NeueHealth, Inc. (NEUE) Earnings Call Transcript & Summary

I think we're going to go ahead and get started. Good morning, and welcome to Bright Health Group's 2021 Investor Day. Thank you to everyone joining us in person as well as on the webcast. Before we begin, we want to remind you that today's discussion will contain forward-looking statements under U.S. federal securities laws, including statements about our future performance. You should be aware that these statements are estimates only and are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations. A description of some of the risks and uncertainties can be found in the reports that we file periodically with the Securities and Exchange Commission. Except as required by law, we undertake no obligation to revise or update any forward-looking statements or information. During our presentation, we will also reference to non-GAAP measures including adjusted EBITDA. A reconciliation of these non-GAAP measures to the most directly comparable GAAP measures is available in the appendix of today's presentation, which can be found on the Investor Relations page of the company's website. We'll have 5 members of our management team speaking today. In terms of the agenda, we'll start with an overview of Bright Health Group's differentiated alignment model from our President and CEO, Mike Mikan. He will be followed by leaders of our 2 businesses: Simeon Schindelman, the CEO of Bright HealthCare; and Sam Srivastava, the CEO of NeueHealth. We'll then take a brief break before hearing about the strides we have made in our product and technology foundation from Jon Porter, our Chief Product Officer and CEO of DocSquad. Finally, our Chief Financial and Administrative Officer, Cathy Smith, will provide an update on our recent performance including our 2022 outlook and discuss the capital raise we announced yesterday afternoon. The presentation will be followed by about 45 minutes for Q&A. And we expect to wrap around 11:30. With that, I will turn the presentation over to CEO, Mike Mikan.

Thanks, Steven. Good morning, and welcome to Bright Health Group's Investor Day. We're excited to share with you the progress we've made in building our fully aligned and integrated care delivery model. Bright Health Group has grown rapidly since we first started selling individual and family plans products in Colorado in 2017. Since then, we've added significant scale to our Bright HealthCare business through strong organic growth and strategic acquisitions. We've also established our NeueHealth care delivery business and expanded our own clinics to 5 markets while supporting Bright HealthCare with high-performing networks with our care partners across 17 states. Both businesses are backed by significant investments in our technology platform. Our model delivers the best results clinically and financially in the markets where we have full alignment between our businesses. And today, you will hear from our team the ways in which we continue to scale and optimize this model. We're just starting to realize the full potential of our differentiated model, and we're excited about the future of Bright Health Group. Our mission is central to what we do at Bright Health Group, making healthcare right, making healthcare right together is built on the belief that by connecting and aligning the best local resources in health care delivery with the financing of care, we can deliver better outcomes at a lower cost for all consumers. Bright Health Group is building a truly unique model that we believe will transform how health care is delivered. We believe when health care is delivered in a fully aligned integrated system of care, we can bend the cost curve and, most importantly, enhance value for both consumers and providers. We believe Bright Health Group is well positioned for continued success in the future. Over the past 5 years, we've gone from serving 10,000 members in a single state to serving over 700,000 members across the national footprint today while simultaneously building our differentiated NeueHealth care delivery business. In 2021, we demonstrated the strength of our fully aligned model and are actively expanding it by growing the number of risk-bearing affiliated providers and extending our own clinic footprint to 3 states. In 2022, we're reaching the next phase of our evolution, where we expect to realize the full potential of our fully aligned and integrated care delivery strategy. We continue to expect strong growth through our focus on areas where we can demonstrate the greatest impact. This includes the consumer health care markets in the individual market exchanges and Medicare Advantage. We have expanded our footprint for 2022 and are now in the 5 largest exchange markets, where we will drive disciplined growth going forward with significant opportunity for market share gains. Core to our strategy is deep alignment of payers and providers financially, clinically and technologically. This includes not only alignment between Bright HealthCare and NeueHealth but also Bright HealthCare with care partners and NeueHealth with external payers. Our fully aligned model has delivered strong proof points, and we will continue to shift our business towards this model in 2022 and beyond. We expect to grow Bright HealthCare membership in aligned plans, add scale to NeueHealth to serve more patients with our strategic payer partners and continue moving our relationships with care partners towards the fully aligned model. We will continue to deliver rapid growth in our NeueHealth business. As I mentioned, NeueHealth will expand its relationship with Bright HealthCare, but NeueHealth also has significant opportunity to expand with external payers and through CMMI's direct contracting model. The NeueHealth clinics we are opening in preparation for 2022 and will have strong patient volumes out of the gate through the alignment with Bright HealthCare and will also benefit from capacity filled by contracts with external payers. The direct contracting model gives us an opportunity to address the 61% of the Medicare spending that is currently in fee-for-service model. We're excited to participate in this emerging model as well as any future government innovation programs where we see potential opportunities to take on responsibility for quality and cost. The NeueHealth business delivers capital-efficient growth and the potential for higher long-term margins relative to our health plan business. Overall, we remain confident in our model and believe our fully aligned, integrated systems of care deliver differentiated results. As you will see today, we have the team, capital and strategy to execute on our model. Here is a reminder of what Bright Health Group looks like as we go into 2022. We continue to expect 2021 revenue of $4.1 billion to $4.2 billion and as of the end of Q3, served 607,000 commercial consumers and 114,000 Medicare Advantage consumers in our health plan business. In 2022, we are operating across 17 states including 4 new states and offering IFP products in California for the first time. Our NeueHealth clinic footprint will extend to Texas and North Carolina and today, is approaching 70 owned clinics in 5 markets as we prepare for an influx of new patients in 2022. We have built a diversified business with breadth across both products and geographies. Simeon and Sam will go into additional details on the Bright HealthCare and NeueHealth businesses later in the presentation. While Bright Health remains a young company, we now have data on where we can drive results and are moving to a more focused and disciplined growth model. The first phase for the company was building the foundation for future growth. We established consumer-driven health plans across the retail marketplaces in IFP and Medicare Advantage, expanding this model from 1 state in 2017 to 13 states in 2020. We first offered Medicare Advantage in 2018 and our first special needs plan in 2019. We worked with care partners during this time to build the foundation for an aligned model of consumer health care. The next phase of our growth was establishing and scaling our NeueHealth care delivery business. We formally launched NeueHealth -- the NeueHealth brand in 2020, quickly reaching over 20,000 value-based patients. We started with NeueHealth clinics in Florida, serving both Bright HealthCare members and consumers from third-party payers. During this time, we also worked on transitioning our financial relationships from fee-for-service models to value-based contracting models where possible. Our NeueHealth business is already an emerging leader in taking on global risk for the consumer retail health care market. While we were establishing the NeueHealth business, Bright Health Group continued to grow quickly, and exceeded $1 billion in revenue in 2020, with over 200,000 health plan members across commercial and Medicare Advantage. 2021 has been a year of substantial growth for the company, reaching more than 700,000 health plan members and 170,000 value-based lives supported by our significant market expansion in Florida. We have meaningfully expanded our fully aligned model and demonstrated the proof point that our model delivers superior performance. The Centrum acquisition added materially to our own clinic model, and we grew the business by affiliating Bright HealthCare members to NeueHealth clinics. We expect 2021 revenue of over $4.1 billion. We are now positioned to realize the full potential of the Bright Health Group strategy. As we enter 2022, our footprint covers the 5 largest IFP states as well as very large Medicare Advantage markets. Going forward, we expect to focus on these states and look to increase market share where we can offer a differentiated model at a competitive price -- at competitive price points supplemented by disciplined geographic expansion within existing states. We also expect to grow NeueHealth by attributing a higher percentage of our Bright HealthCare membership to NeueHealth's fully aligned providers. The growth in NeueHealth external revenue from external payers and direct contracting will continue to diversify our business. More modest market expansion for Bright HealthCare with NeueHealth growing faster than the overall business and greater NeueHealth revenue from external payers will result in more capital-efficient growth. Given all the progress that I've discussed across our business, we are introducing expectations for 2022 revenue exceeding $6.3 billion. We will continue to progress towards scale of the business, giving us leverage on our operating expenses. And we expect to achieve breakeven enterprise adjusted EBITDA in 2024. We're excited about the positive momentum across our business and are pleased to have the support from key investors for our growth plans. Yesterday evening, we announced a $750 million fully committed capital raise and are excited to have the support of Cigna as a new strategic investor as well as the continued support of NEA, our largest existing investor. We expect the capital raised to close in early January next year. Cathy will provide additional details later this morning. We're pleased to welcome Cigna as an investor and see opportunities to work together as strategic partners, including collaboration around NeueHealth expansion as well as Bright HealthCare working with Cigna's Evernorth Health Services business. As I indicated earlier, the next phase of our growth will be more capital efficient as Bright HealthCare focuses on market share gains in existing states while NeueHealth drives differentiated performance as we continue to optimize our alignment model. Our top line growth will continue to deliver operating leverage and support our path towards profitability. And we continue to expect to reach adjusted EBITDA breakeven in 2024. Our model is built to serve consumers in retail health care marketplaces, including the individual exchanges, Medicare Advantage and other emerging direct-to-consumer models. We expect the health care market to continue to move toward consumer-directed health solutions including increasing Medicare Advantage penetration, growth of the consumer marketplace and employers shifting to models that enable employee choice. We also believe there is a growing trend with consumers and providers moving from traditional fee-for-service to value-based reimbursement models. We have strong conviction in our model that aligns the financing of care with the delivery of care. We believe our fully aligned and integrated care model, which is purpose built around the needs of the consumer, not the broad PPO networks of the past, is well positioned to address these market trends. Our Bright HealthCare business offers consumers health plans with a differentiated value proposition, combining competitive prices, leading consumer engagement and networks built around high-performing care partners. Bright HealthCare is also clinically, financially and technologically aligned with our NeueHealth business. The NeueHealth business incorporates our integrated system of care including our own clinics, fully aligned affiliates and our broader care partner network. The Bright HealthCare and NeueHealth businesses are connected technologically through the Bright Health Intelligent Operating System or what we call BiOS. The alignment between Bright HealthCare and NeueHealth is built to drive personalized care for consumers in the retail marketplace including through member and provider facing technology solutions. Jon Porter will provide additional details later today on our internal and consumer-facing technology platforms. While our model is built around the relationship between the consumer and their primary care provider, our integrated systems of care go beyond just the primary care setting, to support members in navigating care across all care settings. This is a critical differentiator. We believe the health care system works best when there is deep alignment between payers and providers. The core elements are clinical, financial and technological alignment. While there are differences in local markets, we believe these 3 key areas of alignment drive better outcomes for consumers. We're seeing proof points from our fully aligned model that show the success of our strategy and give us more conviction in expanding the model to new geographies. Clinical alignment means that we're collaborating with care partners to develop and operate joint clinical programs to ensure evidence-based practices are consistently followed. The highest level of clinical alignment comes when care is delivered through our NeueHealth clinics, which removes any friction between the health plan and the provider. Financial alignment is when Bright HealthCare is able to enter into value-based arrangements with care providers. These arrangements range from upside risk to full capitation, and we look to advance care providers over time to financial arrangements that include greater risk sharing. Technological alignment helps bring the clinical programs to the point of care for consumers and providers. The combination of BiOS and our DocSquad consumer-facing solutions drive better consumer engagement and better outcomes for patients. Our fully aligned model in Florida has demonstrated the benefit of clinical, financial and technological alignment with 21% lower inpatient admissions and 13% lower emergency department visits in the first 3 quarters of 2021. It has also resulted in a 22% relative medical cost ratio improvement compared to members not in the fully aligned model. These are just a few examples of the power of the fully aligned model. Our disciplined growth reflects greater focus across our businesses. The Bright HealthCare IFP footprint will, in 2022, include the 5 states with the largest addressable markets, providing meaningful opportunity for growth without the need for expansion to additional states. Our Medicare Advantage business will focus on the 5 states where we have a differentiated value proposition for consumers. We believe we will continue to grow Bright HealthCare membership faster in our fully aligned model, driving differentiated clinical and financial outcomes. And we will maintain pricing discipline with pricing reflecting our underlying unit economics, cost structure and the benefit of our alignment model. We expect NeueHealth to execute on the integrated systems of care performance in Texas and North Carolina as well as building on our success in Florida. NeueHealth is expected to operate approximately 70 owned clinics in early 2022, and we plan to expand our footprint to 100 clinics or more by the end of the year. NeueHealth will also continue to grow the network of fully aligned providers by preparing affiliates to take downside risk. In addition to the growth with Bright HealthCare, NeueHealth will diversify revenue materially in 2022 through new value-based external payer contracts and the participation in CMMI's direct contracting program for Medicare fee-for-service beneficiaries. We expect NeueHealth to drive profitable, capital-efficient growth through the clinic expansion and the diversification of revenue with outside payers. The growth of both Bright HealthCare and NeueHealth will be supported by our technology investments. We're in-sourcing critical pieces of our technology foundation and enhancing our consumer and provider-facing tools. We will continue to deploy tools for our fully aligned and integrated care delivery model. We also expect to generate operating efficiencies from integrating our acquisitions and centralizing support functions. Our target is for an operating cost ratio excluding noncash items of approximately 15% of revenue by 2024, supporting our plan for breakeven adjusted EBITDA. The investments we're making in the business and our disciplined growth plans position us for long-term success. We expect to deliver strong performance in 2022 and to see additional benefits as the business continues to gain scale and we progress towards realizing the company's full potential. Our 2022 Bright Health Group consolidated revenue expectations are for $6.3 billion to $6.5 billion of revenue, representing over 50% growth from our reaffirmed 2021 guidance. The 2022 revenue growth is driven by Bright HealthCare membership growth particularly in Texas and NeueHealth external revenue growth. And NeueHealth's 2022 revenue is expected to be approximately $2 billion before intercompany eliminations, with 1/3 coming from external sources. Sam and Cathy will provide additional details on the drivers of NeueHealth revenue growth. We continue to drive revenue diversification across Bright Health Group. We now have large businesses across risk-bearing care delivery, commercial health plans and Medicare Advantage health plans. We also have a health plan membership base that is spread across more markets, lessening the impact of regional trends in pricing or medical costs. In 2022, Bright HealthCare IFP business will be in states that cover 2/3 of the total addressable market. Our Medicare Advantage business is focused on 5 states where we have a differentiated offering. And our NeueHealth business is expected to have approximately 400,000 value-based patients in 2022 across Bright HealthCare and external payers. We have several tailwinds for our business going into 2022. We expect higher average member duration as the mix of returning members increases and we expect a more limited impact from in-year enrollment. This should drive better member engagement, more accurate risk coding and, hence, better risk adjustment performance. We also expect lower COVID-related medical costs in 2022 but expect ongoing COVID treatment and testing costs as the disease becomes endemic. We forecast less disruption to member engagement and health care utilization related to COVID, also a positive for risk coding accuracy and risk adjustment performance. We are confident in the power of our alignment model. We have increased the number of markets we are in and gain scale in key markets, which should lead to more predictable results. We continue to move toward the fully aligned model and expect approximately 40% of Bright HealthCare IFP members to be fully aligned with NeueHealth providers in 2022. We expect a fully aligned model to continue driving differentiated performance, and we will work to attribute more Bright HealthCare members into it over time, giving us confidence in the long-term trajectory of our business. So with that, I'll turn it over to Simeon Schindelman, CEO of our Bright HealthCare business.

Thank you, Mike. Good morning, everyone. I'll start with an overview of the Bright HealthCare business. Bright HealthCare is focused on the health care consumer retail marketplace primarily through Medicare Advantage and ACA exchange products. As of the end of the third quarter, Bright HealthCare served 607,000 consumers in our commercial plans and 114,000 consumers in our Medicare Advantage plans. We operate across 17 states. Among our 16 IFP states are the 5 with the largest number of consumers enrolled in ACA plans. Our Medicare Advantage business is focused on 5 states. We expect 4 of our states to make up greater than 75% of 2022 Bright HealthCare membership: Florida, Texas, North Carolina and California. These high opportunity markets increasingly leverage our fully aligned model driven by NeueHealth. In Florida, we built an exceptional business in 2021 when the vast majority of our current Florida member base joined us. In 2022, we expect our Florida business to be even stronger. Compared to 2021, a more substantial portion of our Florida membership will be made up of renewing members who selected Bright during the last OEP or during the extended special enrollment period and are choosing to stay with us. We also expect more Florida members to be managed by NeueHealth clinics and affiliates in our fully aligned model during 2022. We've had strong performance in member engagement during the fourth quarter and expect to continue to build on this engagement in 2022. The longer average member duration we'll have next year due to many more renewing members, along with increased NeueHealth management of our membership will support this momentum and contribute to better risk adjustment scoring accuracy. Our 2022 entry to Texas is off to a strong start, with open enrollment period membership for Bright HealthCare on a path to beat our internal target. Our Texas business will leverage our partnership with NeueHealth alongside growth with care partners. We believe that more than half of our Texas enrollment will be managed by NeueHealth clinics and affiliates in our fully aligned model. In California, we have a strong Medicare Advantage business with over 100,000 members, mostly in highly aligned care delivery models with providers taking both up and downside risk. We have now complemented our Medicare Advantage position by entering California's IFP market for the first time in 2022 also with providers taking risk. We expect to continue to grow our service area in California for Medicare Advantage and for IFP plans. In North Carolina, we have a strong IFP business, and we expect total performance to continue to improve as we partner with the NeueHealth clinics that are opening in 2022, work with NeueHealth to add affiliate providers and drive even tighter alignment with our care partners in North Carolina. In other states, we continue to refine and enhance our networks, shifting providers to more value and performance-based arrangements over time. We expect health care to continue to shift towards value-based care over time across our markets, and Bright HealthCare can be a catalyst for moving these other markets to value-based care arrangements. Bright HealthCare continues a focused and disciplined drive towards scale and predictability while expanding the depth and breadth of our NeueHealth partnership. We began selling IFP plans in Colorado working with our first care partner in 2017. This established our clinical, financial and technological alignment model and demonstrated that it would be valued by both consumers and providers. We then expanded from Colorado to new geographies adding care partners and growing our relationships with existing partners. This early phase further established our business and showed the flexibility of the alignment model to succeed in different markets and with different care partners, continuing to deliver high value to both consumers and providers. We then moved to expand and diversify Bright HealthCare. We launched our Medicare Advantage offerings in 2018 and significantly expanded our capabilities through the acquisition of Brand New Day in 2020 and then the acquisition of Central Health Plan in April of this year. These acquisitions brought us proven Medicare Advantage performance in important areas, special needs plans, in which Brand New Day is the nation's third largest chronic special needs plan payer; and in serving ethnic communities, where both Central Health Plan and Brand New Day have excelled. We also continue to expand our commercial business, reaching 11 states in 2021 and adding 5 new states for 2022. This expansion of our Medicare Advantage and commercial businesses has helped to diversify the revenue of Bright HealthCare across products and geographies. We have also partnered ever more closely with NeueHealth, validating the differentiated performance of NeueHealth's fully aligned model. Going forward, we are optimizing the business and expect more focused growth. We're now in the 5 largest IFP states and have meaningful opportunity to grow market share and, therefore, membership without adding new states. Growing within existing states has benefits for our medical and administrative unit costs, our operating expense leverage and capital needs. Increasing market share also will enhance the richness of our data, giving us even more strength to continually improve clinical and financial performance for members and providers. We also expect to have better medical cost ratio visibility as our business mix continues to shift toward retained members and new member growth leverages NeueHealth fully aligned providers and maturing care partner relationships. We will continue to expand and deepen the NeueHealth partnership. As NeueHealth grows, it's fully aligned owned clinic and affiliate footprint and as a higher percentage of our Bright HealthCare members are in plans that leverage the fully aligned care delivery model. We've built a Bright HealthCare business on 4 principles that are critical to the success of the health plan and that create an ongoing cycle of elevating the value we bring. Build on expertise is a critical starting point. We base our business on national expertise and local delivery. We have a highly experienced team of experts that understand our business well and understand fully the array of what's required to run a great health plan. Benefit design, actuarial analysis, pricing, risk management, regulatory relationships, clinical affairs, member and provider services, distribution and channel management, we understand all of it. We attract consumers with competitively priced plans that leverage our fully aligned model and our care partner relationships. Our clinical, financial and technological alignment allows us to customize plans to the local market, and those plans are built off our underlying unit cost structure. We utilize technology to personalize the clinical experience for our members and to build their relationships with a primary care provider and other care providers in a care team tailored to the individual member. Technology also helps drive clinical and financial performance at the care partner and Bright HealthCare levels. We use these insights to refine our offerings, attract more consumers with plans that respond to the local marketplace. As we gain scale, the data insights at each step allow us to improve our performance and continue to grow. Our commercial business has grown significantly, serving 607,000 members as of the end of Q3. This business will be operating in 16 states for 2022 including 5 new state entries. These 16 states comprise approximately 2/3 of the entire national U.S. IFP market. This means there is significant opportunity for growth within our 2022 footprint. Our IFP pricing continues to be disciplined. It reflects our network composition, provider partnerships, the unit cost structure within our provider contracts as well as the benefit of longer member duration for 2022. The expansion of our NeueHealth partnerships in South Florida, North Carolina and Texas for 2022 also supports our pricing in those markets. We evaluate our benefit plans and pricing each year based on market dynamics, any changes in unit cost structure, our experience in prior years and any other circumstances that may impact medical costs. For 2022, we have made rate changes in some of our largest markets with high single-digit pricing action in North Carolina and South Florida while continuing to deliver solid open enrollment performance. We've built strong relationships with consumers, care providers and the distribution channel, all of which support member renewals. Our IFP business benefits from our broad and deep partnership with NeueHealth, broad because we are substantially expanding the geographic areas and the proportion of IFP membership served by NeueHealth's fully aligned model, which we expect to reach 40% in 2022 through expansion with NeueHealth in South Florida and in parts of Texas and North Carolina; deep with NeueHealth in part because our benefit plans and other programs are built to encourage long-term, trusting, 2-way relationships between members and primary care providers; and especially deep because we are working so closely with NeueHealth to embed managed care tools and activities into NeueHealth's care delivery operations in order to drive even better clinical and financial performance. We continue to refine our customer acquisition strategy. Scale helps, but just as important has been earning member and channel and provider loyalty and support. This work has been delivering results. We're enjoying better-than-expected member retention and even gaining share in some of the markets where we do not have a price advantage. In many of our markets, more than half of our renewing members are selecting plans that are not the least expensive options available to them. Turning to Medicare Advantage. We have a very strong business with 114,000 members today largely concentrated in California. We're working to consolidate our Medicare Advantage business to one platform across both our acquired and organic MA businesses and have positioned accountability and decision-making with a single leader. We expect to see benefits from the combined business in both clinical and financial performance. For example, as we leverage our scale for national contracting with vendors but we expect to capture even more improvement from leveraging our best of performance, the best of our capabilities and leveraging our size in California as we integrate the platforms, we are currently doing this in areas such as clinical affairs, IPA management, provider contracting, distribution management, STARs performance and risk adjustment accuracy, all of which are benefiting from best of within our company. Our Medicare Advantage business is built on 3 focus areas. The first is our special needs plans, where we have scale in chronic special needs plans in California and expect to continue to grow in the dual-eligible special needs population. Brand New Day has proven success in serving the SNP population and growing that business. Known for caring deeply about members' health and providers' clinical performance, Brand New Day's model of working closely with providers, members and the distribution channel has been very successful. As I mentioned earlier, Brand New Day is the nation's third largest C-SNP payer. This is part of the best of performance that we are leveraging across our MA markets. The second area is our expertise in cultural competency in which both Brand New Day and Central Health Plan have demonstrated success. For example, today, 2/3 of Central Health Plan's members speak either Chinese, Korean or Vietnamese as their primary language. We serve them all with native speakers. Our approach goes beyond member services, and it includes benefit plan design, provider network composition, provider service and channel management. Our demonstrated success with cultural competency has given us the opportunity to go deeper in Medicare Advantage markets where we have care partners with language and cultural depth that supports long-term relationships with consumers. The third area of focus for our Medicare Advantage business is IFP agents in 4 of our 5 key MA markets. We also have commercial business, creating an opportunity for Bright HealthCare, our members and our care partners to continue our relationship as our members reach the age where they transition to Medicare. We expect this opportunity to grow as our proportion of retained IFP members increases as we build longer-term relationships with our members and as our care partners increasingly want to retain their relationships with Bright HealthCare and their patients through all stages of the patient's lives. We're using all these capabilities as we optimize our Medicare Advantage business. We're building the business in the 5 states where our growth focus areas have the greatest opportunity and where we have a differentiated value proposition for Medicare Advantage consumers, care providers and our distribution partners. Building alongside our established IFP business in 4 of those states has been and will be important. Even more important is our experience in special needs plans, cultural competency and provider delegation in California and our ability and our willingness to adapt all of those to local interests in other states. This has made us an especially attractive partner for providers that want increased accountability that may not be ready for full delegation or global risk. Early partnership results outside of California demonstrate that this works in each of our MA states. We are bullish on California and on how our acquired capabilities are beginning to bring new growth opportunities outside of California. Our Bright HealthCare business has grown rapidly since our first year offering IFP plans in 2017, approaching $4 billion in revenue in 2021. We have delivered solid MCR performance while adding a large number of new members every year. We expect full year 2021 Bright HealthCare MCR excluding COVID to be in the range of 89% to 90%, strong performance in a year impacted by the confluence of challenges we detailed during our third quarter earnings call. In 2022, we expect end-of-year Bright HealthCare membership between 875,000 and 900,000; revenue of approximately $5.7 billion; and a reported MCR between 85% and 87%. At the midpoint, these figures represent 27% membership growth and 46% revenue growth with the faster revenue growth driven by business mix and full year contributions from acquisitions completed in 2021. We're excited for the Bright HealthCare business in 2022. There are several specific reasons for this, which you've already heard from me and I will summarize now. We're seeing positive indications from AEP and OEP with membership growth above our internal expectations, supporting the revenue and membership forecasts we're providing today. This comes even as we increased pricing in our IFP business in certain large markets and as our MA special needs plan expansion outside of California remains in an early stage and has not yet had the opportunity for in-year growth. In 2022, IFP will benefit from business scale and focus as well as longer average member duration as the proportion of our membership that comes from renewals will increase meaningfully. We do not expect an extended special enrollment period such as in 2021, and our in-year enrollment will be relative to a larger overall membership base. The positive impacts of longer member duration include preexisting primary care relationships, more thorough clinical information, greater opportunity to engage with our members and, ultimately, getting more complete and accurate coding for risk capture and risk adjustment scoring. Our partnership with NeueHealth demonstrated strong performance from our fully aligned model in Florida in 2021 with proof points on lower utilization and medical costs. This is good for members and providers and, ultimately, for Bright HealthCare. We are excited to substantially expand this partnership in 2022 across what we expect to be our largest IFP states of Florida, Texas and North Carolina. And we anticipate 40% of our IFP business to be managed in NeueHealth's fully aligned model in 2022. Our Medicare Advantage business is being transformed by our 2 strategic California acquisitions. As we integrate the businesses, bring demonstrated and successful capabilities from California to other states and carefully adapt to local interests, this has made us a unique partner for providers and for the distribution channel outside California. And we believe it's a strong foundation for a differentiated and high-performing MA business. Early results building new partnerships outside California support this. Inside California, integrating the businesses and geographic expansion both give us strong opportunity to grow and improve performance across multiple dimensions. We expect lower levels of COVID utilization in 2022, allowing for better member engagement. We expect a normalized progression of member engagement through the year with an additional benefit from technology solutions such as our DocSquad platform. Better member engagement should result in improvements in clinical performance, medical cost management and risk adjustment accuracy. We're especially excited about the progress we've made and continue to make at Bright HealthCare. It is becoming a more mature and focused business, run in a disciplined manner with an expert leadership team. We are bringing strong value to our partners, and we're benefiting from expansion of our NeueHealth partnership. We continue to refine and optimize the business. We are focused on disciplined growth and expect to see more predictable and consistent performance as we begin to reach our full potential. I will now turn this over to my good friend and close business partner, Sam Srivastava, CEO of our NeueHealth business.

Thank you, Simeon, and good morning, everyone. I'll start with an overview of the NeueHealth business. Now NeueHealth is a leader in risk-bearing care delivery that is purpose-built for the retail marketplace. And as Mike has indicated, Bright Health Group, we focus on 'Make healthcare right together'. At NeueHealth, we believe this can be achieved through the transformation of how we deliver care. Done right, we can incent behavior change to improve access, affordability and the quality of care for all consumers. As health care continues to be plagued with high cost, fragmentation, poor service and outcomes, there's never been a better way to be -- there's never been more need than to be able to address these trends. They've shaped the supply side-driven system, and they've really trended towards, one, the rise of retail and the 24/7 connected consumer; two, the shift from fee-for-service to a value-based delivery system; and three, the increase in aging and chronicity of complex populations. So this has all been accelerated by government program expansion in the individual, Medicare and Medicaid programs along with advancement in the adoption of new technologies to enable care. We believe NeueHealth is perfectly positioned to capitalize on these secular trends and market actions. We deliver differentiated capital-efficient growth through Bright Health Group, through our NeueHealth risk-bearing alignment model that is consumer focused, value-driven and market specific. As you heard from Mike, NeueHealth expects to have approximately 400,000 value-based patients in 2022 across Bright HealthCare, external payer partners and Medicare direct contracting. Next year, we forecast having approximately $2 billion in revenue prior to intercompany eliminations. And in NeueHealth, we -- our own clinic footprint has expanded to Texas and North Carolina, and we're approaching 70 owned clinics. And we intend to increase that number to over -- to approximately 100 clinics by year-end 2022. In addition to those own clinics, NeueHealth supports our Bright HealthCare business with comprehensive, high-performing care partner networks across our full 17-state footprint. This includes over 200,000 providers all working together in order to create a value-based care system. We're continuing to transition our Bright Health Care members to a fully aligned model. And as Simeon mentioned, we expect approximately 40% of Bright Healthcare's 2022 IFP members to be in this model. We're also growing our Bright -- our business on an external basis with payers, and this should be a meaningful expansion through our participation in CMMI's direct contracting program from a single state and the implementation period today to additional states with attributed beneficiaries once the 2022 performance year begins in January. With the growth of these relationships, we expect revenue from external sources to be approximately 1/3 of NeueHealth's total revenue. And as you can see, the power of the alignment model has accelerated our ascent as a national leader in risk-bearing care delivery. Now at NeueHealth, we're rapidly coming of age as market trends are fueling demand for our integrated care services. NeueHealth's early-stage development consisted of building out high-performing networks to support the Bright HealthCare business. We started our first care partner relationships in Colorado focused on a model that drove high-end network [ keepage ], increased care partner share of wallet and reduced overall cost of care. And in 2019 and 2020, we expanded the high-performing care partner networks to over 13 states while validating the portability of the model to local markets with varying levels of clinical, financial and technological alignment. In 2020, NeueHealth focused on building an integrated system of care that was anchored by 3 owned clinical delivery capabilities. Through July 2021, we completed 3 acquisitions to establish the foundation of our payer-agnostic primary care offering. Our model serves people across their health and life stage including IFP, Medicare and Medicaid. In our high-performing networks, we also begin to help affiliated providers make that transition from fee-for-service to value-based care. During this time, we were able to demonstrate significant value and performance under the fully aligned integrated care model. And as we enter 2022, we're exporting and scaling the model by moving into new geographies, adding external payer relationships and continuing to build a risk-bearing integrated care system that includes our own clinics, our affiliated providers and high-performing care partners. These initiatives are designed to make NeueHealth a larger contributor to Bright Health Group's overall performance and to drive differentiated capital-efficient growth. Now NeueHealth specializes in the developing of curated, high-performing, value-based networks across our 17-state footprint. These networks are focused on an integrated system of care that delivers differentiated performance across the full continuum of care. This includes primary, specialty, institutional and alternative site care. And these are through in-person, virtual and asynchronous services. The financial terms with providers typically include some form of pay for performance, whether it be through quality incentives, professional capitation or upside gain sharing against a total medical cost target. This delivers good performance and may be ideal for select markets where providers are not yet ready to take full responsibility for the total cost of care. And now the best results come when providers are in a fully aligned model. This combines the power of, one, NeueHealth's own risk-bearing clinics; and two, our risk-bearing primary care providers who utilize NeueHealth's Health's platform and tools to manage population health. These providers are compensated based on their performance against an overall medical cost target with both up and downside opportunities. This more advanced alignment model incents investments in tools and allows us to leverage data to be able to engage patients across the continuum and navigate services to the most effective and appropriate care setting, whether that be inpatient, outpatient, in office or even at home. It allows us to successfully increase patient engagement, ensure quality gap closure, accurately risk code and manage the total cost and quality of care on a real-time basis. Our fully aligned model in Florida has demonstrated strong results. When measuring performance compared to Bright HealthCare's other Florida IFP members, we've seen 22% increase in relative MCR performance, 21% lower inpatient admissions and 13% reduction in emergency department visits. Our Medicare Advantage-focused clinics in Central Florida have also continued to demonstrate strong MCR performance. Across IFP and Medicare populations, the model has delivered expanded access to care and a better experience, with Net Promoter Scores in the 80s. We continue to expand our fully aligned model and expect strong growth in attributed Bright HealthCare IFP membership. We expect Bright HealthCare consumers in our fully aligned model to increase from approximately 130,000 lives in 2021 to 290,000 lives in 2022, a full 2.2x increase year-over-year. So with that overview of our business in mind, I'd like to show you a quick video that will help us bring to life how NeueHealth supports patients at our clinic. Go ahead. [Presentation]

So as you can see with the video, NeueHealth clinics are designed to deliver personalized, evidence-based care in an environment that is supportive to our patients across their health and life stage. I am very proud to have over 1,000 NeueHealth associates working hard every single day. We have a deep and experienced leadership team and a talented group of clinicians, pharmacists, dentists, radiology technicians, medical assistants, transport drivers, coders, care managers, network developers and more. They wake up every single day with one objective in mind, and that is to provide our patients with the best possible care. We've discussed how the health care delivery system today is fragmented, misaligned and built for that fee-for-service supply side of care. It's an expensive system that results in inconsistent and poor outcomes. I'd like to be able to convey how NeueHealth clinics as part of a fully aligned integrated system of care are fundamentally different from what you see in the market. First, our platform and model is value-based. We take the tools and capabilities that managed care plans use in population health management and embed them directly into the care delivery system. We have expertise in pricing, planned benefit design, clinical and quality programs, network development, care management and medical cost management. These are all, in effect, health plan capabilities that we bring to bear as we partner with payers and providers to drive performance and a better experience. Second, our risk-bearing clinics are purpose-built for the retail marketplace. That means we are multi-payer, multi-segment and multi-market. Unlike others who may be seniors focused, we serve all segments, including individual, Medicare and Medicaid, so we can maintain lifelong relationships with our patients. Also, what we have, we don't have a field of dreams where if you build it, they will come. Our clinics are a part of an integrated system that is built in concert with payer partners, resulting in better utilization of capacity and quicker paths toward profitability. And third, our clinic and our affiliated practices and our high-performing care partner networks are focused on supporting patient care beyond the clinic across that care continuum. We engage our patients throughout their care journey, whether they are healthy, at risk, acute or chronic, and across their care settings, whether that's in a primary, specialty facility or in home. We are managing our patient's entire longitudinal care journey. The best way to demonstrate that's through an example. In the initial stage of development, we work with our payer partners to support health plan benefit design, network composition, and collaboratively build clinical and quality engagement strategies. We take robust integrated data from health plan claims, from provider EMRs and from delivery system HIEs to design personalized outreach to our patients to establish care plans. We also confirm attribution. We assess health risk. We provide value-add benefits, and get patients access to primary care, in either the home, in the office, or virtually, which actually represents over 20% of our clinic visits today. Our multilingual clinical and support staff ensure patients and their caregivers understand the situation, treatment options and follow -- have key follow-ups. Once we've engaged our patients and built out a care plan, we coordinate follow-ups for diagnostics, lab and pharmacy services, all typically which take place in that located office. And through our non-emergent transport services, we can also help our patients get to their specialists to and from inpatient and outpatient settings if transport is a barrier. And the largest challenge in health care isn't really knowing if you have a problem, but it's actually doing something about it. So behavior change and next-step fulfillment of a team-based care plan is our core differentiator. And we curate these preferred high-performing specialty and hospital networks so that we can provide high-quality, low-cost care, supported in a shared data environment. We use our team of care navigators as well as smart care team members, like nutritionists, behavioral therapists, complex care managers and even housing specialists, to provide continued support for patients who require support well beyond the clinic. For our most complex patients, we even provide transport of meals and medications to their home. What all this means is that our integrated system of care, including our clinics, affiliated practices and our high-performing care partner networks, serve as a data-driven, evidence-based gateway to care, not a gatekeeper from care, like other models. We enable our providers to engage more patients beyond the clinic setting with a purpose-built, risk-bearing care delivery system designed for the consumer retail marketplace. The data and technology component of this model will highlight in more detail with Jon Porter. Now there are 3 strategic areas of focus for NeueHealth in 2022. The first is to expand our integrated system of care to new geographies with Bright HealthCare, supporting their IFP expansion in 5 new states, and advancing our fully aligned model of care in Florida, Texas and North Carolina, with our own clinics, our affiliated providers and our care partner networks. The second is to deepen our relationship with strategic payer partners. As we offer our risk-bearing fully aligned model to other payers, we intend to develop existing markets, but also move into new markets and build products together with them. This will provide revenue diversification and more density in the markets we serve. And third, direct contracting for Medicare fee-for-service beneficiaries will allow us to further diversify our product mix and revenue sources, while also providing long-term growth opportunities for a very large addressable market. So I'll go into each one of these in a little more detail. Our success in 2021 with our fully aligned model of care in Florida gives us confidence to expand it to new markets in 2022. We are always looking to improve the performance of our model, and we'll be focusing on optimizing our affiliate practice performance in Florida for 2022. And in Texas, we're entering the state with a tightly aligned partner in the form of Bright HealthCare, and we're providing strong patient volumes from the start. So as a result, we'll have 20 clinics ready day 1 to be able to support these patients. And in North Carolina, we'll be adding NeueHealth clinics and developing affiliated practices that complement our existing care partner network. We're targeting a total of approximately 100 owned clinics by the end of 2022. And we expect technology enhancements and the rollout of additional DocSquad solutions to improve our member engagement. NeueHealth will be able to support our affiliated practices as they transition to this fully aligned model. Our capabilities in data, technology and services, as well as our proven ability to drive clinical and financial outcomes will be a key to supporting these practices as they look to enhance performance under value-based care. Augmenting our own clinics with aligned affiliate practices is a capital-efficient approach to expanding our capacity and our service area. And we're continuously looking to refine the composition of our care partner network, and we'll continue to encourage Bright HealthCare members to utilize high-performing clinicians. As we gain scale in local markets, we will ensure that our care partner agreements reflect our ability to drive patient volumes and better outcomes. Our deep alignment brings value not just to Bright HealthCare relationships, but also with key strategic payer partners. We presently have managed care agreements with most major payers. However, we're targeting tight alignment with a few key national payers who will be willing to grow and develop together in our partnership with NeueHealth. The Bright HealthCare partnership has demonstrated NeueHealth value and ability to perform in a fully aligned model. It drives patient volume to NeueHealth care clinics. It reduces the time required for clinics to break even. And Bright Health Group as an enterprise, we have performance benefits from this deep alignment, with better care management and lower medical costs. Ultimately, the consumer wins with better experience and lower costs. The NeueHealth clinics have been payer agnostic from the start, and we're growing the external payer portion of our business. We focus on a few key partnerships, with the potential to expand to a national scale. And these external payers bring additional volume to our clinics and to our affiliated practices while driving additional revenue, with a limited additional capital need from our perspective. In addition to partnering with national payers, we're contracting with local and regional payers at our clinics. These partnerships also improve utilization in the clinics in a capital-efficient manner. The payer-agnostic clinics allow patients to maintain a relationship with their primary care provider, even if they switch plans. And we have that relationship with payers that span across individual Medicare Advantage, Medicaid and commercial products. Now we're excited about our newest opportunity, which is direct contracting in Medicare fee-for-service populations. Nearly 2/3 of Medicare spending is outside Medicare. This work represents a $440 billion addressable market that is relatively untapped. There are significant opportunities to better manage care for these beneficiaries in risk-bearing payment models directly with CMS. The DCE program is one of those, as it affords risk-bearing organizations the ability to directly manage beneficiary health, quality and cost in an aligned financial and clinical model. And at NeueHealth, we're well positioned to penetrate this untapped fee-for-service Medicare market and migrate patients to more tightly managed models as part of a continuum of services to our patient base. We've target -- we have a targeted approach centered around tightly aligned NeueHealth clinics, affiliated practices and our care partner networks. NeueHealth has 2 global DCEs that were approved by CMS. And we plan to meaningfully expand our participation in DCE in the performance year 2022 to cover multiple states. The direct contracting strategy aligns with CMS Innovation Center's long-term vision around accountability for quality and total cost of care. The benefit enhancements in direct contracting are similar to Medicare Advantage as they enable more responsive care and better total cost of care management. Strategically, direct contracting gives us the potential to better serve the lifetime needs of our customers. As our IFP consumers age into Medicare, they can move seamlessly into DCE or choose to transition into Medicare Advantage products. And while direct contracting model is a relatively new model, our approach is well designed to serve this segment and help drive lower costs. As the direct contracting program evolves, our risk-bearing model is well positioned to adapt, ensure durability and capitalize on the product adjacencies so that our patients can stay with NeueHealth throughout their health care journey. Now bringing these key growth drivers together in numbers, we expect to have significant growth in 2022, built on the strength of our alignment model. We're forecasting approximately 400,000 value-based patients in NeueHealth for next year and growing contributions from our external payers, including DCE. We expect strong value-based patient growth and additional growth at our NeueHealth offerings to drive significant revenue for next year. We're forecasting approximately $2 billion in revenue or 4.2x growth over our $475 million in 2021 guidance, excluding investment income. We expect approximately 1/3 of our $2 billion in revenue to come from external payers, including the contribution from DCE. We look forward to scaling and exporting our alignment model for 2022, while diversifying our revenue and product mix to become a more meaningful contributor to value creation for Bright Health Group. Our strong revenue growth comes in capital-efficient model that is highly visible to clinic utilization and growing contributions from our external payers. We expect to serve Medicare beneficiaries at scale in multiple states in 2022, with long-term opportunities in fee-for-service Medicare population. And we are increasing our revenue diversification, with growth in revenue from external payers and DCE. And we're excited about seeing the validation of this model from other payers. NeueHealth is supporting the expansion of Bright HealthCare into additional geographies through the expansion of our integrated system of care in new markets, including new clinics in Texas and in North Carolina. And we're expanding our partnership with Bright HealthCare through growth in the share of Bright HealthCare members in our fully aligned model. All of our efforts are to support the technology solutions that we bring to bear, including the deployment of DocSquad solutions in NeueHealth clinics to improve clinical capacity, increase consumer engagement and to create better overall consumer experience. NeueHealth has built a strong foundation with a high-performing network and differentiated care delivery capabilities. We've proven our fully aligned model with Bright HealthCare and are expanding our business with external payers. NeueHealth has significant runway to continue to deliver capital-efficient growth for Bright Health Group and -- while also diversifying our revenue base. We're gaining scale in our business. And we're confident in the long-term opportunity for NeueHealth to serve as a leader in risk-bearing care delivery in the retail marketplace. Thank you. So with that, we're going to take a 15-minute break. And Jon Porter will be back to talk to us about our product and technology story. Thank you. [Break]

Welcome back. I'm Jon Porter, Bright Health Group's Chief Product Officer and CEO of DocSquad. As Sam and Simeon outlined before the break, the integrated system of care is designed to give a different experience to our health care consumers. We use that word consumer word consumer purposefully. To us, they are not health plan members or doctor's office patients. Rather, they are consumers of our combined services. And working together in the integrated system of care, our goal is to give them a smoother experience. To deliver on this experience, our technology plan adheres to 3 key principles. First, we build our data platform around the consumer. Most organizations think they own a consumers' data. We believe the consumer should have control over their data. We have architected our data platform to be a shared asset that spans all Bright Health Group business units. Second, we build our consumer and provider experiences to strengthen the relationship between the doctor and the patient. There are only 2 essential parties in the health care transaction: the person seeking care and the person providing care. Our experiences seek to strengthen this relationship and remove the layers of complexity that get in its way. And finally, we build our administrative platform to support an integrated care model. Care financing and care delivery should work together to provide an efficient and coordinated experience to every health care consumer. We are halfway through a 3-year technology transformation, with strong results to show so far. The plan is being implemented in 3 phases. First, and most important, strengthen our technology foundation to support our future consumer, provider and administrative experience. Our rapid health plan growth was enabled through vended solutions over the first 3-plus years of our business. While this was the right direction at the time, we needed to strengthen this foundation and bring certain technologies in-house to support our long-term strategic ambitions. The second phase of our plan is to own end-to-end consumer experience, giving them a single point of entry to engage in their health care. A key to our integrated model is to meet consumers where they are. We must give them this singular experience and put them in control of their health care, instead of trapping them in the void between care financing and care delivery. And third, build and deploy tools to support our health plan and care delivery teams in offering a fully aligned and integrated system of care. Data transparency is an industry-wide problem and a constant source of pain for individuals as they use the health care system. We must empower our health plan and care delivery teams to work as one for the benefit of the consumer. Only then can we realize -- fully realize the integrated care model and deliver a superior experience to consumers. 18 months ago, we began this journey, and we have made significant progress against the plan. Starting in mid-2020, we began to invest in strengthening our technology foundation by consolidating our vended platforms and bringing in-house key capabilities that were important to our long-term vision. As the foundation began to take shape, we moved toward owning the end-to-end consumer experience early in 2021. We have taken an iterative approach to this, and I'll speak about that a bit later. We have made progress, and the results are measurable. Now as we enter 2022, our focus is on extending these foundational capabilities to NeueHealth to support its rapid growth. Because the application we roll out to our NeueHealth clinics are in the same platform as our Bright HealthCare staff, those clinics will immediately see a tighter alignment and ability to drive results that previously required data exchange. Here are just a few examples of the benefits NeueHealth will realize as we continue to roll out the platform. An alert currently for our health plan care navigation team that is triggered based on admission or discharge events identified in our data platform will be routed to the consumer's entire care team, allowing the care team familiar to the consumer to intervene without involving health plan staff. A practice staff member who gets a question about why a patient was billed for a certain service has the information available to them to answer the question in real time. Without the response, we see all too often in health care, you need to call your health plan and see why it is not covered. Practice staff will be alerted if an authorization is approved for a provider not recommended by the consumer's primary care provider, allowing the primary care provider to redirect care to the proper downstream setting. And a final example, a consumer overutilizing virtual care visits on the platform can be routed to the care navigation team for outreach and scheduling of a proper in-person visit. We are at the halfway point of our 3-year transformation. And as of today, we have built an extensible end-to-end platform to support our integrated system of care. The second half of this transformation will focus on continued rollout and optimization of our platform to drive performance and efficiency as our care financing and care delivery teams partner together to improve health care. We call the platform the Bright Intelligent Operating System or BIOS. We approach BIOS in 3 distinct zones of work. At the core of BIOS sits our data platform. This consumer-centric platform holds all information we have about health care consumers from any of our connected systems. It was designed from the start for a multi-payer environment. This means that when NeueHealth providers view the data, they can see that data for all health plan partners. And when Bright HealthCare use the data, it contains data for all care partners. The 2 business units are working together on a shared and transparent data asset. On top of our data platform sits our administrative platform. This contains integrated third-party systems as well as Panorama. Panorama is a proprietary set of administrative workflows that are designed to support our consumer and provider service teams, our clinical operations teams and other support staff across both NeueHealth and Bright HealthCare. Because these administrative experiences are built on the same platform and supported by a combined data asset, there is no latency or opaqueness of data between our care financing and care delivery businesses. This is an important concept in giving the consumer an experience where their health plan and health care provider are working in concert to support their needs. And finally, our consumer platform is designed to bring experiences to the 2 people that really matter in health care: the consumer of the service and the clinician providing that service. And like our administrative platform, the experiences we build for health care consumers and for the care team that serves them are supported by our shared data asset. This means, as we roll out new functionality to help consumers interact, the data generated from those interactions can be used to improve their experience as well as their outcomes. 18 months into the build, we have made tremendous progress and are already seeing results that surpass our expectations. But truly, we have only just laid the foundation. The second half of the 3-year plan will see us continue to implement these capabilities, optimize our rapidly expanding NeueHealth business, and continue to iterate our development based on feedback from our consumers and providers. Now let me dive a bit deeper into the progress we've made in each phase. Before our focus could turn to strategic experience builds, we needed to invest in strengthening the foundation of our technology platform. Our investments over the last 18 months have allowed us to migrate key infrastructure that we use to support our business, in-source important enterprise systems and invest in our consumer-centric data platform that is foundational to our strategic experiences. We standardized key infrastructure while in-sourcing the internal systems our employees use to support consumers in Bright HealthCare and NeueHealth. We grouped these systems into a proprietary administrative workflow called Panorama, which was built to support our patients, member and provider service teams, our network design and management teams, as well as our clinical operations teams. By leveraging unified data from our data platform, we ensure everyone across the continuum is working off the same information. Some of the milestones we have achieved include: completing the in-source of our sales call center platform; we were able to eliminate the costs associated with a third-party vendor; as well as provide an optimized experience for our call center staff. Over the course of October, we handled over 5,000 sales calls a week on Panorama. Driving a better experience that scales is critical to our growth. Additionally, we completed the build-out of our network design and management teams system. This was an important step to move this to Panorama in order to standardize performance. As of this summer, all contracts and related terms are captured for use by downstream systems, allowing decisions, such as provider search recommendations, care navigation outreach, clinical consultations or any other interaction, to take into account contract terms. Our general service and clinical teams are handling thousands of cases each week in support of our customers. The technology upgrades we've made have resulted in significant time savings for these teams. We have saved hundreds of hours through automating tasks, reducing follow-up phone calls and streamlining internal reporting. The systems are also driving improvements into our referral process and increase in care management engagement opportunities. And as we have turned the focus to optimizing the platform for our NeueHealth business, our development is benefiting from our existing knowledge base, reusing components previously built and deployed to our health plan teams. In addition to building foundational platforms, there was a need to invest in the infrastructure core to running our business. While this might not feel strategic, it is an exciting and critical part of the foundation necessary to grow and scale our business. We are well underway on implementing a modern, scalable human resource information system and ERP system. Included in this implementation is the integration of our acquisitions into those systems, a process which will be completed over the course of the first half of 2022. We have integrated clinical claims and other financial data from our vendors and acquired companies into our data platform. This enables us to consolidate reporting systems and analytic platforms around a single data lake, and is a prerequisite for a consolidated ERP systems and for the management of our business. We have standardized and consolidated security, authentication and networking capabilities, along with our core employee productivity tools. And finally, we have put in substantial effort to consolidate our telephony platforms. For much of the foundation work, our initial focus was geared toward Bright HealthCare as NeueHealth was early in its growth when we kicked off. However, everything we built as we strengthen our technology foundation, we did with a multi-payer operating environment in mind. With each asset we build, we see our velocity pick up as we can reuse components in other parts of our platform. This foundation will enhance our ability to meet the rapidly evolving needs of our NeueHealth business unit. To that end, we are bringing NeueHealth service operations onto Panorama so that consumers interacting with NeueHealth owned and affiliated practices can benefit from the unified data and workflow that is already improving the experience of members interacting with Bright HealthCare staff. Investing in a strong foundation was important not only to sustain our continued growth, but also to enable investment in strategic experiences that drive performance across our business. As we began to achieve key milestones on our technology foundation, we turned our attention towards owning the consumer experience. Our first focus was to in-source our health plan member hub. Not only was the outsourced experience a variable cost, but it allowed us no direct control or interaction with our members. We began this effort in earnest in the last quarter of 2020. We started with simply owning the log-in experience and launching our own member rewards platform embedded into the third-party hub. Our rewards program was the initial focus because we needed a way to make early contact with our members. As Simeon outlined earlier, nearly 9 in 10 Bright HealthCare members as of the end of Q3 are new to us in 2021. This means we often don't have as much information on them as would be ideal. Our rewards program, launched in early 2021, was successful at giving us an early connection point with these members. Nearly 1/3 of all active IFP members are enrolled in the rewards program. We have seen a steady rise in this penetration throughout the year. Of those enrolled, 97% both selected a primary care physician as well as filled out a health risk assessment. We've also launched a revised health risk assessment in the second half of the year, which allowed us to uncover significant additional care gaps and data that support us in accurately capturing the risk of our population. Having this technology in place as we enter 2022 will give us a head start on ensuring we understand our members' needs earlier in the year and get them in for visits they need to support their health conditions. And because this information is all stored in our data platform, it is available to NeueHealth as they serve their patients. We used the momentum generated by our rewards program to drive adoption in our next experience, our member portal. We launched the portal on June 30 for all Bright HealthCare members. As of the end of November, over 160,000 consumers have active accounts on the member hub. When surveyed, over 95% gave positive feedback and said the portal was easy to use. Additionally, members surveyed through the portal that are enrolled in rewards have an 18% higher NPS score than those of non-enrollees. Our portal activity will be used to drive adoption of our next consumer experience, DocSquad. DocSquad is an experience designed to be a consumer single point of entry for all health care needs. As of today, it allows the consumer to find care, build out their care team, understand their insurance benefits as well as conduct virtually to doctors on the platform, including their own. We did a pilot launch in the first half of 2021 and are preparing for full launch in early 2022. We are excited about what this platform offers to consumers. We are seeing over 60% of all visits handled fully asynchronously, meaning the consumer is not wasting any time for a provider to respond. When the consumer does need to be seen by a doctor virtually, they experienced an average of wait time of under 4 minutes. We can deliver these visits in all 50 states at a price of less than half of a traditional telehealth provider. And when we show a member hub user that DocSquad is available to them, 4.8% of the time, they download it and begin using it immediately. We are excited about quickly driving usage by opening up the funnel and prompting all Bright HealthCare members and NeueHealth patients to use DocSquad. Remember, one of our key principles in our technology strategy was to strengthen the relationship between the consumer and the provider. The DocSquad virtual care capabilities are designed with that in mind. A consumer can connect to their doctor if that doctor is on the platform, and DocSquad is free to use for any clinician. Although we provide doctors to support all health care consumers, our goal is to route the consumer to the doctor they know. This routing is already live at some of our NeueHealth clinics. And we will continue to roll it out to all NeueHealth managed providers as well as make it freely available to other providers in 2022. Again, this is a critical component to adhere to the principle of strengthening the relationship between a consumer and provider. Instead of adding staff in front of a consumer's preferred provider, we enable an efficient experience for the consumer to connect to their preferred provider. Because nearly 2/3 of visits on the platform are fully asynchronous, the average clinical time spent per encounter is less than 2 minutes. No more blocking a 15- or 30-minute time slot for something that can be handled in seconds. Now let me show you a quick demo of what DocSquad looks like today. [Presentation]

Not a cup of coffee. [Presentation]

100% of what you saw is live and available to all Bright HealthCare members today. We did a controlled launch to Bright HealthCare members beginning in October to test different parts of the app and to ensure satisfaction. Beginning in late December, we expect to ramp usage as we continue to add functionality and expand to non-Bright HealthCare members. We are already working on several additional capabilities as we march toward our goal of creating a single entry point for all health care consumers. Areas such as scheduling, enhanced pharmacy cost savings and convenience features, continued expansion of clinical protocols as well as bringing more services to a consumer's home are all areas of focus in 2022. 18 months ago, we laid out an ambitious 3-year plan to advance technology as a strategic asset to enable fully aligned care. We are well on our way to achieving this goal. We started by building around the idea that a consumer deserves to own, access and dynamically utilize a complete picture of their health care needs. Constantly keeping the consumer in mind ensures that capabilities we are building improve the health care journey for both our members and patients. We have taken a purposeful approach to developing tools that reduce friction between consumers and providers, the 2 essential parties in any health care transaction. With NeueHealth, we are embedding value-added experiences into existing workflows to ensure data is accessible at the point of care, reducing the need for duplicative procedures and creating operational efficiencies. In addition, we are incorporating constant feedback to refine the experiences over time and increase adoption. While we began building tools for Bright HealthCare as NeueHealth has taken shape, we have extended our experiences directly into the clinics we operate in order to deliver on the promise of an integrated care model. Additionally, we have made great strides in strengthening our infrastructure, key internal systems and modern data platform. These investments are designed to create a best-in-class foundation and are necessary as we support both Bright HealthCare and NeueHealth's ability to deliver a consistent, predictable performance. As we look to the future, we continue to take a staged approach to our technology development, focusing on disciplined investments, with a clear value proposition, and ensuring that we execute against key milestones. Our technology and product teams are building a valuable strategic asset that will help Bright Health Group deliver on the mission of making health care right together. I will now turn it over to Cathy Smith, our Chief Financial and Administrative Officer.

Thanks, Jon. As you heard from the team today, Bright Health Group has expanded the business significantly since launching our first IFP plans in 2017. This is reflected in the strong revenue growth we've generated, with 2021 revenue forecasted to be between $4.1 billion and $4.2 billion. In our press release this morning, we also introduced 2022 revenue guidance of $6.3 billion to $6.5 billion, as we continue to drive disciplined growth in both of our businesses. Our next phase of growth will be more capital efficient expansion of our business and will leverage the benefits of our fully aligned model. We are encouraged and humbled by the significant growth our business continues to generate. We continue to exceed our internal expectations, driven by strong Bright HealthCare membership growth, as consumers entrust us with their health and well-being. On top of our significant 2021 ACA open enrollment growth, we grew in-year new IFP members every month this year through November as a result of the extended 2021 special enrollment period and our differentiated consumer value proposition. Our Medicare Advantage business has also grown in-year, driven by new members added in special needs plans and the acquisition of the Central Health Plan. Year-to-date, in 2021, over 80% of our membership growth was organic. Including our new 2022 states, we're now in the biggest markets nationwide, and are making great progress diversifying our business to serve all consumers. We've also seen NeueHealth prove the strength of our fully aligned integrated systems of care. NeueHealth significant growth in value-based patients is due to both the acquisition of Central Medical Holdings as well as the strong organic growth with Bright HealthCare and other payers. We believe growth and diversification are essential for long-term sustainability, predictability and durability. With the maturation of the company should come more consistent and predictable performance. In the early years, we focused on aggregating consumers to get the attention of the delivery side of the health care equation, always with the consumer at the center and aligning with our care partners. Bright HealthCare tested, iterated, and began expanding and diversifying products. More recently, Bright HealthCare has added new geographies, including some of the biggest health care markets. Equally important, NeueHealth has demonstrated the power of our fully aligned care delivery with financing of care. By embedding care management and navigation into the delivery system, connecting consumers with their care providers using data and technology, NeueHealth drives differentiated performance. As we move into this next phase, our company is coming of age. We're focused on disciplined growth in Bright HealthCare, going deep in existing markets as we approach 1 million health plan members. NeueHealth will grow and diversify our business through capital efficient means. We expect that Bright Health Group's scale, diversification and fully aligned model will yield more consistent, predictable results as we move toward our target of enterprise adjusted EBITDA breakeven in 2024. Turning to our year-to-date 2021 results. Compared to the first 9 months of 2020, our revenue increase of 262% reflects a strong membership growth, including the contribution from SEP. Year-to-date, Bright Health Group revenue through the third quarter was over $3 billion. Year-to-date MCR of 90.3% compared to 81.6% in the prior year period. And as a reminder, COVID costs impacted the year-to-date 2021 MCR results by 420 basis points versus 290 basis points in 2020. We continue to make progress on our operating cost ratio, with a year-to-date ratio of 25.4%, reflecting a 540 basis points improvement compared to the first 9 months of 2020. We are seeing a benefit from top line growth in our operating expense leverage, partially offset by broker commission expenses associated with the new member growth. As we've shared before, we are at the peak of inefficiency as we consolidate our systems and processes. Our year-to-date adjusted EBITDA declined to a loss of $291 million from a loss of $81 million in the prior year period, but was a similar percentage of revenue in both periods. For the full year, consistent with our most recent guidance, we're expecting full year revenue to be $4.1 billion to $4.2 billion. We expect MCR to be 92.5%, plus or minus 50 basis points, and adjusted EBITDA loss to be between $550 million and $600 million. Overall, despite the headwinds to our business in 2021, we continue to see the power of our fully aligned care delivery model in action, as it improves our ability to onboard and care for new members and manage through the challenges of rapid membership growth. We have a good book of business, with underlying medical costs in line with our expectations. Our integrated systems of care provide a significant advantage compared to traditional networks and highlights why we are deploying this approach in our largest, fastest-growing markets. Our deep understanding of the pain points in health care and our model connecting the financing of care and the delivery of care enable Bright Health to access a greater share of each dollar spent in health care. Our Bright HealthCare business aggregates consumers and is positioned to receive a greater share of the health care dollar from the government and from other individuals. This increases our revenue opportunity and enables vertical integration with the delivery of care. Yet this business is subject to regulated margin requirements, and we have long-term targets of mid-single-digit adjusted EBITDA. In contrast, through our NeueHealth care delivery business, we capture care delivery revenue in value-based arrangements with payers, both Bright HealthCare and external payers. This is a mutual relationship where we are rewarded with the financial benefits for the outcomes we drive, we work to deliver high-quality care and avoid unnecessary utilization, and we enable and support providers as they enter value-based contracts. Long term, we are targeting double-digit adjusted EBITDA margins at NeueHealth, when you blend together Medicare Advantage and IFP risk-bearing care delivery as well as our services contract and our opportunity in direct contracting. Importantly, our risk-bearing care delivery provides EBITDA margin expansion. In total, we are targeting near double-digit combined adjusted EBITDA margins, the achievement of which would differentiate us from the other solutions in the market that only address a part of the problem. As we look to 2022, NeueHealth is expected to rapidly grow, building on 2021's successes. Value-based patients are expected to expand 135% year-over-year, driven by continued partnership with Bright HealthCare, additional external payer relationships and our participation in the direct contracting program. Segment revenue is expected to grow even faster at over 300% due to a full year of Centrum contribution, continued growth in Florida and Texas with Bright HealthCare, new external payer relationships and the direct contracting program. NeueHealth's revenue drivers have different margin profiles worth mentioning. When NeueHealth serves Bright HealthCare and external payers, EBITDA will approach double-digits over time. The direct contracting program is a new innovation program serving Medicare, the Medicare population, and long-term, could be strategic for a number of reasons. However, given the program's newness, we're taking a conservative approach and assumed breakeven margins in the near term. Given NeueHealth's diverse revenue streams, each having a different contract structure and margin profile, segment gross margin will be a better metric than medical cost ratio to measure the margin profile of the NeueHealth segment going forward. We introduced our 2022 guidance in our press release this morning. We expect Bright Health Group consolidated GAAP revenue between $6.3 billion and $6.5 billion, which is 1.5x our 2021 revenue guidance. Enterprise medical cost ratio is expected to be between 86% and 88%. At the midpoints of 2021 and 2022 guidance, this represents a year-over-year improvement of over 500 basis points. Our forecast for adjusted EBITDA in 2022 is for a loss of between $400 million and $500 million, which at the midpoint represents a 20% improvement compared to the midpoint of our 2021 guidance. Additionally, at the midpoint of our guidance ranges, our adjusted EBITDA margin improves from a negative 13.9% of our 2021 revenue to a negative 7% of our 2022 revenue. Finally, we expect an intercompany revenue elimination consisting of payments from Bright HealthCare to NeueHealth of between $1.2 billion to $1.4 billion. Let me provide some segment details. While we are still in the annual and open enrollment periods, Bright HealthCare performance to date is strong, and we expect total enrollment of approximately 900,000 members. We expect a more normal year in 2022, with much lower in-year enrollment and normal IFP attrition rates over the course of the year, partially offset by in-year growth in Medicare Advantage. Given these dynamics, we are forecasting 2022 end of year Bright HealthCare membership between 875,000 and 900,000 members. Additionally, we are expecting Bright HealthCare segment medical cost ratio to be between 85% and 87%. As I pointed to before, we expect NeueHealth value-based patients of approximately $400,000 and revenue of approximately $2 billion. This represents phenomenal year-over-year growth, driven primarily by the partnership with Bright HealthCare, our entrance into direct contracting and additional contributions from external payers. We expect approximately 1/3 of NeueHealth's 2022 revenue to come from external payers and DCE. Looking longer term, our goal is to achieve breakeven adjusted EBITDA in 2024. Key to achieving this goal is twofold. At the MCR and gross margin level, we're focused on growth and scale within existing states for Bright HealthCare and increasing contribution from NeueHealth. On a consolidated basis, Bright Health Group will drive predictable and consistent results. Over the next couple of years, we're also migrating to one operating platform, in-sourcing key functions that have previously been outsourced. We're integrating our acquisitions and transitioning our financial and people systems to common platforms. Lastly, we expect to see workflow efficiencies and process improvements, driven by our technology investments. We expect our operating cost ratio to decline over time with a forecast for approximately 27% in 2021 and 22% to 23% in 2022, and are targeting an operating cost ratio of approximately 15%, excluding noncash items, in 2024. Driven by the efforts I just detailed, we are confident in our ability to achieve breakeven adjusted EBITDA in 2024. As Mike shared, we are pleased to announce a fully committed $750 million capital raise, structured as a convertible preferred equity investment. The preferred equity has a 5% dividend rate, which will be payable in kind or in cash at Bright Health's election. The preferred equity is convertible into common stock at a price of $4.55 per share, representing a conversion premium of 25% to the 10-day volume weighted average price as of December 3. More details can be found in the 8-K that we filed today. We are also pleased to have Cigna join as a new strategic investor, with a $550 million investment. We believe Cigna's Evernorth capabilities and NeueHealth differentiated care delivery model create significant opportunities for mutual value creation. We are also fortunate to have the support of our largest existing investor, NEA, who contributed $200 million. NEA's participation represents continued support from our longest-standing investor, who has participated in every private and public financing since the Series A in 2016. With this additional capital as well as our nonregulated capital at the end of Q3 of approximately $500 million and our undrawn credit facility, we are in a strong capital position to continue to support our growth. And as we've shared today, the next phase of our business represents a more capital-efficient growth. We are optimistic about 2022 as we come into our full potential and move to the next stage of growth. We expect a more focused Bright HealthCare growth, complemented by strong new health growth and diversification that will drive consistent and predictable long-term performance. We expect continued strong growth in 2022, with consolidated revenue of over $6.3 billion, up approximately 54% at the midpoint of our guidance. NeueHealth is key -- is a key driver of our 2022 growth, with approximately 320% growth expected in 2022 or nearly $1.5 billion of year-over-year premium and services revenue growth. We are forecasting an improvement in our medical cost ratio of -- in 2022, benefiting from lower COVID costs, a higher mix of retained members, smaller in-year enrollment and expanded NeueHealth alignment. Our losses are expected to diminish in 2022 versus 2021. Increased scale, improved medical cost ratio, strong cost management and platform migration are expected to drive this performance. The capital raise we announced this morning supports our continued growth plans. We have established our business in all major markets needed to support our long-term growth. We've proven the success of our fully aligned model, and we will focus our growth on the markets that best leverage this model. We will continue to optimize our markets, portfolios and care partners to drive better performance. And NeueHealth will serve as a core differentiator for our business. We expect our focused growth model to support capital efficient growth at Bright -- both Bright HealthCare and NeueHealth well into the future. I want to thank you for your time this morning. And now I'd like to invite the leadership team back to the stage as we kick off our Q&A portion of today's session.

So what we'll do is we will -- we'll pass the microphone around, and I guess [ Lauren and Steven ] will identify. We'll take some questions for 30-40 minutes or so. If you wouldn't mind just identifying yourself. I think I know most of you, but it would be helpful.

Steven Valiquette from Barclays. Within the Bright HealhCare segment guidance, I think 85% to 87% MLR for next year, it's obviously encouraging you have a large percent of the membership blocked in with NeueHealth. Provide greater visibility on that, this 290,000 IFP members signing at NeueHealth for next year. Within that 85% to 87% MLR guidance, is there any additional color you can provide on the MLR assumption for that aggregate members tied to NeueHealth versus the members not tied to NeueHealth. Is there a pretty wide [indiscernible] between dose those 2 categorization? Just any color around that might help or if there's a similar, [indiscernible] it will be good to know that too, I guess. But any color?

Yes. I think the best way -- so without giving guidance to it -- that level of granularity, the way I'd probably frame it is, is the way we've kind of shown the difference of the fully aligned model in Florida versus the non fully aligned members. And there is a material difference between the two models, as we showed. It's about 22% improved favorable MCR in the fully aligned model versus the non-fully aligned model. I'm not sure I would say it's going to continue to be that far apart because I do think, over time, we will bring people more into -- as you saw that one slide that we had that showed fully aligned versus aligned, the fully aligned is when we have full upside-downside risk. So we're fully aligned with the providers. When you're just aligned, you have some form of relationship. It could be a gain share. They're just not comfortable with taking risk. And you get different performance in those models. So the more we can move people along the spectrum to fully aligned, the better we're going to perform. But we also know that by working-within our high-performing network, that, over time, as we share information with them, as we engage with them that they're going to perform better. So we are going to see a difference. Is it always going to be 22%? I don't want to commit to that per se because that -- but there is a material difference between the two. Josh?

Josh at Nephron. Two questions. The first one would be, looking at the integrated model from the Bright HealthCare side, what percentage of the Bright HealthCare payments to providers, that about $5.5 billion revenue, [ 86% ], what percentage of that is going to value-based care providers? And within that, how much of that is NeueHealth? And then are you giving full risk 100% capitation to non NeueHealth value-based providers?

Yes. So I'll try to answer it off the top of my head. But in the -- if you split out Medicare, the Medicare book of business and value-based arrangement, this is about 70% of our Medicare business is in some form of value-based arrangements. Principally, you know that, Josh, that's in California. So it's highly aligned as I think Simeon had said. And then in terms of the value-based arrangements, we do enter into value-based arrangements outside of just NeueHealth, and we seek to continue. We believe in the fully aligned model, that's not always where we're going to have control over the clinical delivery and what have you. So we want to partner with those that are willing to take capitation. So we do enter in with them. And I would say today, pretty much the fully aligned model is -- it's got to be around 40% of the -- [ right ] around 40% of Bright HealthCare's lives today are in value-based arrangement, principally in NeueHealth, but we are moving other business there as well. But starting with Medicare, which is mostly non NeueHealth relationships is value-based payments.

And then just my second question around the Cigna relationship now. And I'm just curious what services that Cigna provides, will you be using? I'm assuming $1 billion of drug spend or something like that. That seems like a pretty obvious starting point. And then conversely, how do you think about Cigna contracting with your capabilities on the care delivery side?

Well, I don't want to get too far ahead of the relationship. We're really excited to have Cigna as a strategic investor and as a partner going forward. We -- obviously, they're a world-class organization, steeped in managed care capabilities that our Bright HealthCare business can benefit from. Whether it's the pharmacy business, specialty networks, some of their MSO capabilities, all of those are areas that we're interested in exploring. But -- and then on the NeueHealth side, we're -- as Sam had pointed out, we're really interested in relationships with national payers to expand our business. So it's capital efficient for us. It's where -- throughput -- through with our providers is an advantage. And we want consumers to have a common experience. So whether it's a common experience in payers or a common experience in provider, nonetheless, it's common for the consumer. And so expanding our external relationships, including Cigna, potentially with NeueHealth, is an area of opportunity. But again, I don't want to get too far ahead of the relationship. It's early, but we're really excited about the potential of the partnership.

Michael Ha from Morgan Stanley. So as we think about the $750 million you raised in the capital position, your capital needs, both from NeueHealth and technology, I understand NeueHealth is very capital efficient. You're expecting 25 new centers next year. What's a reasonable expectation for kind of go-forward de novo center growth? What type of upfront cost? And what's the time line to breakeven? And then quickly on the technology side, as you kind of cost leverage to 15% operating cost ratio by '24, how should we think about the balance of capital needed to invest in technology versus achieving that cost leverage?

I'm sorry. I -- the first question, I think I got, but you're talking about specific clinics. What the investment is in them? And the timing to breakeven of a clinic?

Right, right.

Yes. So it's relatively -- I mean, compared to the capital costs that we're spending in technology and other things, it's relatively nominal. But a -- the benefit of our model is, as Sam talked about, because we're aligned to the health plan, we're building clinics based on expected demand with the health plan, starting with Bright HealthCare, but also with our external payer. So we're really building. And they're essentially full at capacity when they open up. So naturally, just as a result of that, they perform well out of the gate. So it's a high return on investment. They're generally profitable out of the gate. We don't look at -- we do look at, but we don't want to get into just an individual clinic profitability model because we look, as Sam talked about, the integrated system of care. And that includes our integrated clinics, our affiliate providers as well as our care partner network, all working together to control and manage the total cost of care of the consumers that we serve. And so it's a component of the model that we're building. And the -- like I said, we're building it for -- based on the capacity expected or the demand expected with our external payers so they're profitable quickly, with a high ROI. With respect to the operating cost ratio, do you want to answer that question?

So on operating cost, I think your question was, how do we think about the mix given our guidance and then eventually to a 15% type level by 2024? How much needs to go to technology investment versus maybe other? That's all contemplated in there. I think if you would see John and the team accomplish an amazing amount with, I would say, a very reasonable technology spend, I am sure we can always spend more, but I think we accomplished a great deal in there. And it's all contemplated in the guidance we gave.

Jeff Garro from Piper Sandler. I want to ask about risk adjustment for the IFP population. Maybe you could speak to some of the headwinds you experienced in '21 and how they'll turn to tailwinds in '22. And then to try to translate it into the guidance, where you're going to land on kind of gross versus net payments in IFP in '21, and what's forecasted in '22? And also in that, maybe discuss how visibility improves throughout the year and how that's contemplated in your guidance as well for that population.

Sure. Hopefully, I'll get all of that. And if I don't, one of you can jump in. But -- So this year was notably a challenge. And it started with the growth in Florida that was beyond our expectations. We built our clinic model to serve about 100,000 to 125,000 lives. We built an affiliate network around that, high-performing, not necessarily capable or out of the gate expected to serve 250,000-plus lives. So it's just the starting point of that rapid growth without recurring members put us behind the 8 ball, so to speak. That was a big challenge for us. And one of the reasons for that is the -- our model, as you heard us talk about, is really about attributing our members to a primary care physician and engaging them. We engage them through the rewards program. And we engage them through outreach member engagement through our providers. So getting them attributed, assigned and then communicated with their primary care provider is critical for us. We relate to that this year. And then just as we started to really understand the population we were serving, SEP started to kick in. We got a churn in the membership, added a bunch of lives, while COVID hit the Southeast literally about the same time period. And so our ability to not only attribute and get them engaged with their physicians, we just couldn't -- we couldn't -- we didn't understand the population fast enough. And so risk adjustment is all about member engagement. It's about proactive care with their provider. And so we got behind. And frankly, when we looked at our practices, the clinics that we own and manage, when we came out of COVID, we were able to ramp up the services significantly between inpatient, at home and virtual visits. Our network of physicians, we obviously don't have the influence over them the way we do with our own and managed practices. And so that was a challenge for us. So if you just take that in its totality, the confluence of factors that worked against us, we don't expect that same result going forward. Texas, this year, as Simeon said, we built the capacity for the demand of -- for what we expect in the marketplace. So between our owned and managed clinics and our affiliate practices, we're expecting the lives that we're forecasting right now. And so we're going to engage a lot earlier than we did this year. Our processes are better around attributing lives, engaging them. We've ramped up the consumer rewards. And so we expect a much different result. And then we won't -- we don't believe we're going to have the confluence of factors highly concentrated between SEP and COVID impact to the Southeast that we had. So Texas, we expect a different result. It's going to be challenging. Risk adjustment, we are planning for probably a higher payable than we expect the risk of the population, its first year. We expect that in every population, but we think it will perform better than it did in Florida. So then go back to Florida this year coming in, as Simeon talked about, we have higher retention. We've got a big base of business. We know the members and the patients. And so we're working with them. We can target them early on, so we expect better performance. So that's why we expect better. And we're doing that nationally in our other markets as well. So we expect better performance just relative as a result of those things. In terms of payable, this year, we're forecasting 24%?

Yes.

24% pay in this year and next year.

Yes. So existing markets improve based on our historical performance, and obviously, deeper engagement. And then in the new markets, as Mike said, we would say, we would estimate exactly where our historical performance has been for new markets, and we'll improve over time. We're more confident, obviously, with the fully aligned model.

Maybe one quick follow-up there. You just mentioned strong retention so far. I think I asked this on the last call, but I'll try to ask it again here. The enrolled population as of January 1, 2021, versus the SEP population, any difference in retention trends for those 2 groups?

If we take our membership and break it down into 3 elements, the 1/1/21 membership across the country, that was renewal membership. They've been with us before 1/21. That's kind of Group 1. Group 2, the 1/1/21 membership new to us on 1/1/21, and 3 is SEP. Those -- that's the way we think about retention. The very first one, those who renewed with us, if you go back about a month, we've kept 80%, 81%, 82% of those so far this year. So a little more than 80%. It's the high -- that's the renewals. If you go to Group 2, those who were new with us, we're at about very, very slightly below that number, maybe 79% retention on those. SEP members we're at about 90%, maybe 91% or 92%. All in all, we're very pleased with the year-to-date retention. And it's a little bit over 80% for renewals, just a tiny bit under 80% for new business and a little bit over 90% for SEP.

And I'd also say, just maybe expand on SEP, and I know there's a lot of talk about SEP. While we don't think there'll be an extended SEP program that we had this year; in-year enrollment, to some degree, we believe, is here to stay, and we actually think it's a good thing. Look, growing the exchanges, we think, is a positive. We look at our SEP business. There is the notion of pent-up demand for services, people gaining the system. Does it occur? Yes, it occurs. This year, what we saw, we didn't see as much pent-up demand for outpatient procedures. We saw pent-up demand for inpatient care. They were in the hospital, behavioral, whatever it may be. But over time, as we get to know the patient base, while we can't code a COVID case, we get to know their underlying conditions, the SEP population that we got is slightly younger, slightly healthier -- excuse me, than the population that we started with. So we're overall excited about the growth of the marketplaces as they mature. And whether they're doing it in-year or starting 1/1, we believe our processes, our clinical programs, our understanding of data and patient base will help us manage that population better. It's just early into the marketplaces. And so we favor it. And I just want to make sure we understand that SEP, while it was an impact to us this year, it was new to us, new to everyone. Everyone was impacted by it. It was a surprise. We don't think over time that it will be the same negative impact as it was this year.

[ Carl Sternick, JPMorgan ] So you talked about the 40% of IFP members being in the fully aligned model next year. Just in general, I mean, I think we're hearing a little bit more about providers taking risk on commercial lives. So just curious to see the appetite that you're hearing from payers and providers on taking commercial risk. And then related on the NeueHealth external payer growth, can you tell us a little bit about the population underlying that? How much is commercial, Medicare? And how much of that revenue is tied to risk base -- to value-based contracts?

Sure. So do you want to start with demand?

Sure. I think in terms of value-based care delivery, it's been around for a while, and there's been a slow onset. And only in the last few years have you seen a lot more kind of pivot towards that model as the government has embraced that as the component of primary payment model moving forward. And historically, we've seen a lot of demand on Medicare Advantage. And most recently, I'd say in the last 3 to 5 years, a lot of providers have shifted not really understanding the individual population. It's kind of grown. It's a population that can churn. It is unique with its risk coding. It's all done in-year relative beat. And the complexity of the population with behavioral health issues and transition is difficult for traditional primary care physicians to manage. So what we've seen is, if given the right set of tools and support, we've seen a lot of interest in that. If you talk -- I was just talking off the side that if you talk to any physician and they talk to their son or daughter, they say, please don't be a primary care physician. Because the challenge is, over time, the high level of administrative burden and the kind of reduced income is occurring. And a push to value-based beyond Medicare Advantage of predictable population towards the individual population is something that is growing in nature. There's been a lot more demand in. And so we've seen it's significant in every market, not just typically in the markets that have advanced risk-bearing care delivery. What they're looking for are tools to move from just capitation towards upside and downside gain sharing. So it's been surprisingly in all of our markets, and interest on the individual side, not in commercial, not just on Medicare.

So I might just add to it and say, we are seeing a trend of providers interested in moving to capitation outside of just the seniors marketplace. And the reason for that is, generally speaking, internists, they practice medicine 18-year-old to end of life. And so they're not just taking -- managing a population that's 65 and older, they're managing population that kind of span the gamut, whatever, you know what I mean, the whole spectrum. So we're seeing more doctors who are saying, look, I'm seeing 55 -- we talked about our population. About 25% of our population today within our IFP space is between 55 and 65. So it's a big portion of our book of business. And it's very attractive for us to -- for us, as we look at it from a business perspective, put aside the clinical side, we look at it as cost of acquisition and then the span of life that we hold them with us is part of our -- a part of NeueHealth or Bright HealthCare. So that's what we call lifetime value. So the longer we have them with [ it ], a better lifetime value for us. And so keeping them with their physicians, we know that, that primary care physician relationship and knowing that care team that they have, as they get older, that care team and that primary care physician becomes paramount in their life. We all know that. If you're a mother, you're a grandmother, grandfather or what have you, you've seen that. And so the more we can build those relationships early on as they age in, the better we're going to have the opportunity to serve them for a longer period of time. And so we believe that more and more doctors, and especially in the markets that have moved to managed care delivery risk business, more and more are saying, "I want to manage the 55-year-old, the 45-year-old in the same way I'm managing the 75-year-old." And they're doing it through managing unnecessary -- eliminating unnecessary procedures, unnecessary inpatient admissions, getting them to come into the office as opposed to ER and urgent care, building 24/7 capabilities like John is talking about with asynchronous and having virtual care and things like that. More and more, as tools have become available and more of the consumers using those tools, the more we believe that more doctors will move to value-based arrangements. So we're seeing that trend.

Great. And then if I could just ask one on the quarter. I think on the call, you guys talked about COVID costs subsiding and that you were looking for non-COVId utilization roughly in line with historical trends. Just curious if that's tracked to your expectations so far. And then what you're seeing, either in terms of Omicron, and how you're thinking about the potential impact in the quarter there.

Yes. I'm happy to take that. So I'm not going to give you an inter-quarter, intra-quarter update. But what I'll tell you is we did say through Q3, that -- and we said early indications where we were starting to see a subside after Q3, which we said in the call. And we've seen $124 million or so of costs through 3 quarters. And we had contemplated a little bit less than what we saw in the first -- individually, for the first 2 quarters and for the remainder of the year. So I would just say, I think we feel good, obviously, confirming our guidance today, that we've got that captured with what we've seen.

And then on Omicron, just too early to tell.

Nathan Rich from Goldman Sachs. Maybe first, could you maybe elaborate a little bit more on how much of the NeueHealth revenue will be from direct contracting in 2022? I know it's within the 1/3 of its external revenue. And also, how the economics for that program, how you see that playing out? And specifically, maybe how much visibility you have into the risk profile of the members that will be part of that program?

Yes. We are somewhat limited. Because we're in the implementation period, we got guidance from CMS, we are somewhat limited on what we can talk about at this stage. But maybe I would -- maybe you want to describe some of the different arrangements we have within DCE.

So we are limited, and we'll probably give more information in January when we get the information from CMS that we're allowed to share with you. So specifically, when we think about the DCE program, when we look at value-based delivery there, the opportunity there, we look into the first year of a very new program where CMS is taking a little bit of profitability off the top and looking for us to kind of manage the care. We're looking at breakeven for next year, and then kind of longer term, likely in the low single-digit in terms of margin profile and opportunity for DCE. But the real opportunity wrapped around DCE for us is the opportunity for our IFP members as they age in to an opportunity to continue to be able to manage the care and for that DCE population to be a bit of a landing page for us to be able to potentially migrate over to Medicare Advantage products for us as well. So we feel like there's product adjacencies associated with DCE. And as you look kind of multiyear, the program is going to evolve and change. And so our retail model focused on the continuum of care and low-cost and high-quality is really built well for DCE. So as the program evolves, and as CMS looks to drive levers to be able to improve care coordination, admits, readmits, quality, we're positioned well with a high level of alignment with our clinics and with our affiliated partners and our care partners to be able to continue to have a durable business with that moving forward. But again, new program. And we have an opportunity that our model is built for it moving forward to be able to be successful in it.

Do you want to just answer some of the different arrangements, gain share versus full risk? Just give an example of some of those.

So I'd probably I'll kind of bifurcate them into maybe 2 different types of arrangements that we have with the delivery system. One is where we're working with advanced IPAs and/or management service organizations, where they're aggregating risk on behalf of their primary care physicians. And in those cases, we have -- we essentially get fees. And we have the opportunity to have the upside gain sharing as they improve performance and they use our tools. But the downside risk there is taken by that advanced provider organization. So there are some entities like that, that we have. But the other entities are primarily individual provider organizations, PCPs, as well as our own clinics and our affiliated providers. And in those cases, we're essentially the risk-bearing entity, taking full up and downside risk and helping them drive performance. And in those cases, those providers typically have primary care capitation and they have incentives for upside as well as some incentives, in some cases, for downside as well. And again, it's -- you're bringing those providers along on a multiyear journey to be able to manage population health. So we see that as kind of getting to full capitation or full global risk over a period of a couple of business cycles with those providers.

So maybe I would just -- Thank you. I would just add that taking a step back and looking at the opportunities that we are excited about, we think more and more of the government, whether it's the federal government or individual states are going to partner with providers to manage the total cost of care and the quality of care among their consumers. So whether it's state Medicaid programs, going direct to providers or it's federal government, Medicare, with some form of alignment model, that aligns perfect to our care partner model. So whether it's our own and managed practices, where, as Sam said, we're willing to take full risk on that. We know how we perform. We know we form against benchmarks. We've got great data. We know the consumers or the patients. We're really excited about that. With fully aligned providers, kind of the same thing. We're willing to jointly take risk with them and manage population. As you go upstream into more independent doctors and less aligned, we're not as interested in taking full risk year 1, maybe over time. But regardless, we think we continue to see that. Not only are we seeing it in the commercial private sector, we're seeing it with the government, who are ultimately shifting providers into alignment models that are going to take some form of risk, whether it's full downside, global capitation. Maybe not in early years, but we do see that. And so that aligns perfect to our model, so we're excited about it. I'd also say with just respect to DCE, we didn't go into it with the idea that DCE was going to make or break our year or it's the future of -- we're excited about the opportunity. I would say -- to couch it, we took a methodical approach, a targeted approach with partners we trust. And we'll step in it before we jump into it. But we are excited about the CMMI innovation programs, what are yet to come. And so we're taking a reasonable approach to it.

That's helpful. And then if I could just ask a follow-up. You talked about moving to more capital-efficient growth. Can you maybe just talk about how the company is going to approach M&A going forward relative to what we've maybe seen in the past 1 or 2 years?

Yes. We don't forecast any M&A. We look at it as an opportunity. We're really not in M&A mode. As we kind of set out to build out, as Bob built the original -- the initial strategy around the care partner model, we knew there were certain things that we could organically develop. But there are also opportunities to add pieces of, call it, the equation or the puzzle through acquisition, if we could do it in an accretive way. And so we did that. We're -- we look at opportunities from time to time, but I'm not going to say we're M&A focused. We're really focused on disciplined growth, organic growth. And if something could emerge over time, if it was the right opportunity, the right capital allocation and gave us something that we didn't have, we would maybe consider it. But I wouldn't say, include it in your forecast model or anything like that. That's not really part of the way we're looking at the -- at least the near to midterm.

Just another question. Michael Ha from Morgan Stanley. So as I look at your membership guidance, I'm just trying to understand it. 900,000 lives, started the year flat, maybe down 25,000 by the end of the year. You're assuming typical attrition in IFP and partially offset by Medicare growth in-year. So typical attrition on IFP would be 20%, so maybe 100,000 lives. It would take a massive membership growth on Medicare to kind of bridge that. Is there any assumption baked in for Medicaid redeterminations, capturing those lives given your Silver Plan offering? It sounds like you're in a good position to potentially capture that. And also, if so, is there an MLR kind of component to that?

Do you want to take the...

If I got is less than 10%. So I think the part that you may have missed, if I kept up with the calculation was we're going to pick up IFP membership in year as well, absent Medicaid redetermination, absent the Build Back Better Act, which both present upside opportunities in membership, which are not counted in the 900,000. So our net is 10%, maybe a little less than a -- 10% atrophy in the IFP business. So it's -- that's probably going to be the part of the missing calculation or in what I think I heard you say.

But it's also 2 1 growth, right? So we're talking about 1 1 growth when. You grow into 2 1 as the exchange stays open, in the federal exchange, plus in Colorado, we're going to grow into February. And then you'll start to see net attrition. So that's how the math ends up getting in that range.

Yes, I did too. Yes. As I mentioned, neither Medicaid redetermination nor the Build Back Better Act are incorporated into the 900,000.

They're not incorporated in the guidance.

. This is Adam Ron with Bank of America. Kind of back to the capital efficient growth question. Related to that, I haven't heard you talk about Small Group or Medicaid on the Bright HealthCare side today, whereas previously, you mentioned it as an opportunity. So curious if you can expand on that. But just broader, is it fair to say that the messaging today around capital efficient growth is like a shift from the previous commentary? It seems like you're more focused on existing geographies, whereas maybe prior, you were talking about newer states. And if there's a shift in tone, is it related to the experience of COVID [ in ] 2021?

So why don't I start with the shift and then you want to talk about the small group and we can talk about Medicaid, our thoughts on it. I think our position ran the same on Medicaid. We see it as an opportunity. But we'll see as things arise or emerge, we may bid on certain contracts in certain states and what have you. But why don't you start with small group so?

Sure. We have an employer business. It's modest. It's not only small employers. It's also midsized employers. And it's a business that I would maybe say we're incubating because we want to be ready as employers to say that the retail model is appropriate for them. We think it's certain that many employers, over some window of time, we hope shorter rather than longer, will move to a retail model from the model that's been in place for so long. And so we're using the employer business as a way to improve our capabilities, build the distribution relationships, ensure we understand the direct-to-consumer purchasing that's required in an employer environment and build up all the capabilities. So we're ready as employers make those decisions. We're not only waiting. We're also in a handful of states [ seeding ] -- that is S E E D, that is C E D, [ ceding ] that by helping educate the marketplace. And we're getting where we're having some positive results. We've had some[ microconversions ] already this year. And that's been in a couple of examples, in municipal environments where employers look at the -- the city governments looking to get to what you would expect. Maybe manage costs better, but certainly get away from administrative burden. So we're using the employer business right now as a way to add a small amount of growth to the organization, but also to make sure we're very well prepared as employers make the decisions we expect them to make to move into the retail model.

So then coming to your question on what you might characterize as a shift. The way I might characterize it is, early on in the company, keep in mind, we're essentially 5 years operational, right? So early on, as we built our first relationship in Colorado, and we proved the model that the model did work, but we wanted to replicate it, it was really about our -- the care partners pulling us in the markets. So we sought markets where we knew we had good care partners and that we would jointly go to market together in those markets. They weren't necessarily the biggest markets because our risk appetite was somewhat limited because we had capital limits as well. As we proved out the model over time, the alignment model, we started to enter bigger markets, like Miami-Dade, Florida this year and Broward. And what Florida has taught us is getting the scale and a differentiated, fully aligned model with our integrated system of care, we can perform really well and see a profit, a path to profitability quicker than we do in a market where maybe we don't have the scale or the leverage or however you want to refer to it. So we do -- we're excited about. We talk about the big markets that we're in now. We believe we can compete there. And we believe we have a differentiation and a right to grow market share there and grow market share profitably. And so I think the shift might be our focus is on where we can really have differentiation, where we can demonstrate scale and a path to profitability. And that's more efficient than trying to incrementalize other markets. We don't -- we're not anticipating significant state expansion in the coming years ahead with respect to the IFP commercial block business because we're in the biggest markets today, in the biggest states. We might expand markets within states. But that's not really our trajectory. In years past, where you might see the shift is, we obviously grew from one state in 2017 to now operating in 17. So we've seen a lot of additional states, including 4 new states this year. We don't anticipate that, at least in the next couple of years as we seek to get to profitability. So that's really the shift is, the focus on our core big markets where we know we can differentiate and perform.

[indiscernible] overlap between NeueHealth and Medicare Advantage and now that you're serving seniors through the direct contracting program. It sounds like the operating playbook for direct contracting comes more from the NeueHealth side. But curious if there are any learnings from your Medicare Advantage business, most specifically in California, that you'll be applying. And then the related question is that, a lot of the metrics on performance, clinical outcomes and costs related to that for new hub come from the IFP population. So curious if there are any metrics you can give for NeueHealth with the senior population and maybe specifically from your Central Florida operations.

Sure. So as we think about Medicare and taking advantage of the opportunity of working with care partners to have more density in the ability to manage populations, DCE allows us an anchor point with our providers. But our learnings from our Medicare Advantage book in California as we're exporting that model of care within Florida and other markets, for us, Simeon talked about concentrating Medicare Advantage efforts, and we see there's a strong alignment between DCE. Consider that almost like a kind of large network PPO style, and then moving into more tightly managed products, which could be alongside a Bright HealthCare, Medicare Advantage product. So we see the opportunity of them running kind of aligning next to each other, with giving patients the ability to move within our practices, from IFP agents to DCE or they can go to any network provider, and then moving into a tighter performing Medicare Advantage product. And there's the similar level of clinical programs, but they become more and more concentrated and more opportunity for further alignment within Medicare Advantage. There's some limitations on what [ you can do at DCE. ] So we see that as kind of the natural glide path. The second question? I'm sorry.

Well, I can -- maybe I'll talk about the -- our -- one of the reasons why -- if you go back to the way I answered the strategic adds that we did. We added Premier Medical about 18 months ago or so. And part of the strategy around that is, again, the differentiation in our model today is we want to serve all consumers in value-based care, fully aligned ways. And so we don't differentiate between the commercial population versus the senior population. Premier operates one of the best fully risk-bearing clinics that at least I've seen in terms of performance. Loss ratio, well managed, high star rating. And the -- we're taking that model and integrating it with our other clinics to become risk-bearing across the whole continuum. So there are workflows. Integrating the senior population with the IFP population, there's -- a lot of similarities as you get closer in the age when -- where they overlap. Where you get the challenges is when you're managing a 30-year-old versus managing an 80-year-old that you may pick up and transport and have to stop at 4 different homes along the way. The 30-year-old isn't going to do that. And so managing that is really the work that we're doing. A lot of it is this member hub approach that we've taken. And that's where we've got larger centers where we can do chronic care management, specialists that come into us, either part of our group or contracted. If you're there -- if you're a chronic member that has multiple comorbidities, you're going to be likely going to .one of the member hubs, one of the bigger hubs. Other than that, we are going to have decentralized clinics that are out into the community, the vulnerable populations access points, mobile vans, smallest pop-up clinic, and things like that, using technology and the like, and as all that kind of converges, that's where we see we can manage the consumer continuum across the commercial population, the senior, but our senior management, risk management is as good as I've seen.

Excellent, I appreciate those comments And just one more on the senior population from me. Any expectation you can give for us on open enrollment on the MA side of things on the key geographies that you are focused on.

So as Simeon talked about, we are focused on 4-5 key markets going forward. Our growth historically both in California and really in California has been in-year growth, as Simeon talked about, we are the third largest chronic SNF plan we can enroll all year long. So we do not expect significant 1 1 growth, we think we will continue to see in-year growth as you have seen us progress throughout the quarters. We will expect to see that again next year. So that's the way I would characterize it. Strong in-year growth is what we expect.

This is [ Christine Long ] from Morgan Stanley for Rivka Goldwasser. I had a question about MLR. So [ just reporting ] your 2022 Enterprise MLR guide, so it is 86% to 88%, so that's higher than what we were expecting around the time of IPO, but at the same time, Bright HealthCare MLR is in line with initial expectations, with -- I think it was around 86%, maybe in the 86% range we were expecting, which is within the 85% to 87% provided at this point. So based on the conversations so far, is what's mostly driving this NeueHealth and technology or platform investments? Or what color can you give on that bifurcation as it relates to guidance provided this morning compared to your initial expectations?

Yes. So you got to include DCE. So that obviously works against you when you've got a low margin. So that's a big component of it. And the second is in Texas, first year, with half of the business moving over to NeueHealth, I think we're taking a prudent approach to forecasting on risk adjustment that are bringing that down. Over time, we believe that the NeueHealth loss ratio will be a positive contributor too, but first year between DCE and Texas.

We're going to do one last question.

This is Harrison on for Justin, Wolfe Research. For the integrated clinics, it sounds like a lot of them are coming on at full capacity based on your cost today. Is it as simple to think about those as a, call it, like a 2-year maturity curve? Like you come in at full capacity, you get the risk coding in year 1, and then you're near your long-term target margin? Or is there more nuance to that? Because it sounds like -- the reason why I1 love your other kind of more value-based provider peers or -- have a longer maturity curve is just the membership ramp. But you're getting them all as you sit down the center. So how should we think about that? And then on the capacity side, is there a capacity number that you think about for each of those centers? Or is it more variable by geography?

Yes. So in terms of the kind of cycle to profitability or maturity, it is quick. We're out of the gate at -- most of our clinics are at 100% capacity out of the gate because we build them based on as expected demand. Performance, again, I just want to couch because I know -- I get the question, but I want you to understand the way we think about managing risk. We manage it within our overall integrated system of care. And the clinics is one capability that we have and won't be in every market. And so we look at it as one lever, if you will, to manage the total cost of care of the population. With that said, obviously, we look at the return, the investment, the capital investment and the return that it provides, because we have to assess, are we going to put physical retail points in certain markets to drive a better cost --- drive a better experience and cost structure? So as we look at it, I would say two years is probably a reasonable assumption to get to. Because in year one, as we just talked about in Texas, regardless of the member engagement that we want to get 70- to 80-plus percent member -- every patient engaged with our primary care, you're just at a disadvantage year 1 with you don't have all the records of the data to manage risk adjustment. If you're under full capitation, that impacts the result. If it were just a fee-based model, it'd be -- year 1, you would say we would get to target the profitability. But because we're taking risk, it kind of rides along the risk insurance side of the business. And so -- and we saw that this year in terms of -- I think it was the second quarter call, where we got impacted by risk adjustment. And that not only had an impact on revenue for us from the enterprise perspective, but also had a revenue impact at NeueHealth and we didn't do a good enough job explaining that, that has a downstream impact as a result of the risk capture that's in the clinics. But from a performance perspective, underlying performance, we performed well out of the gate. So I think that's all for now. Really appreciate your time and for those that came in person. I just want to give a couple of concluding remarks. As you heard from the team today, we're really excited about the progress we've made, and we're well positioned to achieve the full potential of the company. The next stage of our growth, as we've said, will be more capital efficient as Bright HealthCare grows market share in existing states and NeueHealth serves fully aligned Bright HealthCare members as well as growing revenue from external payers. We're focusing our growth efforts in markets that best leverage our fully aligned model and where we are delivering exceptional outcomes for consumers with strong financial performance. We've built a differentiated model that brings together the health care financing and distribution with a high-performing care delivery business, supported by technology solutions that John took you through today, that put the consumer at the center of their care. We strongly believe in our strategy. And as I've said, we have the team and the capital and the model to execute on it. So I want to thank you again. We look forward to keeping you updated on our progress. And have a great rest of the week.