P3 Health Partners Q1 2023 Earnings Call Transcript

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May 10, 2023

There are 9 speakers on the call.

Operator

Afternoon, everyone, and welcome to the P3 Health Partners First Quarter Results Conference Call. Currently, all participants are in a listen only mode. Later, we will conduct a question and answer session and instructions will follow at that time. As a reminder, this conference call is being recorded. I will now turn the call over to Karen Bloomquist, Vice President, Investor Relations of P3.

Operator

Please go ahead.

Speaker 1

Thank you, operator, and thank you for joining us today. Before we proceed with the call, I would like to remind everyone that certain statements made during this call are forward looking statements Only predictions and are based solely on our current expectations and projections about future events and financial trends that we believe may affect Our business, financial condition and results of operations. These statements are subject to risks and uncertainties that could cause Actual results to differ materially from historic experience or present expectations. Additional information concerning factors that could cause actual results to differ Statements made on this call is contained in our periodic reports filed with the SEC. The forward looking statements made during this call Speak only as of the date hereof, and the company undertakes no obligations to update or revise the forward looking statements.

Speaker 1

We will refer to certain non GAAP financial measures on this call. These non GAAP financial measures are in addition to and not a substitute There are a number of limitations related to the use of these non GAAP financial measures. For example, other companies may calculate Which may be accessed from our Investor page of the P3 Health Partners website. I will now turn the call over to Doctor. Abdu, CEO and Co Founder of P3.

Speaker 2

Good afternoon, everyone. I would like to kick us off today by saying how Proud I am of our team and its performance and achievement over the last period. As you have heard me saying before, we've committed to our investor that we would deliver on a number of very impressive Profitability metrics to validate the model and we believe we have delivered. Our results will show that we have great momentum Our business model and we are feeling very confident and optimistic how we are tracking in the second quarter and toward our 2023 overall performance. Today, we're updating our full year 2023 adjusted EBITDA guidance To an improved range of loss of $55,000,000 to $35,000,000 This updated guidance from the prior range A plus of $60,000,000 to $40,000,000 reflect our confidence in the performance of the business and all profitability data That we are sharing today will validate that.

Speaker 2

As I've shared with you in the past, 2023 is an inflection year And P3 Health Partners Live. We have a significant number of persistent lives that we've never had before. For the first time, 83% of our lives that we are serving today, they're persistent. And we believe That metric is important as a first step to more clearly demonstrating the future profitability and trajectory of our model. The overall population funding had improved about 9.2%, up from $8.89 PMPM last year 1st quarter to $9.63 PMPM this quarter.

Speaker 2

Our medical margin for the quarter was $39,000,000 The medical margin percentage was 13.1, which is consistent With our guidance and with other public peers and we view this as a validating data point for the P3 model. Our network contribution was $17,000,000 It is important to note that once we tip that point where network contribution Operating expense, the pendulum will swing toward profitability and we're quickly approaching that key threshold. The distance to reach That point is about $62 per member per month. And just to give you a context of this, we improve our Funding by over $70 PMPM. If we do that again, that will help us cross that bridge.

Speaker 2

We improved our medical costs by over $30 PMPM. If we continue to do that, again, we will cross into profitability. So it's important for us to see the levers that we're pulling. It's all improving about the health of our Our adjusted EBITDA showed very strong improvement With a loss of $19,100,000 compared to a loss of $40,100,000 in the prior quarter. Included in the Q1 2023 adjusted EBITDA is approximately $3,000,000 in costs that we do not expect On going forward basis, adjusted EBITDA PMPM was a loss of $62 PMPM, An improvement of $71 PMPM compared to a loss of $133 PMPM in the Q4 of 2022.

Speaker 2

In our newer markets, we have scaled up quickly. We are feeling optimistic and confident about what we're seeing. Oregon, for example, is quickly moving toward profitability and had a very insignificant loss in the Q1. California has a positive adjusted EBITDA. Across all of the markets we serve, we noticed an Extremely increase of the demand and a full robust pipeline of growth opportunity And we're very confident about our growth the rest of this year and in 2024.

Speaker 2

In Arizona, our performance is strong. Our focus is always on quality had made us the leader in the markets as we serve. That focus on quality is clear and I'll give you an example. We recently received full plus recognition From the CDC for our diabetic prevention and hemoglobin A1C program, which Doctor. Backus will provide some color on later on.

Speaker 2

With these very solid results, we are well on our way to realizing the $200,000,000 embedded EBITDA in our mature Population and cohort and that we believe that is inherent in the P3 model. 2023 is a year where we have committed to deliver the data points to validate the P3 model and our first quarter results Our reflection of that, when we think about where we are as an organization, I believe that we are with the right team, in the right space, in We have done extensive financial benchmarking analysis Comparing our results to our direct public peers, some of which that currently have $10,000,000,000 valuation, When they have similar revenue level, we are spot on. I will leave you with this. Our momentum is building. We're executing on our plan and I expect to share with you more positive news in our second quarter results.

Speaker 2

I'd like now to turn the call over to Atul Kevkar, our CFO.

Speaker 3

Thank you, Sherif, and good afternoon, everyone. I'll start today by providing detail around what we achieved in the Q1 and how we are progressing towards meeting Our full year guidance and anticipated profitability in 2024. Top line results for the Q1 were strong With capitated revenue of $299,000,000 and total revenue of $302,000,000 The capitated revenue includes a higher mix of persistent lives on our platform, which in turn improves profitability. In the Q1 of 2023, we had Strong improvements in both medical margin and network contribution in the quarter. Our medical margin, which represents the amounts earned from capitation Revenue after medical claims are deducted improved over the prior year period to $39,000,000 or $126 on a PMPM Network contribution, which we define as medical margin less network expenses, improved by 114 percent over the year to $16,500,000 We believe that the trends in these two critical data points give a clear view of the progress we are making As we work towards reaching profitability in early 2024.

Speaker 3

Adjusted EBITDA loss was $19,100,000 in the Q1 of 2020 3, a big improvement compared to the loss of $40,000,000 in the prior quarter. Included in the Q1 2023 adjusted EBITDA is approximately $3,000,000 in costs that we don't expect on a go forward basis. The Q1 2023 adjusted EBITDA Is in line with our expectations for the quarter. And as I mentioned on the last call, we anticipate the second and third quarter to show significant improvement and into cold and flu season. That said, Q4 should still see a meaningful improvement over Q1.

Speaker 3

Our net loss in the Q1 of 2023 improved by 14% compared to the same period in the prior year, in part due to the 300 basis point improvement in SG and A as a percentage of revenue. For the remainder of the year, we expect platform expenses continue to taper as we exit the 2nd quarter and get to a more normalized go forward run rate unencumbered by these costs present in Q1. We started the Q2 of 2023 with a cash balance of $95,000,000 although this is not reflected in the Q1 financials due to the timing The transfer of funds from the capital raise we announced on March 31, which were received in the 1st week of April. For the remainder of the year, we expect our cash burn to be We're feeling really great about where we are from a liquidity perspective, even better now than we did on the last call. The capital raise put to rest our liquidity concerns and we are now myopically focused on operational excellence.

Speaker 3

As I sit here today in mid May, I'm feeling really good about Q2 and 2023 guidance. I want to remind you of our guidance for 2023. We still expect 2023 revenue to be between $1,200,000,000 $1,250,000,000 And we are increasing the adjusted EBITDA guidance to now be a loss of $55,000,000 to $35,000,000 Compared to the prior guidance of a loss of $60,000,000 to $40,000,000 In addition to that, we are expecting our medical In 2023 to be in the range of $155,000,000 to $175,000,000 Thank you all once again for your interest in the P3 story. And With that, I'll turn the call over to Doctor. Bachus, who will give you an example of how we are able to bend the cost curve at P3.

Speaker 4

Thanks, Atul. Good afternoon. As Sherif mentioned, we are winning in the markets that we serve from both the provider and patient perspective. From last year to the Q1 of this year, We have been better able to align stronger incentives for our providers to improve access to both their EMRs and patient visits, delivering better outcomes and quality of care, Documentation and utilization. As we discussed in previous calls, it takes physicians approximately 24 to 36 months to fully encompass the care model on their persistent Patients and become converts to the value that value based care brings.

Speaker 4

This is precisely why we're seeing the significant medical margin improvement company wide. The provider engagement is paramount and I'm happy to report that we have more providers engaged with our teams in each market than any time previously. But not only is the provider engagement important, patient engagement is equally important to engage patients to improve their care. By utilizing our care managers, care navigators and others on the team, we have been able to significantly improve results on our high risk, high cost population cohort from 2021 through 2022, reducing both hospital admissions and emergency department utilization by 19%. For our diabetic population, we have seen a 10% improvement in control of this condition, which is why we were recognized by the CDC, as Sherif described earlier.

Speaker 4

Key Key technologies like our risk stratification tool or our Care Connect tool allow us to understand who is at risk and how to monitor them through their care journey. To push the point further, This high risk, high cost population saw a 71.5% improvement in their medical cost ratio, leading to a savings of almost $13,000,000 Success as we see it is striving for meaningful relationships with both our providers and patients and enable both of them via improved data, team support With that, I will turn the call back over to Sherif before we begin Q and A.

Speaker 2

Thanks, Amir. Before we go into Q and A, I just wanted to remind you all that our KEPT promises to our shareholders and investors that we will work hard on improving the funding And we have improved that from 8.99 pm, PM last year Q1 to $9.63 per member per month Q1 'twenty three, that's about 9.3% improvement. We have promised and committed to improve our medical margin. Q1 of 2022 was $83 PMPM and as we promised we delivered increased the medical margin To $127 per member per month, that is constitute about 13.1% Margin from our revenue and medical cost ratio had improved from 91%, 92% Q1 of 'twenty 2 To 87% Q1 of 'twenty three. We promised, we said it, we did it.

Speaker 2

And network contribution The $7,700,000 Q1 last year or $26 PMPM or 2.8%. This year, 1st quarter, as we promised, it's more than double, dollars 17,000,000 Network contribution, positive $53 per member per month. That's 5.5 percent of the revenue. That is why that confidence that we have in all the performance and the fundamentals of our operation and improvement in the health of our population, We increased our EBITDA guidance for this year that as I mentioned early. With that, I'm going to we're going to open for question and answer.

Speaker 2

Operator?

Operator

Thank Today's first question comes from Brooks O'Neil with Lake Street Capital Markets. Please go ahead.

Speaker 5

Good afternoon. I apologize, I'm juggling between a couple of calls. But I'm just curious, What specifically is it in your opinion that gives you the confidence to raise the adjusted EBITDA guidance at this time?

Speaker 3

Well, Brooks, this is Atul. Thanks for the question. Look, I think there's a combination of events, and I think Sherry touched on them all. We feel Good about where the revenue is coming in. We feel good about some of the cost reduction efforts that In the hopper and are being worked on by the teams.

Speaker 3

And we feel really good about some of the reductions in operating expenses that have And that are expected to come through. So I think all of those things combined, just compared to where we And where we initially set our guidance, we feel really good about where we are. Great. And then could

Speaker 5

you just say Obviously, there's a lot of buzz in the industry about the importance of value based care and the transition The value based care, as you have taken steps to slow your enrollment growth This year to improve the performance of the various cohorts, I'm curious if you see in the marketplace Growing or shrinking interest from payers? And then how you'd characterize the interest in providers Working with P3 to deliver value based care to members.

Speaker 2

Brooks, this is Sharief. Thank you very much. Great question. So Definitely growing, intense growing, excessive demand And our business and in our services and our engagement from both the payers and providers. So that's why that gives us the confidence.

Speaker 2

We have a clear sight line of sight to our growth within this year and next year. And we're grateful that we have in our platform almost 150,000 lives that we will convert From either share saving or fee for service into our full risk model over time. So We're seeing increased demand, exponential increased demand from payers and provider.

Speaker 4

Brooks, I would also add, hi, this is Sameer. From providers, yes, providers are getting more interested In value based care primarily because the whole trend is headed that way. So because of that, they're looking for Teams of people that can enable them to be successful. And we do it in a very in a way that's Very easy for them to align with what we do to drive better performance. They don't have to sell their practice.

Speaker 4

They don't have to do So because of that, the enablement and driving more value based care into these fee for service practices is Very, very

Speaker 5

strong. Makes sense to me. Let me just ask one more question and then I'll jump back in queue. Obviously, it's a little bit old news now at the end of COVID. But how would you characterize the impact of going from an environment that Was strongly influenced, let's say, by COVID a year ago to an environment in which It seems like we put COVID in the rearview mirror and life is returning to normal.

Speaker 4

So I think COVID taught us a lot in regard to even how we practice medicine from telemedicine and things like that. It's created us to be a little bit more nimble, how do we improve or drive the access that we need to drive. And all those things have worked. And I think whether you're an Independent fee for service practitioner to a large group, everybody has had to adjust. Yes, it's good to see that COVID is really now Very much on a downturn.

Speaker 4

I mean, we still are seeing some cases, but very, very small. Also understanding that the government recognizes that as well With the potential reduction as of May 11 in regards to really the surcharge that hospitals will be getting, which will be stopping. So all of those things turn to create more value for not only companies like ours, That allows physicians to continue those face to face visits that most patients, especially our senior patients prefer. With COVID going down, it's a good thing for everyone. But again, it has taught us to be more prudent in how we manage patients With any potential disease that may be similar in the future.

Speaker 5

Thank you very much for taking my questions and I'm excited about all the progress you're making.

Speaker 4

Thanks, Brooks.

Operator

Thank you. And our next question today comes from Ryan Daniels of William Blair. Please go ahead.

Speaker 6

Yes, guys. Thanks for taking the questions. Congrats on the strong start to the year and the EBITDA guidance uptick. A couple of housekeeping upfront and Broader ones. First off, do you just have the number of lives on the platform at the end of the period for our models?

Speaker 3

Yes. The at risk lies, we have 103,400 at the and that's full risk on the platform.

Speaker 6

Okay, perfect. And then you discussed the $3,000,000 in cost that appeared in the Q1 that won't be in subsequent quarters. Was that due to any one time cost during the period or is that just a reflection of some of the operating expense reductions you put in place Really starting to hit their stride in the second quarter and then carrying into the back half of the year?

Speaker 3

Yes. It's a good call out. It's really The latter. I mean these are expenses that are in the number. They're burning the first quarter's EBITDA.

Speaker 3

But we know That just based on either contractual changes or decisions that we've made, they're just not going to repeat. And I would also characterize $3,000,000 is potentially a conservative number. I think we intend to really continue working on operating expenses. We've been Talking and I feel really good about saying it again, we talked about high single digit platform expenses for the company going And so we certainly expect to see that and really take shape over the next couple of quarters.

Speaker 6

Okay, perfect. And then maybe one deeper dive into the numbers here. The medical margin performance really notable and pretty impressive. I'm curious if you could double click on that a little bit more and give us some color on what's driving that. I don't know if it's ramping effectively in new markets, some of the clinical programs you mentioned, Just maturity of the patient base, just what's driving that?

Speaker 6

Is that a pretty remarkable improvement? And if that continues, obviously, it bodes very well for the path to So I want to get some more color there.

Speaker 4

Sure, Ryan. It's actually a combination of a lot of those factors that you just described. Our whole model is geared towards as we get in front of our providers and our care model from an education standpoint, so how they can improve in communication, understanding how to improve their charting and at the same time improve quality to drive the revenue number. In addition to that, we also have a lot of work with our care managers, care navigator teams, etcetera, working directly with them on those patients That are high cost and high risk. So therefore, we're able to drop that medical cost expenditure, especially on that top 10%.

Speaker 4

So those things together obviously lift the revenue and at the same time drive down the overall medical expenditure. So as we continue to work with our practices and Educate them. And as I said earlier, it takes a little while for providers to really get in the groove about 24 to 36 months. But once they do, you really start to see a turn. The persistent number of lives are therefore very important.

Speaker 4

The longer you have a patient with you, the more you can improve on their overall care. So you see less expenditures and improved diagnostic ability over time. So it's kind of like you said, all these factors work together to drive the overall result.

Speaker 6

And then maybe just one more quick one, if I could, just giving you the opportunity to hit on the Medicare Advantage rate notice and Changes to the Radvi, the risk adjustment, a lot of providers have talked about that. It seems like it's not a material impact to the space. But just given the markets you're in and analysis you've Don, any thoughts on how they could potentially impact the organization in 2024, if at all? Thanks.

Speaker 3

Yes. Look, I think, as you can imagine, this is an area where our analysts spend a lot of time reviewing and analyzing. And I think also important to It is going to affect different companies in different ways. For our business, for our particular company, there's 2 components to it. There's an HCC component and there's a rebasing component, and they largely offset one another.

Speaker 3

So as Sherif mentioned, I believe, on the last call, I think our position remains the same. We do not expect any material impact on the business.

Speaker 6

Okay, perfect. Thanks so much and congrats on Strong performance and progress. Appreciate it.

Speaker 3

Thank you.

Speaker 4

Thanks.

Operator

And our next question today comes from Josh Raskin of Nephron Research. Please go ahead.

Speaker 7

Hi, thanks. Good afternoon. The number of affiliate providers was flat from 4Q. And I'm just curious if there was some growth in there and then maybe some terminations and sort of if so, what causes the terminations? And then more broadly, if you could just talk about Provider Relations and Growth and Market Development and sort of how you feel about that pipeline?

Speaker 2

Yes. So great, Josh. Thank you very much. So You're right. We've added a significant number of provider and we have said goodbye to some of them.

Speaker 2

And part of the improvement that Amir and Atul had mentioned in the numbers, including the medical margin and the maturation of the population, It's either moving the population to the same provider and increasing our concentration with the relationship with existing providers Or letting go of the provider and the patient bringing new population in. So we have experienced Significant increase in our providers, but also we have I like what we said last time and the time before, our Purposeful and responsible growth may let us to terminate some of the non productive relationship And non profitable population and providers.

Speaker 7

So is that typically a Jan 1 effect, right? Because I sort of think about that With the 3,400 MA ads, which typically you would expect more in January, but maybe you lost some patients as well and that's why you still think you can grow 15 20 this year, is that is there some seasonality to that process?

Speaker 2

Yes, definitely with the annual enrollment That takes effect oneone and recently last year Medicare started having open enrollment, which is For the following 90 days after January, you can change plans if you so desire. So We are putting a lot of effort, Josh, into realigning our plan partner with our provider partners, Where we can increase and enhance the membership without having to go add new providers. So basically Doctor. Smith that I have only Humana Labs with them, I have Humana, United, Centene, Aetna and Cigna and Anthem with them. So that is a lot of our growth is within the same Providers.

Speaker 2

So we continue very bullish in our growth this year and in next year.

Speaker 7

And then just last one for me. The capitated revenue, the PMPM, you mentioned in your prepared remarks as well,

Speaker 8

was up a little bit more or

Speaker 7

a lot more than we were expecting. Is that coding and effectiveness? Is that the persistency of membership? Or is there some mix issue or something like that as well?

Speaker 2

So it's all of the above and mostly the compliance of the integrity of our coding process. And For the first time, as I mentioned, we have almost 82,000 to 83,000 lives that are persistent from last year This year, we've never in our lives had that many or 82% of our lives were persistent. So mainly that persistent and the hard work that our team did last year.

Speaker 7

Okay, perfect.

Operator

Thanks. Our next question comes from Gary Taylor of Cowen. Please go ahead.

Speaker 8

Hi, good afternoon. I had two questions. The first one, just A little bit of a net, I think, but the $5,000,000 PDR charge in the quarter, I know that's excluded from EBITDA, but That's related, I guess, to a specific contract. Is there any more detail on that?

Speaker 3

I'm sorry, could you repeat the question, Gary? I didn't quite hear you.

Speaker 8

Yes. The $5,000,000 premium Efficiency charge in the quarter, I know it's excluded from EBITDA, but that's just is that related just a single Specific contract? Or is there any color on that?

Speaker 3

No. It's not related to any specific contract. What we do is we take a look at and this The GAAP requirement, it's non cash item, as you can imagine. This is just reflecting sort of an estimate of unknown Claims exceeding premiums. We are taking a look at that, just our general policy around how we are doing that calculation.

Speaker 3

We do expect that, by the way, to Essentially reverse when we become profitable. So this is a temporary thing. I think the way I think about it, I expect it to reverse by the end of the year or Early next year, all over.

Speaker 8

Okay. My second one, can you just elaborate a little bit on, So you're expecting sequential improvement in EBITDA loss the next couple of quarters before it Comes off a little bit in the 4Q, but that's very different than the seasonality over the last 3 years where generally the EBITDA loss, the MLR has accelerated throughout the year. So just wanted to understand that expectation a little bit better?

Speaker 3

Well, I mean, if you think about it from the bottom of the P and L up, I mean, our operating expense is something I think that Like in the prior year, I think we are expecting much more consistency and much more predictability around. Last year, with the challenges with the audit and A lot of consulting fees, I think that complicated matters. But we do expect a much more predictable flow over the next few quarters. And as I think as we talked about also around the revenue expectations, the way that we manage excuse me, the way that we account for revenues, particularly the Midyear and final sweeps as we accrue them effectively on a cash basis, we do expect to see some of that benefit Coming forward in the next couple of quarters in the second and third quarter. And so when I talked about the Contour, that's really what that's reflective of.

Speaker 8

Okay. Thank you.

Operator

And ladies and gentlemen, this concludes our question and answer session. I'd like to turn the conference back over to Doctor. Sharif Abdul closing remarks.

Speaker 2

Great. Thank you very much, Robko. So as I mentioned, we're very confident Our results, we're excited to share those results with you. Our growth remain robust and as I mentioned to Josh, our membership, Some of that remain in our platform, but just moved from a full risk into an upside that we turned us to more positive as part of our purposeful and smart growth. And finally, I want to tell you We're very committed to our vision of transforming the healthcare and very committed to our mission.

Speaker 2

More importantly, we want to continue to do well while we're doing good. With that, I thank you all very much and talk to you next quarter.

Operator

Thank you. This concludes today's conference call. We thank you all for attending today's presentation. You may now disconnect your lines

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