Onestream Q4 2023 Earnings Call Transcript

Quartr
Provided by Quartr
February 14, 2024

There are 11 speakers on the call.

Operator

Good afternoon. My name is Brianna, and I will be your conference operator today. At this time, I would like to welcome everyone to the Amwell Q4 2023 Earnings Call. All lines have been placed on mute to prevent any background noise. After the speakers' remarks, there will be a question and answer session.

Operator

I would now like to hand the call over to Sue Dooley, Head of Investor Relations with Amwell. You may

Speaker 1

begin. Hello, everyone. Welcome to Amoil's conference call to discuss our 4th fiscal quarter and year end of 2023. This is Sue Dooley of Amoil Investor Relations. And joining me today are Amoil's Chairman and CEO, Doctor.

Speaker 1

Ito Schoenberg and Bob Shepherdsen, our CFO. Earlier today, we distributed a press release detailing our announcement. Our earnings release is posted on our website at investors. Ammol.com and is also available through normal news sources. This conference call is being webcast live on the IR page of our website where a replay will be archived.

Speaker 1

Before we begin our prepared remarks, I'd like to take this opportunity to remind you that during the course of the call, we will make forward looking statements regarding projected operating results and anticipated market opportunities. This forward looking information is subject to the risks and uncertainties described in our filings with the SEC, and actual results or events may materially. Except as required by law, we undertake no obligation to update or revise these forward looking statements. On this call, we'll refer to both GAAP and non GAAP financial measures. A reconciliation of GAAP to non GAAP financial measures is provided in our posted earnings release.

Speaker 1

With that, I'd like to turn the call over to Ito.

Speaker 2

Thank you, Sue, and hello, everyone. Q4 marked the close of the strategic year for Amwell. We advanced the breadth and maturity of our offering and migrated a big part of our installed base to our new platform, Converge. We have had an excellent reception to our solution, sizable market wins, powerful client validation and we documented compelling proof points. Also, we improved focus and efficiency in our company and are committed to continue optimizing our organization to streamline and propel growth.

Speaker 2

Based on these 2023 achievements, we begin 2024 with high conviction regarding our path to profitability. So tonight in our guidance, we will provide new transparency into how we are completing this replatforming period, Returning to growth and how our path to profitability will play out. To begin, here are a few highlights of Q4. The standout event of Q4 was the previously announced win with the Leidos partnership for Defense Health. Together, as described in the $180,000,000 task order, we will modernize and provide digital care enablement the Defense Health Agency benefiting that organization's 9,600,000 beneficiaries.

Speaker 2

We are progressing well with deploying our solution for the U. S. Military, enabling the DHA's Digital First initiative. I'm pleased to report that we have achieved the 1st milestone as planned and on schedule, we launched our digital behavioral health program for the initial 5 sites. In Q4, we also prepared for large payer migrations have already taken place in Q1.

Speaker 2

The percentage of Q4 visits on converge were relatively similar to Q3 when we met our goal for the year a quarter early. In the 1st days of Q1 'twenty successfully migrated our strategic clients, ELEVANCE and Highmark. As a result, visits from Converge today approach nearly 70% of total. Our platform is scaling and performing well. I would also like to mention a sizable Q4 win with Ampler, part of Medibank, 1 of Australia's largest private health insurance companies serving more than 3,000,000 customers.

Speaker 2

Their initial rollout is planned to include automated section measured by our thumbs up rating metric reached all time highs. Also indicative of high client satisfaction, We had an active quarter for renewals and expansions, including the following. The HSC in Ireland is expanding use of our digital behavioral health solution, thanks to healthy adoption. Integris Health was a large win for us in Q2 of 2023 and is already a Q4 expansion win. Entegris will extend its use of our ED discharge program outside the ED.

Speaker 2

With our automated chats, Integris Behavioral Health specialists can stay closer to patients between visits, while prioritizing high acuity patients. In addition, our virtual nursing solution continues to resonate in the market. Related to this, We had a healthy expansion with St. Bernard Healthcare. Our Q4 performance demonstrates how our existing client base is fertile ground for future growth.

Speaker 2

Continuing on the topic of growth, we are putting the final pieces in place to transform our commercial and reaccelerate bookings momentum this year. Specifically, here are a few highlights. We completed the sales model transformation Moving from distinct account management and sales to a combined hunter farmer model. This will allow us to streamline client interactions, engaging more strategic selling discussions and sell a broader basket of services. We completed tenant review and upskilling initiatives, including adding important leadership in sales operations.

Speaker 2

New talent is coming from ROI oriented Hunter Pharma based enterprise selling environments with optimal experience and skill set to sell our new hybrid care delivery platform. We launched the new sales and compensation model at our commercial kickoff held last week. The bulk of this work is behind us with fine tuning going on in the first half of this year. We have a growing list of expansions and new client wins under our belt, And we are confident our selling motion resonates across the health care landscape. It's an approach squarely in line with operational and financial pain points We direct our client spending priorities.

Speaker 2

We have achieved a lot in the past year. I believe we are better positioned than ever to deliver the profitable growth promised by our large market opportunity and highly differentiated SaaS based software infrastructure platform. As we turn the page to 2024, I believe it is crucial to understand the transformation we have successfully achieved. It's a transformation from a telehealth vendor to a hybrid care enablement partner that healthcare organizations are turning to as we seek to modernize and achieve operational goals. It's also a transformation from selling video visits to connecting and mobilizing digital assets and provider networks within and between client organizations.

Speaker 2

I want to share a couple of key points about this. Our infrastructure platform acts as a distribution system The digitally empowers our clients to address the challenges they face and generate better financial and health outcomes. Our clients are looking for 1 infrastructure consolidating their digital initiatives. The path forward connecting disparate healthcare Teams, patients and digital assets is far from obvious. Time and again, we feel they have tried to build this layer themselves and they are coming to us recognizing our expertise.

Speaker 2

In addition to our technology platform, Our professional services teams are proving to be a powerful differentiating element for us. We are particularly good At the challenging and complex work of integrating workflows and connecting our clients' most important assets And our AMG services further set us apart in the market. Our payer clients leverage our AMG providers to deliver high quality care for members and also increasingly virtual primary care that improve access and reduces costs. Our provider clients look to make the most of their own teams while maintaining the highest standards for care and wait times. AMG provides a combination of critical bandwidth, clinical expertise and load balancing provider services that are unique in the market today.

Speaker 2

Our partnering role is validated in the market. Our strategic clients, CVS, Elevent, The Leidos partnership for Defense Health and others are powerful examples of organizations turning to us to help them achieve their goals. And while our largest clients give us validation, Amul expertise and value benefits a broad spectrum of clients. Our future ready platform enables clients of all sizes to address the needs of today and expand to new use cases when they are ready. Our installed base of clients is a substantial baseline from which we intend to grow our company.

Speaker 2

And finally, at Amwell, We believe we are in the early innings as healthcare has only just begun to modernize and leverage the benefits of technology driven care. The market for enabling this is substantial. From where we see today, we never been more clear that at Amway, We are unique in our approach to this market. Before Bob covers our financials, I'd like to share our key priorities for the coming year. With our healthy balance sheet and improved financial visibility, we have high conviction in our path to profitability.

Speaker 2

We are laser focused on advancing towards profitability, supported by the following top three priorities. First, we will work to ensure a successful deployment of a broad portfolio of our solutions for the military health system. We will continue to execute on the initial phase of our implementation, demonstrate value and support the DHA's enterprise expansion, which is anticipated late this year. 2, we will migrate the majority of our remaining clients on to Converge. Finally, our sights are set on reaccelerating bookings.

Speaker 2

We believe we've made the right moves to return to growth by expanding our footprint within our installed base and winning new clients. In 2024, we will continue to enable the digital aspirations of healthcare organizations with long term profitable growth well within our sights. With that, I would like to turn the call over to Bob to review our financials, some key metrics and our guidance. Bob?

Speaker 3

Thank you, Ito, and good evening to everyone on the call. We begin the year in a position of strong visibility into our future growth and our path to profitability. Tonight, I will walk you through a few operating metrics financial results from Q4 as well as our guidance for 2024. Then given the near term opportunity we have To meaningfully expand our revenue and profitability, I will provide you with additional transparency into our expectations for 2025 as well as our plan for adjusted EBITDA breakeven. To begin, total visits were approximately $1,650,000 in the 4th quarter, a small decline versus $1,700,000 last year.

Speaker 3

Last year's early and severe flu season did not repeat this year, So the relatively strong visit volume reflects growth within some of our strategic payer clients. Scheduled visits represented 60% of total, Continuing to highlight the evolution of our company from provision of virtual urgent care to a platform provider enabling hybrid care. We continue to make good progress migrating our clients to Converge. After achieving our migrations goal for the year 1 quarter early, Q4 migrations temporarily leveled off as we teed up strategic payers for January launches. Visits on Converge were 52% for Q4.

Speaker 3

We successfully migrated some of our largest payer clients at quarter close. With their volume now on Converge, that percentage is materially higher and at the end of January stood at nearly 70%. We will report a formal visits on converged number for the quarter on our next earnings call and we expect the steady stream of migrations to continue this year. Another important metric is our average annual contract value or ACV, which is a good indicator of the success of our land and expand strategy. Health plan ACV was $902,000 and ACV for health systems was $415,000 in 2023.

Speaker 3

We look for ACV for both groups to expand as we grow our footprint within existing clients and add new clients over time. The number of active providers on our platform was 103,000 at the end of last year. After careful consideration, we plan to sunset this metric Beginning in Q1, active providers was initially conceived as an indicator that the activity on our platform in a post COVID world was healthy and sustained. After growing from approximately 8,000 in late 2019 To almost 100,000 by the end of 2021, our number of active providers for the last eight quarters has remained steadily at or above the 100,000 level. With the majority of our volume now on converge, we are finding that many of our clients are aiming to improve outcomes less by adding providers, but rather by increasing the number of patients each provider can care for by using our platform capabilities, including our automated care programs.

Speaker 3

Turning to our Q4 financials, Total revenue was $71,000,000 for the quarter, an increase of 14% to last quarter and down 11% from a year ago. Approximately $3,000,000 of the decline in revenue versus last year was subscription related driven primarily by legacy platform declines with a balance split between lower visit and services and CarePoint's revenue. Subscription revenue declined slightly from Q3 and was $27,300,000 in the 4th quarter. AMG visit revenue trended 8% lower than last year and was $32,100,000 for the quarter. AMG visits were 10% lower this quarter versus a year ago, reflecting the early and severe flu season in 2022 and a return to a more normal onset of flu season in 2023.

Speaker 3

Average revenue per visit was slightly higher this quarter than last year at $72 driven by a mix shift within AMG. Our services and CarePoint's revenue was $11,300,000 for the quarter, an increase of $4,400,000 from last quarter, driven primarily by an increase in professional services and marketing. These revenues can be uneven from quarter to quarter due to customer buying patterns for our marketing services programs and for CarePoints, as well as the timing of professional services that precede deployments. Turning to profitability, our 4th quarter gross profit margin was 34%, flat to last quarter and down from 42% last year. This was largely due to lower subscription software revenue combined with a revenue mix shift away from higher margin implementation services to lower margin marketing services.

Speaker 3

Recall that in 2022, Q4 was a professional services heavy quarter as we performed deployment work associated with a strategic client go live in January. Turning to operating expenses, we are applying ongoing cost discipline across our company that figures into our guidance. As a merit based organization, our incentive compensation in 2023 reflected our revenue attainment, which was below plan. Our operating expenses reflect this and underlie a portion of our expense containment over the year. Further, since the end of 2023, We have reduced our headcount across the company by approximately 10%.

Speaker 3

We are tracking well on our path to the normalization of R and D spending. GAAP R and D expense was 5% below Q3 and was flat after adjusting for $1,000,000 of software development capitalization associated with our DHA work. This brings the quarter the year to down approximately 27% 19% respectively compared to last year after adjusting for software capitalization. SG and A declined approximately 8% in Q4 and 18% overall in the second half of twenty twenty three compared to the first half of the year. This is primarily due to lower stock based compensation expense.

Speaker 3

Sales and marketing spend increased by $1,000,000 primarily due to severance costs And G and A expense was 18% lower this quarter compared to last quarter also on stock based comp. We continue to streamline and rationalize our commercial headcount in keeping with the changes in our growth organization. We believe we do not need to spend more on SG and A to achieve our growth goals and there is healthy operating leverage as we scale. Putting it all together, adjusted EBITDA for the quarter was negative $36,900,000 a 4% and 15% improvement on last quarter and last year, respectively. And transitioning to the balance sheet, we ended the 4th quarter with $372,000,000 of cash and marketable securities.

Speaker 3

In conclusion, While our 2023 financials reflect the headwinds associated with our replatforming, we believe we are coming out the other side. Our business has moved meaningfully ahead in terms of putting in place our growth transformation, normalizing and rationalizing costs and growing our contracted backlog. Turning to our outlook, the progress we made this year significantly adds to our financial visibility and meaningfully de risks our path to profitability. The impact of our plans supporting the DHA, including the enterprise expansion is not fully visible within a single year of guidance for 2024. So we are taking the extra step tonight of providing a look at the growth and profitability we expect in 2025 and we will also provide some thoughts on our plan to reach adjusted EBITDA breakeven.

Speaker 3

First, I would like to provide our 2024 guidance. We expect revenue for 2024 to be in the range of $259,000,000 to 2 $69,000,000 for the year. We expect subscription revenue to be roughly similar to that of 2023. We expect visits to range from $1,600,000 to $1,700,000 and services and care points to be in the high single digits percent of total revenue. Here are a few key assumptions we carefully assess in arriving at our guidance range.

Speaker 3

The replatforming related headwinds from prior periods will impact 2024 subscription revenue, which we expect to decline approximately 10% in the Q1, then build back up with contracted go lives. With respect to our DHA work, our plan is to implement the full portfolio of solutions at the initial five sites for the DHA over the year, with the enterprise rollout anticipated at the end of the year. As we have discussed, there are 3 separate go lives in the initial deployment, So revenue will ramp over the course of the year. We've achieved the 1st milestone as planned. We expect little to no revenue from the enterprise expansion in We are assuming a gradual return of bookings growth as we finalize the transformation of our growth organization in the first half of the year.

Speaker 3

As to profitability, we expect our 2024 adjusted EBITDA to be in the range of negative 160 to negative $155,000,000 As for additional context around our assumptions, we are on track to reduce our converge related R and D spending annually by 25% to 30%. This year, however, government related customization of our platform will moderate the overall decline in R and D to a circa mid teens percent reduction. Our headcount actions will result in over $15,000,000 in compensation related savings, though our guidance assumes we return to normal levels of incentive comp versus 2023. As we complete 2024 and move beyond the initial phase of deployment for the DHA and reaccelerate bookings, Our financial story changes fairly dramatically in 2025. We currently expect revenue in 2025 to be in the range of 335 to $350,000,000 representing growth of circa 30% compared to 2024, primarily driven by go lives of contracted software backlog, including our planned enterprise wide DHA deployments.

Speaker 3

Moving on to 2025 profitability, we expect an approximate 70% improvement in our adjusted EBITDA to a range of negative $45,000,000 to negative $35,000,000 We expect the change in our revenue mix towards subscription software to lift gross margins from the high 30% area in 2024 to over 50% in 2025. After customizing our platform for operation in the government ecosystem, it will be fully scalable and ready to deliver complete hybrid care across the entire military health system enterprise with minimal future development required. And finally, rounding out our forward looking guidance, We currently expect to achieve adjusted EBITDA breakeven in 2026 with a cash and investments balance of approximately $150,000,000 In conclusion, we are encouraged by the strides we've made in our business. We believe we are just beginning to capitalize on our market opportunity And this guidance marks the early days for the long term profitable growth trajectory we envision. Thank you for listening.

Speaker 3

With that, I'd like to turn the call back to Ito for some closing remarks. Ito?

Speaker 2

Thank you, Bob. We are driven every day at Amwell to advance along the path to achieving our goals and pursuing our mission. Our solution solves the most important problems facing healthcare organizations today and is now proven in the marketplace. We begin 2024 on a strong footing with a high degree of financial visibility and laser focused on our priorities. As always, I want to take a moment to thank our team for their extraordinary work and passion as we pursue our mission as one team.

Speaker 2

With that, we are ready to conclude our formal remarks. Thank you for listening today. Operator, we are ready to open the line for questions. Thank you.

Operator

Your first question comes from Craig Hettenbach with Morgan Stanley. Please go ahead.

Speaker 4

Yes. Thank you. Understanding you're going through some transitions in 2024, it does look like there the health systems are starting to benefit from improving utilization and just curious what you're seeing from spending intentions kind of at Health systems versus health plans currently?

Speaker 5

Hi, Craig. Well, you're right. I mean health systems are going through a financial hardship as we all know and what they buy is different from what they bought only recently. In general, health systems are interested to buy platforms and systems that help them improve staff retention and help them improve efficiency. So I'll give you an example.

Speaker 5

Virtual nursing is The high demand item for health systems as well as the automated programs to do variety of tasks to improve their performance. So they continue to be a very important part of our business. However, the biggest story in many ways is the transformation that we see in payers They are now laser focused on becoming much more meaningful for their clients, for employers as members, Putting in place digital first options and especially virtual primary care options that allow to upgrade the member experience and stickiness and greatly improve effective storage to available and cost effective option, A special area of focus for them is behavioral health, which seems to be in very Big need. So I would suggest that in general the need and awareness for a platform to enable All parts of digital hybrid care are very relevant today more than ever. There is growing understanding Of the challenges and sophistication required for such a platform and the fact that we have so many clients migrated to converge with very clear proof points is definitely a very strong tailwind for us in both segments, both for providers and payers.

Speaker 4

Great. And then just a quick follow-up. Bob, thanks for all the detail on 2024 and bridging to 25 and 26. On the 10% headcount reduction, can you just touch on kind of maybe some of the things you were doing with that in terms of getting leaner within the organization and anything else you're able Chair?

Speaker 3

So this was Across the company and some of it was programmed in as we get right sized in terms of our spending related to R and D And some of it was related to what we're doing in the growth organization, Craig, and really And maybe it's best if Ito really addresses in a little bit more detail what we're doing there and what we're trying to accomplish?

Speaker 5

Thank you, Bob. Look, in essence, Craig, the headline or zooming out for a second, we are completing, if we didn't even complete, The reclassoming period for Amrail and our investors and our partners have been enormously patient with us As we went through this very important investment and we are today reporting on what is very clearly Already the growth phase that comes after retaxoning. The biggest opportunity is in the top line, in the growth And we talked quite a bit about it in Bob's guidance. You can see what's happening, which is all contracted In 2025 and beyond and really the only risk and focus area is execution. But in addition to that, we are completely transforming our entire cost structure across the company.

Speaker 5

So obviously in R and D, we completed this giant investment and R and D is really rightsizing very dramatically. But in addition to that, people need to understand that our delivery organization is now doing less and less migrations only because we sort of did most of them And we have some to go, but not a lot. But much more importantly, everything we do with converge is dramatically more efficient. The deployment cycle are shorter. The support is easier.

Speaker 5

It's a very, very modern, very reliable platform. The support tickets are a fraction of what they were in legacy. And in sales and marketing, The changes that we've seen in the marketing and competition really allow us to completely transform the growth organization. The first thing we've done is to reassess our segments and we're going after very well defined segments where we have the right to win. And of course, that includes the very large, very sophisticated clients where we have an enormous advantage over others.

Speaker 5

Then we are implementing a very specific go to market plan with great operational rigor and are beginning to execute on that. We changed our team. We upskilled a lot of our team. The headcount is smaller right now. And we changed the model From a fragmented account management and sales representatives Into a single hybrid partner, individuals that are very well trained, very skilled to sell the full portfolio of our offering in the model of hunter farmers.

Speaker 5

So we have less quota carriers, but their impact is already very clearly much bigger. We also changed our compensation to encourage the high margin reoccurring subscription software And that change is beginning to pay off. So we are now in a product that we believe is significantly more attractive in the market. It's proven in the market by very large sophisticated customers. The cost of maintaining it and selling it is smaller And that all explains the results that Bob shared, which really don't require us to do anything unnatural.

Speaker 5

It's mostly contracted. We just need to continue and execute and we have a lot of execution under our belt. So we think that execution risk is very small from where we sit today.

Speaker 4

Got it. Thanks for all that.

Operator

Your next question comes from Jack Wallace with Guggenheim Securities. Please go ahead.

Speaker 6

Thanks for taking my questions. And I appreciate the multi year guidance outlook Echoing comments from the prior analyst, it does sound like a transition year and then pretty exciting 2025.

Speaker 7

Focusing on 25, just wanted to get a

Speaker 6

better understanding for how the MHS deal impacts That's a model and maybe more specifically with the terms of that contract. If I understand correctly, the task order And sometime in the middle of 'twenty five and just thinking about contribution from MHS in the back half of that year, what is In the guidance for 25% and how should we be thinking about that customer once the task order ends?

Speaker 5

Maybe I'll take the headline and then Bob will give you more of the details. '20 this year is really not a transition year of any sort. We are basically investing In the new market segment, which is the government market segment, take this out and you can see the transition in our number already today, but we are doing some really big investment with the military health service that will allow us to get very strong returns, which are already contracted with this client and hopefully with other similar clients in the same sector for our work with Leidos and others. We talked in the last call on the last call about the task order, the $180,000,000 task order. It is already budgeted and contracted and it includes a few phases.

Speaker 5

The initial phase, which we are now going through and Already part of it is live, as I mentioned earlier, is the deployment in 5 sides of the entire portfolio that will step up For the full enterprise deployment, this is about one go live per quarter across the behavioral health, the Automated chronic care programs and of course, the converge deployment. From that, we're going to step up in 2025 to the full enterprise. This vehicle that We are using the financial vehicle is covering us, but it does cover the entire military health service Genesis contract of the government that includes the EHR and other elements. So this is really the core infrastructure For the military health systems, we are quite confident that this will continue through the process going forward. And we believe that assuming that we execute on what we need to do, Our likelihood of continuing to provide it is very, very high because of the enormous investments that us and the rest of the partners are making in this deployment.

Speaker 5

We don't believe there is a budgetary risk For this, this is a mission critical infrastructure and we don't see a scenario where the government will not do that. We think that in that setting, us not continuing, as I mentioned earlier, is very slim. Bob, I don't know if you have anything to add.

Speaker 3

I think you covered it. I think our just to be clear, Jack, we're assuming that run rate From the end of 2024, beginning of 2025, it continues Going forward, we're not assuming any growth in it, although I think that's conservative. But We are assuming that it's part of a sustaining contract together with the multibillion dollar EHR deployment that the government undertook for the DHA here over the course of the last couple of years.

Speaker 6

Excellent. That's really helpful. And then You alluded to it before, but as we're thinking about potential expansion within the broader Your government customer, I think with the VA and others, what I think I heard you say was pretty much all of the heavy lifting on the R and D side getting done this year. So in future expansions potentially happen, it's a matter of Just turning on the software and some training at that point, There's not the big lift. Do I have that correct?

Speaker 6

And if so, just as a quick follow-up to that, how have your discussions with the military health system and others about potential expansion opportunities? Thank you.

Speaker 5

Sure. So yes, the short answer is you are correct. Look, we are doing a lot of work today that is super relevant to the military health that will pay off to the entire sector. So just a little quick headlines, we are now creating multiple environments, A demonstration environment, staging environment, production, preproduction across our entire portfolio, Figuero Cloud, Automated Care and converge, we are configuring all those systems. We are going through the elaborate and detailed cybersecurity hardening and Appreciation of the MHS and the government.

Speaker 5

We are training a lot of users and administrators. And of course, we are going live in the sequence that I described and beginning to measure impact, which we are confident will be very encouraging going forward. Upscaling from there, which is contracted And budgeted fully is it does not require any additional effort. It's an identical environment. And as I mentioned earlier, when we turn to the next government client, we are probably not going to repeat a lot of this work, we do a lot of similarity between these clients and other clients in the segment.

Speaker 3

Jack, I'd just add that the great thing about the project we have now is we're integrating into a brand new singular EHR across the DHA that was just implemented. To the degree that like in many health systems, you might have a customer in the government sector that has multiple EHRs and different environments that have built up over time, It's not going to it wouldn't be as clean, but this one really is. And this is a great one to get going on. And all of the work that we're doing here relates to operation in that ecosystem regardless of what the EHR is.

Speaker 5

Maybe just to end with one last point, which is an important takeaway. 1, with the bookings that we shared today, we really have a very, very high degree of visibility into everything, into our full profitability in the 26. And something that is even more important, we believe that the mechanics and DNA of this transaction is going to be very typical to future transactions you're going to see in Ambrell, namely We are mostly selling almost entirely selling software, which is very scalable and much higher margin than before. And if you can connect the dots and extrapolate from there, this really opens the new page and new era for Amwell is we are really moving into software SaaS almost entirely a world, which is very different from where we were only a couple of years ago.

Operator

Your next question comes from Charles Rhyee with TD Cowen. Please go ahead.

Speaker 8

Yes. Hey, thanks for taking the questions. Hey, wanted to touch on, you were talking about bookings and one of your key initiatives right is to have the bookings acceleration. You mentioned Integris at the start as an expansion client. Can you talk about sort of the focus of the sales force in this next period?

Speaker 8

Is it really trying to expand services with existing clients or is there a focus on getting new clients on board? And just curious, going back to an early question, Sort of receptivity in health systems who have not yet really thought of an integrated platform for digital capabilities, How high is that on the priority list at this point? And so is the focus more on clients that are already committed to this strategy going forward?

Speaker 5

Hi, Charles. That's a great question. The answer is both. Obviously, we have a very, very large installed base that is currently Even after migration, it has a lot of room to grow in way of traction and additional solutions that we can offer Through us and through third parties that we can resell to those customers, the demand and sophistication It's growing almost daily. The appetite really depends on the type of client.

Speaker 5

As I mentioned earlier, What's high on payers' mind is very, very different from health systems. Health systems are really Focusing on savings and staff retention, while health plans have different aspirations as We tend to offering better outcomes for their clients and for their at risk population through ownership of the member and better So we are so pleased that most of our clients are on converge And it's going to only get better from here, so this effort is waning. We know they are really, really happy. Our NPS is at all time high, It sums up of both patientsmembers and providers in the high 90s. It's very, very Impressive.

Speaker 5

So that's a great starting point to begin as we discussed in the past, the dialogue or further expansion that are higher margin and of course will make our relationship more valuable both for them and for us and obviously more sticky. But there is a world big world out there Of additional systems and health plans and even governments that don't use Amwell, Typically, this entire market is very risk averse. They are very, very careful. So the value of the proof points, The referenceability of this enormous installed base that is now on converge is our biggest asset. And we certainly plan to expand to also new logos and begin the journey Starting with what they need today and with our future ready platforms, telling them more as we go, we see those relationships It's really lifelong relationships.

Speaker 5

It's not transactional. We are even hopeful and expect that some of the people that we lost during the replatforming years are likely to come back as they discover the value of what we are offering But everything we discussed to bring us to profitability doesn't require anything dramatic or herculean On the contrary, it's mostly based on what we already booked. It's entirely dependent on the quality of our execution going forward and require very, very realistic work by our market facing teams. That's not to say that we are not optimistic. We are hugely optimistic.

Speaker 5

We just don't count on it to get to this very important milestone of profitable growth.

Speaker 8

That's helpful. And maybe Bob, as we think about the 25 sort of revenue guide here, it's kind of a step up of Around $80,000,000 How much of that is really DHA? Because it sounds like with the enterprise expansion coming at the end of the year, Most of that contribution falls into 25. You can kind of give us a rough sense perhaps of how much from government versus Backlog from existing clients?

Speaker 3

Yes. Look, Charles, I think the important thing there is A very high percentage, 90% plus of that is contracted backlog. And I really don't want to go into too much detail beyond that in terms of what's associated with one client versus another. Clearly, this our work with Leidos for the DHA is a big component of that. But The most important thing from that I want to communicate about this 30% increase in revenues and 70% increase In adjusted EBITDA is that a huge amount of that is predicated on contracted backlog inclusive of what we're doing with Leidos.

Operator

Your next question comes from Jalendra Singh with Truist Securities. Please go ahead.

Speaker 7

Hi, guys. This is Eduardo on for Jalendra. Thanks for taking the question. On the comment of achieving breakeven adjusted EBITDA in 26, I think you guys previously mentioned that you could get to breakeven on $400,000,000 of revenue. Is that sort of indicating A ballpark of what you're expecting for 2026?

Speaker 3

Yes. I mean, look, we've updated, I think, everything from a few quarters ago. Our mix, I would expect is more heavily weighted towards software than prior. And so that has a meaningful impact on our gross profit And what's available obviously to cover operating costs. And so the 400 number I would view is kind of ancient history.

Speaker 3

And I think the important thing is that I'm really reluctant to we've kind of gone long guidance here in 2024 and in 2025 and, talked about what has to happen in 2026. It's pretty clear that we're guiding negative 35, negative 45 on EBITDA. So that goes to 0 plus in the following year. I feel like we don't need to put yet another number out there for top line in 2026. But I think it's fair to say that it's lower than 400 given the change in mix that we're anticipating.

Operator

Your next question comes from Eric Percher with Nephron Research. Please go ahead.

Speaker 7

Thank you. Bob, another question for you. I think you flushed out the revenue side. I'd like to ask you to dig in

Speaker 8

a little bit more on

Speaker 7

the R and D commentary. And I think what I heard was a path to 25% to 30% reduction over time. Remind us how that kind of stair steps with Converge getting to 70% of volume, what the step function reductions are? And then what was the last part that with DHAs there is mitigation, but that's In the mid teens, what was that mid teen reduction?

Speaker 3

Yes, let me clarify, Eric. So, the converge related spending, So, assume pretend there's no work for the government here. We saw year over year high 20s decline in 2023 versus 2022. I would expect that that would have continued in the area of down 30% in 2024. The spending, the investing that we're doing for operation in the government ecosystem will mitigate that decline to more like mid teens as opposed to 30%.

Speaker 3

Is that

Speaker 7

clear? Okay. That's helpful.

Speaker 3

Yes. Overall, declines are going to be more like mid teens. If you segment that, it would have been down 30%, but the spending the investing on the government side takes it back up to mid teens. And then I expect that we'll and then From going forward from 2024, we get back on track for those declines. And by 2026, we're envisioning a kind of run rate that's in that zip code of call it 25% to 33

Speaker 7

Got it. And at that point, you're getting the dividend from sunsetting anything beyond Converge?

Speaker 5

Yes.

Speaker 7

Perfect. Thank you.

Speaker 3

Thank you.

Operator

Your next question comes from Jessica Tassen with Piper Sandler. Please go ahead.

Speaker 9

Hi guys. Thanks for taking the question And appreciate the updates just on ACV by customer type. I guess just maybe can you help us understand whether the 4Q Q subscription revenue level includes kind of the CVS and Elevate or all of these large customer payer migrations that you spoke about? And then just kind of as those transitions or the migrations to converge have occurred there, is there any shift in the way you Back to recognize revenue from these big payer customers like a shift maybe from subscription to visits that would have occurred alongside the migration? Thanks.

Speaker 3

No. Short answer is no, Jess. There is I think Q4 includes all the revenues from the customers that you mentioned. We're not charging for migrations. And just migrating clients alone won't change the Type of revenue that they're doing with us or how we recognize it.

Speaker 3

What it does do, it puts us in a fantastic position to upsell those Customers now that they're on converge. And so the revenue potential from them is much enhanced relative to them remaining on the legacy platform. So there is that. And then doing yes, so I think that's really I think where you'll see the upside associated with the current base is we expect to be able to see increases same store sales and expanding with those customers over time.

Speaker 5

Maybe I'll just hi Jess. Maybe I'll just give you one example. So I think it's public information. The go live of Elavance, which was the largest migration we did in our history, included everything we've done before on a converge fully integrated with Sydney. But in addition to everything we've done before and the different programs We enable a lot of things for Elevent.

Speaker 5

We also, in Elevent, who was public about it, begin to do virtual primary care. And we are currently very cautious in the way that we think about how to model this. But that interaction has enormous potential All same store growth and enormous value for Elevent. There are similar examples with other customers, some are public and some are Note, so the biggest opportunity with migration is increased stickiness with the customer, increased level of satisfaction In an opportunity for selling additional solutions and we're seeing a much significant ramp up in volume Because the experience is just dramatically different for the different participants, for both providers and the members of patients.

Operator

Your next question comes from Stan Berenstien with Wells Fargo Securities. Please go ahead.

Speaker 10

Hi, thanks for taking my questions. Bob, I want to crystallize a comment you made earlier. It seems You expect DHA to be a steady contributor to revenue beyond 2025, is that correct?

Speaker 3

No question. That is our expectation.

Speaker 10

Okay. And I guess if that's the case, where do you expect

Speaker 7

to pick up in constant growth?

Speaker 5

I mean,

Speaker 3

it's no different than any other customer that we would Sign. We expect that they'll be with us for a long time. I don't know why we would think about this one any differently, Especially given the level of investment that we're making, right?

Speaker 10

Of course. Just parlaying that into a question about 2026, If we're thinking about incremental growth in 2026, if it's not coming from DHA, where is it coming from? And what's your visibility there? Thanks so much.

Speaker 3

It's a big wonderful world out there of customers And we expect to do a lot of business with all of them. We're signing new logos and we are expanding with our existing customers. So, Yes, Stan. I mean, we're presuming success across our lines of business. But if you look at what the guide is for 2025 and then breakeven in 2026, there's probably about The improvement there from a cash flow perspective is probably somewhere at 25%, 30% driven by costs, The balance driven by revenue and gross profit.

Speaker 5

Got it. Super helpful. Thank you.

Operator

Sure. Your next question comes from Ryan McDonald with Needham and Company. Please go ahead.

Speaker 6

Hey, this is Matt Hsieh on for Ryan. Thanks Taking the questions. Wanted to circle back on an earlier question about the referenceable base of customers. You have this nice base now, but also commented over the last Couple of quarters on how the sales team has been seeding opportunities with new health systems and payers. Just curious if that referenceable base is Starting to make Converge less of an evangelical sale and more of a must have best of breed solution or just ultimately Curious how the wind down of converged development in the new sales force design is increasing the velocity of those net new customer conversations?

Speaker 5

Ned, this is almost not a question. It's almost like a statement, which I wholeheartedly agree with. So I would still Maybe give you more color and details. The initial customers for Converge were super early bleeding edge doctors that We're excited by the vision, understood the value and signed up to be first to market with our platform. There are not too many of those in the market.

Speaker 5

They are essential obviously for any new platform to be accepted. We are very quickly reaching a point with all the goal lines that we have, where we are becoming a very proven infrastructure that is Scaling does really well with very good proof points and metrics and a very safe choice In the market, in healthcare especially, that's a really big deal. It's not only the value of the workflow and everything else, these are things like cybersecurity or regulatory compliance. There are so many things that you need to think about when we deploy an infrastructure for digital care for the entire organization. So a few things happened.

Speaker 5

Our platform really matured and is proven, but also the need for our platform in the It's much more palpable and clear today than it was a year or 2 years ago. We don't need to explain much about what we do and why it's important. The RFPs are detailed and long. People know what they want to buy. And we are invited to participate today more than ever.

Speaker 5

So we are at the boring execution phase, if you will, following an age of a lot of innovation and daring and dreaming. Now it's really about we will build it, it's working really well and it's 100% about execution, efficient execution to generate the positive growth, which also means laser focused on software subscription, high margin part of our business more than anything else.

Operator

Your last question comes from Glenn Santangelo with Jefferies. Please go ahead.

Speaker 3

Yes. Thanks for taking my question. Ito, I listened to the prepared remarks. I think Bob said subscription revenues were down just modestly from Q3. And I think, Bob, maybe you suggested there was a decrease From legacy platform, maybe that was the source of the decline.

Speaker 3

I'm kind of curious about from those customers that have already migrated over Converge with now with more than half your volume on Converge, like what sort of your booking experience has been with those new customers? And is that sort of translating to some increased subscription revenues with those that have already migrated over to the new platform? Thanks.

Speaker 5

Hi, Glenn. Well, a few things. You're absolutely right that what we've seen in subscriptions that are missing are The outcome of decisions that were made sometimes 4 or 8 quarters ago, there is always a tail in the heart of replatforming and we are experiencing this Today, as I mentioned earlier, the results we see with people that have migrated are really excellent in Almost any metric that you would choose. And as I gave a few examples and which are not atypical For expansion, I mean, the first thing that clients are doing when they're happy is to buy more and to use the platform more often. So we are now in a just different reality than we were even 12 months ago, Well, we are very optimistic on retaining and growing our converge clientele.

Speaker 5

There are many, many ways to do that. But I'd like to point out again that nothing in our guidance assumes any dramatic thing beyond the reasonable And that should not be confused with lack of enthusiasm, which we share. We just don't want to put it into our guidance and focus at this point.

Speaker 3

Okay, thanks.

Operator

There are no further questions at this Time, I will now turn the call back to Doctor. Schoenberg for any closing remarks.

Speaker 5

Thank you everyone for joining us this evening. Again, I'd like to express Roy, Mai, Bob and so many other people in Amwell For your faith, for your patience, as we went through the replatforming, we are very excited to be in the growth phase of our company And really humbled by the opportunity to help wonderful people, including our Women and Women in uniform and many other people that deserve better care than they get today. So thank you again.

Operator

This concludes today's conference call. You may now disconnect.

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Earnings Conference Call
Onestream Q4 2023
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