HCA Healthcare, Inc. ($HCA)

Well, good afternoon. Welcome back to KeyBanc's Healthcare Forum and HCA's presentation. My name is Matthew Gillmor, and I lead healthcare services equity research coverage for KeyBanc. Joining me on screen is Jon Foster, HCA's EVP and COO; Chris Wyatt, SVP and Controller; and Frank Morgan, Vice President of Investor Relations. As most everyone on this call knows, HCA is one of the country's leading health care providers, comprising about 190 hospitals and 2,500 ambulatory sites of care. The company is also distinguished by the depth of its local hospital networks that are concentrated in faster-growing geographies. This will be a fireside chat. I'll lead the Q&A. Feel free to submit questions through the dialogue box or you can message me. So with that, Jon, Chris and Frank, thanks so much for being here. We appreciate it.

Thank you.

Well, guys, I think this is probably best directed to Jon, but anyone feel free to jump in. We did want to start off these conversations with a little bit of a state of the union and sort of review of what happened in '25. What were some of the positive drivers? What were some of the challenges? And then how you're thinking about '26. Is there anything new or interesting that you're focused on this year as it compares to last year?

All right. Thanks, Matt. Well, certainly, 2025 was another solid year for the company. We executed well on our strategic agenda. And our markets, our 43 markets, and all of our networks, we saw 47 million patients last year. And every 1 of our 15 domestic divisions had adjusted admission growth, which yielded 2.4% adjusted admission growth for the company for the year. I'd say also that we managed our expenses well, both from a labor and a supply perspective. And all those things combined drove a 90 basis point improvement in EBITDA margin, which ended up at 20.6% for the year. So all in all, felt really good certainly about 2025. In terms of some unique challenges, I would just point out, we seem to have those in our industry. We get choppy waters every year, and HCA has a pretty successful track record of managing and navigating through those particular challenges. But if I were to call out just a couple of them, I would say that the lingering effects of Hurricane Helene, particularly in our North Carolina market, was a challenge. And the other that we've referenced I think in the past is some of the cost pressures related to hospital-based physician services. And so that's a particular challenge for us as well. You may recall that a couple of years ago we acquired Valesco. And that's a large physician platform, primarily of ER physicians and hospitalist physicians. And at the time, our growth rate in hospital-based physician services was about 20% a year. So in 2024, it was 20%. We were able to bend that down to 10% in 2025 and are really pleased with the cost performance, the stability of our hospital-based physicians in ER and hospitalists as a result of that integration there. When we think about 2026 hospital-based physician services in total, which would also include anesthesia services and radiology services, that's a pressure point. And we're managing through that. We anticipate that those costs will be in sort of the high single-digit range in 2026. On other matters for 2026, we'll continue to execute on our strategic agenda. We're going to be very disciplined in our capital allocation, as we always are. We'll continue to make investments in our AI and digital capabilities and double down on our financial resiliency initiatives and continue to invest in our network optimization and network development strategies.

Got it. I wanted to build off of the resiliency topic. At least in my mind, that was a point of positive surprise as we're entering the year, just in terms of your all's ability to continue to advancing that initiative, and I think you built in about $400 million of savings from resiliency. And one of the things that struck me was it was -- these were also -- sounded like operational improvements, which is impressive given HCA's pedigree, and investors obviously view you all as a best-in-class operator. So maybe just to start off on this topic, can you just remind us sort of where the resiliency program has been focused and what are the priorities as we're thinking about '26? And then we'll dig into some of the details.

Yes. Well, I appreciate your reference to it being a program, because it is that. It's a multiyear program; it's not just sort of a one-and-done for 2026. It's how we operate. It's how we do business. And there are really 4 focus areas in our resiliency effort. First is in our revenue integrity, revenue cycle area. And then secondly, it's in sort of our operations area. It's in our sort of asset optimization area. And then it's in the fixed and the variable cost reduction area. And so those are the 4 focus areas for resiliency. We have a number of capabilities and tools within the company that helped us supercharge that effort around financial resiliency. We have quite deep capabilities in benchmarking and analytics. Our AI and automation capabilities also help to supercharge those efforts. And then our shared service platforms, Parallon from a revenue cycle perspective and HealthTrust from a supply chain perspective. And all those things are coming together to give us confidence in our $400 million number that we shared with you all for financial resiliency in 2026.

Got it. Let me try to dig in, I guess, on some of those. I was curious to see if we could get some details on particularly revenue integrity and asset optimization and then some of the variable and fixed costs. But on revenue integrity, how should we sort of think about that opportunity? Are there certain payer classes or types of claims where you're just not getting the yield that you ought to be getting? How would you kind of characterize that opportunity for us?

Yes. Maybe we should -- let me pull up just a little bit and talk about what we're doing overall with our payers. And that's primarily focused right now on the digital integration of information between the payers and between HCA. Oftentimes, denials and lack of authorizations happen because the payer does not have the clinical information that they need in a timely fashion to make that determination. And so speeding that up and creating the integration digitally between the payers and HCA, we think, is going to reduce friction, is going to improve that information flow. There's latency in there today that creates some real friction, as I mentioned. We think it also has the opportunity to lower the administrative costs, both for HCA and for payers, to the extent that we can do that. And we're having some success with some of the major payers. Now that said, certainly, denials are increasing at HCA, just as they are across the entire industry. What I would say is different, however, is our response to those increasing denials. We've made significant investments in our revenue cycle capabilities, particularly in the AI and automation areas, that we think is having a very positive effect and mitigating largely the impact that we have on the incremental denials that we're seeing as a company.

Got it. And then on asset optimization, I think I've heard you all describe the opportunity to further improve throughput in OR and ER and focus -- continuing to focus on length of stay. Is this more about sort of benchmarking and getting hospitals that could be better performers today up? Or are there sort of systems and processes that are flowing through the portfolio that will raise everybody's performance? I'd just be curious how you're thinking about that opportunity.

Yes, I can address the asset optimization or the throughput item. It does start with benchmarking. That's where we start, and looking across our enterprise around where are there opportunities. And we look for both where are there assets that are performing very well. And we take time to go study those hospitals and understand what are the gains that they're making as it relates to, let's say, length of stay, and what are the initiatives they're putting in place that are allowing them to have such success in terms of reductions of length of stay. And then we also look for some of our assets that are not performing well, and where do we need to be taking those best practices and then moving them over to those assets to be able to drive better throughput, better length of stay, better emergency room throughput, whatever it is inside of asset optimization. So it starts with benchmarking. But then there, of course, is people, process and technology underneath that, that is part of what allows us to manage this better. So very focused on asset optimization. We had good gains in '25. We had about a 2% length-of-stay reduction overall. But we think there's still more opportunity ahead of us in that regard.

Okay. And then maybe last follow-up on this topic, on variable and fixed costs. Can you -- I think I understand conceptually what that means. But if you could describe any details in terms of where you're focused on this year or generally how you're thinking about the opportunity to address variable and fixed costs.

Sure. When you think about fixed cost and take our overhead structures that may be inside areas like our shared service platforms, where we are taking a really hard look at, for instance, in labor, spans and layers of control and as we think about opportunities there, or areas inside of contract services that we think may be opportunities in our fixed cost platform that we can address through the resiliency program. And on the variable cost side, of course, we've got our labor inside of our hospitals or our supplies. If you take supplies, we continue to see opportunities around rationalization of vendors, where we see opportunities there, where we think about there's utilization opportunities. We still do have some pockets of noncontract spend where we think we have opportunities as well that are all part of our resiliency initiatives that we think will address the variable cost as well. And I just want to go back on resiliency, to what Jon said, where we started here, that it really is a program. And we've got a very structured approach that includes a team that sits here very centrally located that is taking these initiatives and that is vetting these ideas that are coming out of the field that come from a bottoms-up standpoint but then we provide our top-down analysis as well to -- for idea identification, vetting them, what is the opportunity, what are the investments it takes to get after them, but then making sure we have the right accountability around it as well to ensure we're tracking and we're monitoring each one of these initiatives. And we're seeing the benefit that we expect to see inside of each one of these initiatives that we have across the revenue integrity or the capacity management or the fixed and variable costs. So we've put a very structured program around this that, again, we think benefits us to the tune of $400 million this year. It's what gives us confidence in it. But then we think will also help us as we go forward and think about the multi -- the layered multiyear approach to our resiliency program overall.

Got it. Okay. Resiliency rolls on. I appreciate you letting us kind of dig deeper there. Why don't we talk about AI or ask about AI? I know we've maybe kind of tangentially hit AI with some of the resiliency program initiatives. I think we've heard you all talk about the opportunity to improve documentation and nurse rounding and patient monitoring and improve patient satisfaction. Give us a sense for where you are in that AI journey and how you test some of these programs and what you think the opportunity will be over the next couple of years.

You bet. When we think about our AI agenda, we think about it within the context of what it is that we do every day, which is to care for patients. And as I mentioned earlier, we had 47 million patient encounters last year. And in that process, when you have 45,000 doctors and 100,000 nurses, there's friction oftentimes in some of those processes. We think the use of technology and the use of AI is -- shows a lot of promise for us to be able to reduce that friction and help people do what they do best, which is to care for patients. We've made significant investments in our AI capabilities, both from a labor perspective, the technical resources as well as the technology. And we feel like that's really building our capabilities there. We've developed some capabilities that we think are industry-leading. We're very disciplined in how we focus our innovation efforts on really large problems, not just small problems. So we're disciplined about what we develop solutions for and we're disciplined about how we pilot those solutions in our innovation hub hospitals, which are located throughout the United States. And then for those scaled solutions that are proven, we move those out. We scale those across the enterprise. And with that many people, those aren't often just overnight rollouts. Some of those take a while and some of those might take multiple years. But we believe there's great promise in our AI agenda and what that can mean in terms of extracting the embedded value that we know is there in the organization. We've organized our AI initiative into 3 domains: an administrative domain, an operational domain and then a clinical domain. So Chris, would you talk a little bit about and provide some color and fill in the detail around each of those domains?

Sure. First of all, as you think about the administrative domain and we think about our revenue cycle, and how do we manage things like denials and underpayments in a more efficient manner, whether it is creating appeal letters or summarizing clinical records as we have conversations between our physicians and the payers as it relates to addressing some of those denial and underpayment matters that we've talked about. So that's on the administrative side. On the operational side, as we think about predicting demand in our facilities and matching our staffing and our scheduling to that demand, there's a tool that we've already rolled out across a significant number of our hospitals that we continue to implement that we think will be very helpful as again we predict and then match staffing as best we can to demand using AI technologies to do that. So that's part of the operational domain. And then finally, on the clinical side, we think about nurse handoffs and how do we make our nurses more efficient. We have thousands of handoffs a day as we do shift change for our nursing colleagues. And how do we make that a more efficient process as we transfer information on patients as part of that shift change? So that gives you a sense underneath each of the 3 domains that Jon mentioned, of some of the specific items that we're working on as it relates to our AI agenda.

That's great. Chris, this is probably a question for you. It's on the exchanges and the expiration of the EPTCs. And that is one of the headwinds that the company is having to overcome this year. I think you sized it at $600 million to $900 million. And this is an area that, of course, requires a lot of judgment in terms of just figuring out what that headwind may be. Can you remind us what are some of the assumptions that are underneath the surface in terms of how you're thinking the exchange subsidy expiration will play out? And then not asking in terms of what you're actually seeing, but what are just the markers you're looking to see whether your assumptions are conservative-leaning or on the aggressive side? Just curious sort of what are those internal and external data points you're looking for.

Sure. Let me start with just context around the exchanges, and we've given this in the past. But the exchanges represent about 8% of our volume, about 10% of the revenue for the company in 2025. And as you mentioned, we went through a pretty extensive exercise as we came to 2026 to think about the impacts of both the expiration of the enhanced premium tax credits as well as the administrative reforms that were enacted in 2025, just thinking about their impact on the exchanges. And so we took both internally-developed information that we have just about our historical experience with exchange patients as well as external sources, and we used that to come up with our $600 million to $900 million estimate in terms of the EBITDA impact. Some of the most significant assumptions that are underneath that $600 million to $900 million is, first, how much of our exchange volume did we think would go away as part of, again, the administrative reforms or the expiration of the EPTCs? And we think that's 15% to 20% of our exchange volume goes away. And then of that volume that goes away, where do those lives migrate to? And of that 15% to 20%, we think 15% to 20% moves to employer-sponsored insurance. And there's a benefit to the company through that move to employer-sponsored insurance. But 80% to 85% moves to uninsured. And for that uninsured population, then we think there is a decline in utilization because those individuals without coverage just won't seek health care to the extent they did previously when they had exchange coverage. So those are a couple of our most significant assumptions that went into the $600 million to $900 million. In terms of what are we watching, what are we thinking about for 2026, I would say in the first quarter we're really thinking about items such as effectuation. So if you looked at the enrollment numbers, I think everybody is aware, enrollment was maybe a little better than was initially expected for 2026. Exchange enrollment was down about 5% nationally, about 4% in HCA states. But what really remains to be seen as we move through the first quarter and beyond is the effectuation. How are individuals able to pay their premiums? And are they able to sustain premiums that may have increased with the expiration, for instance, of the EPTCs? Secondly, we're also looking at metal tier shifts. Are there individuals that are trading down from silver to bronze, for instance, because it's a more affordable premium? And then what does that mean as it relates to, for instance, their ability to pay their co-pays and deductibles because they may be shouldering more burden individually from that metal tier shift? And then lastly, we're just looking at utilization of the remaining exchange population or from the uninsured utilization that I mentioned as well. So all of those are items that we're watching. We're getting early reads on. And as we come to the end of the first quarter and we do our call, we'll be in a position to give more information around our thoughts and views and the experience that we're seeing as it relates to each one of those items. But that's what we're -- that's, one, how we constructed our guidance for this year; and then two, what we're thinking about as we roll through the first quarter here and what we're watching around the exchanges.

Fair enough. And Chris, another swing factor as we're thinking about '26 is just the state-directed payments. And I appreciate the assumptions you've built into the guide. There are a couple of states out there where there could be approvals, and there's maybe been a little bit of news over the past week or so. But just sort of remind us, for the states that are still in play, where there could be approvals, just so we know what to pay attention to.

Sure. Maybe let me start with just a reminder for everybody that under the One Big Beautiful Bill, the OB3, there was opportunities for states to submit incremental applications for some additional dollars to be grandfathered at a higher rate, that included higher provider taxes that came along with that. And we saw, in late 2025, certain states get approved under these grandfathering provisions. Kansas, Texas are a couple of examples. And then as we've rolled into 2026, we've seen some additional states be approved, most notably, Georgia, was recently approved. I think you all may have seen, that's publicly available now. So we continue to be encouraged by seeing these incremental applications get approved by CMS. I think the one that we're asked about the most that I know is a top of mind for people is the State of Florida. And we have seen some of the -- a certain news outlet mentioning there's some sort of agreement between CMS and the state. And we're aware of ongoing dialogue between the state and CMS, but the bottom line is there is no approval yet for the State of Florida. We'll continue to monitor that one closely. And we would comment on that as part of our first quarter call if there's anything to discuss at that point in time. But there is no formal approval yet for the State of Florida. But we continue, as I started, to be encouraged by the fact that we see applications getting approval in a number of states. And we hope that will continue to portend good news for those that have not yet been approved.

Got it. Fair enough. Let me transition back to some higher-level questions, and particularly on the volume environment. So maybe Jon can lead off here. It's certainly been much more durable, I think, than the investment community at least expected over the last couple of years. Could you just give us some sense for what do you see as the big internal and external drivers? And what are the things that give you confidence on sustaining that 2% to 3% volume growth?

Sure, Matt. Well, I think I would start by saying that our significant capital investments in growing our local networks has given us a good bit of momentum, and there are sizable investments there. Also if you think about our 43 domestic markets and you look at the population growth within those markets and you look at the demand growth within those markets, and you look at the effective execution of our network development strategies in those markets that are producing market share gains, it really frames up for us our thinking about growth going forward. Now obviously, underneath that, there are specific assumptions, there's a bit of fluidity as it relates to the exchanges and things like that. And I don't know, Chris, whether you want to talk about any volume assumptions that we might have by payer, if you will.

Sure. I can talk about briefly the mix underneath that 2% to 3% as we think about how that breaks down by payer. When we think about Medicare and Medicaid and then the commercial, excluding the exchanges, we think all of those will grow around the aggregate 2% to 3% growth. On Medicare, we have seen growth that is within and maybe even slightly above that 2%, 3% range historically. So we feel good about that assumption. On Medicaid, we know that's been depressed the last few years because of the redetermination process, which we think we have largely worked through and anticipate Medicaid would move back to more of a normal type growth, in that 2% to 3% range. And then commercial, again, we expect to be in that similar range, in part aided by the exchange dynamic that I talked about earlier where some of that growth will be fueled by individuals that lose their exchange coverage but we think will be able to migrate to employer-sponsored insurance. And then we have the 15% to 20% decline in the exchanges that I've already spoken to. And then we do expect an uptick in uninsured as well, primarily driven by the exchange lives that will move from exchange to uninsured, in that 80% to 85%. So that's how we're thinking about the mix underneath that 2% to 3% growth assumption that we have overall for '26.

Got it. That's very helpful. And Jon had mentioned the reinvestment into the markets in terms of the in-flight capital. And just what you reinvest every year as being one of the things that sustains the volume growth? I think if I did the math right, you probably reinvested something like $40 billion into your markets over the past 10 years. That's my number, but I think it's pretty accurate. Could you just give us a sense for your approach to capital deployment? What are sort of the big buckets of investment back into the markets? And how do you prioritize projects and measure returns? I'd love to get some perspective on that.

Sure. As we think about capital allocation for the company overall, we start with the cash flow production of the company. We generated about $12.6 billion of cash flow from operations last year. We are projecting $12 billion to $13 billion in 2026. So that provides us a lot of flexibility in terms of how we allocate capital. And then we think we have a very disciplined process for how we go about our approach to capital allocation. And it starts with CapEx and reinvesting into our markets. And Jon spoke a little bit about the opportunities that we see to continue to invest at very significant levels in our market. We spent a little less than $5 billion in CapEx in 2025. We're lifting that to $5 billion to $5.5 billion in 2026. We've talked about the over $7 billion in CapEx pipeline that we have in terms of in-flight projects, both building out our inpatient capacity as well as outpatient sites of care as we continue to surround our hospitals with a network and outpatient sites of care that we think are very productive for the company. And so we continue to see good opportunities to deploy capital, which is really our first thinking from an overall capital allocation standpoint. In terms of the buckets that you asked about, in very broad brush strokes, when we think about our $5 billion to $5.5 billion this year, roughly half of that amount is what I'll call pure growth capital. It's the expanding our facilities like I've spoken about, it's building new freestanding emergency rooms. It's, in a couple of instances, new inpatient facilities. And so that's roughly half of the capital. The other half of the capital is more routine or technology in nature. As you know, we're a capital-intensive business. We got to continue to maintain the assets in our facilities, maintain the equipment in our facilities. And so we had to devote significant CapEx to that every year. And then we have the technology element of it as well where some of that is also maintenance capital for our technology and our computers and our systems. But then some of it is also fueling our digital agenda for the company that we've talked about, in part how we're, for instance, replacing our clinical information system in MEDITECH Expanse, or fueling our AI agenda. And so that's the other half, is that routine or technology bucket of capital that we have. In terms of how we think about priorities for our capital spending, we think we have a very disciplined process that we go through. We have a centralized function inside the company that is charged with vetting, working with our group operators or other business leaders around our modeling for these projects. And we think about, say, a hospital facility expansion project, what are the right assumptions around our volume growth, our payer mix? And all the things that you would expect that we put into a financial model, that we vet inside the company and then move it up to the right levels of the organization to ultimately get to a decision of do we move forward with that capital project. But it doesn't stop there. As you can imagine, it's, while we go through the construction project, are we keeping ourselves on time? Are we hitting the cost metrics that we expect during the construction phase of the work? And then when that project is done and turned over and operational, then we're looking at how does it perform versus the models that we developed. And we do every year a look-back approach where we look back at all the capital projects over the last few years and see, "Did we meet our return expectations on those projects?" And the short story is, in the aggregate, absolutely, we're meeting and even exceeding our return expectations on those projects. Not every one of them is a hit, but way more hit than don't. And again, in the aggregate, we are meeting our expectations. So that's all part of the process of how we think about the CapEx portion of our capital allocation, how we oversee it, how we think about the buckets, and make sure that we're being very disciplined in our approach to capital and CapEx allocation.

That's great. I appreciate it. Let me throw in a labor question, and I wanted to come at it through the angle of Galen. And it was certainly a really interesting investment you all made. But I was curious, just update us on what you're seeing with Galen in terms of the campuses you've opened and the impact it's having on both the community and supply of nurses, but also where do you see that impacting HCA in terms of controlling labor?

Yes. Well, a number of years ago, as you mentioned, we acquired the Galen School of Nursing. At the time, there were 5 bricks-and-mortar campuses. Today we have 25 bricks-and-mortar campuses. We have 20,000 nurse students in our Galen programs. And it is a really important dimension of our organization. We see that growing to 30 campuses at least over the next several years and up to 30,000 nurses enrolled in those programs. And just for context, when you think about an organization that has 100,000 nurses, and if you assume a roughly 15% turnover rate or so, roughly in that zone, 15%, 16%, well, you're needing to replace 15,000 to 16,000 nurses per year, if you're sort of at that rate of turnover. When you're educating 30,000 nurses across all those different campuses, you have a really rich pipeline there. All those nurses get their clinical rotations in our hospitals, are socialized to the HCA Way, and we think it's very, very important for us. From an overall labor perspective, let me just say that we're in a much more favorable environment right now than we were during the challenges that we had coming out of the pandemic. And our metrics are again down to pre-pandemic levels around turnover rates, et cetera, et cetera. So Galen has been certainly a vehicle for us to help in our recruitment and our retention efforts. But we feel really good about that particular strategy.

Got it. And then, Jon, would you also hit on Valesco? And you had mentioned at the top some of the pressures that I think a lot of folks are seeing on certain hospital-based physicians. Just remind us how HCA is leveraging Valesco to help mitigate some of those cost pressures.

Yes. Well, when you think about the importance, the role of an ER physician and a hospitalist physician in a hospital, there are a lot of opportunities there to drive quality, to drive service, to drive efficiency through the greater integration of what the ER physicians are doing and the hospitalist physicians are doing. So we spend a lot of time working on that integration. It has helped to drive quality, it's helped to drive service, and we think we're turning it into a real strategic asset for the company. Also touch on, really related to the physician side of things, our GME programs. We have 5,800 residents that are operating in 90 different hospitals across our company and 250 different residency programs. And what we know is that residents tend to stay in the geographies where they train. And so we're pretty disciplined about thinking about what kind of residencies we need and where geographically we need them. And it's a source of recruiting for us, obviously, to build the pipeline of physicians that we also know that we're going to need, some of whom are ER physicians and some of whom are hospitalists, obviously. So our GME platform is a pipeline, our nursing platform is a pipeline, and those are critical for us going forward.

Got it. And let me in the last few minutes here, I'd love to touch on the competitive environment and try to understand or better understand HCA's advantages really at the local level. So how has the competitive environment in your mind evolved kind of coming out of COVID? And what are some of the advantages that an HCA enjoys? And how does that compare to some of these really well-capitalized nonprofits that you're competing against?

Well, that's an important question because each market is a little bit different. And while, generally speaking, our strategic approach across our different markets is pretty consistent, how we execute those strategies needs to be nuanced based on the competitive dynamics. We do compete with a number of strong nonprofits across the country. When I think about what differentiates our local systems and what makes them more competitive, if you will, there's a couple of things that come to mind. Certainly, our shared service platforms of revenue cycle with Parallon and supply chain with HealthTrust, our GME platform that we've talked about, our Galen School of Nursing platform that we've talked about, that is really beneficial to our local markets. It helps them be more cost-effective and it helps our speed-to-market with certain solutions that maybe our competitors don't have the ability to take advantage of. Then I would say just the extent to which we are capitalizing our network development and network optimization strategy. When I talk about network development, when we talk about it, we're talking about investments in the inpatient capacity of our hospitals. We're talking about the deepening of clinical capabilities of our hospitals and raising the acuity level of what it is that we're able to care for in our hospitals, whether that be bone marrow transplant or solid organ transplant or trauma programs, burn programs, cardiac programs and the like. And so those are very, very important, while we are simultaneously investing in our outpatient footprint or the access points, in essence, that support our hospitals. Today we have 14 access points for every hospital across HCA. And we want to grow that to 20 access points for every hospital across HCA, all in furtherance of our goal to have a composite market share of 30% by the end of the decade. So we have these investments on the inpatient capacity, investments in the clinical services and investments in the network of access points that are all meant to meet patients and care for patients when, where and how they want to receive that care. And that's development. Then there's the optimization side of it, which attempts to connect those access points, certainly, with our hub hospitals, and wrap around that a set of other services: ground transport programs, air transport programs, patient navigation programs, call centers, telemedicine, et cetera, et cetera, that help to facilitate the movement of patients to be retained inside the system rather than having to seek care somewhere else. That helps grow market share. So we think it's a very effective strategy. But the differentiator I think for our local markets is that we heavily capitalize it and we're accelerating our development of our networks there. So all in all, I think that the company is really well positioned in terms of the breadth of our portfolio, the scale that we have and our ability to use that scale for the benefit of our local networks. A lot of companies say they have scale, but they don't necessarily know how to use it. And we do know how to use it. And then overall, just sort of the capital resources that we are accelerating into our markets for them to grow market share.

Well, Jon, I could tell you can go on and on about that topic, but I think we're up against time. So Frank, Jon and Chris, really appreciate you joining us today.

You bet. Thank you.

Thank you.