ModivCare Q2 2024 Earnings Call Transcript

Quartr
Provided by Quartr
August 8, 2024

There are 10 speakers on the call.

Operator

Good morning, and welcome to Motivacare's Second Quarter 2024 Financial Results Conference Call. At this time, all participants are in a listen only mode. A question and answer session will follow the formal presentation. Please note, this conference call is being recorded. I would now like to turn the call over to Kevin Ellich, Head of Investor Relations.

Operator

Mr. Ellich, you may begin.

Speaker 1

Good morning, and thank you for joining MotiveCare's Q2 2024 Earnings Conference Call and Webcast. Joining me today is Heath Sampson, MotiveCare's President and Chief Executive Officer and Barbara Gutierrez, MotiveCare's Chief Financial Officer. Before we get started, I want to remind everyone that during today's call, management will make forward looking statements under the Private Securities Litigation Reform Act. These statements involve risks, uncertainties and other factors and may cause actual results or events to differ materially from expectations. Information regarding these factors is contained in today's press release and in the company's filings with the SEC.

Speaker 1

We will also discuss non GAAP financial measures to provide additional information to investors. A definition of these non GAAP financial measures and to the extent applicable, a reconciliation to their most directly comparable GAAP financial measures is included in our press release and Form 8 ks. A replay of this conference call will be available approximately 1 hour after today's call concludes and will be posted on our website, motivecare.com. This morning, Heath Sampson will begin with opening remarks, Barbara will review financial results and guidance, and

Speaker 2

then we'll open

Speaker 1

the call for questions. With that, I'll turn the call over to Heath.

Speaker 2

Good morning and thank you for joining our Q2 2024 earnings call. 2nd quarter results were in line with our expectations with adjusted EBITDA of $45,000,000 and revenue of $698,000,000 These results were primarily driven by our strong operational performance in our NEMT segment due to our improved go to market capabilities, resulting in new business wins and upward pricing. Additionally, our cost structure continues to improve as we automate and optimize our omni channel engagement capabilities and multimodal network. Within personal care services, the ongoing centralization and standardization has provided a solid platform to build upon, but has temporarily increased our cost structure and moderated growth. That said, our PCS performance improved sequentially and we exited the quarter trending towards our long term margin target.

Speaker 2

Additionally, the softening labor market is favorable for our recruiting and retention efforts. Remote Patient Monitoring revenue growth was lower on a year over year basis due to client membership churn, primarily because of reduction in our membership within our largest Medicare Advantage client. Although the overall MA supplemental benefit market is under pressure, we have a differentiated market position as our RPM business is primarily Medicaid Term Services and Support, and we feel confident about RPM growth normalizing in the second half of the year with mid-thirty percent margins. Based on our first half results, we reaffirmed our 2024 revenue guidance of $2,700,000,000 to $2,900,000,000 and lowered adjusted EBITDA guidance to $185,000,000 to $195,000,000 primarily due to lower than anticipated personal care services results from the first half of twenty twenty four. However, we expect to exit 2024 at a seasonally adjusted run rate of $210,000,000 to $220,000,000 of adjusted EBITDA.

Speaker 2

Next, I'd like to recap some highlights for the Q2. Starting with business development. During the Q2, we won $33,000,000 of annual contract value, adding to the $36,000,000 in the Q1. In addition to various other client onboarding, we onboarded a significant state contract in early June, which is already demonstrating strong performance and results. Importantly, we received extensions on 84% or $526,000,000 of the $623,000,000 in our state Medicaid contracts that were up for renewal this year, including a verbal commitment from our largest state contract in New Jersey to extend through July of 2025.

Speaker 2

We remain highly confident in our ability to extend the remainder of our state contracts and win additional contracts in the second half of the year. Next, an update on our cost saving initiatives. In the Q2, we realized $7,000,000 in net cost savings driven primarily by our strategic initiatives in our NEMT segment. Our omni channel engagement includes digital tools that help members, transportation providers and medical facilities manage trips through apps, text messages, web portals, IVA IVR or when needed, a low cost, high touch experience with our integrated contact center. For example, digital reservations increased to 33% in the Q2, up from 23% a year ago.

Speaker 2

Additionally, we are the most connected and connectable NEMT provider, meaning that we are the only company that's digitally integrated with our nationwide network of transportation providers through 40 trip management systems. We're fully integrated with rideshare providers like Lyft and Uber and we're connected with over 4,000 medical facility portals and we have over 250,000 members and caregivers who are connected through our member app. Additionally and uniquely, we have API connections with our largest clients. This setup allows real time automated eligibility verification and enables clients to manage the member experience through an API connection to our platform. All these components not only improve the stakeholder experience, but also reduce costs, evidenced by our call to trip ratio improving to 38% from 52% a year ago.

Speaker 2

Our second strategic initiative involves sophisticated AI algorithms and technology to manage transportation using fit for purpose modes, which is our multimodal network management initiative. This ensures the optimal time in place for the members' transportation needs, enhancing the client and member experience. This initiative has also shifted more trips to lower cost modalities that are the most appropriate level of service for members, including rideshare, pilot reimbursement and public transit, which combined accounted for 45% of trips in the 2nd quarter. Additionally, our digital engagement and AI algorithms are further reducing waste and improving efficiencies in routing, enabling us to lower our purchase services cost per trip by 5% year over year and payroll and other expenses per trip by 17% despite inflationary pressures. Our strategic initiatives are also effectively offsetting the impact of rising healthcare utilization and Medicaid redetermination.

Speaker 2

We remain confident in achieving our targeted savings of $30,000,000 to $50,000,000 in 2024, as most of the initiatives have been developed, implemented and are in varying phases of adoption and optimization. Our platform enhancements result in a member facing data rich platform, which ultimately improves the member experience and allows us to save costs through greater efficiencies in our trip management and related revenue cycle activities, which will help us achieve targeted cost savings of $60,000,000 on a run rate basis in 2025. Additionally, our data rich capabilities further differentiate our ability to meet client needs beyond the trip itself. Our clients greatly value our access to their hard to reach members. And when this is combined with critical insights from our tech enabled, data rich platforms that impact the cost and quality of care, we become an indispensable partner.

Speaker 2

This differentiation not only strengthens our position to retain and expand also drive incremental revenue through value based care programs. Shifting to our debt refinancing. On July 1, we completed the successful refinancing of our $500,000,000 20.25 senior secured notes with a new $525,000,000 Term Loan B. We thank our partners and new investors involved in this transaction. Next, I'll turn to our free cash flow.

Speaker 2

As anticipated, free cash flow in the first half of twenty twenty four was negative due to settlements on contracts payables, growth in contracts receivables and our semiannual cash interest payment. However, the increase in our contract receivables is primarily related to a few customers with whom we are actively negotiating prepayment resets. These adjustments correspond with Medicaid redetermination and higher utilization and will be retrospective, generating positive cash flows in the second half of 2024 and improving our cash conversion cycles. While our quarterly free cash flow fluctuates throughout the year, we expect a normalized adjusted EBITDA to free cash flow conversion rate of 30% exiting 2024. Recovering from COVID and Medicaid redetermination has been challenging and extended, but our sustained differentiated offering and optimized cost structure are now delivering strong sustainable results that will enhance shareholder value.

Speaker 2

Diving a little deeper into our segment performance. 2nd quarter NEMT performance showed meaningful top line sequential growth and meaningful improvement in our gross margins, driven by our cost saving initiatives. We are encouraged by performance in NEMT as overall healthcare service utilization continues to normalize. And again, we expect the new normal at year's end. Our strategic positioning and enterprise go to market approach has enabled us to secure upward pricing to offset higher utilization even in a challenging environment.

Speaker 2

Our payer clients are under significant pressure to maintain their margin amidst rate cuts and inflationary pressures impacting their growth. We have successfully navigated Medicaid redetermination and the resulting increase in healthcare and utilization, diligently managing the corresponding impact on our working capital. As evidenced by our contract wins and retention, we are well positioned to secure additional NEMT contracts. Incremental volume flows through at a strong contribution margin to adjusted EBITDA, which is why we are excited about consistently adding net new volume each quarter and the significant positive impact this has on our future growth and margin prospects. In the second quarter, PCS performance showed sequential improvement with steady growth in both revenue and hours.

Speaker 2

We recently secured a meaningful rate increase from New Jersey effective July 1 and continue to benefit from rate increases in New York that became effective on March 1. Over the past year, our centralization and standardization efforts have driven efficiencies, aligned incentives and strengthen our core capabilities. However, as often occurs during a rapid transformation, margins and growth have been temporarily affected. We have 2 focused strategic initiatives. 1st, business development and referral management and second, optimizing our centralization and standardization efforts to enhance our hyper local community focus, thereby enabling and empowering us to accelerate caregiver recruiting and retention.

Speaker 2

As a result, we remain confident in driving profitable growth in our Personal Care segment and have implemented the necessary people, process and technology changes to return to a 10% margins in the coming quarters. With respect to PCS regulatory environment, while there is ongoing information from New York regarding the Consumer Directed Personal Assistance Program or CDPAP, we are well positioned with a diversified and healthy book of agency and high acuity waiver business. Only $3,000,000 to $5,000,000 of PCS adjusted EBITDA is derived from CDPAP. Additionally, we may benefit from changes as we have the expertise and scale to manage consumer directed programs. Our RPM business continues to experience higher than expected churn from MCO clients, primarily within our largest MA client.

Speaker 2

However, we expect top line growth will reaccelerate in the second half of twenty twenty four. We remain confident that growth will normalize and we believe margins will remain in the mid-thirty percent level as we invest in our offerings and focus on getting more share of clinical budgets allocated for monitoring and engagement services, which have not been impacted by the shifting reimbursement landscape. We have made significant progress over the last 18 months. Our strategy remains clear as we are well positioned to capitalize on the evolving healthcare market, which demand services to manage health outside of the clinical settings. We are focused on enabling members to stay at home and are taking a more proactive approach to their health.

Speaker 2

We have added technology and clinical resources to go beyond trips, in home care or monitoring devices to manage high risk cohorts, truly lowering costs and improving health outcomes for our clients. Our proprietary platform and differentiated tech enabled healthcare services delivers risk appropriate care based on member acuity and SDOH needs that serve as an extension of the members' existing primary care and care team. We have modernized 3 service lines that can operate independently as differentiated scale platforms. When combined, our service lines leverage our unique cost structure with shared services and business development, while also having ability to drive incremental growth from cross selling opportunities. Also, it's important to note that our business is countercyclical.

Speaker 2

Given the ongoing uncertainty about the macro environment and potential economic downturn, the demand for our supportive care services is expected to remain stable. Regarding our capital structure, now that our debt refinancing is complete, our top priority is to proactively deleverage our balance sheet. We will evaluate all options to enhance value by optimizing our operations and continuing our mission to build a scaled FDOH platform. As for Matrix Medical, we remain aligned with our partner and Matrix Management and we'll provide updates about a potential monetization event when there are developments to report. As we previously indicated, we anticipate this will be later this year or early next year.

Speaker 2

I appreciate the hard work and effort from all team members at MotiveCare as we continue to provide great value to the healthcare system, our clients and our members. Now I'll turn the call over to Barb, who will share additional details about our future results and outlook for 2024. Barb?

Speaker 3

Thank you, Heath, and good morning, everyone. 2nd quarter 2024 revenue was flat year over year at $698,000,000 driven by 3.5 percent PCS growth, offset by a 1% decrease in both NEMT and RPM. 2nd quarter net loss was $129,000,000 largely due to the 100 and $5,000,000 goodwill impairment in our RPM segment and adjusted net loss was $375,000 or $0.03 per diluted share. 2nd quarter adjusted EBITDA was $45,000,000 or 6.5 percent of revenue, driven by solid performance in our NEMT and RPM segments as well as sequential improvement in PCS. Turning to a review of our segment financials.

Speaker 3

NAMT's 2nd quarter revenue decreased 1% year over year, but increased 2.4% sequentially to $491,000,000 NEMT revenue incrementally benefited from successful execution of contract reconciliations and negotiated pricing increases that were more favorable than expected. Average monthly membership increased 2% sequentially to 29,700,000 due to the onboarding of previously announced contract wins, modestly offset by Medicaid redetermination. Trip volume increased 2.5% quarter over quarter, while revenue per trip decreased modestly due to contract mix. Sequentially, NEMT gross margin increased 120 basis points, primarily due to trip mix and our cost savings initiatives. Notably, payroll and other expense per trip decreased 11% sequentially to $6.94 while purchase services expense per trip was relatively flat.

Speaker 3

The decrease in service cost unit metrics illustrates continued traction from our cost savings initiatives. NEMT adjusted EBITDA was $35,000,000 and NEMT margin improved 150 basis points sequentially to 7.2%, driven by $8,000,000 of repricing and contract reconciliations, of which 2 point attributable to 2023 and greater than anticipated. Dollars 5,500,000 was related to repricing and in year contract reconciliations for the first half of twenty twenty four. The increased pricing is in our run rate as well as our guidance. During the Q2, our membership was impacted by Medicaid redeterminations of approximately 600,000 members, which is modestly higher than we previously expected for the quarter, but still in line with our overall expectations impact from redetermination.

Speaker 3

We believe redetermination is essentially complete and expect a minimal impact on our Medicaid membership for the remainder of the year. Redetermination impacted 2nd quarter revenue by $3,000,000 and adjusted EBITDA by approximately 1 Medicaid redetermination is tracking in line to slightly better with our expectations and is estimated to adversely impact revenue by $60,000,000 and adjusted EBITDA by about $25,000,000 to $30,000,000 in 2024, which aligns with our original adjusted EBITDA range of $20,000,000 to $40,000,000 Turning to our Personal Care segment. 2nd quarter Personal Care revenue increased 4% year over year to $187,000,000 driven by 2% growth in hours and 2% growth in revenue per hour. We are seeing solid revenue growth driven by hours and a reimbursement rate increase in New York that became effective on March 1, subsequent to their minimum wage increase earlier this year. Additionally, during the quarter, New Jersey approved dollars or 8% of revenue, which was a 200 basis point improvement from the 1st quarter, driven primarily by rate increases and operating expense RPM revenue decreased 1% year over year to $19,000,000 As we also indicated during the Q1, lower RPM revenue was primarily attributable to Medicare Advantage contract churn from earlier this year.

Speaker 3

With churn issues believed to be behind us, we saw solid growth exiting the quarter, which we expect will carry into Q3 and the second half of twenty twenty four. RPM adjusted EBITDA was $6,100,000 or a 32% margin. We continue to expect RPM margins in the mid-thirty percent range in the second half of twenty twenty four. During the quarter, we performed our annual goodwill impairment assessment and we recorded a non cash goodwill impairment of $105,300,000 for the RPM segment. As a reminder, the impairment is a non cash expense and does not impact our operating cash flows or ongoing activities.

Speaker 3

Turning to our balance sheet and cash flow. During the quarter, free cash flow was negative $62,000,000 consisting of a net use of cash provided by operating activities of approximately $55,000,000 and capital expenditures of $7,000,000 which was 1% of revenue. Driven by NEMT working capital dynamics, we ended the quarter in a net contract receivables position of $79,000,000 Contract receivables increased by $12,000,000 sequentially to $166,000,000 primarily due to successful repricing and contract reconciliations during the quarter. Contract payables decreased by $41,000,000 quarter over quarter to $87,000,000 primarily due to the expected annual reconciliation and settlement on certain contracts. We have made progress on renegotiating prepayment terms on our shared risk contracts and expect the growth of our contract receivables will be reduced going forward.

Speaker 3

We have visibility into the collection of approximately $60,000,000 of contract receivables in addition to our normal run rate collections

Speaker 4

in the

Speaker 3

Q3 through retrospective rate increases and settlements. As a result of increased utilization in the first half 2024 and the mismatch in contract payables and receivables affecting our quarterly working capital, our revolving credit facility balance increased by $62,000,000 in the 2nd quarter to $183,000,000 We ended the 2nd quarter with $10,500,000 in cash, approximately $1,170,000,000 of debt and our bank defined net leverage ratio decreased modestly to 5.22x as of June 30 against our maximum net leverage covenant of 5.5x. On July 1, we successfully completed the refinancing of our $500,000,000 20.25 senior unsecured notes with a new $525,000,000 Term Loan B, with a current interest rate at the secured overnight financing rate, SOFR, plus 4.75 basis points. Since this is a variable rate debt, we will see a benefit if there are any rate cuts. The refinancing was in line with our expectations, and we appreciate the diligence and support from our lending partners and advisors on the transaction.

Speaker 3

Shifting to cash flow, free cash flow was a use in the first half of twenty twenty four given the payment timing mismatch of contract receivables, certain larger settlements on our contract payables and our semiannual cash interest. We've made progress on the retrospective renegotiation of the prepayment amount on a number of our shared risk contracts and in year contract settlements, which gives us confidence that free cash flow will be positive for the year. Accounting for the first half of twenty twenty four results with the impact of our debt refinancing, we now expect an adjusted EBITDA to free cash flow conversion rate of approximately 30% exiting 2024. Shifting to guidance, we maintained our 2024 revenue guidance in the range of $2,700,000,000 to $2,900,000,000 and lowered our adjusted EBITDA to a range of $185,000,000 to $195,000,000 due to the lower than anticipated results from PCS during the first half of the year, while we continue to see solid performance from NEMT. Here are a few qualitative and quantitative items for you to consider for the remainder of 2024.

Speaker 3

Medicaid redetermination continues to track in line to slightly better than our original expectations. For the year, we expect a $25,000,000 to $30,000,000 adjusted EBITDA impact, nearly all of which is in our run rate now. We continue to expect business development to be a meaningful contributor to adjusted EBITDA in the second half of the year, largely driven by NEMT contract settlements and repricings as well as net new contract wins. Cost savings are expected to be at least $30,000,000 for the year, net of investment and digital service cost. The majority of cost savings are in our run rate, and we expect to generate an incremental $4,000,000 to $6,000,000 in the second half of twenty twenty four.

Speaker 3

We expect utilization within our current contract mix to normalize in a range of 10% to 11% for 2024 and to be a headwind of $4,000,000 to $7,000,000 in the second half of the year. We anticipate continued momentum coming of the Q2 for PCS and RPM, which are expected to contribute $13,000,000 to $15,000,000 of adjusted EBITDA growth in the second half of 2024. We expect to invest $7,000,000 to $8,000,000 in innovation and G and A for the second half of the year. We continue to expect a steady progression in adjusted EBITDA over the next two quarters, driven by new contract implementations, greater cumulative benefit from cost savings, the diminishing impact from Medicaid redetermination and sequential improvement in PCS, all contributing to financial results consistent with our revised guidance. In summary, our overall 2nd quarter financial results were in line with our expectations, driven primarily by solid NEMT performance.

Speaker 3

Personal Care and Remote Patient Monitoring were moderately lower than our expectations. However, we saw notable progress throughout the quarter in both segments. We feel positive about the momentum of these segments for the rest of the year and achieving previous growth and margin targets as we exit year. Now that our refinancing is behind us, our top priority is proactively delevering our balance sheet. In closing, I'd like to thank all of our teammates for their unwavering commitment and diligent efforts serving all of our members and clients.

Speaker 3

With that, operator, please open the call for questions.

Operator

Thank you. The floor is now open for questions. And our first question comes from Brian Tanquil from Jefferies. Brian, your line is open.

Speaker 5

Hey, good morning, guys. I guess Heath, as I think about the results here, pretty good NEMT progress and RPM as well, it looks like. So it's kind of like a state of the union, but as I think about the moving pieces between PCS and just the cash flow performance for the quarter, I mean, from where you sit, how are you thinking about the path moving forward here?

Speaker 2

Yes. Hey, good morning. Thanks. We have made a lot of progress across all our three segments and you can see that specifically within NEMT. There's a lot of transformation around all things people, process and tech.

Speaker 2

In Personal Care as well, especially over the last 6 months, like we said there, we exited well in the Q2 and we expect to be back to growing and approaching the margins there anyway. So each of the individual parts are doing very well. And together, as a whole, we're getting scale and leverage. You can see that we're able to generate free cash flow. And as Barb just said, we expect to be positive free cash flow for the year, even though we're high users because of coming out of redetermination and higher utilization in the NAMT contract.

Speaker 2

So yes, our job is to ensure that all the 3 of these segments in the company as a whole is performing. But with that, with where we are from a leverage perspective, everything is on the table for us. So we'll look at performing. So whether that's delevering through our current cash flow or looking at other options for us. So again, we're evaluating everything and everything is on the table for us to ensure that we are able to deliver and drive shareholder value.

Speaker 2

And Heath, maybe just

Speaker 5

to that point, I know you touched upon it in your prepared remarks as well, right? So is there a leverage target that you've set? Or how are you thinking about when you say like everything's on the table, just evaluating the different options or the different business segments that you have in terms of their contribution to the enterprise? I mean is that like a returns based analysis or a cash flow based analysis? Just curious how you're viewing that evaluation process review?

Speaker 2

Yes. So consistent what we've been saying for a while, 3 times is the target. And from where we are today, that's a ways away, right? So considering the 3x, that's why we're evaluating all the options. And the way we look at it is having each of those businesses to be strong and where they're kind of at from a value today and what can that be that incremental value that we could get from each of those segments or from the business as a whole.

Speaker 2

So it's a pretty simple analysis. The best thing for us is to do what we're doing, is to ensure each of our businesses are performing. They're all at scale. They're all meeting where the market is going. We see that with our customers and we know what's happening in healthcare.

Speaker 2

So that is our priority. But again, if there is an option for us, we'll evaluate those options. And again, it's just where we are today to what we could get is how we're

Speaker 5

looking at it. Appreciate it. Thank you so much.

Operator

Thank you. And our next question comes from Bob Labick from CJS Securities. Go ahead, Bob.

Speaker 6

Good morning. Thanks for taking our questions and thanks for all the information.

Speaker 4

Good morning, Bob.

Speaker 6

Good morning. I wanted to start and just ask you to elaborate more on the free cash flow discussion for the back half of the year. I think you said something along the lines of actively negotiating prepayment resets on $60,000,000 of receivables. I don't know, I was typing fast. But maybe just help us understand kind of the process, the visibility and the when we get to get a normal run rate of working capital and stuff like that?

Speaker 6

But more specifically, what's the visibility to that free cash the strong free cash that you're talking about in the second half?

Speaker 2

Yes. Thanks, Bob. I'll start here and Barb can add some color. And we did in the investor deck, I think Slide 18, we gave a lot of disclosure and even some disclosure of what we expect for contracts payable and contracts receivable for Q3 and Q4. So it really gives a good kind of picture of what we expect.

Speaker 2

So the main driver for us because the businesses are performing on our working capital is the contracts, right? And again, the contracts, especially over the last kind of 2 years, 18 months have been redesigned to ensure that we're in this win win relationship from a margin and P and L perspective. But where we're hit, just as a reminder, you know very well that many other people, with redetermination and then utilization with the settlement times within our shared risk contracts that goes on the balance sheet, mainly in AR and then we have from the past being below that, we're at the same time paying contracts payable. So that the contracts are working as designed and protecting the downside and protecting the P and L, but there's no question there is a working capital challenge that we've been working through. So, within those contracts, we know the timing and when those happen.

Speaker 2

They're written down. Unlike it was in the past, they were a little more ambiguous because COVID was new and wasn't contemplated. But now they're all contemplated in the contract. So that's the general statement. And Barb, do you want to add some?

Speaker 3

Yes. So I'll just add a little bit of color. Thanks for the question, Bob. So just to expand a little bit on what Heath said. In terms of the $60,000,000 that we referenced in the script, as Heath said, that's a contractual amount.

Speaker 3

It's not a fuzzy amount at all. So it's a contractual amount. It's a few payers where we've been successful in our repricing efforts and even successful in an in year contract settlement, which is earlier than normal. So we have very good visibility to that $60,000,000 in the Q3. And again, it's primarily related to our successful efforts in repricing.

Speaker 3

So good visibility, it's contractual, and that really will contribute to the improvement in the free cash flow in the back half of the year in the Q3 in the back half of the year. We also in the prepared remarks commented that from an exit perspective, the free cash flow will be improving, the conversion rate will be approximately 30% as we exit the year. So maybe those are a few highlights and data points to give you a little bit more color on the improvement in the free cash flow.

Speaker 6

Okay, great. And I appreciate that. And then on NEMT, obviously, a nice quarter and I think utilization and payroll and other were kind of the drivers there. So two questions. I'm bouncing between your slide decks and trying to figure this out quickly, but it looks like the ending number of membership is lower than last quarter, 30.5 versus maybe 32.

Speaker 6

The net client growth in the back half may have changed a little bit. What am I again, I apologize if I got it wrong there, but what changed there? And obviously, what are the expectations for client growth? Is this going to is the onboarding taking longer or were there addition? Thanks.

Speaker 2

Yes. Very good question. Well, the current deck is the deck to look at with our membership because we have a really good understanding of the timing of clients onboarding, a couple of things on that. If you triangulate in redetermination on the membership, it's about $500,000 higher than we thought around that. We also did have one of our that we won state businesses that got pushed into 2025.

Speaker 2

And then the other items are just a general estimate that we had before and when stuff is coming online or when contracts get ultimately finalized with the right mix. And that's probably the biggest driver that we had that membership too high. The important item is that's just the membership item that you're seeing. The economics and the ultimate bottom line and ultimate cash flow and timing are right in line with what we expected last quarter. It just is really a membership estimate change for those reasons that I just talked about.

Speaker 6

Okay, great. And last one, I'll get in queue on this. The payroll and other was a nice substantial decline sequentially. And I mean, this is a trend we've been looking for and it was good to see in part of the strength in ending EMT in the quarter. Just kind of a little bit behind that, Are we at a new run rate?

Speaker 6

Is there still more improvement there? Was there any one time benefit there, etcetera? How should we think about that? Again, it was a great comforting number. I just want to get a sense of how that plays out going forward.

Speaker 2

No, it's again, the efforts of the team and what we're doing within our platform is tremendous. We gave a lot of detail in my opening comments. Hopefully, that was helpful because it really all those items together are what are driving our ability to meet the member where they are with technology tools and processes in place. So that's a real number and we still have more in the tank. You'll see in the cost savings that we're actually achieving what we thought we would in that for the year, right?

Speaker 2

We're going to be right where we expected. And then also in my comments, I do expect that we're going to continue to accelerate beyond that to get closer to the 60. So we expect more and more kind of on a linear basis as we finish the year and go into 2025. So it's been really, really well done by the team. So you see that in payroll and other in purchased services as well.

Speaker 2

There is some kind of one time timing between Q1 and Q2, but that trend is going to continue down as well. Again, from all the hard work we're doing in each of those initiatives, it's really paying off. So we feel good about it continuing.

Speaker 6

All right. Thank you very much.

Operator

Thank you. And our next question comes from Pito Chickering from Deutsche Bank. Go ahead.

Speaker 4

Good morning, guys. Just going back to the timing of those cash flows from NEMT risk contracting, Medicaid, liquid determination and liquidation has

Speaker 7

been hot last sort of 2 years.

Speaker 4

So why is this happening this quarter versus other quarters? Is there any debate around how much is owed to these contracts? Have you had any issues collecting revenue from these risk sharing contracts in the last 12 months?

Speaker 2

Yes. So you're on it and you've covered the payers and I think many people on this phone know what's happening. It's pretty clear that utilization has been hot and it continues really to be hot. But why it's kind of isolated to really the it's been happening, but really it's kind of hitting this crescendo right now. It's just kind of the timing of where we've kind of benchmarked and estimated when this was going to happen, coupled with our contracts get settled whether that's 6 to 12 months.

Speaker 2

So even though utilization was increasing in 2023, you're just going to settle up with a lot of those kind of 12 months later. Again, and then coupled with where we've snapped the chalk line earlier on, that's why it's all coming to ahead right now, which again, which is why we said 1st part of the year, we're going to be using a lot. And in the 2nd part of the year, we'll be able to delever. So it's not a surprise. It's really the design of our contracts and the timing of that.

Speaker 2

And yes, correct, the utilization has been high, but again, that's as expected.

Speaker 4

Okay. Please go ahead.

Speaker 3

Yes. Sorry, Peter. I would add. And in fact, it's actually in part, it's been our success in the contracting process where we've accelerated some of the reconciliations, some of the settlements in a couple of contracts. And so we've talked about that in the past that that is our goal to try to accelerate that so that there's not so much time and distance between when we're actually incurring those costs and that actual cash settlement.

Speaker 3

So we've actually been successful in accelerating a couple of those.

Speaker 2

Yes. And just a little bit on that because what does that mean? So let's just say it's 12 months and we're halfway through and we're knowing and we and the client are knowing that utilization is going up. So we know, I don't know, 6 months from now, we're going to have a large true up or settlement that. So we go to the client and say, hey, it's going to be so large, you can see this, you see the data, which is why we've been, okay, let's kind of reset that line.

Speaker 2

So we don't have a big growing receivable and payment at the end. And our clients again are in a win win relationship with us to ensure that we're doing them. That's why, as Barb articulated, we've been successful in a few of those large contracts to do that ahead of time.

Speaker 4

Great. So 2 more quick ones here. So just to be clear, there's no risk for charges on rev rec around these restructuring contracts. And then last quarter, you said that we exited the year at a free cash flow conversion of 40%, 50%, excluding the debt refinancing now it's 30%. Just wanted to understand the change of the 40% to 50% to 30%.

Speaker 4

Is it just the debt financing or something else?

Speaker 2

Yes. So we do have still a couple of quarters ago, we talked about one contract in Florida that we didn't collect on, but we've collected 75%. That one is still open that remainder. So there's one client that we're having some, but it's really small. So just to be transparent that there was one client that we're still in discussions to get the last 25%.

Speaker 2

Outside of that, we expect to collect all our receivables. And then to do with the cash conversion, it really is we just with the higher cost in our new term loan that we got, it's just math to take us down to that 30% from the 40%.

Speaker 4

Okay. And then last one for me here. On RPM churn rate, I guess, why is the churn rate so high from your largest customer? Is it pricing or service levels? Thanks so much.

Speaker 2

Yes. The main reason is one of our large clients on the MA side, again, if you're talking to payers and specifically supplemental benefit pressure within MA is high across the board. And this is what happened with this payer. That's where the churn was. First off, the churn related to them not winning states.

Speaker 2

So they lost states, therefore, we don't get as much volume. That's the biggest driver, but it also is just some pressure on supplemental benefits and offering that is what is the issue. But as we pointed out, and we get some data in the deck here, we, unlike maybe a lot of other RPM businesses, we're not as exposed to MA. It's about 25% of our business. So though, yes, that was the reason.

Speaker 2

Going forward, we believe we'll be able to manage through that challenge in the MA market.

Speaker 4

Great. Thanks so much.

Operator

Thank you. And our next question comes from Scott Fidel from Stephens. Go ahead, Scott. Your line is open.

Speaker 8

Hi, thanks. Good morning. First question, just thought it might be helpful if you wanted to bridge us just on the margins for NEMT and then with PCS did catch the comment about getting to close to the 10% by 4th quarter and the exit rate. Maybe if you want to sort of I guess embedded in getting to that 2.20 or dollars or $0.02 to $0.20 exit rate, how you see the NEMT margins progressing in 3Q and then 4Q and similarly with PCS in 3Q and 4Q as well?

Speaker 2

Yes. Thanks, Scott. Well, starting with NEMT, you can see the margins in that 7% -ish range. And then to Bob's kind of question around improving cost savings, that continuing, coupled with our continued onboarding of clients, where we have, again, contribution margin that flow through is strong. So I do expect an uptick, call it, kind of to the end of the year around 100 basis points plus is probably the right way to think about on the NAMT side.

Speaker 2

PCS, you saw the jump in Q2. Again, lots has transformed there and still lots of work to do. But we also said that we exited that quarter in a strong way. And then you couple that and why with PCS, not only have the cost kind of centralization cost normalized for us because we got it out, but we also have rate increases and that's a big driver for us. So and those started here in early Q3.

Speaker 2

So you'll see that jump. So that will be more than and as Barb alluded to, we'll get closer to that 10% range. And then RPM will be kind of in that mid-30s range as well. So really, so that's the bridge and all in front of us. Most of it is the actions we have in place or things that we have done and if it will trend that way.

Speaker 2

Is that helpful, Scott?

Speaker 8

Yes, it is. Heath. And then just one follow-up around that. Just on the PCS side, I was thinking, I mean, should we see more of a step function up in the 3Q just because you guys have now gotten those rate increases? Or are there still some costs from the centralization and transformation that offsets that in the 3Q so that we see more of the margin in the 4Q show

Speaker 4

to get

Speaker 8

to that sort of close to 10%?

Speaker 2

You'll see a step up because of the stuff. It won't get all the way to the 10% range, but you'll see a meaningful step up.

Speaker 8

Okay, got it. And then second question, just wanted to just get your update on and I know we you guys talked a little bit about it with PEDO, just on the soft benefits in MA and some of the churn there in RPM. Just looking out to 2025, just given the reimbursement pressure that MA plans are facing and the utilization they've seen on supplemental benefits this year. What's your visibility at this point into your MA books in NEMT and then in RPM in terms of sort of retention of volume and then your sort of pricing with your MA customers. Is that remaining consistent just or are you seeing some pushback just given the rate pressures and cost pressures that MA plans are experiencing?

Speaker 2

Yes. So first, you know this, but no exposure to MA on PCS. Within NEMT, those really supplemental benefits over have really been under pressure for the last couple of years and probably steady. And so we know the markets that our clients are not going to offer NEMT. So we know that and expect that.

Speaker 2

There are no question pricing pressures, but we anticipated that and it's been baked into our current numbers and even what we expect in 2024, which is why again, a company like us that has the size and scale and what we're doing around automating, we can get to the right win win price where we save money for people as well as ensure that we maintain our margins. The RPM business is probably the biggest business that is going to be impacted on supplemental benefits. I could spend a lot of time here. In the end, the technology in someone's home is going to be really important, especially for people on certain population types. So though, yes, the current model is under pressure, but I do think there is going to be a more outcomes based, populations based device in a home transformation.

Speaker 2

And those are the discussions we're in. So I don't expect large, large growth in the short term around MA and RPM, but I do expect more of a sustained kind of competitive advantage even on the MA side for us. And again, the other thing, and this is what's happening. It's not about the alert anymore. It's really about what are you going to do with that alert and the clinical outcomes that are there.

Speaker 2

And because of what we've invested in with our clinical people as well as our technological capabilities, we're able now to get into the clinical budget because we're really going to change outcomes. And that's what I mean about the changing dynamic within the RPM world.

Speaker 8

Got it. And then one more if I can. Just as we sort of put all of this together, thought it might be helpful just at this vantage point if you wanted to sort of summarize what you see as the key headwinds and tailwinds for 'twenty five and sort of your confidence in sort of getting back to EBITDA growth in a nice way. Obviously, there's been a number of these headwinds that seem to be more impacting the first half relative to the second half, but we all need to be respectful around the environment and a lot of fluidity that we see in the Medicaid market and in some of the businesses. So sort of taking all that Heath, sort of how would you lay out what you see as the key tailwinds and headwinds for next year?

Speaker 2

Yes. Well, so for next year and beyond, a lot of tailwinds from the pressures that are helping in the healthcare system and the societal demands of moving into the home. Again, those pressures, whether that's cost or the evolution of understanding that care really matters outside of just the clinical episode. Continue to accelerate because it reduces costs as well as improves access quality and costs. So those kind of macro are only going to continue and will happen in 'twenty four and I mean, sorry, 'twenty five and beyond.

Speaker 2

So we're with that and what we've invested, we're in a really good spot to ensure that we are meeting that. But specifically around 2025, a lot of what we've done within this transformation has been in place. So a lot of the hard work around culture, ensuring the strategies there, ensuring the right operating model is there has been in place. So, now it's about this continued execution and really being customer centric. I know that sounds kind of cliche, but that is our focus because our customers whether they are doing explicitly at the contract level because they're doing explicitly at the executive level.

Speaker 2

Yes, I love the trip Heath. I love that you've done the work in the home and I love the device alert. But really, I want an outcome and I want you to understand my population. So that's what we're doing now. So and then just a little bit around, I think, implicit in your question, PCS is a good example.

Speaker 2

We had a soft Q1 and Q2 because of what we've been doing from a centralization, standardization of 1 platform. But you're seeing that grow. So those kind of internal dynamics of are done. I guess you're never done transforming, but from a reality of how much transformation we had, we're able to build on top of that. So long story short, I feel good about what we've done internally.

Speaker 2

The headwinds, of course, are going to be these continued reimbursement pressures. But again, for each of our units, we have scale and size. And then the market tailwinds, as long as we are meeting where the customer wants to go beyond just the transaction, which we are, we're going to ensure that we're in a good spot for growth. So I expect 25% to be a really solid growth off our run rate that we disclosed earlier today.

Speaker 8

Okay. Thank you.

Operator

And our next question comes from Rishi Parekh from JPMorgan. Go ahead, Rishi.

Speaker 9

Hi. Thank you for taking my questions. First on the contract renegotiations that you're referring to earlier, I get that as a win win or at least you noted as a win win with the payers, but can you just help me better understand how is it a win for the actual payer? I mean, I get that you're getting paid earlier, but are you giving up price or are you reducing price or what are the economics that you're changing to make sure that the payers are paying you early? And what does also mean for payables?

Speaker 9

Are you going to also have to pay those out faster?

Speaker 2

Yes. No on the payable side. But the win win, yes, the payer wants the best price. So we're able to offer the best price because of what we've done with our platform. But we've estimated that.

Speaker 2

So it's not different than we saw. They are getting a better price as we re underwrite these deals. For us, just in general, because and the other item that we need to perform. So you need to ensure that on NEMT that of course you're picking people up on time. There's no complaints and then you're starting to do more at the individual population.

Speaker 2

A dialysis member is very different than a mental health member. So we are doing all that. So that is really the main reason why our customer status high. Layer on that we can be the lowest cost, even better. So that's what I mean by win win.

Speaker 2

But specifically on your question around kind of the renegotiation, the renegotiation is twofold. It's when something comes up for renewal or when we're at a juncture where we need to reset because of a mix change or because of what's happening in redetermination. Those we know that we're going to get a lower price. Again, those are what have been baked into our 2024 numbers and what I expect in 2025. The other item around our free cash flow timing, that is the contractual design we set this specific estimate of $5 and we know now that it's $6 and we're not going to settle up for that $6 that is incremental 12 months.

Speaker 2

We've negotiated to get, call it, half of that or some of that earlier. So it's not an economic issue, it is a timing issue. And because of all the benefits that I talked about earlier, our large customers are receptive to do that for us.

Speaker 9

And just a follow-up on, is that something that's going to happen every year? Or is this just a temporary move just to collect on those receivables now for this year?

Speaker 2

It's this year. We do expect as we exit this year, redetermination will be done, really the kind of normalized healthcare utilization. So it's just a bolus because of those two reasons that we expect to be finished this year.

Speaker 9

Okay. And then I know you went through some of the numbers on this and I apologize those did not type fast enough. But your first half, second half EBITDA split is usually dollars -sixty. So there's about a $35,000,000 $40,000,000 delta just to get to your guidance or at least the

Speaker 5

Yes. So the

Speaker 2

Yes. So the uncontrollable again and this is redetermination. Redetermination, major large headwind for us and that kind of peaked in Q2. So that's one. The other is timing of our kind of net sales wins.

Speaker 2

We did have legacy attrition. We're offsetting that and that onboarding of all those contract wins we had in 2023 2024 really starts in Q2 and continues to accelerate. So, it's working through the losses and the timing of putting the new ones on. So, that's a big those 2 big items. And then the last one, it's across the board, but primarily within AMG is the continued traction and acceleration of the cost savings.

Speaker 2

So it really is and there's not a big gap. We need to do X or Y. It really is those items that are in place and run writing or coming on board as scheduled. So we have a lot of conviction in our ability to hit that appears ramped second half of the year for those reasons.

Speaker 9

If I could just squeeze one more in on your leverage target, I know you said 3 times. One, can you give us a target timeframe as to when you plan on getting there? But more importantly, is that 3 times based upon your covenant EBITDA number, which is about a 2 turn difference? Or is it based upon actual EBITDA, which is about a 4 turn difference?

Speaker 2

Well, so first off, the timing and this is important for us too. The timing will be hard to predict because we need to there's options for us to get there. So if it's just generating cash from our businesses, that's going to take longer. If it's some other alternative, that would be faster. So for us, it really is evaluating what's the best economic answer for us.

Speaker 2

So timing is tough to predict. At the same time, we are looking at everything so we can do it as well. We really do understand and how important it is to ensure that we bring down leverage as fast as possible. So, sorry for the fuzzy answer, but really it's about ensuring that we do the right thing at the right time. But again, we have many options in front of us.

Speaker 9

Sorry, if I could sorry, go ahead.

Speaker 2

What's your second question? I can't remember what it was.

Speaker 9

Is it based on the covenant EBITDA or actual EBITDA?

Speaker 2

Well, so for us, it's through economics. We don't have a covenant. Obviously, we have covenants. We have to abide by those. But the decisions we make around timing are going to be economic, not driven by covenant, because we feel good about our ability to meet those covenants.

Speaker 9

And sorry, when you say the alternatives, how far down that path are you with those alternatives other than Matrix? I mean, are you in the 3rd inning, 4th inning or are you just scratching the service to evaluate those alternatives?

Speaker 2

Yes. That is not something we're really because we're not announcing anything like that. We are fully aware of all our businesses and the opportunities in the market. So we're not in any inning or anything that we want to disclose around that, again, other than Matrix, which we know the timing we talked about there already.

Speaker 7

Great. Thank you.

Operator

And our last question comes from Mike Petusky from Barrington Research. Mike, your line is live.

Speaker 7

Good morning. Heath, and I apologize, but you can do this super quick if you're willing. I missed multiple calls this morning. I missed first 8 minutes of your prepared remarks. What did you say about Matrix?

Speaker 2

Yes, consistent what we said last quarter, the timing is either later this year or early next year.

Speaker 7

Okay. All right, great. Yes, great. I'll read the transcript for anything else there. I appreciate it.

Speaker 7

So just going back to the $60,000,000 contract receivable that you think is sort of teed up. How many contracts does that come is that like 3 or 4 contracts primarily or how many different accounts does that cover?

Speaker 2

Yes, it's definitely more than one contract. As you all know, the concentration of payers, there's really big eight people. So it is though it's multiple contracts, it's isolated to a couple large payers.

Speaker 7

Okay. So like 2?

Speaker 2

Yes.

Speaker 7

Okay. All right. And then just curious has we're about into the quarter. Has any of that been collected to this point or no?

Speaker 2

So there's lots of cash flow moves in and out. So yes, we're not going to front run Q3 for us. We just feel good about our ability at the end of Q3 to get those collections happening in total.

Speaker 7

Okay. So can I just ask one more question just on sort of connected to the subject? So given the call out of the $60,000,000 that you think is likely to be collected sooner rather than later. I mean, is sort of the cadence of the free cash flow in the second half going to be a little bit more heavily weighted in Q3 versus Q4? Is that reasonable sort of guesstimate?

Speaker 2

Yes. No, you're right. And if you look at Slide 18, you actually can see that, which is why we gave all that disclosure.

Speaker 4

Yes.

Speaker 7

All right. Okay, very good. Thank you so much.

Speaker 2

Yes.

Operator

Thank you. This does conclude our question and answer session. I'd now like to turn it back to Heath for any closing remarks.

Speaker 2

Yes. Thank you for participating in our call this morning and for your interest in our company. Our updated investor presentation is posted on our Investor Relations website. If you want to schedule up a follow-up call, please call Kevin Ellichar, Head of Investor Relations. We look forward to speaking to many of you over the coming days, weeks months before we report our Q3 results in November.

Speaker 2

Thank you again. Thanks to the team. Everybody have a great day. Operator, this concludes our call.

Operator

Thank you. This does conclude today's conference. We thank you for your participation. You may disconnect your lines at this time and have a wonderful day.

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Earnings Conference Call
ModivCare Q2 2024
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