Humana Inc. (HUM) Earnings Call Transcript & Summary

Hi. Good afternoon. Thanks for joining us, continuing on at the 41st Annual JPMorgan Healthcare Conference. My pleasure this afternoon to host Humana. As many of you know, Humana is a leading health insurance and health care services provider with over 15 million enrollees in various health products. Over 75% of Humana's revenues are derived from the Medicare Advantage sector. The company also owns and operates some captive PBM, has been building out a home health, hospice and physician platform as well. So it's my pleasure this afternoon to host President and CEO, Bruce Broussard; and Chief Financial Officer, Brian Kane. And we're going to be in a fireside chat format, so no slides. We're going to jump right into some Q&A. So gentlemen, welcome to the conference. Glad to see you.

First question I think I'm going to ask is just around your Friday 8-K. Generated a fair amount of investor interest. So some of the unmitigated positives in that are boosting the individual MA enrollment guidance, boosting the estimates of PDP losses. So maybe just starting on the increase in the individual enrollment guidance. What do you think is the driver of that? Is that just your typical sort of conservatism, looking at your benefits offerings in the marketplace? Is there any sort of subsequent intelligence post open enrollment about competitive dynamic and what benefits are put into the marketplace by competitors? Any color there?

Why don't I start off, Gary, and then Brian can spend -- provide more color on the 8-K, if you want more details. First, thanks for having us. These are all -- it's always a great conference. This is a new format, but it's great to be here. On the membership growth side, I got to tell you, we are really, really excited about how we performed in this new world, so to speak. We saw all channels performing well. Our internal channels, both [ the call ] and our proprietary sales force, did an excellent job in the virtual world. We did see some really good results with our partners. We -- early on in the year, we started working deeply with the partners and -- about getting it established and how we were going to approach the market in general, but then secondarily, we also then worked on the virtual side. We did see some continued growth in the external channel, specifically around the telephonic side and the number of our partners, I think, saw some really good growth within their particular area. We saw some real good results in our retention. We did see some positive there. And our teams have been working really hard in being able to make it easier for our members, especially our first year members. We found, sometimes, they become frustrated quickly and want -- and they begin to become disenchanted with Humana. So we saw some really good results there. Our value proposition, especially in a number of growth markets, I would say, probably exceeded a little bit of our expectations, but not terribly. It just -- it was -- I think we just sort of showed up in a much better way. And then the last thing I'd say is our brand. I think the response that we had with COVID this year and all the proactiveness we had just created some really great goodwill in the marketplace and some really good brand awareness. And I think that also was helpful. So it was a combination of a multitude of things, but I would say it's been -- our channels worked well. Our retention was strong as a result of working on some of our -- improving the experience, our value proposition and then our brand as a result of a lot of response within COVID.

The other part of the 8-K, I think, generated a little more investor questions, at least from my perspective, and that's sort of thinking through the impact of the pandemic on 2020 and completing the risk assessment for members and capturing those diagnosis codes and how that plays into your 2021 revenue outlook. So maybe just sort of clarify how that works for people. I believe that if you didn't get a chance to see a member and you weren't able to collect those diagnosis codes, whatever the real risk score is, the real underlying health conditions, I believe that resets for 1.0 risk score for -- in '21. And so basically, I think you're describing there's some missed opportunities there. And then theoretically, in '22, if the world sort of normalizes, you get back to sort of doing these normal interactions with patients, perhaps you'd see your risk scores normalizing back to the level you'd expect. Am I characterizing all that correctly?

I think you are, Gary. It's Brian. I think you've framed it well. As we've indicated for a number of months, really, since the pandemic again, because our revenue in '21 is based on the documentation of the conditions our members have, whether it's our existing members or new members we get from other plans, is based on what we document in 2020. When there's a reduction in utilization in 2020, that could impact the following year's revenue, in this case, 2021. And so when we really were first faced with the pandemic, as you know, we talked about potentially there being a 2021 headwind. We priced for that. We created a, I would say, a pretty large range around that because there was some question as to whether the historical completion patterns that we've seen would follow through in an environment where there's much lower utilization, people aren't going to see the doctor, and the question is whether those conditions, we would be able to find them in the medical record to document the fact that we should get paid for the risk that we're taking. And so we knew coming into pricing, and then when we gave our guidance on the third quarter call, that there was some headwind that we had to consider. And so we have a pretty wide range around that. And I would say, actually, our fourth quarter assumptions were pretty reasonable, I would even say conservative, in terms of the amount of utilization that we would see. Importantly, there's 2 elements of the utilization. There's the sort of organic utilization where people normally just go to the doctor, see the doctor and the doctor documents the conditions. And then there's also things that we proactively do. So we go into the home through in-home assessments, where we not only ensure that the member is being treated clinically, and we are very, very focused on that, particularly this year in light of the fact that people weren't seeing a doctor, but it also allows us to collect those risk codes that I mentioned. Or we have the ability to do telehealth to be able to collect those -- some of those codes as well as provide the clinical care that our members need. And so that, we've done as much as we can. We've worked, as we said in the K, we've worked tirelessly over the last number of months to ensure as many members as possible get care. But the reality is most of the codes come from those organic doctor visits in the ordinary course that we see. And that depression in November and December, in particular, being 15% below normal, that came as a surprise. I think really there's some discussion as to whether there might be a second wave. We certainly planned for that. But how widespread it is, the fact that it's everywhere, frankly, it's a lot worse than it was in the spring as you've seen just in the case counts and, unfortunately, some of the hospitalization and death rates that we've seen. It's a lot worse in November and December. And so as we go into '21, what we're saying to investors is we still have a pretty wide range of revenue. We have planned for that kind of range, and we issued our guidance back in October, early November with that in mind, but it's gotten worse. And so therefore, we said, well, the revenue side may have gotten worse, and we'll see where it falls into that range. And again, I emphasize that it's a range. There's then the cost side of the equation that says, well, how much does utilization remain depressed in, say, January, February, March? And so far, going into the first week of January, while we've seen significantly elevated COVID cost, not surprisingly, we've also seen that non-COVID utilization remained depressed. And so there's a natural offset there, but there is some uncertainty as to how the revenue and the cost will offset one another. Importantly, and the last point I'll make is, to your point about 2022, our expectation is that 2022 will be a more normal year. And by that, we mean, as we get into the spring and summer, the expectation is the vaccine will take hold. Utilization will, we think, go back to more normal levels, which will enable us to see our members in the ordinary course and collect the codes we need to be paid appropriately in 2022. And so as we think about 2022, we think the right sort of framework investors should consider when they're thinking about our earnings power is the midpoint of the '21 guidance that we provide, and that hasn't changed since the third quarter, we reiterated that on Friday, and you'll see us come out with specifics in a few weeks. That midpoint is the baseline off of which you should think about growing for 2022. And so that's, I think, an important element. And to the extent we may be a little short in 2021 because utilization doesn't come back as quickly, our intention is to price for that delta. And so we have that opportunity to price for it, like we did this year. And so all in all, I think, as Bruce said, the business is running great. The membership is an unmitigated positive both for '21 and then for the earnings power, in particular, going forward in 2022 and beyond. We just have to deal with some of this pandemic volatility that we're seeing.

It makes sense to me. When we think about what the potential revenue impact might be, do we look at -- I think as you were exiting the third quarter, you were saying you were kind of running 90% of baseline utilization. Now you've sort of implying 85%. So that 5-point delta, does that tell us the potential revenue from the coding issue is a low single-digit sort of potential variance in your thinking for 2021? Is that the right way to put some guardrails around it?

Well, what I'd say is, I mean, our expectation is probably a bit higher than 90% for the quarter. But again, we're at 98% in October. And so I'll give you a broad ballpark for the falloff in utilization. The actual utilization was in the high 90s. We were pretty, I think, reasonable about what we would have assumed for MRA or Medicare Risk Adjustment purposes, but it doesn't quite correlate exactly the way you said. I guess the way I would frame it, and we'll be prepared to talk a little bit more about this on the earnings call in a few weeks, is that it's not material to our revenue numbers overall, but it could be more material to our profit numbers. And that's because of the relatively low margins in the business. And so that's why we've talked about sort of a claims offset with respect to lower utilization, but the documentation is a pure hit to revenue, and it goes right to profit. And so therefore, you need that offset. And so it certainly isn't material from an overall revenue perspective. But just given the operating leverage in the business, it was something that we felt important to call out to investors and that we are expecting and counting on this offset on the utilization side. Although, again, I would emphasize that, that revenue range is pretty broad. And we're going to go after every documentation opportunity we can appropriately to ensure that we're getting paid appropriately for the risk that we're taking.

And final question on this. How do we think about how this shortfall, so to speak, on the coding side is shared or passed down through your capitated arrangements in '21? I think the way the 8-K, right, sort of alluded to at least from a utilization perspective, you were maybe going to treat some of your providers, I guess, your fee-for-service providers, maybe with a little more relief or a little better than the actual environment. So when we think about your capitated providers in 2021, is a lot of this pass-through because they're taking a percent of your -- per member per month?

It's a great question. And actually, I think it goes to a broader strategic question, which we can talk about, which is when our members are in value-based relationships, it's interesting. What we're seeing is a lot less degradation in those risk codes than we are seeing in the fee-for-service world. And that's because our risk providers, our value-based providers, where we're fully aligned, have all the incentive in the world to see their members and to make sure that they're getting their care. And in that process, they are collecting those codes. And so the delta we're seeing is much less. But you're correct. To the extent that our risk providers also have a shortfall, they will bear, call it, 85% of the impact of the revenue from that. So really, a lot of the impact is on our fee-for-service providers where there's less, frankly, aligned incentives to ensure that the members get the care they need.

I want to move this conversation now back to a little more high level, maybe come to you, Bruce, and just talk about political environments. I think in the last couple of months, I fielded so many investor questions who have this perception that the democratic administration, the Biden administration would hold some inherent animus towards the Medicare Advantage product. And I think these investors were thinking about back in 2010, as part of the funding for the Affordable Care Act, you did see some sizable cuts to Medicare Advantage rates. So do you think the investor perception is largely correct, largely incorrect, somewhere in the middle? How do you think about Medicare Advantage rates and enrollment outlook under a Democratic administration?

First, I think contrasting to our current environment to 2010 would be helpful. In early 2008, when it really came about and ACA conceptually, the -- what was paid the Medicare Advantage payers was in the 110% to 120% level because it was higher than Medicare fee-for-service in a number of markets that got up to 125%. And so first, there is just -- it was out of whack to Medicare fee-for-service. The second thing, the population that was in Medicare Advantage was also small. It was in the low to mid-teens. So it was a fairly small population. The second thing is the STARS program wasn't fully developed at the time. That came in subsequent to that and the quality side of that. And so what you've seen over the last decade and -- there's really a change, a change in the amount of people that are in the program that is a voting block for senators and Congress in general. And you see that is approaching 40% of the Medicare population. So that's a large population. The second thing you've seen the industry really innovate and really advance in is quality area. And so you've seen a significant change in the -- just where the orientation of the industry. Once it was around, let's just aggregate members to today is really around how do we improve the health outcomes and programs like STARS is that way. The third is that there's been an expansion in areas where health and equities are really part of the probably a higher percentage of the population in Medicare Advantages related to where health and equities are. And that's a result of the over-the-counter benefit. That's a result of the social determinants, efforts that have been going on and part of the benefits there. So you've seen an expansion of the program that really takes advantage of serving the under resourced area. And that has not been on the back of Medicare. That's actually been a result of the savings that's being incurred in the Medicare Advantage program and reinvested into expansion of programs. So you just see a different program in totality. I would say even since 2015, '16, you've seen this program expand. So I continue to believe that you see really great cross-party support for this. You see a population that is passionate about it, a voting population that would represent any kind of major change as a threat. And I think they would voice their concerns on behalf of the industry in general. And then the third is that I think because of both the growth and the bipartisan support, you see a program that's totally different. So all that being said, I think you'll see stability in the program. I think you'll see adjustments probably more on the regulatory side than the congressional side. I think those adjustments probably will come into the MRA area, possibly STARS, but those are not -- I would say they're not material. They're adjustments. They're not going to change the program in a significant way. And at the end of the day, the organization can always price for any material change, but we don't anticipate that. We think the program is really solid. In engagement with a number of different congressional and administration, we hear Medicare Advantage is an example of a program that should be carried out in other parts of the health care system. So you didn't have that back in 2010. I think you have that today, and I think it will continue to be that case in the foreseeable future.

If I could get ultra granular just to finish this point. The 2022 advance notice came out at least 3 months early -- 2 or 3 months early, and there were some industry chatter that the '22 final notice might actually get released by CMS before the current -- before the administration -- before Joe Biden was inaugurated, which sort of theoretically mean that whatever regulatory change, whether it's MRAs or STARS that you're alluding to might be possible, presumably, we wouldn't see until the 2023 advance notice. So I guess the question is, one, do you think we're going to get the '22 final notice well before the typical April time frame? And does -- in your mind, does that really sort of lock in '22? Or does the administration still have the ability to essentially do whatever they want and could sort of reopen that, for lack of a better word?

I don't want to speculate on when we'll receive it, but I will try to address the latter question. I think the administration -- the incoming administration has so many things to deal with that this is a small issue for them. And I don't see it raising to the concern that would be required to address it in a very short period of time. If you think about the timing, you have to have a comment period, and you have to go through that. And I just don't see that being a top priority for them. Now if it was something material and it was out of whack and it was not consistent with historical kind of rate increases, which this one is, I would say maybe. But right now, I feel that it's pretty much right down the middle of the fairway here, and I don't feel that it would raise to the concern that some of the other programs that maybe the current administration has announced. I think this one will probably just be more delegated to the career staff, and they've been part of that process.

I'm going to do one more question, and then I've got a couple of investor questions in the queue. Capitated medical groups inside of Medicare Advantage is kind of a growing topic, both private and public companies. It's probably one of the most highly valued investment ideas around your ecosystem. Can you talk about Humana's approach? You've -- in some places, you've built [ up ]. In some places, you've developed. In some places, you're partnering. So what is your overall approach to capitated medical groups inside of MA? And is there -- how do you differentiate the value that you see in your proprietary assets versus independent assets that you might be contracting with?

First, we have been a long, long time supporter of this. It was spread before it was in vogue, so to speak. And we continue to have that [ void ]. We see senior dedicated clinics that are oriented to value-based holistic care produces better quality outcomes, better cost, in addition better customer satisfaction. So we're big believers in it. And I know, Gary, you've seen our charts all the way from fee-for-service to [ capital ] risk and the capitated and the benefits of that. So big, big believers in that. First, our approach has been and will continue to be geographically oriented based on the needs of the marketplace. I think health care over the years has always said it's local, and there's a lot of structural differences between one market to another market. And so we will accommodate our strategy to meet those markets. And there are submarkets within our larger markets. If you were to take Houston, Texas and you were to take the Gulf Bank region in Houston, Texas, there's no primary care assets in that marketplace. And therefore, it makes sense for the primary care clinic in there versus an overcapacity of beds in that marketplace from a hospital system point of view. So it is geographically oriented. I think over the years, we've been consistent in saying we would -- the supply of this particular provider strategy is limited. I think the largest asset was the DaVita asset, which was ultimately bought by United. Split up a little bit, but majority of the assets went to United. But there has been a capacity issue. And we have needed to and continue to find that it is a combination of the ability to partner and actually through investments aligned with providers and being able to develop it through contracting, more direct contracting there and not have a financial equity interest in that and then build our existing assets and be able to develop that. And that is, again, market-by-market basis. We have tried over the years, especially the last few years, is to be thoughtful about the dollars we invest from our balance sheet and income statement point of view. We are big believers in it. We have some very good performing assets. In fact, some of our partners actually use some of our capabilities in -- within the assets that we own. And so they're really well-performing assets. I think it's more around how much capacity do we want to take from the income statement and invest in those assets to accelerate our internal ownership versus partnering external and building with a combination of the internal side. What the internal assets offer us is at any point in time where we do need additional investments, we can bring that to the marketplace. Even in addition, if we need protection in a particular marketplace, we can always change out the existing partner and move our asset into that marketplace. So it does give us a defense as well as an offensive strategy there. But I would say capacity and geographic orientation is the 2 big things that go through our strategic view of how -- when do we deploy internally versus externally.

And I think you've said, historically, when you look at cost management, quality of care, member satisfaction, that you're having equal success in sort of your proprietary model and in some of your preferred contractor groups. Is that correct?

That's correct. And we've seen that over the years. We have a little over 200,000 members that are in our owned assets, a material amount. In fact, if you were to sort of spread that across the United States, one of the larger risk-based senior-oriented clinics in the country. And we have seen over the years that their success is equal to some markets, less than some markets, more than the existing assets that we have investments in.

I want to go to a few of the investor questions that we have in the queue since we're doing our breakout session all here together. The first question is talk about use of direct-to-consumer brokers as we head into 2021. I think in maybe your opening comment, you sort of alluded to all channels working well and do the direct-to-consumer brokers, does that accelerate? And then the follow-up question is, do these brokers help in any way with any continued engagement with the consumers, particularly with respect to health profile and risk scores? I think the answer to that last one is no unless there's something I'm not understanding. But that's the 2 parts of the question. How do you see that channel performing as your referral source? And does it provide any subsequent roles, touch point with those members?

Yes. A few things, Gary. First, they continue to demonstrate that there is a growing need both for awareness and education and then ease of and simplicity of enrollment. And I think that's been a very large value that they've provided. I mean the amount of advertising, the amount of sort of telephonic connectivity has just increased significantly in the industry. And frankly, I think that's a little bit of why the industry is growing, too, is a lack of awareness has been one of the biggest challenges in MA, and I think they've really brought that awareness there. What we've also seen is that there has -- we have saw some retention issues in the call centers in the past in this particular channel. We have been working with our partners in improving that through their both direct dialogue with our members and really encouraging them to stay in that. And in fact, we are -- and some of our partners have put in incentives or penalties, whichever way you want to look at it and compensation formulas about retention. And then secondarily, what we've also done is to try to create a handoff to our existing sales force to be able to continue to manage them on an ongoing basis, ensuring that they have our touch points. So this idea of being able to encourage and continue to be engaged with the member both from their perspective and our perspective has been something that we've worked on in 2020 and continue to work on in 2021. In respect to your question around risk scores and other engagements with health, we do ask our brokers to -- and our partners to engage and inquire relative to individuals' health needs and where they are and have an assessment. Sometimes those assessments are helpful in the risk adjustments, sometimes they're not. But they are very helpful for us to begin to start to understand the clinical programs and the proactiveness of getting people into the clinical programs going forward. So yes, we do ask them to engage in people's health, and we do utilize that information back to us to help in a more proactive aspect of being able to engage with our members around their clinical needs.

Is there any particular reason to think about 2020 being a year where it's probably more telephonic enrollment? Does that mean whatever the typical retention curve is could be weaker in 2021? Or do you think that's plausible concern or not?

No. I would say that we, in 2019, actually, in 2018, learned some things that prepared us for 2020 in the retention side, both external relationships with the members, the handoff that I referred to. And in addition, we have been doing a lot of work. We have a whole dedicated team around retention and making it easier around the ability to first use their benefits and be able to understand what kind of pharmaceutical needs there are, so we can be proactive. So I have a lot of positive outlook around the ability for us to improve our retention and continue to improve our retention for this population. Even in the wake of the growing channel, I just think that we got on this problem pretty quick. And I think we've been very resourceful in using -- utilizing multiple different leverage points.

Another investor question is in terms of capital allocation over the next 3 to 5 years. How much should we think about going into core Medicare MA product versus health care services?

Yes. Obviously, and I'll start and look to Brian to add to it. The first capital deployment is statutory capital, and between 10% to 12% of our revenue growth is always put into statutory capital. And so that will be a continued need for us as an organization. That will be the primary investment outside of technology and digital side, investment in the Medicare side. Obviously, being able to aggregate and buy plans and everything else is very difficult as a result of the concentration in the marketplace. Medicaid, just carrying that on, will continue to look for opportunities that are regionally-based and be able to take that on. We just acquired a small company in the Minnesota area that allowed us to be able to carry that forward, and we'll continue that going forward. The third and probably the largest area will be in our health care services area. We talked about the wonderful opportunity we have in primary care. We'll -- you see us continuing to invest in the home both through the Kindred and the ultimate ownership of Kindred. But in addition, the acquisition of Heal is an example of that. I suspect that you'll see a few more acquisitions that build that out further to be moving more and more into value-based post-acute management in an additional care into the home. Specialty pharmacy is an area we continue to have an interest in, in acquiring some assets that can advance our platform there. So you'll continue to see us invest in the health care service side. And I suspect that will be the -- probably the area where you'll see more capital being deployed. And then obviously, we are very thoughtful about giving shareholder -- returning dollars to shareholders through our dividend program, but more importantly, through our stock buyback program. But Brian, do you have anything to add to that?

Well, I think that was very comprehensive. I just would say we're very disciplined with our capital. We like to be creative with the use of our capital. We like to leverage our relationships with our various partners that we bring a lot of additional elements to the equation beyond our balance sheet that allows us to, I think, really be in a preferred position to get people to want to partner with us or I think perceive to someone that they can partner with and grow their business and be successful while also ensuring we earn a good return for our shareholders. In fact, if you look at some of our venture investment in the last few years, we've had really excellent returns. And so we want to be very disciplined with the use of our capital. We want to make sure that it earns far in excess of its -- of our cost of capital, and you'll continue to see us invest in creative ways, I think.

Another investor question. You accelerated investment spend by $900 million in 2020. How much flexibility you have with respect to that in 2021 if the risk codes get worse? I'm not sure if that means worse than your thinking today or versus 4Q, but basically, is there -- how much flexibility and how much lever around that G&A line as we move into next year?

Well, I would say, I mean, the investments that we targeted for 2020 were intended for 2020. After the pandemic started, we committed to our shareholders and all of our constituents that we would stay within the range of our $18.25 to $18.75. And as we said in our 8-K on Friday, that's where we'll finish the year. So we don't expect any material investments really to have continued into 2021 other than basic COVID testing and building, cleaning and those sorts of things, which are relatively material. But look, we always build contingency into our plan and ensure that we can cover most scenarios. We thought it was important to highlight what we did on Friday because this was certainly not what we were expecting with respect to some of the revenue challenges given the utilization decrease, but we do believe that, at least as we sit here today, that there will be meaningful utilization decreases to help offset that. But again, we always have -- we always think in terms of ranges where our point estimates, and we build various contingencies into our plan to be able to handle situations we weren't expecting. But we still felt important to call out this one because it was potentially meaningful to our 2020 earnings profile.

Could we spend a couple of minutes talking about Medicare direct contracting? I wonder, on paper, I look at this and say, this could be the most transformative change to Medicare fee-for-service medicine, for lack of a better word, since prospective payments in the early '80s. Of course, real-world reality, how things play out, don't always play out as they do on paper. So one, wanted to kind of get your thought on potentially how impactful this is. But then just, two, how is Humana thinking about participating with some of your clinical assets and professional global direct contracting this year? And then as we think about next year, geographic direct contracting more sort of designed for health plan participation, how are you thinking about participating in that program?

Yes. Yes. Let me provide a few perspectives. First, as a company, we have always been looking over our shoulders and thinking about how does the addressable market become bigger in value-based chronic care management. And I thought about, just because this has been top of mind for both the previous administration and the current administration and I think the incoming administration, around how do you evolve Medicare fee-for-service. And so our platform that we've been building over the years with Medicare Advantage positions us well. One of the reasons also that we look at our health care service investments that we are developing as being agnostic, not just dedicated to Medicare Advantage members inside Humana. But actually, today serving multiple different other payers and obviously serving Medicare and fee-for-service in the home side. So we see the opportunity of taking those programs that we have on the provider side and actually addressing not only Medicare Advantage, but having a broader market to be able to bring our capabilities of chronic care management and the coordination of care and value-based payment models. We are approaching this with the test and learn mindset where we want to test and learn it with our plan. So the Humana plan will participate in the global side with some partners that we have on the value-based payment side. And then in addition, our provider assets will also be participating in the global plan, and that obviously is starting in the March-April time frame, and we will be preparing -- prepared to launch as that program launches. We're in the first cohort. And so we see it as an opportunity. We will go into it in a way and being very mindful of how do we learn the most. And -- but at the same time, we -- similar to other programs, we don't want to just sort of shoot for the sky here. We want to manage it and make sure we don't -- we manage the downside risk as well as the upside opportunity to learn. This is a 5-year program. So there's a lot of learning, I think, that we all will have, both company-wide and within the governmental side. And so we'll see changes as they evolve. But I think the concept of moving the Medicare fee-for-service chronic orient -- population to a value-based model is really exciting for us. And I think we've -- we have a number of capabilities and capacities and a leadership position in the marketplace. On the global side, we will also participate in that. The details are much less. That is a program that's evolving. They're requesting -- they have a request for application. We will participate in that process. As we see the details of that process, we then will make the ultimate decision, do we go into it or not? But I would say we are embracing this because we see it as a growth opportunity for us and the capabilities that we've built over the last 2 decades and really goes in -- and is aligned with our health care service strategy of being agnostic and serving multiple populations that are requiring value-based payment models that are oriented to serving the chronic population.

Thank you. With that, we're out of time. I want to thank Bruce and Brian for participating today. And everybody have a good afternoon. Thank you.

Thanks, Gary.

Thank you very much.

Goodbye.