LifeStance Health Group, Inc. (LFST) Earnings Call Transcript & Summary

June 15, 2022

NASDAQ US Health Care Health Care Providers and Services conference_presentation 36 min

Earnings Call Speaker Segments

Jamie Perse

analyst
#1

All right. Good morning, everyone. We're going to kick off our next session. I'm Jamie Perse, the health care provider analyst at Goldman Sachs. And we've got LifeStance joining us today. CEO, Mike Lester; Chief Operating Officer, newly minted, Danish Qureshi; and VP of IR, Monica Prokocki, thanks for joining.

Michael Lester

executive
#2

Thanks for having us.

Monica Prokocki

executive
#3

Thank you.

Jamie Perse

analyst
#4

I want to start just high level. Just how are you going to gauge your success over the next few years? What's next for you in building this company and opportunity?

Michael Lester

executive
#5

Sure. So we're in the middle of our long-range planning process right now, so we don't have all the details of that. We'll roll that out later this year. But I would just reinforce that the very original premise when we started the company maintains that premise today, which is increasing access to affordable mental health care. So that's -- nothing has changed about that. And then patient volume, patient demand has never been stronger. You can't pick up a newspaper in any MSA and not read about the mental health crisis in the country. And it continues to get exacerbated by all different stuff that's going on in the world today, so that hasn't changed. And then the other thing is we continue to have a very unique hybrid model, where we can see patients either in person or virtually and be completely agnostic to the economics of that environment because we have rate parity negotiated for in-person versus virtual in virtually all of our contracts. So we're continuing to just be very focused. We're not concerned about all the volatility and the nonsense that's going on in the market these days. We're just heads down, continuing operating. We really don't need to do -- we're not looking for a new revenue line. We're not looking for a new service line. We just need to keep doing exactly what we're doing because of the supply-demand issue and the patient volume that's out there.

Jamie Perse

analyst
#6

Okay. Great. I want to get one just out of the way and move to fundamentals after that. But there's been some stock sales recently. I was just wondering if you can comment on that and just this...

Michael Lester

executive
#7

Sure. So to be extraordinarily clear, I've never sold a share of stock. Danish has never sold, CFO has never sold. So the stock sales that you've seen in the last few days are strictly a sell to cover for taxes. So no executives are selling any equity.

Jamie Perse

analyst
#8

Okay. So you're saying you still like the company?

Michael Lester

executive
#9

I still like the company a lot.

Jamie Perse

analyst
#10

I reckon. All right. Let's move to the market. It's obviously -- you mentioned there's a ton of demand out there. It's attractive to a lot of players. We've seen new companies enter the space, a whole bunch of them. What are you seeing competitively out there? Are you running into some of these larger companies out there? And what's the basis of competition when you run into them, both on the clinician recruiting side and maybe on the patient side as well? Although it's probably more of the clinician.

Michael Lester

executive
#11

Sure. I'll let Danish talk about the clinician piece. There's obviously been a lot of money poured into mental health care. There's a lot of new shiny objects out there. At the core, we're in a low-cost outpatient provider setting, right? And we're just focused on, again, creating access to affordable mental health care. They're really -- I just don't think about competition from a patient standpoint. We have more patients than we can possibly service. So we just need to hire more clinicians as fast as we can hire them to see the patients that we're getting sourced from every single day. I'll let Danish talk about the clinician piece of that.

Danish Qureshi

executive
#12

Sure. On the clinician side, I mean, this market has always been competitive for clinicians. Nothing has changed from that sense. But we continue to have a very robust pipeline on both the organic recruiting side as well as the acquisition side, where we're able to continue to grow at the paces that we want to hear going forward. And competition, though has always been fierce, hasn't really changed our approach.

Jamie Perse

analyst
#13

Okay. I'll come back to the pipeline in just a minute. Your model is unique. A lot of other companies are just approaching this from a telehealth perspective. And why is the hybrid model the right model today?

Michael Lester

executive
#14

We think it's the right model really from a patient care standpoint. There are a number of studies out there. Rock Health did one, Blue Cross Blue Shield just did one. 70-plus percent of patients want to have an in-person connection with their mental health provider. So it's just -- it's the right thing to do from a patient care standpoint. We were -- pre-COVID, we saw about 5% of our patient visits were virtual. That spiked up into the mid-90s. It's about 79% right now virtual, and it's ticking down about 1 point a month. It sort of stalled out there with Omicron for a little bit, but now it's starting to tick down. Long term, we think the right answer for us is a 50-50 model, where 50% of the patients are -- 50% of patients' visits are virtual and 50% are in person.

Jamie Perse

analyst
#15

Okay. I want to bring in payers to this piece. You mentioned rate parity and that being a differentiator for you. You've got 79% of your patients on the telehealth side today. And you've announced slowing some of the de novo activity and maybe creating some capacity on the telehealth side to accommodate where the market is today. What's your level of confidence that rate parity can hold if you're sustaining higher levels of telehealth? And are the payers kind of getting what they're paying for if the model ends up 75-25? I mean just how should we think about that and your level of confidence that holds?

Michael Lester

executive
#16

Yes. So I continue to have a high confidence level of us being able to maintain rate parity. And I think CMS extended rate parity through end of 2023. I think you're going to continue to see that extended. But we also have -- payers have their customers, the Microsofts, Coca-Colas and Delta Airlines of the world, screaming at them on a daily basis of not having an adequate provider network for mental health clinicians for their employee base. So there's still this big supply-demand issue. And it's because 50% -- almost 50% of mental health clinicians are cash pay-only. So it doesn't create good access. It doesn't create affordability for patients that even have good insurance. They can't find a clinician that will accept their insurance. So I just don't see -- I don't see rate pressure coming from payers and a clinician population that is probably one of the lower-paid specialties in all of health care. So I'm not worried about rates going down. I think that would sort of politically be the third rail for a payer.

Danish Qureshi

executive
#17

And the one thing that I'd add there too is all of our contracts, which are commercial contracts, are individually negotiated. And we have negotiated de facto parity in those between telemedicine and in-person. So regardless of what CMS or others do, that doesn't affect us. Our contracts are what holds for LifeStance.

Jamie Perse

analyst
#18

Okay. Let's go to the next stakeholder, your patients, and then I want to spend a good amount of time on the clinician side. So just on patients, I think you get most of those today through your relationship with primary care. Do you see that changing at all just as we move towards this consumerization of health care? And will you need to develop more marketing capabilities? You see commercials all the time for trying to recruit patients. Is your -- is that a direction you might need to go eventually? Or is the primary care funnel plenty for you?

Michael Lester

executive
#19

Right. So we don't and never have been dependent on direct-to-consumer paid marketing. So we think that approximately 50% of our patients come from primary care physicians. You see all sorts of studies done, but we think it's 30% to 50% of a primary care physician's patient population has a mental health diagnosis. So they're desperate to find somebody to refer their patient to for that issue. And a lot of times, they'll refer the patient out. It's a 6-month queue. They ultimately don't get seen, which is back to the access problem that we're trying to solve. We think another 1/4 of our referrals come from third-party payers. And then the last 1/4 are self-referred online. So it's a patient population that will typically go online looking for therapist more so than you or I going online looking for a cardiologist or dermatologist. So we think we have really good sticky referral relationships across the board, but particularly with primary care who really has a true need for that referral base.

Jamie Perse

analyst
#20

Okay. Let's go to the clinician side. This is obviously very topical for those who focus on the company. Coming out of the IPO, you had this clinician turnover rate that was below industry average. That seemed to change pretty quickly last year, and you moved much closer to the industry. Maybe first question, just do you have an update in terms of how your turnover is tracking today? And then got some follow-ups after that.

Michael Lester

executive
#21

Sure. So we've been -- I think, good or bad, we were one of the first companies to talk about this Great Resignation issue. And in the next quarter, that's all the companies talked about, right? So it's a real thing. We have said publicly that our retention rate is around 80%. That's been consistent for the last 3 quarters. So that's what we're planning for on a go-forward basis. If there are some tailwinds and that changes, that's going to be good for us. But at this point, we don't know, and I don't think anybody knows, but it appears that this is going to be somewhat structural. So we're just continuing with all of our planning on a go-forward basis around 80%.

Monica Prokocki

executive
#22

Jamie, if I may clarify one point. You mentioned that we've moved closer to the industry. I think the entire market has moved. And so it's very anecdotal. There's no good data to support it. But we believe that we're still better than industry average when it comes to turnover. It's just impacted the entire market.

Jamie Perse

analyst
#23

Yes. Understood. Just on the comment on the structural side, I mean, what's really changed? I mean there's always been opportunities for these types of clinicians. And is it just that there's more competition for these folks? Where are they going to?

Michael Lester

executive
#24

They're leaving the workforce. They're compassion-fatigued, COVID-fatigued, whatever you want to call it. It's -- they're just -- they're leaving the workforce. And in a very strange way, no one likes this inflationary environment that we're in. But in a strange way, that could actually help us because I think it's going to drive people back to the workforce paying $8 a gallon for gasoline and milk.

Jamie Perse

analyst
#25

You've talked about some of the initiatives to try to move the needle on your own turnover. How are those initiatives tracking versus your expectations? And are there incremental plans to further reduce turnover? Just how are you supporting your clinicians? And do you think that will move the needle?

Danish Qureshi

executive
#26

Yes. So we made the announcement 2 weeks ago of my transition to COO role, which is effective July 1. So in this period here, what I'm doing is going out meeting with our operations team members, our clinical leaders as well as the clinicians themselves to understand what's going on, where are their opportunities, where are their challenges and how can we address them. Retention is obviously one that's top of mind on how can we impact that in terms of what is within our control, obviously, outside of this broader labor dynamic that's affecting the entire industry. So as we dig in, we'll start to come up with are there incremental opportunities to impact that further. I think just the fact that we've been able to get it stabilized and had it at the same rate for the last 3 quarters in and of itself is a pretty big success. But whether there's incremental opportunities beyond that, as I continue to dig in, I'm excited to see what we can do.

Jamie Perse

analyst
#27

Okay. I want to see if we can decompose the turnover by organic hires versus M&A. It strikes me that when you hire a clinician, arm's length transaction, they're probably going to stick with you for some period of time and maybe the turnover is higher on the M&A side. Just wondering if you can react to that premise. And on the M&A side, are there clauses and contracts clinicians have to stay for a certain period of time and then you see elevated turnover as that laps? Just any color on those 2 pieces.

Danish Qureshi

executive
#28

Yes. So historically, what we've witnessed is relatively equivalent turnover amongst both the clinicians that are coming to us through organic hiring as well as those that have come through an acquisition. So we haven't seen a significant difference. Now as -- again, as I dig in here over the coming weeks, trying to get a sense of how are we doing on our integrations, do we have a seamless handoff, how are we incorporating those clinicians into our culture and helping to make sure that they both are wanting to be here, not just contractually required to be here because of an acquisition, is really going to be key. What I don't know yet is where the areas are for improvement or if there are areas for improvement. But again, we'll be digging in there and seeing if we have something. But to your original point, we don't actually see today disparity between turnover amongst acquired versus organically hired clinicians.

Michael Lester

executive
#29

And one of the unusual things in the mental health space as opposed to cardiology or surgery or dermatology, if you have a group of 50 clinicians that you're going to acquire, in every other specialty that they're -- it's democratically owned. So there's 50 owners in that example. That's not the case in behavioral health. There are 1 or maybe 2 owners. So everybody else is already used to being an employee. So it's much easier to integrate that into a company versus having 50 owners where nobody got enough money to make a difference, and then they just look at you as taxing their income on a go-forward basis.

Jamie Perse

analyst
#30

Yes. And just I wanted to follow up on the -- if there's clauses in these contracts and if clinicians have to stay for sort of a set period.

Danish Qureshi

executive
#31

Every acquisition is going to be slightly different in terms of what are the actual contractual terms both for the seller as well as the employed clinicians. But in a lot of cases, we either have retention clauses and/or retention bonuses given as part of the initial integration to help ensure and drive a high retention rate of the clinicians. That is obviously the primary asset that we are "acquiring" in one of these acquisitions. So we want to make sure that it's seamless. But where there is incremental opportunities to add on top of that going forward and/or make that transition smoother or have the retention rates perform even better on acquisitions is something we're going to be digging into.

Jamie Perse

analyst
#32

Okay. So we touched on turnover. Let's go to the clinician hiring side. What does the pipeline look like today? You've given some stats in the past that 650,000 clinicians out there, and you've touched in some way a bunch of them. Where is that funnel today? Any color you can give in terms of stages of recruiting and what the visibility looks like over the next 6 to 12 months?

Danish Qureshi

executive
#33

Yes. So the recruiting pipeline on the organic side continues to be extremely robust. I mean, as you just mentioned, there's 650,000 clinicians in the country. We today represent, ballpark, 5,000 of those. So there is a lot of white space and conversations for us to have with clinicians that are not yet part of LifeStance. And so our clinical recruiting team continues to get better every quarter. They continue to grow their capabilities and scale with the size of the company and the future growth needs of the company. So we feel really good about where we are and that we have a best-in-class organic recruiting engine.

Jamie Perse

analyst
#34

How has the pitch to clinicians changed as you've gone through this period of higher turnover, more competitive market for clinicians? I know you've added participation in equity as part of that. But how are you -- you've got a clinician who's on the fence. How do you get them across the board? And has that changed for you?

Danish Qureshi

executive
#35

Yes. So our value proposition to clinicians continues to resonate. When we started the company, we had a 6-point value proposition. We now have a seventh, which is the addition of the ownership mentality or their participation in the long-term incentive plan, which is new since we've gone public. And so that 6 -- now 7 points continues to resonate. We haven't had to really pivot off of that in any meaningful way. Every clinician regardless of where they are in their career, what type of provider they are, where they're coming from, something on that 7 points resonates with them and has continued to reinforce to us that we've really nailed it on that side and continue to have the pipeline that we need to grow at the pace we want to.

Jamie Perse

analyst
#36

You're slowing the de novo cadence to kind of accommodate some more telehealth. Does that broaden the pool of clinicians? Do some clinicians -- they just want to work from home. And maybe now going in this direction incrementally, does that broaden the pool of clinicians that can be attracted to your model versus requiring these clinicians to partially work in-person?

Danish Qureshi

executive
#37

Yes. I mean we've been hybrid now for not just the pandemic, but even prior to that and being able to offer the ability to flex between working from home, in office or a combination of both. And so we've always been open to all of those different scenarios. So it doesn't really change anything for us. Right now, the moderation of de novos is really to -- is really just a reflection of where the shift has been in terms of work preferences for clinicians and how many want either exclusively working from home, which, again, is an opportunity with us; exclusively in office, which continues to be an opportunity; or what the majority are choosing is the ability to move back and forth depending on the day of the week.

Jamie Perse

analyst
#38

Okay. Let's talk about the M&A funnel as well. Maybe just same question, give us some color in terms of what the pipeline looks like. Obviously, it's a very fragmented market. So the number of larger opportunities, that's a question we get often. Just how many of those are there? Just give us a sense of what you're seeing in terms of pipeline.

Michael Lester

executive
#39

Sure. So we continue to have a very robust pipeline. We have a 10-person M&A team. That's all they do. We probably have a more accurate database of all the practices in the country than anybody else. So we've said we're going to moderate our M&A a little bit. We're going to spend between $50 million and $70 million this year. We spent, I think, over $100 million last year in M&A. So that gives us the opportunity to make sure that we pick the absolute best assets that are out there. There -- we sort of operated in a stealth mode the first 3 years that we started the company, and we acquired almost everything of any size out there. So that created a little bit of a barrier to entry to all these other private equity guys that are trying to get into the space and that there's nothing large to buy. So it's hard to get started. There's still a large number of 20-, 30-person groups, but there are very few 150-, 250-person groups.

Jamie Perse

analyst
#40

Okay. I think investors -- you guys have made the decision not to disclose the organic hiring versus the acquisitions on an annual basis. What's the rationale for that? And I ask just because it's central in all my conversations. I'm sure people just want to understand the -- what's driving growth.

Michael Lester

executive
#41

Right. So it was a couple of years ago, we reached that precipice where we started organically hiring more clinicians than we were acquiring. And that's been our long-term strategy all along. We used M&A to get the platform built and really get the growth engine started. And then we put the recruiting engine in place, and we recruit hundreds of clinicians per quarter now. As far as metrics, I'll tell you in 2021, our revenue growth contribution was about 50-50 organic versus inorganic. And our gross clinician adds was in excess of 60% organic. So we continue to have a very strong organic growth engine that can supplement that. Sort of at our whim, we can adjust what we want to spend from an M&A standpoint just because of the pipeline that we have really at any point.

Jamie Perse

analyst
#42

Okay. You've added 1,700 clinicians each of the last 2 years. Street's modeling about 1,000 or so this year. That's obviously our number, not yours. And when I use the elevated turnover, that maybe accounts for 200 or 300 of the difference. Is M&A the rest of that? And again, I acknowledge that's our number, not yours. But I guess the key question is, is the organic hiring trajectory consistent?

Michael Lester

executive
#43

You're correct about the M&A. And again, that we're modulating that to be $50 million to $70 million this year versus the $100 million last year. I'll let Danish talk about the organic trajectory.

Danish Qureshi

executive
#44

Yes. I mean, that's exactly right. I mean you have the impact of the labor market dynamic on retention and then our active decision to spend $50 million to $70 million in terms of acquisitions versus previous years that have been elevated beyond that. The organic engine continues to deliver the same or better every quarter and is very consistent in how it performs.

Jamie Perse

analyst
#45

Okay. Let's talk about the utilization. This has been another headwind. Just the mix of clinicians has -- is a little bit less mature today. How should we think about the tenure of clinicians going forward? And just expectations for utilization ramping into the back half of this year?

Danish Qureshi

executive
#46

Yes. So for our overall base of clinicians, they are truly spread across all tenures. If you kind of remove the limit over the fact that LifeStance as a company has really been only in place for 5 years and take into effect that clinicians have oftentimes been with the company "through an acquisition for longer," our average tenure across the entire clinician base is in the 3- to 4-year range. So it's pretty long, again, taking into account that LifeStance has only been around for 5 years. That being said, as we continue to accelerate the organic growth, and you've seen kind of the labor dynamic of the last year, there is a cohort -- a significant cohort that remains within kind of their first year or definitely within their first 2 years. And so as that cohort matures, we get them full -- to full productivity levels, which for us takes an average of 4 to 6 months, depending on whether you're coming through the organic side or inorganic. You'll continue to see productivity kind of lift there. The question is the balance between full time versus part time, geo mix of where they're coming on, where we have better rates in certain markets versus others. And so when we think about it, we're really looking at a revenue per clinician number and that stayed relatively stable at $160,000 to $170,000 on an annualized basis per clinician.

Jamie Perse

analyst
#47

Are there any stats you can give in terms of the percentage of clinicians that are not at maturity today and where we should be by the end of the year? Anything comparable?

Danish Qureshi

executive
#48

I don't think we have any information that we've guided towards of where that cohort is shaking out in the course of this year. I mean, as of today, where we stand, you're seeing about 30% of our clinicians within their first year. You're seeing about 25% of our clinicians beyond the 3-year point and then kind of the mix -- the rest in between.

Jamie Perse

analyst
#49

Okay. Just on compensation for clinicians, have you seen the market move at all in reaction to just the competition, the turnover? You guys are adding the stock-based compensation for your clinicians. That's a piece of it. But what's the risk that your compensation structure has to match the market and there will be headwinds there? What's the risk around that?

Danish Qureshi

executive
#50

Yes. So again, our clinician base has always been in high demand, and it's always been competitive. And we've taken that into account in all of our planning assumptions, both historically and for this year specifically. We feel like we've planned for the right level of that and are cognizant of that in both our conversations with clinicians and how we pass pay increases to them as well as our conversations with payers and how we are -- continue to see great lift there. All that being said, we don't sit on our hands and look for an annualized, gosh, what happened with the market and how do we play catch-up. We are doing constant reviews at the MSA level, so not even the state level, to understand are we offering competitive compensation, are we in the market, where do we need to adjust and where do we not need to, sort of being very dynamic there.

Jamie Perse

analyst
#51

If need be, are you guys willing to give up gross margin to attract more clinicians, stabilize turnover and just compensate clinicians at a higher rate?

Michael Lester

executive
#52

We haven't seen the need to do that at this point. When we implemented the long-term equity incentive plan at the beginning of the year, that wasn't in lieu of compensation. That was on top of their current compensation. So in a way, that was a raise in and of itself. So we feel confident in the way we've been modeling compensation today.

Jamie Perse

analyst
#53

Okay. The move to -- we've touched on this a little bit, just the move to slowing de novos in the back half of this year. What does that mean from a gross margin perspective? And you guys have described the business as being mostly variable costs. So how much fixed cost is actually tied up in things like rent or the infrastructure to support a de novo?

Danish Qureshi

executive
#54

Sure.

Monica Prokocki

executive
#55

Yes. So we definitely see opportunity to improve our margins, especially in the back half of the year by moderating de novos. Now that we view de novos as primarily real estate and are focused more on clinicians and clinician revenue growth, we have the flexibility to do that given the current mix of virtual versus in-person. We don't need 100% capacity. So we do expect margins to expand, although we haven't kind of guided very specifically as to that impact. About 20% of the center costs related to Center Margin are fixed costs, so things like leases and office admin.

Jamie Perse

analyst
#56

Okay. And is this a strategy we should assume continues into next year, just a slower cadence of de novo openings to accommodate more telehealth?

Michael Lester

executive
#57

I think that's right. I think we've literally been talking about telemedicine for 40 years. I think it really is here to stay. It's here to stay in a bigger way than before. And the clinical specialty that we're in lends itself to telemedicine more so than cardiology or dermatology. So I think we're going to see this. Again, we think long term, 50-50 is the right mix for us. So math says I can double the number of clinicians and keep the same physical footprint that I have today. We opened up de novos for different reasons. So the math doesn't work out exactly like that, but we need less of a physical footprint than we did pre-COVID.

Jamie Perse

analyst
#58

Okay. Let's talk about payer conversations. Obviously, there's inflation out there. Where does behavioral health rank in terms of priorities for payers? And taking your call relative to maybe the acute care setting, very large systems are also calling and asking for reimbursement increases, where does behavioral health rank? And what's your pitch to them?

Michael Lester

executive
#59

Right. So I think behavioral health has become -- it's come way up the list than where it was 5 years ago. And it's again because of the payers, members not being pleased with the network of mental health clinicians that the payer has in place right now. So we have good payer relationships. Some payers are more proactive about mental health than others. There are a number of payers that truly believe fully integrated mental health care into primary care will lower their overall medical care costs. So they could see their mental health utilization go up, which they don't like from that person's P&L standpoint within the payer. But the overall P&L improves because of the lower overall spend. So we have good relationships with payers. But I will tell you in an approaching 9% inflationary environment, that gives me permission to pick up the phone and call every one of them and have a rate discussion. And we're in the process of doing that.

Jamie Perse

analyst
#60

And I imagine there's a spectrum of just some payers paying below average, some better than average. You've got a ton of demand for your services. Are you calling those payers that are below average and canceling contracts or threatening that to move them up to the average given that you have such robust demand and can probably backfill?

Michael Lester

executive
#61

Sure. I'll let Danish talk about the payer strategy.

Danish Qureshi

executive
#62

Yes. So that's exactly right. As we look at it, we have over 200 commercial payer contracts. And so we look to do an annual review of all of them to understand where there's an opportunity to either bring them to average or above average and/or have a specific negotiation as it relates to that payer in that market. And so we're constantly going through all of them to try to understand where there's an opportunity. And it's not just about saying, "Hey, payer, give us more." It's about here are the reasons why LifeStance is the right partner for you. This is how we increase access for your members. Here is the value that we bring to the table that can be positive for your members. This is not just a approach with a stick. However, in the end of the day, payers that are below average are the ones that we are having the more kind of stern conversations with about. You are not keeping up even within your peers of other payers. And that puts us in a difficult spot of having to make a decision.

Jamie Perse

analyst
#63

Okay. Let's talk about things you can do internally to deal with this inflationary pressure. You're a growth company, you're investing in the platform, building for the future. How do you balance some of the key initiatives to build this infrastructure and capitalize on the opportunity in this environment we're in where profits are important to investors?

Michael Lester

executive
#64

Sure. I'll let Danish talk a little bit about that, but I'll start with -- we've essentially doubled the size of the company every year. So we've sort of gone through hyper-growth. And with hyper-growth comes some growing pains. So we're in the process of building the appropriate infrastructure and making sure that we're focused on building the company for the long term. We can't get distracted with a bunch of nonsense in the market. We're just heads down, continuing to build the company. We have an incredible patient demand. We have incredible ability to recruit clinicians. So we just make sure that we have the right infrastructure in place to have a very large scalable platform going forward. Do you want to add anything to that?

Danish Qureshi

executive
#65

Yes. So again, I've been getting out there and starting to meet with operations team members, clinical leadership as well as the clinicians themselves. We've seen consistency in that there are places where there are clear operational challenges that have been because of the fact that we have doubled in size every year since the start of the company in places that we want to make sure that we dive into quickly and we're building a scalable infrastructure for the future. At the same time, we're also identifying opportunities that are areas that we can go after that could potentially generate some positive returns as well. So we're in the process of looking to all of them, and we'll have some more color going forward. I think the key piece is we're looking at everything through a lens of managing capital deployment with profitability with growth. And we really want to look at all 3 to make sure that we are balancing appropriately all 3 of those things, not focusing just on one or the other.

Jamie Perse

analyst
#66

So how should we think about the incremental infrastructure you need to add to capitalize on the opportunity, just costs you need to add to the business to support your growth trajectory? And how should we think about operating leverage when you get to a point where that's more material than it is today?

Danish Qureshi

executive
#67

I think it's too early for us to give an answer on that right now. There are sort of 2 things that are happening: again, my transition into the COO role, which will help to kind of identify areas that we want to put investment into; and the other thing is our LRP process is underway right now. So we will have more information about that later in the year. But again, as we dig in with any company, again, that has had hyper-growth like this, there's going to be opportunities to improve operational areas or tackle operational challenges that may have not been paid attention to as we have grown as quickly as we can. But the good news is that there is an equal number of opportunities that we're excited to start to dig into as well.

Jamie Perse

analyst
#68

Okay. Maybe just quickly on the LRP. Obviously, I'm not looking for numbers. You won't give it anyways. But just a quick preview, what we should expect. Timing, should we think about January next year? As the calendar rolls over, you'll lay out a 3- to 5-year view on revenue growth and margins. Just what are the things you expect to give to investors?

Michael Lester

executive
#69

Monica?

Monica Prokocki

executive
#70

Yes. We don't -- we haven't given a specific time line yet, but around that time frame would be pretty reasonable.

Jamie Perse

analyst
#71

Okay. Last one for me. Stock-based comp is -- it's an important tool for young companies to attract talent. How do you think about utilizing that as one of the currencies to attract talent? And I know you've given guidance for this year, so there shouldn't be surprises there. But how do we think about your use of stock-based comp over the medium and long run?

Monica Prokocki

executive
#72

So we did guide, as you mentioned, to $190 million stock-based comp expense for this year. $160 million of that is related to pre-IPO vesting, and then $30 million of that is related to our 2022 LTIP. We expect over time as the pre-IPO stock vests for the overall stock-based comp expense to go down. In terms of the overall LTIP expense, it's very standard. We had third-party independent comp consultant provide benchmarking. And so we're right at the median there across various metrics. So we expect that to come down over time. But it's -- in the case of folks like clinicians, as Mike mentioned, that's in addition to their typical comp, so a way for them to build wealth and build an ownership mentality as part of the company.

Jamie Perse

analyst
#73

Okay. Well, I think with that, we're out of time. Mike, Danish, Monica, thank you so much.

Michael Lester

executive
#74

Thank you very much for having us.

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