks so that we can become more efficient and look for areas of savings in that aspect of G&A.

And moving on to Home Health rate outlook. So like you mentioned the final rate was 0.5% for the industry. So thanks for clarifying that. For the company, it's actually better because of the wage adjustments there. But still the 1% is well below what the wage inflation is, I would assume. So maybe can you talk about the wage inflation you would expect heading into next year? And also, what are some ways that you could try to kind of close that gap, so to speak, between the rate update and the wage growth? I mean you kind of touched on the cost savings, but is there anything else you want to add to that?

Sure. I would say we're probably entering another year where it's going to be important for us to stay competitive with the wages in our markets. We do believe that around that 3% to 4% is a good place to be combining merit and market adjustments. So as you mentioned, the 1% from CMS is really not enough for that. And so really, the focus continues to be on -- focused on productivity, optimization. And as we grow, that increases our ability for optimization because at a local branch as that branch census grows, that's when they're really able to add LNs, PT assistance, OT assistance so that we can really focus on that optimization. And the other piece I would add is the visits per episode, right? We've continued to use the Medalogix tool. We've seen nice progress here in 2024. We believe there's still opportunity there. So when you look at not only fee-for-service, but the other episodic payers that we have, it's really about that right care plan for the right -- for the acuity of the patient to manage those visits per episode so that we can use the other visits for new starts of care and other patients.

And in that regulation, the behavior adjustment was reduced, right? But the CMS keeps talking about the recruitments, which -- a pretty meaningful number, right, over $4 billion. So that will be over 25% of the annual spending on the industry. So very, very big numbers we're talking about here. So how -- what are your expectations? How the government is going to try to either implement this or postpone it or spread it out? Any thoughts on that large recruitment that CMS keeps talking about?

Sure. Well, I think, first, it's been always good to see that we've had bipartisan support for the home health industry. But I do think we'll have an opportunity within the new administration as we talk about how do we best use the dollars in the Medicare Trust Fund to really focus on the fact that if these cuts continue, the lowest cost setting of care is going to be greatly impacted. And that then would mean there's going to be more access to the higher cost care settings than there is the home care. And so really that focus on -- there's been evidence of closures of branches across the country. There's been evidence of not having the referral conversion for patients because of capacity issues across the industry, so I think really focused on if we want to preserve access to the lowest cost setting, then we need to protect that access. And so I do think that there will be a new opportunity to really focus on that within the new administration.

And since you mentioned new administration, that was my other question too. Any other comments about implications to your businesses post elections, anything you expect to come out that could impact your businesses?

No. I mean I think the main thing is we're hearing more about making sure, right, being good stewards of the resources. And so again, I think the industry has done a better job, I think, over the last year or so really providing to show kind of the access issues, to show that it is affecting especially in rural markets, some closures. So I think there's been good data, and it will give us an additional audience to present that information to, to really get attention, especially to those temporary adjustments.

Right, exactly. And I guess switching a little bit to the Medicare Advantage contracting, right? So you guys have been on that for a couple of years now and making very nice progress, especially with the United, I guess, though, it's not innovative contract. But can you give us kind of a state of the union where you are right now on this? What percent of your MA book is in those per visit contracts versus the more innovative episodic type contracts? And can you also touch on the rates? Because I guess by our math, non-Medicare revenue per visit, so that includes different contracts in there. But it's still 29% below the Medicare rate per visit. So sort of kind of what needs to happen to be able to kind of narrow that gap, I guess, over time? Or is that even possible?

I think it's possible. And again, as you know, our payer innovation kind of ranges between that 0% to 25% discounted. So the focus really is to continue to move as much of the non-Medicare into the payer innovation contracts. That's going to happen within the contracts that we have. We continue to have a pipeline of contracts that we're working on. And then, as I mentioned earlier, it also is about we've been working to renegotiate some of those smaller regional contracts. A lot of those that came over years with acquisitions. And now that we have gotten across the finish line with United, it was really about either getting them to a payer innovation rate, these smaller agreements, or terminating them so that really then the focus is on getting more patients into those payer innovation contracts. And that's really what's going to help that rate continue to improve over time.

So is there a sort of a targeted timeframe in mind where you would be able to narrow the gap? I mean, is there a way that -- or is there a path that you can actually close the gap entirely? Or is there's always going to be some sort of discount because I guess that's what Medicare Advantage plans try to do? They try to pay a little bit less than the prevailing rate would be.

Yes, I think it's going to be a journey of closing that gap. I don't think it's going to have -- that the full gap is not going to be closed anytime soon, but I do think that there will be continued progress on closing that gap. We have been successful in signing a lot of those contracts as episodic. That, again, gives us the opportunity to not only have better rates within that agreement, but also again, managing those visits per episode so that we have those for the right patients with the right acuity and that's another area of opportunity to continue to work to improve that rate per visit.

Because also on the flip side Medicare Advantage plans are seeing their own rate pressure, right, in '24 and then into '25, also star rating pressure. So do you see this being sort of an obstacle for your innovation team as in -- is it getting harder to get these contracts moved or the rates improved because the plans themselves are seeing pressure?

I think it creates a real opportunity for our payer innovation team. I think on how it's looked at by the Medicare Advantage payer depends on how they look at their data. If they're looking at the data like Home Health as a commodity and they're just looking at another place to squeeze more dollars, then you're right, I think there's risk there. But I would say that the majority of them have started to understand that Home Health is the lowest cost setting. And if they really want to focus on those high cost dollars of emergency room visits, hospitalizations and rehospitalizations, they need timely access to high-quality home health providers. So if they are willing to look at their data more wholesomely, then I think it gives our payer innovation team quite the opportunity to talk about the value that Enhabit brings to them.

And the other area around payers, right, has been providers complaining about these prioritizations, utilization management, so are you seeing any changes there? Because like you mentioned at some point, those plans are faced with just high rejection rates, right, or just not able to access the care that they would need for their members. So kind of what are your observations more recently around these activities from the health plans? Is it getting worse, better or the same?

It's quite the variety. What I would say is that, again, for those payers that we can sit and show that timely initiation care can really prevent hospitalizations and rehospitalizations, we have seen some of the payers that were contracted with actually waved pre-auth for the initial episode saying we don't want to delay getting the home health care out to them. We understand how timely access is critical. And so we do have some plans that have waived that pre-auth for the initial. Now they may still require an authorization for a recertification, but that's because they believe, right, that the patient has received the care at that most urgent time. We do have others though that continue to expect the pre-auth, and we bring data back to show them that then if they want that, they have to focus then on timely pre-auth because they can sometimes be the biggest barrier of the patient getting that timely initiation of care.

Right, exactly. And there were specific comments. I mean, less from the home care providers, but more from some of the acute care hospital providers about increasing denials in third quarter. So have you seen that?

We see more of some payers trying to deny more on the research side of things. And so again, it's really important for us to go back and share information with them that we cannot continue to see the patient in hopes that they're going to auth it and approve a research. And so you really can end up with a disruption in service if it's taking them 7 to 10 days to give us re-auth. And so it's really been more on that part of it, but we bring back specific details to the payers to share that with them so that they understand kind of the predicament they're creating because especially a patient who, let's say, for example, a wound care patient, if we don't get a quick re-auth or if they try to deny on the back end, they're really increasing the risk that, that patient is going to end up in the hospital. So that's where it's really important for our payer innovation team to be involved with our revenue cycle team to be able to share very timely specific data with the payers.

Right. Exactly. And maybe you can also touch bases because MA or the Medicare Advantage sense has been growing nicely, but I guess the Medicare fee-for-service admissions declined like 9% year-over-year in third quarter, right? And sequentially, I mean, maybe there's some seasonality and some hurricanes. I guess you called that out a little bit of a headwind there. But can you talk about your market share? I remember you've been talking about this Medicare people service, I guess, dynamics where Medicare Advantage has been very aggressive in certain markets and certain locations and these patients would be switching to Medicare Advantage. So kind of where you are on that front? Are you still losing share or you think that has stabilized when it comes to Medicare people service?

Well, we do feel that we are stabilizing. If you look at really our last couple of quarters, we've been -- around 44% of our admissions have been fee-for-service Medicare because as you mentioned, there is some seasonality just in the overall volume. So we've been around that 44%. Now what I will say is that what we've seen is we do have some markets that are regaining some market share. We have others that we're finally seeing it kind of flatten a little bit, but we do have some markets that continue to lose market share. And those are the markets that there's a real focus on how can we share those best practices from the markets that have really turned the corner so that those business development teams can focus on how to regain and stabilize that fee-for-service in their market? So we do -- every time we get a quarterly update on the market share, we look at it at that local branch level and not only are they losing but who are they losing to and how do we readdress their books of business so that we can get back to regaining that fee-for-service share.

So is there any color you have from these markets where you're losing share? Sort of who's the -- I guess who's gaining and like why it's happening?

Sure. So what I would say is that we've learned several things from the markets that are doing well. One of probably the biggest ones is really how those teams have been agile with their books of business. So one of the examples that I've given for a while now because I think it is a really important one is this company has for a long time had a very successful role in assisted living and senior living settings. It's been a great place to be to serve those communities because it can be very efficient. A nurse and a therapist can go and sometimes spend almost their day in those settings. The problem is that those settings have been the most ripe for move to Medicare Advantage. You get one really good salesperson from an MA plan in one of those buildings, and it's amazing how quickly that building can change in its payer mix. And so where we've seen markets that have kind of adjusted and said, "Okay, well, we need to look at where else do we need to spend our time so that we can balance our payer mix." There's others that have kind of maintained that referral relationship because it's been a strong one, but we're seeing it negatively impact the payer mix of that local branch. So it's really about being more agile in how they're building out their referral base in that book of business. And that's kind of the work that we're doing with the team to look into. We use Trella to look at that Medicare claims data and really understand how to build out that referral business.

And I guess -- so you mentioned some more pressure, I guess, on recertifications from some of these payers. And I guess when you talk about your outlook for the year, you reduced the guidance. And I guess you called out $2 million from the hurricane headwind, but also you mentioned lower recertifications. So can you flesh it out a little bit more for us when it comes to the latter, what's driving that dynamic?

Sure. Well, some of it is about this update in books of business. Against those patients that I mentioned that are in like the assisted living or the senior settings, do tend to be more community referrals, the physicians are trying to keep them out of the hospital, so they do tend to come to us with more chronic conditions, those patients do tend to recertify more. But as we've kind of adjusted some of our focus on our books of business to get more of institutional, particularly institutional early because there is one of our MA payers that does reimburse us more for institutional early so that we can help get their patients out of the hospital. So when you turn your focus to more of those institutional early settings, those patients do come needing less recertifications. They need more of that initial urgent home healthcare to help them get back home, get settled at home, but they don't tend to recertify at the same rate. And so it's really about at that local level, reestablishing how are you going to grow your home health census. If your book of business is now going to be less research, well then we need more admissions. So it's really resetting those targets for those branches and those business development teams so that we can grow the census.

And I guess that's a nice segue, you said the growing census because obviously, the biggest constraint has been for a couple of years now, right, the labor, right? So can you talk about the hiring and retention? And we've seen nice improvement there. So this is great, but kind of what's the state of labor in Home Health right now and kind of how you're thinking about this going forward. Because obviously, like you mentioned with the rate out, they're only being 1%, that's still sort of not matching where this nurse wage growth would be, right? So kind of how are you thinking about managing through that? And where is the status of the labor pool in Home Health?

So how to make smarter hiring decisions because we do still have our greatest opportunity in managing the turnover within those first 6 months? Once a nurse or a therapist is with us for a year, our retention is really strong. It really is about when we hire those individuals that have never worked in the home setting, and it is a very different setting. We want to make sure we can give opportunity for people who want to work in this setting, but how do we paint that picture at the time that they're an initial candidate to have them as much as possible understand what the environment is like so that we're not investing a lot in onboarding and precepting only to have them decide this is not the work setting that they want, and they want to go back to a facility setting. So that's our greatest area of opportunity. I would say, though, seeing the strong candidate pool is a good sign. We do have some markets that are harder than others. Those are ones that we continue to look at and say, do we need to do a market adjustment so that we can be more competitive? And then there are some markets where we're seeing some tightening for therapy. And so that's a focus for us as well.

And I guess on your other business in hospice, can you also kind of comment on the similar? So we've seen the hospice census. We just mentioned at the beginning of the conversation that was improving nicely through the year and actually grew -- the census grew year-over-year in third quarter. So can you talk about your labor situation, I guess, in hospice as well?

Sure. So I think one of the best things we ever did was investing in the case management model. And we knew that, that added some fixed cost, but what we have found is being able to commit to candidates for hospice that we have the on-call and the triage covered. We have seen nice hiring and retention in hospice. We do not have any capacity constraints. And I think that's why we've continued to see that nice sequential growth. So it really has been about stabilizing that clinical workforce so that we can really put attention to growing our business development teams, growing our books of business, adding our admission departments so that we can be quick to say yes to the referral sources and continuing to grow that hospice census.

I would think that it's -- the rate environment helps, right? Because I guess, the hospice rate out there has been much better. So what is it for the company? Because I guess there's some adjustments there versus the industry, some companies talking about much higher hospice rate update. Do you have an update for...

Right. So for the company, it's right below 4%. So we saw a nice impact for our hospice pricing.

So still very, very nice update there. And I guess talking about hospice and census growth, so obviously, nice improvement, but still there's some of your competitors where the growth has been really very, very strong, high single to even low double digits. So is this something that you could be striving for? I know you're guiding to more small numbers, which are solid, so I'm not saying it's bad. I'm just asking -- trying to figure out like how sustainable is the growth from this other providers? Can other companies -- other hospice providers grow as fast?

Yes, I think it really does come down to the markets that you're in. I know some of them that have seen kind of that double digits have a very strong presence in Florida, which is a CON state for hospice. And so when we look at, for example, in some of our CON states, we do see that higher growth because you do have more of a captive audience, if you will, not quite the proliferation of competitors in the market. So again, I think our ability to continue to grow that mid to high single digits is really going to be based on us being able to be the quick answer to a referral source so that they can really feel confident that Enhabit is going to be there. And again, sometimes the answer is no, the patient doesn't qualify, but what that discharge planner really wants to know or that physician wants to know quickly is does this patient qualify for hospice. And we've really done a good job in improving that turnaround time.

And in hospice rate updates, like you mentioned, are pretty good or I guess, much better than home health. And I understand it's not fully covering the entire cost inflation that the industry has experienced in the last few years, but nevertheless, a pretty good updates relatively speaking. But then on the flip side, in hospice, there are more changes, I guess, on oversight, right? So can you talk about this a little bit? How are you thinking those changes could impact the company? Because obviously, there's this -- a special program that's supposed to launch the kind of targeting providers, but there's also more audits and other things. So kind of can you give us your views of those changes in hospice and how those could impact the company?

Sure. So we've been very supportive in the additional oversight because we do feel that there are some bad players out there, and so, we welcome the oversight because we feel very confident in our practices. I would say on the special focus program, the one concern is that, unfortunately, some of the folks that are not the good players out there don't have enough data to be able to be then considered one of those in the low decile. And so the concern is that the focus if you're trying to find those players, that is probably not the way to do it. But again, we feel confident in our policies, in our procedures, in our documentation, so we welcome the oversight, but feel that there's other things that could be done to maybe look for some of those that are more the bad players out there, if you will.

And I guess there was also this proposal that was, I guess, put out by one of the congressmen that kind of outlined a very detailed, I guess, changes or potential reforms in hospice that included even switching from per diem rate to per visit rate, but it also included some other provisions that were more around like oversight and increased kind of scrutiny a little bit more on hospice provider. So any commentary on that proposal, whether this -- you're hearing any traction in D.C. on that?

Yes. I haven't really heard a lot of traction on it. Obviously, that would kind of overhaul the whole program. I do think there is ways for them to measure. There is the visits in the last days of life, which is a very important metric, right? It's when you have -- usually they are -- your higher visits are when the patient first comes on to hospice because you're working to make sure they have all the supplies, the equipment, that they're stable with good support in the home. And then you really need to be there in those last days of life. And again, our use of the MUSE tool helps us to really make sure that we are there in those last days of life. So I think there are ways to already look and measure those outcomes to make sure that the patients are receiving the visits and the care that they need. So I think in an interim, there are other ways for them to look at it because, otherwise, as you mentioned, that changing to the per visit obviously, would be a big change for the whole hospice industry.

Exactly. And I guess couple of, I guess, like summarizing questions that I've been asking all the presenters during our conference. So when you look out into 2025, I understand you don't have a guidance, you've kind of outlined some of the elements which are helpful, but sort of as you look out to the next year, what are the -- some of the biggest changes you expect to see for the industries for home health and hospice?

Sure. I mean, I think we'll see some of the same things we have been seeing, right, the move to Medicare Advantage. So we're in a better place going into 2025, as we've continued to progress through payer innovation. The focus is, obviously, on our labor. I would say the thing that I would say may be different in 2025 or more attention is, again, how can we use technology, and in particular, how can we use AI as it relates to more of those like back-office type functions, how can we really work to be more efficient as possible. I think there's things we can do with scheduling, communication with the patients on their schedule, things that right now take a lot of people time to do, how can we be more efficient so that our team members can spend the time they need taking care of patients and not doing some of these repetitive redundant tasks that they currently have to do.

And I guess, the very last question. In one word, how would you describe the outlook for your industries?

I would say one word would be growth.

Great. That's a very nice way to end this session. So thank you so much, Barb. Ryan, Jobie, thank you so much for joining us. And I guess, thanks, everyone, for listening. And this is not the end of the day yet. We just started. So please stay tuned for the rest of the day for additional sessions.

Thanks, Joanna.