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

Good morning, everybody, and welcome to today's Bright Health Group Strategic Update. My name is Drew, and I'll be coordinating your call today. [Operator Instructions] I'm now going to hand over to Stephen Hagan, Investor Relations Director, to begin. Please go ahead.

Good morning, and thank you for joining us on short notice for Bright Health Group's investor update call. The question-and-answer session will follow Bright Health Group's prepared remarks. As a reminder, this call is being recorded. Leading the call today are Bright Health Group's President and CEO, Mike Mikan; and CFO and Chief Administrative Officer, Cathy Smith. Before we begin, we want to remind you that this call may contain forward-looking statements under U.S. federal securities laws. These statements 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 with the Securities and Exchange Commission, including the risk factors in our periodic and other reports we file with the SEC. Except as required by law, we undertake no obligation to revise or update any forward-looking statements or information. This call will also reference non-GAAP amounts and measures. Additional information can be found in today's patient slides the Form 8-K dated October 11, 2022, which may be accessed from the Investor Relations page of the company's website, investors.brighthealthgroup.com. With that, I will now turn the conference over to Bright Health Group Chief Executive Officer, Mike Mikan.

Thank you, Stephen. Good morning, everyone, and thank you for joining Bright Health Group's Investor Update Call. I would like to share some details regarding the update on our business we announced this morning, provide additional insights on our financial projections and provide an update on our announced capital raise. We always start with our mission. At Bright Health Group, we are focused on making health care right together. Our model 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. That has always been the promise of value-based care, and that mission has never been truer for us as we continue the evolution of our business. Today, we announced that for 2023, Bright Health Group is further focusing our business on serving aging and underserved populations through our Fully Aligned Care Model and made the decision to no longer offer individual and family health plans for 2023 or Medicare Advantage health plans outside of California and Florida. This is not a decision we made lightly. But one we believe is in the best interest of progressing our mission and the next chapter in our continued story of transforming health care in America. Over the past few years, the health care market has continued to evolve and sees that value-based care can deliver on the promise of better, more affordable health care. At Bright Health, we'd like to think we have played a small role in helping to evolve that landscape, specifically expanding the boundaries on the types of products and financing that can be successful under value-based care. Today, payers are more willing to delegate risk, and providers are more interested in taking on that risk across multiple lines of business, serving all consumers. Bright Health Group has been able to demonstrate the power of our Fully Aligned Care Model to serve these consumers. By integrating the delivery of care with the financing of care, we are lowering the total cost of care in delivering better experience and outcomes for consumers. California is the largest market for seniors and underserved populations and where we have the Fully Aligned Care Model working with our care partners. In Florida and Texas, our new health risk-bearing care delivery and provider affiliate management business continues to deliver differentiated results, and we expect to expand our footprint over time, serving the aging and underserved consumers in Medicare and the consumer marketplace together with our key health plan partners. While our company will look different as we go into 2023, the core principles we've built the company on remain the same. We are focused on delivering affordable health care for aging and underserved populations, doing so now in the largest health care markets in the country, alongside an expanded set of external financing and distribution partners. Our core belief is that optimal care comes when we connect providers and consumers which happens when providers are accountable for the population risk. Leveraging our Fully Aligned Care Model, where we align stakeholders financially, clinically and through data and technology, we deliver the best results. And we leverage our proprietary technology platform that is purpose-built to empower the Fully Aligned Care Model giving our team members a true 360-degree view of the consumer and an integrated workflow tool for better care management and seamless care navigation with one treatment plan for the consumer. With our technology and capabilities, our network of affiliate care providers are more successful at managing population risk. That is what we are focused on. Looking out to 2023, we are excited about the footprint of our business and its ability to drive value and serve as a platform for profitable growth in the future. Bright Health Group is a technology-enabled value-based health care company that organizes and operate networks of affiliate care providers who we call our care partners to be successful at managing population risk. We focus on serving aging and underserved consumers that have unmet clinical needs through our Fully Aligned Care Model in Florida, Texas and California. Some of the largest markets in health care were 26% of the U.S. aging population [ call home ]. Bright Health Group has a robust business in these 3 markets and one that is positioned well for overall profitability. For 2023, we are targeting net revenue of $3 billion or greater, serving approximately 125,000 Bright HealthCare members through Medicare Advantage products. and approximately 150,000 consumers in our new health business through value-based contracts and Medicare's ACO REACH program. NeueHealth will continue to operate over 75 own clinics, with clinics in Florida and Texas in partnership with our growing external payer relationships. And we expect to achieve adjusted EBITDA profitability in 2023. We've gained significant insights about managing health costs through value-based arrangements over the last few years. We believe we have the right structure for our Medicare Advantage plans, where we have value-based arrangements with Care Partners, allowing the cost of care to be managed collaboratively with those care providers. We will continue to focus on vulnerable seniors with chronic conditions and special needs where we are currently the third largest chronic special needs plans provider, which provides a great opportunity for future growth and is a targeted area of differentiation for our business. Our NeueHealth value-based care business is much stronger due to our experience over the past 2 years, managing the significant volume of commercial members from Bright HealthCare and external payers. Managing patient lives in the commercial segment has given us key insights into the 55- to 64-year-old population, a group of patients aging into Medicare. This aged-group combined with the 65 and older Medicare lives is where NeueHealth has had the most impact on patients, particularly for those patients with unmet clinical needs and serving this broader patient population is a key differentiator for NeueHealth compared to primary care providers focused solely on Medicare lives. Critical to this differentiation is that we have added important capabilities to the business by moving much of the care and specialty network management that would normally be managed at the health plan level down to the care provider and closer to the patient. We expect to continue delivering strong performance in both businesses by strengthening the Fully Aligned Care Model and providing the capabilities and data to the care provider to deliver the best care at the lowest cost for our members and payer partners. We continue to see strong tailwinds for our business model in 2023, further supported by the strategic moves we are announcing today. The decisions we have made for 2023 allow us to accelerate our path to profitability, and we now expect to achieve positive adjusted EBITDA in 2023. We have continued to drive operational improvements in the business and are seeing the benefits. Our proprietary technology platform is delivering every day. This further focus on our Medicare Advantage and risk-bearing care delivery and affiliate management business allows us to reduce our need to raise additional capital, adjust our operating expenses to reflect the size of our business, and recapture restricted capital in the future. These levers together lower the near-term capital needs for the business and allow us to fully fund our business through profitability with the preferred equity sale announced today. This more focused model sets Bright Health Group up for long-term profitable growth. We will be very competitive in state with substantial addressable markets. California represents more than 10% of the total national enrollment in Medicare Advantage while Texas and Florida have substantial Medicare Advantage, commercial and Medicaid populations that we will serve through our NeueHealth business. NeueHealth has been delivering solid performance in 2022, including the direct contracting program now ACO REACH and we expect the positive momentum to continue in 2023 as our operational and technology capabilities keep improving. Our Medicare Advantage business in 2022 is achieving our medical cost ratio and profitability expectations, and we expect the alignment with our care partners to drive even stronger results in 2023. In 2023, our business is expected to see the benefit of a balanced portfolio with differentiated offerings in these major health care markets, lowering medical costs and offering value to consumers. We expect approximately 60% of our revenue to come from Medicare Advantage with the other approximately 40% from NeueHealth external revenue, including our ACO REACH business. On the NeueHealth side, we continue to see significant commitments and interest from payers in partnering with our business, which will support capital efficient, profitable growth in the future. We will discuss in more detail on our third quarter's earnings call. However, we have continued to deliver on our expectations for this year with solid performance across each of our businesses. Based on what we have seen so far for our third quarter results, with stable utilization trends and our most recent look at risk adjustment, we would continue to point to the midpoint of our enterprise MCR and adjusted EBITDA guidance ranges for the year. We expect full year 2022 enterprise revenue to be in the lower half of our guidance range for $6.8 billion to $7.1 billion. We will provide additional details on our third quarter results and full year expectations when we report quarterly results in early November. The continued strong performance in 2022 sets us up well for improving profitability in 2023 and long-term success. Building on this strong base, we were pleased to announce this morning a $175 million of new committed convertible preferred equity capital backed by the support of some of our largest existing investors. Additional details can be found in our press release and the 8-K we filed today. Our more focused footprint in 2023, reduces the overall regulated capital we need in the business. And combined with the faster path to profitability results in a lower total capital need compared to our prior forecast as well as less dilution to existing shareholders. We also expect to see a benefit to our unrestricted capital through the release of approximately $250 million in regulated capital from the states we are exiting after medical claims runout and regulatory approval. Going forward, the business is well-positioned for capital-efficient growth with revenue contributions balanced between our Medicare Advantage and NeueHealth businesses. We expect to deliver steady growth off the 2023 base in our Medicare Advantage business, while our NeueHealth business is expected to deliver faster growth as we expand our external payer relationships to fill clinic capacity. We expect the new committed convertible preferred equity capital announced today to fully fund the business through profitability. Given the evolution of the business for 2023, I wanted to provide some further detail on our expectations for 2023 financials. We expect the scale of our Medicare Advantage to be largely unchanged. With steady growth in members and continued solid MCR and financial performance. We expect NeueHealth to serve between 85,000 and 90,000 external payer value-based lives, and approximately 60,000 ACO REACH senior consumers. We are forecasting 2023 revenue to be greater than $3 billion and expect to see modest improvement in our enterprise medical cost ratio relative to our 2022 guidance as continued progress in our Medicare Advantage business is offset by a mix impact. I would also note that with the shift in our business, we would expect to see much greater predictability in our revenue and gross margin. Our more focused business combined with further operating expense actions are expected to result in an operating expense ratio in 2023 between 14.5% and 15.5%, compared to our expectation for approximately 22% in 2022. Overall, the significant operational progress we made in 2022, our continued solid performance in the third quarter and the strategic actions we're taking for 2023 are expected to result in positive adjusted EBITDA next year. We expect similar performance across each of our businesses. We are pleased to accelerate our path to enterprise-level profitability from our prior expectations and believe we are now much better positioned for long-term profitable growth. At our core, Bright Health Group is a technology-enabled, value-based health care company that organizes and operates networks of affiliate care providers to be successful at managing population risk. We are focusing on serving aging and underserved consumers that have unmet clinical needs through our fully aligned care model in Florida, Texas and California. Some of the largest markets in health care, where 26% of the U.S. aging population call home. Before we turn things over for questions, I wanted to take a moment to again acknowledge the evolution -- this announcement means for our customers, our partners and our employees. I want to thank all of our current and previous team members and care partners that help get us to this point in our evolution. Together, we have built a tremendous business. As we move forward in a more focused way, we expect that continuing to build these differentiated businesses will deliver the best long-term results for consumers and our shareholders. Operator, let's go ahead and take the first question. Thank you.

[Operator Instructions] So our first question today is from Joshua Raskin from Nephron Research, LLC.

I've got 2 questions. I'll just ask them both, and you guys can take them in whatever order you want. So first is the -- 15% G&A ratio in [ plug ] admin costs down about 2/3, it's like $1 billion in savings. So what are total corporate costs today versus expectations for -- for next year? And sort of how does that admin leave so quickly? And then the second question is just taking a step back strategically, what does Bright Health Group look like in 3 to 5 years? Are you thinking market expansions are possible? Would that be mostly in Medicare Advantage or through NeueHealth? Or do you think potentially back in the marketplace as well?

Josh, let's start -- we can get into detailed modeling of the operating costs. But just thinking operating costs overall from an enterprise perspective. The larger -- the greatest operating expense as a percent of revenue was the ACA marketplace business for us. Our other business is NeueHealth, Medicare Advantage operate obviously below that and are operating in line with just about our target expectations. So while we do have a relatively significant corporate [ burden ], given the size of the company today, we're going to have to make adjustments to that, but we're confident that we can make those adjustments. When combined with our other businesses that are operating in line with what our expectations are for next year, we're very confident we can achieve that range that we discussed. Thinking about Bright Health Group over the coming years, we're very -- we're still very excited about the direction of the business and how we're having an impact on value-based care. We're focused on serving that aging and underserved population that has unmet clinical needs. And we think where you get the best results is when you align the interest between the financing of the care and the delivery of care. That hasn't changed as a result of this. In fact, if anything, it furthers our conviction that our Fully Aligned Care Model is a model that can differentiate and add value for the future. So we expect to grow that model, NeueHealth. We're going to focus on the core markets that we're in today. That's our current focus. Especially given the capital constraints in the marketplace today, we want to prove that we can not only create value for our consumers but also for our payer partners and then generate targeted operating returns and sustainable cash flow. And we're on a pathway to get there. And we can do that in the largest markets in health care. Florida, Texas and California, just take the aging population alone. That's 26% of the U.S. of seniors are aging that call those markets home. So we've got a lot to grow in. So -- we're going to continue to stay very disciplined, focused on our business model. We're going to grow Medicare Advantage. We're going to grow in our NeueHealth footprint, but in the markets that we operate in today.

Our next question today comes from Lisa Gill from JPMorgan.

Mike. I just want to go back to a comment that you made about provider alignment and just better understand how you're thinking about capitation for both sides of your business. So one, as we think about your Medicare lives for 2023. Can you talk about the percentage of them that will be in some type of a capitated relationship? And then on the NeueHealth side, as we think about -- you talked about 80,000 to 90,000 external members. You talked about ACO REACH but how many of those will truly be in capitated type of program?

Yes. Thanks, Lisa. So with respect to Medicare Advantage, [ roughly ], 70% -- 75% of our business today is in global capitation arrangements and we expect to continue to grow that. We view that very consistent with our model. We build a Fully Aligned Care Model working together with our care partners, our IPAs, our contracted specialists and what have you, where we aligned the interest and then work together through clinical alignment to drive better results. So it's very consistent with the model that we have within NeueHealth where we essentially provide a fully aligned model with our other payer customers. So it's very consistent. In NeueHealth [indiscernible] 85,000 to 90,000 that is fully capitated models with upside and downside. Now they vary in terms, but that's the way we look at it. We do have other kind of fee-for-service that are moving along the spectrum. We'll see how that plays out over the coming period as we cross walk our [ BHC ] lives to our external payer customers and we see that as potential upside to that. But today, the 85,000 to 90,000 is in an upside, downside capitation arrangement.

And just so I understand, if that's profitable today? Or you're expecting that to become profitable as we think about 2023 on the NeueHealth side?

It is profitable today.

Our next question comes from Jason Cassorla from Citigroup.

Just in California, you noted you had a risk-sharing program with care providers there, but you don't have any own clinics. So I guess, just curious how you're thinking about the integrated health care proposition for that state specifically? And if it means your own clinic build out in California and perhaps maybe bringing those risk-sharing contracts in-house? Or how should we think about California specifically, just given your MA footprint there and expectations going forward?

Yes. I would think California, as you know, Jason, California is much further along in terms of physicians taking risk and organized physician associations and what have you. And so our model there very much is working and collaborative with those physicians as affiliates. We work together to manage the population. It just so happens, we've got a Knox-Keene insurance -- license there to provide Medicare Advantage products. But consistent with NeueHealth, it's all -- in the context of building a Fully Aligned Care Model where we align financially through global capitation arrangements. We align our clinical programs, so we have joint clinical models to manage heavily chronic conditions. As I mentioned on the call, we are the third largest chronic special needs plan today. So we manage the frail elderly with a core set of physicians and we wrap services around them to make sure we can handle all their needs holistically. And then we're working together to embed technology where we can integrate around one consumer record and on treatment plan. So very consistent with Texas and Florida, they're just further -- California is further along where physicians have taken population risk, and we're just leaning into that, and we're building it out more in Florida and Texas, which we're really excited about.

Our next question today comes from Nathan Rich from Goldman Sachs.

On the NeueHealth side, I think you had talked about value-based membership in '23 being about 150,000. I think that's down from 450,000 to 500,000 this year. Just wanted to make sure I have those numbers correct. And as membership comes down, kind of how do you make sure you kind of maintain and improve the profitability of that business? And do you feel like you have the appropriate kind of investment embedded in care management capabilities so that you can kind of realize the value-based opportunity that you have with that membership?

Great, Nathan. Yes, so you've got the numbers right. Really, the reduction is -- as you may recall, of the 450,000 to 500,000, roughly 400,000 came from Bright HealthCare, and that was lives that were attributed to our clinics as well as our affiliates. So where the drop really comes in is the affiliates -- where we've attributed to the affiliates -- we're working to build that back and grow that with external payers. We're not ready to get further into that today, but that is something that we see as an opportunity. But in terms of the scalability and the readiness of how we manage our clinics today. As I mentioned earlier, that's a profitable business that's got -- that is structured for growth. So we're really excited about that scale of the 150,000 kind of value-based lives, about half is senior related and the other half is in the consumer marketplace. So we see significant growth opportunities in big markets like Florida and Texas, and we have a profitable model in place today.

Our final question comes from Michael Ha from Morgan Stanley.

So my question, just how much of the revenue decline is NeueHealth versus Bright HealthCare? Because my quick math gets me to around $4 billion for Bright HealthCare. So when I think about $250 million of statutory capital to be released assuming 10% to 15% requirements that would reduce about -- free up about $400 million to $600 million of statutory capital. So I was wondering if you could walk me through the difference. And when do you expect that to be released? Is that an early 2023 timeline?

Why don't we have Cathy and Stephen follow up with you with specifics. But as we mentioned on the prepared remarks that after we settle all claims within the ACA marketplace markets that we're exiting and upon regulatory approval, we free up approximately $250 million, which will come back into the corporate enterprise. And that should happen over the next, call it, 6 to 18 months or so.

Thank you, everybody. That does conclude today's conference call. Please disconnect your lines.