P3 Health Partners Inc. (PIII) Earnings Call Transcript & Summary

Good day, and welcome to the iAccess Alpha Virtual Best Ideas Fall Investment Conference 2025. The next presenting company is P3 Health Partners, Inc. [Operator Instructions] I'd now like to turn the floor over to today's host, Mr. Aric Coffman, Chief Executive Officer of P3 Health Partners, Inc. Sir, the floor is yours.

Thank you so much, and good afternoon or morning depending on where you are today, and thank you for the chance to provide an update on our business, P3 Health Partners. As was stated, I'm the CEO, Dr. Aric Coffman. And at P3 Health Partners, we are a physician-led organization that is transforming health care for seniors, and we're currently driving towards profitability. Here are the typical disclaimers. As a reminder, today's discussion will include forward-looking statements. Please refer to our filings for any risk factors. Let me to start by telling you a bit about who we are. So this is P3 at a glance. And we are transforming, improving health care for seniors in 4 states today. We have 120,000 full-risk lives and about 2,800 primary care providers in our network working with 18 different payer contracts. As a frame up, Medicare is a $1.1 trillion market divided between traditional fee-for-service and Medicare Advantage. Our role is to enable physicians and clinicians to care for their senior populations, improving outcomes, lowering the total cost of care, improving access as well as patient experience and provider experience. If you look at our market footprint, this gives a little closer view of where we are in our various states. And as you can see across our geographies, we have some substantial opportunities for growth. So if you look over to the right side of the slide, where we sit today with in our own geographies with those 2,800 PCPs, we have right around 100,000 lives. But there's room for growth in Arizona of about 1.2 million; in Nevada, 300,000; Oregon, 400,000; and in our counties in California, another 100,000. So the total population that we could potentially take care of here is about 2 million without ever landing a new logo or geography. And I think that's important as we think about smart growth for our business and doing so in a way that we can manage our overall business more tightly. There has been a tendency in the sector over the past many years for people to grow quite rapidly, but we have changed our approach at P3 since I took over about 16 months ago. As far as our market size, Arizona is our largest market with around 50,000 members, followed by Nevada, Oregon and then finally, last but not least, California. When we talk through our mission in being the best partner for our patients, providers and payers, the market opportunity is really large, as we just discussed, and the need for value-based care is actually growing. Our business model has a clear pathway to profitability, particularly given the changes we've made over the last 16 months. And in our business, we take full risk across both Medicare Advantage as well as ACO REACH, and our preference is to be fully delegated, and we have that for significant portions of our population today. We've also assembled a seasoned, accomplished execution-focused leadership team. When we frame from the outside, let me pull up a little bit. The U.S. health care spend across all sectors is roughly $4.7 trillion. If you move to Medicare spend, it's just over $1 trillion, and there's about 68 million Medicare-eligible patients today. When you look at Medicare Advantage, about half of that population is in Medicare Advantage, and we'll touch on that in just a second, and pretty significant spend in the MA sector. Things that the industry is seeing across our payers is increasing pressure on their margins and their costs, and we have an increased demand right now for P3 solutions. We do believe heading into 2026, we're seeing MA rate recovery, which will help expand margins, and that was announced in the final rate notice earlier this year and should help the sector move more positively in the quarters ahead. We're also seeing a trend of industry consolidation. And so our partnership pipeline will continue to grow over the coming months and quarters. And we think that will create opportunities for our business to grow differently than we have in the past couple of years. And then as we're thinking about the addressable market and the other macro tailwinds, I think this is a very attractive and exciting sector. And to talk about some of those overall tailwinds in the sector and the growth potential, this graphic shows what happened in Medicare in terms of Medicare Advantage penetration and Medicare Advantage enrollment since 2017. As you can see on the far left in the first graph, there's about 35% Medicare Advantage penetration. And what that means is 35% of the eligible senior population opted to be in Medicare Advantage in 2017. And you can see a steady increase in that -- those percentages over the subsequent years, up to 54% in 2025. And in terms of sheer numbers of patients, that's grown from 18 million to 34 million. So almost a doubling of lives in Medicare Advantage enrollment from 2017 to 2025. It's a very clear trend of senior preference. And one of the reasons that's important and one of the things that I wanted to highlight is this graphic here. And this brings to life the impact of value-based care on our populations. And so to orient you in this graph, the x-axis goes back to 1970 and extends out in this graphic just beyond 2020. And the Y-axis shows cost per Medicare beneficiary. And what you see is this curve that if you extended that up from when the study was done in 2010 to 2011, it was projecting that the average cost of a Medicare beneficiary by 2023 would be around $22,000. What they actually measured across those periods of time was a lot different than what the graph was predicting. And so when we get out to 2023, the actual cost per Medicare beneficiary was essentially the same as it was in 2011 at $12,000. That's a $3.9 trillion gap in expected costs or if you frame that to think about that span of 11 years, what that really means is about a 30% decrease in anticipated costs in the Medicare population. And so the question is what happened in 2010, 2011 that would afford those changes? And why has that graph leveled off? I would contend that, that's the exact same time that we saw the advent of Pioneer ACOs turning into other types of ACOs like MSSP and ACO REACH. It's also where we saw more patients starting to select Medicare Advantage over other products, which tends to be more tightly controlled in terms of cost. And so you saw those trends on the last graphic going from 2017 through 2025. And the numbers back in 2012 was about 26% MA penetration. So we've more than doubled MA penetration. But to me, this is really good evidence of the impact of how value-based care works and the impact that it's had thus far. And so part of the question is, what can we do differently and what can we do more of based on the success. When we think about the challenges that exist today across physicians, payers, health systems and the local communities is there's a lack of resources and expertise for physicians to really perform true value-based care as they try to transition from fee-for-service. The payers have pressures, too, in trying to make those things happen more quickly, but may not have the capability set to get into the practices and create that alignment. And then if you're a health system, what you see is typically primary care is a loss leader. It is typically something that the health systems absorb, but they haven't created a strategy or a plan for how to make those lines of business more productive and profitable. And then for the community, we don't take advantage of the resources that exist in those communities that we could, that patients could take advantage of. We already talked about the overall cost at $1.1 trillion. We've talked about the need for improved quality of care and clinical outcomes. And you can see that, that is a strain on the system. And then up to 25% of Americans do not have access to primary care. So being able to provide that access for the patients that need it most through the tools that we use that we'll talk about in a second is really important. And last but not least, we have roughly 50% of our physicians today are burned out, and we need to be able to help them with additional resources to help them be successful. So how do we then address those challenges for physician groups, payers, health systems, integrated networks? We've shown that when we partner with our physicians, we have a 98% physician retention through our enhanced support. We're delivering measurable cost savings while driving improved quality outcomes for our payer partners, which is really important for their future and their revenues. And then we're providing proven value-based care expertise in helping health systems think through their strategies differently and then execute in a way that makes sense for their tool sets and capabilities. And then we're creating unified proactive care networks with coordinated touch points to link patients to community resources, social work as well as access to other types of practitioners, behavioral health and otherwise and ensure that they have a personalized care plan in so doing. So part of our value proposition is using our value-based care platform to deliver consistent results. And let me talk through a bit of how we do that. The first is we have to engage their providers. So we do that first by understanding their populations after we've aligned their contracts and then lining out the programmatics in their specific patient population that makes sense for them to get better outcomes in quality and cost. We have care management tools that allow us to focus resources for those highest risk patients as well as those that are rising risk and may be in need of additional services prior to having an event where they go to the hospital or they have medication changes that need to be reconciled or they have a transition of care outside of the hospital and they need to get support at home and then back to the physicians' offices. And the way we do that is through our data and analytics. So by taking in additional information that's available now for us, we can get that information to the point of care that didn't exist before. So if you think about the fee-for-service world, the clinicians are completely blind to the outcomes data that we're able to share with them. And with that, we can then arm them with optimized risk stratification, comprehensive utilization management tools. We tailor our care management to their panels and to those patients' unique characteristics. And then we empower them through collaboration so that we ensure that we're meeting their needs as much as they're meeting the needs of their patients. The pillars of our playbook include a maniacal focus on patient outcomes or targeting the populations with outcome measurements after we do the risk stratification to ensure that disease states such as patients with cancer diagnosis, patients with chronic obstructive pulmonary disease or congestive heart failure or concomitant behavioral health issues or dementia, they get the right kinds of assessments and the right kinds of treatment plans to match what's going to give them the best outcomes, all framed in the quadruple aim. The platform that we're able to bring to bear for the clinicians is one in which they can use these tool sets within their workflows in their existing EMR. And that allows us to streamline their office operations, which helps further drive adoption and engagement from the clinical team. We're able to adapt to the local market and understand what their particular needs are that might be different in one community to the next. And that flexibility gives us a lot of kudos with the partners because many competitors have a one-size-fits-all approach. Because we take care of more than Medicare Advantage, we're able to help them see more of their panel and density within the panels is really critical. So we continue to expand into other types of business that are like Medicare Advantage, such as ACO REACH, for which we now have 17,000 members of our roughly 120,000 members are a part of the ACO REACH model. And then as we continue to expand our lines of business within those practices, we're driving scale with measurable value creation by increasing density in those PCP practices and the more reps that they get typically, the better the outcomes that they will ultimately have. When we think about the path of taking clinical groups or health systems into value-based care from fee-for-service, really think there's a couple of key foundational elements to lay out first. It doesn't happen with a flip of the switch. And the first is really building the foundation. And that hinges around building great physician relationships and great relationships with the partners to get feedback on the challenges they face and what their priorities are as we understand how to intervene in that particular geography. We then prioritize both specialty as well as network opportunities. We focus on things like high-cost drug management, transitions of care, et cetera. And then we use that over time to help align the physicians' incentives and create a contractual relationship with them so that they have the incentives to do the things they need to do in value-based care. We established connectivity with their electronic medical record so that we have more ready access to information and they can get ready access from us. And then we execute on our specialty and network opportunities that were identified in our original assessment. This is typically where we'll launch our transitions of care and chronic care programs, which leads then into how we then optimize the performance. And so once we've rolled through those elements together, we will typically embed what's called a practice operations coordinator into the practice that will help physically come into the office, help with chart prep, help with patient outreach, help with workflows, help with data extrapolations and really get those practices to a higher level of performance overall. And then the clinicians get coaching and feedback for results and impact. We're then able at that point to help them understand the impacts of the choices they make relative to their referral patterns. So they ultimately get higher quality, lower-cost specialists and facilities as a part of the overall ecosystem to achieve the quadruple aim. And then ultimately, as we think through a new market entry, we would have a transition into full risk. We will continue to curate the network. We like to be in a place where the PCPs can share in the surplus that they've created. And then we help them with growth and the plans like this, too, both with agents, people who are aging into Medicare as well as what we call open enrollment, where we can use provider-based growth strategies with those clinicians to help the health plans identify more patients that might benefit from their particular product. I'd like to think of P3 as a bridge in the health care system. And that's what this will try to elucidate. So as you take the first part of this where you see the #1 and the P3, foundationally, we are aligning with the payers contractually to provide them with an offload of their risk on to us and then we assume the membership outcomes for that particular population. We can also take over certain services that a health plan might be providing, such as claims payment, utilization management or care management. And we do that with several of our payers, and that's actually our preferred approach as we think about going into full risk contracts. And then with the physicians, we then allow them to have access to those value-based contracts, which unlocks new incentives that they may not get today, new resources that we can put in their offices as well as the potential to earn additional dollars by doing a great job of managing their patient populations with high satisfaction, high quality. The bottom part of this graphic shows the impact for the patients. So where we help patients connect with their physicians, we can get them better access. We can create personalized care plans that ultimately help them achieve their individual goals as to what they want as a patient. And then we help the payers by curating a better network for those patients that are aligned with those outcomes. This is just a case study that shows a comparison between a plan in which we were not delegated and did not have things like control of the network versus where we were in control of the network in the same market. And you can see a very significant reduction in the overall medical costs for those patient populations that were similar in terms of their acuity, but different in terms of who was in the network and who was not, driving substantive results. Over the course of the past year, we've spoken publicly about our $130 million EBITDA improvement plan. And numbers 1 and 2 around operational efficiencies as well as contract rationalization, as we've spoken about before, have been achieved and the additional $70 million of revenue optimization is still in process in 2025 as the year is not quite over. But we're very happy with the progress that we've made in delivering on what we said we would do. And as we look forward to 2026, we've identified another $120 million to $170 million of EBITDA improvement opportunities in these buckets. Number one is operational performance and medical management, things around end-of-life care, palliative care, we've had really good success with our chronic obstructive pulmonary disease programs in lowering the admissions for patients into the hospital and improving their overall quality of life and then general utilization management in which we are helping to understand some of the things happening with facilities such as inpatient versus observation in those facilities. And that's the first bucket. And this represents about 40% of that EBITDA opportunity. The next 30% is represented by ensuring that we deliver on quality and burden of illness for our patient population. And this allows us to then get patients into the right treatment plans for those chronic conditions and ensure that they're surrounded by the right care teams. An additional 20% of the opportunity is represented by continued contract and network management just as part of the base of the business, and it's a carryforward from what we did in 2025 as well as continuing to manage our provider network. And then lastly, the overall market dynamics where we expect to see continued payer benefit design rationalization and changes in the product offering, such as shifts from PPO to HMO. And those things really make a difference in terms of managing total cost in a particular geography. And then just as a reminder of the guidance that was given with an adjusted EBITDA range of minus $69 million for full year 2025 to minus $39 million of the high and low range of where we expect to hit, driven by a total revenue of $1.35 billion to a high of $1.5 billion, just as a reminder for those who hadn't seen that before. And finally, just end with a statement about the team, really important with the team that we've assembled at this level as well as the level below, and we continue to attract talent to the organization. All the logos below of the places that the individuals on the team have worked historically prior to being with P3 brings a lot of credibility to our operations as we move forward in 2025 and into 2026. And with that, I will turn it over for any questions.

So let's see. First question is, you mentioned $10 million in savings from hospice and palliative initiatives. How durable are these savings? And can they be replicated across more markets? The answer is very durable in terms of the savings that we're seeing from those programs. A lot of it has to do with what we focus on is, one is admissions into palliative care and hospice. Two is the duration that people are in hospice. And then three, what's the referral site for hospice because that's also pretty important. And it has shown to be both durable as well as scalable, and we are doing that across multiple markets. Next question is what milestones should investors track over the next 12 months to gauge progress towards the $120 million to $170 million EBITDA improvement range. And I think that just like we've done with the other parts of the initiatives, we should be looking at what the EBITDA is doing. We should continue to look at OpEx and the stabilization. We should continue to look at utilization patterns and are the programs working. Those are some of the big ones that I would look for. Next question was that I highlighted, $130 million of EBITDA improvement initiatives, which levers are furthest along in execution and what risks remain in achieving that target. So the operational efficiencies, those are completed and done. The contract rationalization at the $35 million of EBITDA opportunity is done. And then the $75 million of opportunity in revenue optimization is partially complete because that includes both med expense initiatives, and we still have more of a year to go as well as quality improvement and then burden of illness capture, all of which are on track. Who are your larger partners? And what are the covered lives opportunities? When would you expect your membership decline to start to trend positively? Great question. So we have several large payer partners, and that includes Aetna, that includes Centene and some of their subproducts that they have in the various markets. That includes Humana, that includes United and that includes regional plans as well. And those are the largest payer partners that we have. In terms of our membership decline, we do expect to continue to refine the network to get to EBITDA positivity. I expect that 2026 and then into 2027, we will see more substantive growth than what we've seen in '25 heading into 2026. And then lastly, it says, I believe Oregon is your only market that is losing money. What's the problem? And when will Oregon turn breakeven? So a couple of things on the markets. And in aggregate, as we spoke about on the earnings calls, we are breakeven or better in 3 of the 4 markets. Oregon is the market that's behind. We have a very collaborative payer partners there, and we've been working closely with them in 2025 to correct some of the things that we think will get us back to breakeven or better in Oregon for 2026. Let me see if there are any more questions. Those are the only ones that were listed. Can you walk through the math of the EBITDA loss of $17 million. When you strip away, the loss was $8 million, up $5 million quarter-over-quarter? I think, Thomas, what you're asking about is the EBITDA loss of $17 million, when we stripped away the prior year impacts is what you're referring to there to get to the $8 million. And it was actually pretty stable quarter-over-quarter in terms of run rate losses. Thank you for all the great questions. And operator, I think that we are at time.

Thank you, sir. Ladies and gentlemen, that concludes the P3 Health Partners, Inc. presentation. You may now disconnect.