Progyny, Inc. (PGNY) Earnings Call Transcript & Summary

Good morning, everyone. Thanks for joining us. My name is Annie Samuel and I'm the health care technology and distribution analyst here at JPMorgan. We're thrilled to have Progyny presenting this morning. With us are CEO, Pete Anevski; CFO, Mark Livingston; and Michael Sturmer. Pete is going to do a quick presentation, and then we'll open it up for Q&A. So if you have a question, raise your hand, and we'll be sure to get you the mic. So with that, let me turn it over to Pete.

Thanks, Annie. Good morning, everybody. Thanks for joining us. As Annie mentioned, Michael and Mark are with me today, and they'll be here for Q&A after the presentation. We appreciate the opportunity to share where Progyny is today, and we're so excited about the future, particularly as we continue to expand our services to address even more of life's most important milestones. Before we get started, I'll pause here, so you can take note of the caution regarding any forward-looking statements or non-GAAP financial measures that we may discuss today. Progyny was created to solve very real problems with the fertility benefits provided by the traditional health plans. These problems exist in virtually every area of health care. Poor patient experience, clinical outcomes that aren't being measured, let alone improved, abrasion with providers and an inefficient use of health care dollars. Before we launched our service, in 2016, the traditional health plans were the only option for employers. By successfully addressing the problems with those traditional plan designs, we've been taking market share every year, growing revenue at a 75% compounded annual growth rate since inception. With the infrastructure and platform we've built, we're able to broaden into other services, and we're excited to enter 2024 with an expanded solution that's addressing multiple areas of women's health. We've been a mission-driven company since day 1 and are building solutions that empower members during life's milestones including their family building dreams. We're entering our ninth year in market. The innovations we introduced to continue to drive our differentiation compared to every other solution, including the carriers. These innovations also lay the foundation for success with other services we're now offering. We pioneered value-based care in the family building by implementing a data-driven approach to plan, design and benefit management. And we're getting patients to better outcomes faster, which enables our clients to more effectively spend their health care dollars. We created a unique and still unparalleled level of collaboration with our network providers. And this is a stark contrast to the adversarial relationships you typically see between providers and health plans. And we invested to provide an extraordinary level of patient education and emotional support, making the journey as easy as possible while also empowering members to make more informed choices. And we're the only solution publishing outcomes for every member and for every treatment, giving an unprecedented level of transparency into the efficacy of our program. Nobody does that. Not 1 carrier, not 1 point solution. And those outcomes are the foundation of the tangible results we produce for our clients through more efficient spend, improved employee recruitment and retention and better productivity. We went live in 2016 with just 5 clients and 110,000 covered lives, and we now have over 460 clients and 6.7 million lives for 2024. But even with a 61x increase in live since our inception, we're still at a very early age of penetrating our market opportunities. And though we started in just 2 industries, our clients today span more than 45 industries, demonstrating the broad appeal of our services. And our growth has been consistent, reflecting strong and persistent demand even across the varying macroeconomic cycles these past few years. These include a global pandemic, periods of sustained high inflation, rising interest rates and continued fears of a looming recession. We're proud of our success, adding clients and even prouder of our near 100% retention rate every year. And think about that for a second. We're in our ninth year. Who else you know can say that? Virtually unheard of in any category, let alone health care? And why is that? It's our unparalleled solution, which has achieved 8 straight years of superior clinical results across hundreds of thousands of patient journeys earning us an NPS score above 80. Again, unheard of in health care. And all of the macro trends that have been driving employer demand continue to be in full effect. These trends include the increasing prevalence of infertility as well as societal shifts that are driving more people to need assisted reproductive care and both create an ever-increasing expectation that employers will help meet their employees' medical needs. Now when I joined Progyny in early 2017, incidents and prevalence was 1 in 8. It's nearly 1 in 5 today according to the CDC, a monumental increase in just a few years. And this is primarily because people are waiting until later in life to start their families. And not only are more people having children over the age of 30 today, the proportion of women having babies over 30 has grown each year for the last 20 years. Let me say that again, each year for the last 20 years. And additionally, 1 in 5 women of childbearing age suffer from 2 or more chronic conditions such as diabetes, autoimmune disease or PCOS, any of which can also affect the ability to conceive. I imagine everyone here today knows someone whose life has been impacted by infertility. That's why it's understandable that family building benefits are top of mind in today's workforce. But unfortunately, gaps still exist. Fertility treatment is expensive, given its specialized nature and for many without coverage, it's unaffordable. And that's why many will never realize their family building dreams. That's also why these benefits are so important to workers particularly the millennials who are the largest workforce population today and in the prime of their family building years. Unfortunately, many phased treatment exclusions by the traditional health plans which typically look to control costs by restricting utilization through blunt instruments like dollar maximums, step therapies and prior loss while often denying access altogether to LGBTQ+ and single parents by choice. And guess what, the workforce is reacting and nearly half say that fertility coverage is important when deciding where they want to work and another 2/3 say they would change jobs in order to get better fertility benefits. It's not surprising. Fertility industry is growing, reflecting the increasing prevalence and more expansive coverage. National ART cycle volumes have increased 4x since 2001, expanding at a 10.5% compounded annual growth rate in just the last 10 years alone. Because we've been growing at a significantly faster rate, we've been increasing our market share every year as compared to every health plan collectively and every [ PC ] back startup. And although corporate America has increasingly realized the need to offer this benefit, the market is still significantly underserved. And I say that because only half of employers with at least 500 employees provide some type of coverage today. And when utilizing traditional dollar maximums, many aren't offering comprehensive benefits, forcing workers to fund a significant portion of their treatment beyond their traditional cost share. And though the lack of coverage hurts employees, there's a significant cost to the employer as well. Those needing care pursue it in an unsupported way, forced to make compromises that result in the worse clinical outcomes and incurring significant but avoidable incremental cost that the employers do bear. We think that's crazy, considering the known adverse effects to society and economies when the birth population starts declining. And while fertility is at least a $15 billion market based on current volumes, we estimate it to be at least 3 to 5x that as people who need treatment aren't getting it when they lack coverage and they can't afford it. When companies decide to add or improve their benefit, they have alternatives, and here's how we're different. Progyny redefined fertility benefit management by leading with member experience, and it all starts with our plan design, which is focused on optimizing treatment success and is uniquely flexible to create customized pathways. Members have unlimited access to a dedicated concierge that provides the education and emotional support necessary to empower decisions that drive to better outcomes. And we work with providers to positively influence the standard of care they provide and contract to receive comprehensive reporting on every Progyny patient they treat. This allows us to actively manage our providers' actions and monitor for adherence to recognize best practices, resulting in the most favorable clinical outcomes. And our approach not only produces a better member experience, but also drives significant value and savings for the plan sponsors. The industry can be measured in extraordinary detail because clinics are required to report outcomes to the CDC for every treatment that they do. And in addition, the substantial majority of clinics also report additional details to [indiscernible] the industry trade association. This provides a vast data set to examine performance. When you compare our results to the national averages, which essentially reflect the health plans, Progyny members have significantly higher pregnancy success, substantially fewer miscarriages and healthier pregnancies overall. For example, our live birth rate is 27% better than national averages, and that means our members need fewer treatments to get to the desired goal of a healthy baby, which drives substantial savings. Additional savings are generated from fewer egg retrievals per live-birth. In IVF, the retrieval is the most expensive, most invasive and more physically growing aspects of the treatment. You want to get to as few retrievals as possible to a live birth. And our average number of retrievals to achieve a live birth is 36% better than national averages. Said another way, the typical Progyny patient needs only 2.2 retrievals on average for a live birth compared to the national average of 3.5 and that difference of more than 1 retrieval represents substantial cost avoidance for our clients, but more importantly and most importantly, significantly less physical and emotional stress on the patient. And when Progyny members get pregnant, it's 98% with singletons which reduces the rate of high-risk pregnancies, time in the NICU and the chronic care conditions that can result from twins and triplets. Due to our clinical outcomes, the typical Progyny client will realize approximately 30% in hard dollar savings compared to a carrier program. And this doesn't include savings from improved recruitment and retention, higher productivity and lower absenteeism, all of which we also impact favorably. And while we continue to improve upon our solution each year, national clinical outcomes have been relatively consistent, revealing that carriers either lack the focus or aren't able to overcome the structural limitations in their approach. Another example of our leadership is that we've been and still are the only fertility solution publishing comprehensive outcomes for every patient and every cycle performed. I wonder why that is. Our differentiated solution is fueling our sustained market momentum. And since 2016, our covered lives have grown at a 67% compounded annual rate, principally through the addition of new clients. Excluding the 2020 COVID year, we've added a greater or equal number of lives in every season, adding a record 1.3 million new lives in our most recent season, including our first population within the federal government. This demonstrates both the growing relevance of this benefit and our superior reputation in the market. Our last 3 selling seasons have been our most productive, yielding 3.7 million new lives in aggregate and we're more than 4x the size we were when we went public in late 2019. Because of the universal relevance of this benefit, we see a strong appetite across all industries and amongst companies of all sizes. Our average client won in the most recent season was larger than the year ago period, even without the benefit of the large federal population. And even with our rapid growth, we continue to be at a very early stage of penetrating our market opportunity. Though our solution is relevant to all types of employers, our initial focus is the 8,000 large self-insured employers who represent approximately 100 million total covered lives. And we're in the very early innings with this opportunity. Even with our strong growth in 2024, we remain at a mid-single-digit percent penetration. Because our earliest clients won included some large, well-known brands, investors ask whether we've won all the large companies out there, not even close. While the Fortune 500 is in a perfect proxy, as there are many hundreds of large employers who don't make that list, it illustrates how we're in the early innings even amongst the largest companies in the U.S. We continue to win Fortune 500 companies every year, adding 7 in the most recent season alone, and now count 17% of the most recent Fortune 500 list as Progyny clients. That means 415 Fortune 500 companies are our future opportunities still. And of those offering fertility coverage, the majority do so through their health plans. Our penetration within the 6 largest industries of the Fortune 500 demonstrates how we're at an early stage within each of those as well. And we also have plans to expand our TAM by broadening into other populations such as government plans, universities, school systems, fully insured and populations outside the U.S. So plenty of [ boost guy ] for us amongst companies of every size. When we broaden the scope to include -- to look at clients of all sizes, you see how our base in '24 continues to be similarly balanced as it was in the earliest years. Comparing clients added from our earlier seasons to more recent ones shows that we're winning a nearly identical proportion of clients above and below 10,000 lives in both periods. The composition of our base by size remains nearly identical today as it was in 2017. Here's just a small sample of the more than 460 employers we work with today. They're leaders in their industries, often named as the best companies for women and LGBTQ+ employees to work for, and they also include some of the most data-driven and sophisticated buyers for health benefits. We believe the caliber of this group reinforces how Progyny is the brand of choice for the benefits that help people meet life's most important milestones. So it's not surprising that Progyny continues to take market share each and every year. There's several components to our growth. First, it's the new logos that we add every year in each sales year. Next, our high rate of retention, nearly 100% each and every year since we've been in market. Then there's the drivers of growth within the base. Upsells have been the most impactful where following the first year with the benefit, the clients add more services such as Progyny Rx or additional coverage such as preservation. In recent years, 20% to 25% of our base has expanded through upsells, underscoring their conviction in both this benefit as well as the strength of our solution. And clients vote with their wallets and they continue to vote for Progyny by staying with us year after year. Beyond any other measure, this most clearly demonstrates our differentiation. And last is organic growth through utilization, which tend to persist or modestly increase across a client cohort over time as well as through population expansions when a client adds to a workforce through hiring or through M&A that they do. The strength in our client relationships also lays the groundwork for future growth. Understandably, employers are very targeted with the solutions they add. Due to our proven history of delivering real and sustained value, our clients regularly share with us other gaps they see with access, member experience and cost efficiency in other areas of health care. In fact, what we achieve is so special, clients routinely tell us of the let down when a member concludes their Progyny journey and has to return back to their health plan or some other solution for care in areas like maternity. And that's why Progyny is uniquely positioned to take our vast experience in evidence-based culturally competent and inclusive care to expand our platform beyond fertility into areas that further support life's other milestones. And to realize these opportunities, we've invested to create a turnkey product organization, and we'll continue to grow that resource further in 2024, giving us the ability to quickly add new features to existing services or expand into new areas in ways that make sense for us and our clients. You saw this most recently with our expansion into menopause. More than 40% of women in the workforce are over the age of 45, with more than 1 million experiencing menopause symptoms annually, incurring billions of dollars in lost productivity and direct medical costs. And while coverage is often available through the health plan, OB-GYNs and primary care docs often lack the training to recognize and effectively treat the symptoms. Our menopause solution provides access to convenient, personalized treatment, building on the concierge support model we've created for fertility. In 2024, we're further extending our leadership position to provide preconception support as well, addressing prevalent conditions that can negatively impact the ability to conceive such as PCOS, endometriosis and obesity as well as maternity and postpartum care, helping members navigate the complexities of their pregnancy journey and their eventual return to work. And with these services, we continue to raise the bar for what employers should expect from their benefit providers while further advancing Progyny's position as the industry leader in women's health solutions. And by leveraging our strengths in network management and evidence-based performance management, patient education and support, Progyny is uniquely positioned to meet the needs of a variety of buyers from those with a singular focus to those looking to address multiple gaps in women's health. And these services will be included in our 2024 selling season with both new and existing clients for contribution beginning in 2025. Here, you see the scale we've achieved, the scalable infrastructure we've built and the inherent operating leverage in our model. Our top line has grown at a 7-year compounded annual growth rate of approximately 75%. We were profitable at a very early stage and even with significant continued investment in our business each and every year, we've been continually expanding our margins with an approximately 20% margin on incremental revenue in 2023 at the midpoint of our guidance. We've also been highly efficient from a capital perspective, generating significant cash flow, enhancing our already strong cash position and balance sheet, giving us the flexibility to invest prudently in areas we've identified for future growth. Before we open up for questions, I wanted to leave you with this thought. In addition to our strong execution, our growth has been fueled by multiple societal macro trends and we don't see any signs of those slowing down. We believe we're in the strongest competitive position that we've ever been and are extremely excited for the future. Our active pipeline consisting principally of [ not now ] is that we are selling and carrying forward from prior years is the highest it has ever been at this time of the year. And we continue to expand our go-to-market resources, adding capacity in large new channels like labor and health plans. And we're entering 2024 with a more comprehensive end-to-end solution, which we built by drawing on what distinguishes us in fertility. There are 3 primary constituencies that every health care solution must address. It's the patients, the plan sponsors and the providers. And every other fertility solution out there is doing something beneficial for maybe one of them, there are a select few that maybe address a couple of them, but our model is uniquely delivering superior value to all 3 which helps explain our sustained success against the incumbent carriers who have substantial manpower and resources at their disposal. And you can see the evidence of this in our results. Our outcomes and NPS score prove the value to the patient, our retention rate and upselling activity proves the value to our clients and as for the providers, listen to what just a small subset of our providers have to say about us. And when you do, think about whether you've ever heard providers talk about their payer like this. [Presentation]

We have like a 100 of those, by the way. We only just showed you like a dozen. Thanks so much for your time today. Michael and Mark is going to join me, Annie for Q&A whenever you're ready.

Yes, that's great. We'll open up for Q&A. I saw you actually groove on there a couple of times. I thought maybe I want to see my doctor [ on ] there. You're coming up on 5 years as a public company. I was wondering maybe you could talk about how the fertility landscape has changed since you first went public. I mean, I noticed even versus last year, it was 1 in 6 in terms of the prevalence of infertility. Now it's 1 in 5. How are your conversations with potential customers different than they were 5 years ago when you first...

Yes. Great question. You point one out for sure. So in the last 5 years, the increase in incidence and prevalence is definitely driving way more people to talk to their benefit managers about having this benefit if they don't have it or even if they have it, about having it more comprehensively. The other change versus sort of prior to us going public, is that usually, we used to have to educate companies on 2 things. First one was should you cover fertility and why should you cover it? And the next one is, what are the alternatives in covering it and why should you cover it with Progyny. In the last 5 years, it's been much more so the conversation of simply why Progyny versus your alternatives than it is educating employers that they should even consider covering it. Probably the biggest changes.

That's great. And this year, there was a lot of angst about the employer market. People are really concerned about the macro, but you still had a really terrific selling season, Can you talk about what were conversations like this year? Are employers still kind of bracing for impact? Or are they really still looking to add good benefits?

Yes. Michael, you want to do it?

Sure. Sure. So we had a great sales year. And really, the buying criteria year-over-year hasn't dramatically changed. It is still about offering comprehensive benefit where you're controlling costs, you're improving member satisfaction and you're improving outcomes. And sort of that core criteria has remained the same over the course of years. And then each year, there's different macroeconomic trends that influence the employer's buying behavior. This year, obviously, there was a little more focus on things like budget and potential recession. But at the end of the day, again, demonstrated by the successful sales year, companies are still looking to put full and comprehensive benefits and they view fertility and family-building benefits as one of their top priorities.

Maybe you could talk about your go-to-market strategy. How does it look different for prospective clients already have fertility benefits versus those that don't? Or is it different?

So there are some differences when an employer has the benefit in place versus when they're contemplating putting the benefit in for the first time. We have success of both -- across both of those opportunities. To Pete's point, most employers are pretty well educated, where they have the or not. when they don't have the benefit, there's maybe a little bit more education that happens around the need, the impact, the budget and cost aspect to it versus when you have the benefit in place, obviously, there's much more of a comparison around. What will this do to my cost? Will it go lower, will it go higher? What will it do to my outcomes and again, that member satisfaction. So really, the difference in the 2 is more -- one is a comparison and one is sort of evaluating it for the first time. But again, the core market strategy and market approach really doesn't change. It's about outcomes, member satisfaction and controlling the cost for the employer.

That's great. And then kind of maybe going back to the selling season and just thinking about kind of what's embedded within next year, how are you thinking about organic growth in lives for next year? Because this year, you kind of assumed flattish just based on the macro environment.

Yes, I'll take that. So you remember last year when we were here, there was a lot of headlines out about -- particularly from some of the tech companies and part of what we were trying to educate folks was that although the headlines were somewhat larger, the impact to us was going to be -- we expect it to be somewhat negligible. And then looking at the labor market itself and how tight it was, we weren't necessarily anticipating any growth, but also not really any reduction. And ultimately, that's sort of what happened throughout 2023. I would say that our lives growth, particularly by industry is sort of matching what you're seeing in some of the labor [ upwards ] where although you might see some industries where they've been cutting back, you see other industries that are growing and in the [indiscernible], it all stayed the same. For '24, we're not really prepared exactly to take a lens forward on that. We'll certainly look to do that when we do our guidance. But I think the difference between this year and last year is that you're not seeing those headlines, particularly from any of our clients. In fact, what we see in here is them talking about beginning to look to build their plans as they set up for their next phase of growth.

Yes. I would say also in the last couple of months of Q4, everybody who's sort of been predicting the looming recession is no longer doing that. I think the outlook is a little more normal relative to normal risk for a recession, but not outsized risk. So I think that's also going to add a tailwind.