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Evolent Health (NYSE: EVH) Q4 2024 Earnings Call
Feb 20, 2025, 5:00 p.m. ET
Contents:
– Prepared Remarks
– Questions and Answers
– Call Participants
Prepared Remarks:
Operator: Welcome to the Evolent earnings conference call pertaining to the fourth quarter and year concluded on December 31, 2024. All attendees will remain in listen-only mode. [Operator instructions] Following today’s presentation, there will be an opportunity to ask questions. [Operator instructions] Please be aware that this conference call is being recorded.
Your hosts for today’s call from Evolent are Seth Blackley, the chief executive officer, and John Johnson, the chief financial officer. This call will be archived and accessible later today and throughout the week via the webcast on the company’s website under the Investor Relations section. I will now pass the call over to Seth Frank, Evolent’s vice president of Investor Relations.
Seth Frank — Vice President, Investor Relations: Thank you and good evening. During this conference call, forward-looking statements will be made under U.S. federal laws. These statements are subject to risks and uncertainties that could result in actual results differing from historical experience or present expectations. Descriptions of some of these risks and uncertainties can be found in the company’s reports filed with the Securities and Exchange Commission, including cautionary statements within our current and periodic filings. For more information on the company’s performance and future outlook, please refer to our fourth-quarter press release issued earlier today. Reconciliations of non-GAAP measures mentioned during today’s call to the most directly comparable GAAP measure are available in the summary presentation on the Investor Relations section of our website, or in the company’s press release issued today and posted on the Investor Relations website, ir.evolent.com, and in the Form 8-K filed by the company with the SEC earlier today. Alongside reconciliations, detailed numbers and operating metrics for the quarter can be found in both our press release and supplemental investor presentation.
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As we reflect on the past three months, we are pleased with the progress we have achieved. In 2024, our revenue reached $2.55 billion, marking a 30% growth compared to 2023. Although our adjusted EBITDA of $160.5 million was at the lower end of our guidance range due to increased oncology expenses in our Performance Suite, we are satisfied with our overall performance.
Today, I will discuss our advancements in the three pillars of stakeholder value creation: organic business growth, improved profitability, and capital allocation to enhance shareholder value. Following that, I will provide updates on operational initiatives aimed at boosting our earnings visibility, particularly the evolution of our Performance Suite products.
John will delve into the numbers for 2024 and share our outlook for 2025 before we open the floor for questions. Looking at organic growth, our 2025 outlook predicts a growth rate of around 15% to 18%, factoring in one-time contract conversions and revenue recognition adjustments. With solid contracted business and a robust pipeline, we are confident in achieving this target.
In terms of new developments, we are excited to announce two significant revenue agreements this quarter. Firstly, we have secured a technology and services contract with a major health plan in New England, serving 2 million members. This renewal and expansion agreement includes new members, geographies, and product offerings, notably in Medicare Advantage. Additionally, a large primary care practice in the mid-Atlantic region has joined our Complex Care ACO, bringing over 15,000 MSSP patients into our care.
Our surgical management MSK offering experienced strong growth, thanks to expanded partnerships and seasonal performance. We anticipate closing several deals in the coming months, with a focus on geographic and specialty expansion. Our client satisfaction and renewal rates for 2024 have been exceptional, with a 100% logo renewal rate among our top customers.
In conclusion, we are optimistic about the opportunities ahead and committed to delivering value to our stakeholders.
We believe that the extension of this relationship demonstrates Centene’s confidence and commitment to our partnership. The extension also includes various contract adjustments that will enable us to implement important automation initiatives for the benefit of our P&L in 2026 and beyond.
Moving on to our second focus area of margin expansion, I would like to provide you with updates on the Performance Suite and our technology and service businesses. We had set a goal in November to swiftly renegotiate three Performance Suite contracts in light of the unusual increase in cancer medical costs we experienced in 2024. As of January, two out of the three contracts have been secured, resulting in over $100 million in earnings improvement through enhanced rates. We have also transferred one contract temporarily to the Technology and Services suite. Today, we are pleased to announce that the third agreement has also been signed.
Collectively, these agreements are expected to bring about a $115 million improvement in projected adjusted EBITDA compared to our Q4 exit run rate. This surpasses what we had previously outlined at an investor conference in January. With the rate increases and strengthened contractual protections, we anticipate that Evolent’s Oncology Performance Suite portfolio will return to profitability in 2025, setting the stage for further margin expansion with approximately 300 basis points of additional margin maturation potential from our existing business.
Furthermore, we maintain our projection of a 12% increase in oncology costs in 2025, which we believe is a conservative estimate. Our focus on technology and services remains strong, with ongoing investments in automation and efficiencies aimed at enhancing margins and improving the patient experience. We have successfully integrated the assets of Machinify Auth, now known as Auth Intelligence, into our platform, with positive early results in our test markets. Based on this and other efficiency initiatives, we anticipate exceeding a $20 million annual improvement in direct costs by the end of 2025 compared to our starting point this year.
Looking ahead, we anticipate that the overall value of these efforts will exceed $50 million annually once fully implemented. This innovation is not just about cost efficiency but also about delivering faster and more effective service to physicians, health plans, and patients, strengthening our market position. While these efforts are expected to be significantly accretive in 2026 and beyond, we do anticipate a one-time drag of approximately $10 million on 2025 adjusted EBITDA due to the implementation costs of our AI-based automation projects.
In terms of our third focus area, efficient capital allocation, our priorities remain consistent – focusing on internal product development and reducing leverage. The executive team is dedicated to achieving our growth objectives and enhancing operational excellence in the near term. Looking ahead, M&A activities are expected to play a role in our strategic growth plans. Before I pass it over to John for a detailed financial overview, let me emphasize the broader perspective as we see it today, following a challenging year in the healthcare industry.
In 2024, we anticipate that Evolent will start 2025 from a position of strength. We have developed a solution to a pressing issue that many Americans are facing. Through contractual enhancements, we have improved our ability to predict earnings more accurately for our Performance Suite business. Additionally, we are actively implementing a clear plan to create value for our shareholders. The demand for condition management in complex diseases like cancer and cardiovascular issues has never been higher.
For instance, in oncology, the United States is projected to experience over two million new cases of cancer this year, breaking a record high and surpassing the two-million mark for the first time. This increase is attributed to more frequent diagnoses of common cancers, along with a population that is aging and expanding. While targeted therapies have greatly prolonged the lives of many cancer patients, the costs associated with these treatments can be exorbitant. For example, a year’s worth of checkpoint inhibitor infusion under Medicare can cost nearly $200,000. While some therapies offer clear benefits for certain conditions, others may not be as effective, leading patients to waste valuable time on treatments with limited efficacy.
We believe that patients and healthcare providers should have access to the most up-to-date clinical information available, which is fundamental to our mission. Evolent offers a patient-centered model that supports healthcare providers in treating patients with complex conditions, utilizing technology and peer-to-peer interactions. In 2024, Evolent physicians engaged in over 240,000 peer-to-peer discussions to better understand individual patient needs and offer evidence-based guidance to treating physicians. This translates to almost 1,000 physician-to-physician interactions daily. With a team of more than 350 physicians, we are capable of reviewing and analyzing vast amounts of current clinical data to provide personalized real-time recommendations.
Our patient-focused approach positions us favorably amidst rapid advancements in science and technology. This model has already shown promising results. Studies have indicated that our interventions have increased adherence to evidence-based practices by over 20% in key conditions. For example, in cancer care, average adherence to best practices typically rises from around 65% prior to Evolent’s entry into a market to over 80% after a year of our involvement.
This improvement not only enhances patient care quality but also tends to lower costs for patients and healthcare payers. Moreover, our high satisfaction ratings from physicians and staff, consistently around 80%, underscore our ability to drive positive change through collaboration and clinical expertise. Our endeavors are guided by the core values of Evolent, central to which is ensuring that patients receive the same level of care we would desire for our own loved ones.
In a time marred by a national debt crisis and steep annual increases in healthcare premiums affecting all Americans, we are committed to balancing affordability with the provision of advanced treatments for complex conditions. Recent research from the Blue Cross Blue Shield Association suggests that without interventions akin to what Evolent offers, healthcare costs could immediately inflate by up
With a focus on managing healthcare affordability and prioritizing collaboration with physicians and patients’ best interests, we are confident that Evolent will play a crucial and enduring role in the healthcare system for years to come. I’ll now pass the floor to John, our Chief Financial Officer, to delve into the financial highlights and our outlook for 2025.
In the fourth quarter, our revenue stood at $646.5 million, serving an average of $83.5 million product members. Despite facing a 6% headwind from Medicaid redeterminations, our product membership grew by 4% year over year. Adjusted gross margin for Q4 remained steady at 11.9%, with our tech and services business offsetting a lower margin of 3% in the Performance Suite, primarily due to losses in our oncology segment.
Our adjusted SG&A expenses totaled $54.4 million, slightly higher than Q3 but approximately $3 million lower than usual due to reduced incentive accruals. Ending the quarter with $104 million in cash and equivalents, we faced cash usage of $26.2 million driven by working capital requirements as we began reconciliations for certain underperforming performance fee contracts that were subsequently restructured.
Our net leverage ratio on December 31st stood at 3.6 times, with the 2025 convertible notes now reflected as current liabilities. By borrowing against our available credit facility in January, our cash balance on December 31st would have been $300 million, providing ample liquidity for liability management throughout 2025. Despite lower Performance Suite revenue, our claims reserve increased modestly to $318 million, reflecting our cautious reserve approach.
Looking ahead to 2025, we anticipate organic growth of 15% to 18% from the 2024 reported revenue figures, adjusted for one-time contractual changes. These adjustments stem from transitioning a major oncology contract to technology and services and modifying terms for two additional specialty contracts in complex care and Advanced Imaging. These changes aim to streamline our revenue reporting and maintain profitability without impacting margins.
Notably, these adjustments do not affect our oncology or cardiology contracts, which will continue to be reported within our Performance Suite. The revenue recognition modifications are expected to result in a one-time revenue reduction of approximately $765 million across three clients, establishing a revised baseline for our future performance.
With a 2025 revenue guidance range of $2.06 billion to $2.11 billion, our forecast on Page 8 of the presentation considers one-time headwinds from membership changes in 2025 at 7%, balanced by anticipated growth between 22% and 25%. Our projections for MFSP revenue mirror those of 2024. On the bottom line, we anticipate adjusted EBITDA to fall within $135 million to $165 million. A bridge from Q4 actuals to the midpoint of this range, taking into account seasonality adjustments and the benefits from Performance Suite negotiations, suggests an exit run rate of around $178 million. Anticipated headwinds in 2025 include partner exits from certain health plans, mostly in MA, and elevated trend in oncology, totaling about $45 million. We are also focusing on automation efforts this year to yield future benefits, impacting 2025 EBITDA by roughly $10 million. Our guidance midpoint envisions adjusted EBITDA expansion from organic growth of $25 million, with 20% of profits expected from the Performance Suite and the remainder from our fee-based business. Details on the oncology trend for 2025 can be found on Page 6 of the presentation. Additionally, we estimate an 11% year-over-year growth in expenses in Q4 of 2024, adjusted for Medicaid redeterminations. Accounting for a 12% projected growth in oncology costs for 2025, we expect to recover approximately 400 basis points of the decline in 2024 Performance Suite margins through rate increases and contractual updates. While the adjusted features of the Performance Suite will stabilize the medical expense ratio, we anticipate at least 300 basis points of additional margin improvement in the future compared to our 2025 guide. Our strategy involves working closely with oncologists to identify nonresponsive patients to certain treatments, such as checkpoint inhibitors, allowing for timely adjustments to more suitable therapies.
In 2023, Evolent implemented interventions for a large Medicaid plan that resulted in a 10% reduction in checkpoint inhibitor expenses compared to initial treatment plans. This cost-saving action demonstrates our ability to impact healthcare costs on a significant scale. We believe that such measures not only lead to more effective care for patients but also contribute to sustainable cost outcomes for the healthcare system. As we look ahead, we anticipate a slight drag on cash flow due to finalizing client reconciliations from underperforming risk contracts in 2024. We plan to invest approximately $35 million in software development and use cash generated from operations to manage liabilities and pay down debts, such as our 2025 convertible notes and senior term loan. For the first quarter of 2025, we project revenue between $440 million and $470 million, with adjusted EBITDA ranging from $31 million to $37 million. We expect that nearly half of our adjusted EBITDA for the year will be generated in the first half of 2025. This financial strategy aligns with our long-term value creation plan, focusing on organic growth, margin expansion through automation, and disciplined capital allocation. Despite the challenges of the past year, we have made strides in enhancing the visibility and consistency of our earnings by evolving our Performance Suite. This shift has allowed us to provide more value to clients while managing downside risk. We are optimistic about the future and remain committed to delivering strong results in 2025 and beyond.
Hey everyone, thank you for the question and providing all the details. Seth, it appears that you are looking to convey the level of confidence in the 2025 guidance. Would it be accurate to say that this confidence stems from the oncology trends, the increased weighting of EBITDA, emphasis on higher services, and the modifications made to the Performance Suite? Is this the right way to interpret it? Are there any other areas of concern that you would like to highlight for us?
Seth Blackley, CEO: Hi Matt, yes, I believe that is the correct way to approach it. Our intention is to instill confidence in the outlook for the year as we are dedicated to meeting and potentially exceeding our targets. John will further elaborate on the impact of oncology trends and how it could affect our performance.
John Johnson, CFO: Hi Matt, to provide context on the 12% oncology trend, if we consider the size of our book this year compared to last year, there is potential for upside and downside. For instance, a 14% trend could result in a $9 million hit to adjusted EBITDA, while a 10% trend could mean a $12 million improvement. This should give you an idea of the level of volatility.
Matt: Thank you for clarifying that. Just to confirm, the 300 basis points margin improvement on Performance Suite and the $50 million efficiency gain from AI investment are separate initiatives, correct?
John Johnson, CFO: That’s correct, Matt. They are distinct efforts.
Matt: Great, thank you.
Operator: Our next question is from Charles Rhyee with TD Cowen.
Charles Rhyee, Analyst: Thank you for addressing my questions. I would like to delve deeper into the accounting trend discussion. With 75% of Performance Suite revenue now covered by enhanced features and rate adjustments, do you still consider the comparison between the 11% in 4Q of ’24 and the 12% in ’25 trend as apples-to-apples when assessing the potential impact?
John Johnson, CFO: That’s a valid question, Charles. The new protections negotiated for this year cover a significant portion of our revenue, leading to a different scenario compared to last year. While there is still movement within the book, the established corridors provide more stability.
Charles Rhyee, Analyst: Understood. Can you provide an update on the cardiology trends as a follow-up?
Is there anything else I can assist you with?
During a recent call, Cigna mentioned an increase in cardiac trend pressure. We are closely monitoring this area to better understand the situation. On a side note, I’d like to wish Seth a happy birthday. Seth, our CEO, expressed gratitude for the birthday wishes.
Regarding cardiology trends, we have observed a smaller increase compared to oncology. Our approach is conservative, similar to our strategy in oncology, and we forecast a modest uptick in 2025 compared to 2024. The impact on cardiology is not as significant as in oncology due to contract structures covering both areas.
When discussing EBITDA guidance for 2025, the potential downside risk lies in unexpected medical cost inflation beyond current projections. We are confident in our organic growth prospects and other factors influencing our outlook.
In terms of oncology trends, our 12% growth projection for 2025 is based on late Q4 data. We do not anticipate trends worsening beyond our Q4 exit point. The impact of trends seen in late Q4 is reflected in our guidance, and we will continue to monitor oncology trends closely in 2025.
If you have any questions, feel free to ask.
Her than 12%, mainly due to Medicaid redeterminations, the Q4 number serves as the starting point for analysis. Jailendra Singh, an analyst, inquired about trends and insights for 2025. The Chief Financial Officer, John Johnson, explained that although there is limited claims completion data for the first six weeks of the year, the authorization information aligns with the forecast. Singh also asked about the Performance Suite book, one-third of which was not part of recent negotiations due to matured margins. Seth Blackley, the CEO, clarified the approach to renegotiations, emphasizing the need for changes where urgent and considering risk-reward trade-offs for future adjustments.
Singh expressed understanding and gratitude, to which Blackley responded. The discussion then shifted to Ryan Daniels, an analyst from William Blair, inquiring about the decision to narrow the scope of solutions outside of oncology and cardiology. Johnson explained that the focus was driven by the company, primarily to streamline resources impacting accounting treatment. Blackley emphasized the theme of consistency and reducing volatility in results.
Daniels sought clarification on the impact of a 200-basis-point uptick under the new contract terms on EBITDA. The CFO stated that it would amount to a $9 million impact. Daniels then questioned how this would compare to a similar uptick in oncology trends at the beginning of the previous year.
I have rewritten the text for you:
John Johnson, Chief Financial Officer: “The increase in visibility would have been around $20-25 million.”
Ryan Daniels, Analyst: “That aligns with what we were thinking. Just one more question – the $10 million in operational investments for the platform. Is all of that concentrated in 2025, meaning a $10 million impact this year followed by a $20 million return in automation and AI next year, resulting in a net increase of $30 million for 2026? Is that a reasonable estimate or too optimistic?”
John Johnson, CFO: “That’s close, Ryan. We’re not providing guidance for 2026, but that’s how we’re approaching it.”
Ryan Daniels, Analyst: “Great, thank you for clarifying. And happy birthday, Seth.”
Seth Blackley, CEO: “Thank you, Ryan.”
Operator: “Next question from Jeff Garro with Stephens.”
Jeff Garro, Analyst: “Good afternoon. I’m interested in the $25 million core organic growth in the FY 2025 bridge detail. Could you provide more insight on the timing and mix of this growth? Specifically, will it be front-loaded, and should we expect any profitability contribution from the Performance Suite in the first year?”
John Johnson, CFO: “The majority of this growth will come from deals going live in the first half of the year. While we don’t anticipate significant EBITDA from Performance Suite contracts initially, we expect a quicker path to mature margins, possibly within 18 months.”
Seth Blackley, CEO: “I want to mention the new Performance Suite relationships going live this year, with all the protective measures in place.”
Jeff Garro, Analyst: “Great to hear. Any updates on the timing of the top five national plan Performance Suite win announced last quarter?”
Seth Blackley, CEO: “We anticipate it going live around midyear, and we’re optimistic about the progress.”
Operator: “Next question from Anne Samuel with JPMorgan.”
Anne Samuel, Analyst: “Thank you. Can you share insights on your pipeline for new partnerships in 2025, especially considering the challenges you may have faced?”
Seth Blackley, CEO: Hello, Anne. Our sales pipeline looks strong, with favorable market conditions due to recent market dislocations. Our new Performance Suite model is working well, offering clients more benefits while protecting our interests. We have a good mix of Performance Suite offerings alongside tech and services, and we are confident in achieving our growth targets for this year and beyond.
Anne Samuel, Analyst: Great, thank you.
Operator: Next question from Richard Close regarding potential policy changes affecting our business, particularly in the Medicaid sector.
Seth Blackley, CEO: Medicaid is a significant part of our revenue, and any funding cuts could impact enrollment and profitability in the short term. However, we have diversified revenue streams from Medicare and commercial sectors, which can help offset any negative impact. We are focused on driving profitability through sales initiatives, and our solutions are well-positioned to address affordability and quality concerns in healthcare.
Richard Close, Analyst: Can you provide more details about the adjustments made in the Centene contract extension and how they benefit your company?
Seth Blackley, CEO: We are constantly evaluating our partnerships, including with Centene, to ensure mutual benefits. The adjustments in the Centene contract extension are aimed at achieving a balance that is favorable for both parties.
Sure, here is a rewritten version of the text:
We have always strived to align our actions with the best interests of our partners. By exploring collaborative opportunities, we aim to generate mutual value. The adjustments we have collectively made in our partnership serve as a testament to this approach. One example of this is our increased investment in ’25, which we believe will yield significant benefits for both parties. This investment focuses on initiatives such as automation and enhancements for patients and physicians, ultimately improving efficiency and outcomes.
We anticipate positive results for our financial performance over time, with an additional year added to our partnership agreement. This strategic decision reflects our commitment to fostering a strong and sustainable relationship that benefits all stakeholders involved. Thank you for your continued support.
Richard Close — Analyst
Operator
Next, we have a question from Jessica Tassan with Piper Sandler. Please proceed.
Jessica Tassan — Analyst
Hello, and thank you for addressing my question. I am interested to know the profitability of the Performance Suite book in 2024. Has there been any change in the percentage of profitable contracts since the third quarter? Additionally, for the contracts that were profitable in 2024 and not subject to rate revisions, are there any implications for their profitability in ’25 due to evolving trends? Your insights are appreciated.
John Johnson — Chief Financial Officer
Thank you for your inquiry, Jessica. The overall profitability mix has remained stable, with a slight decrease in profitability levels across the board. Contracts that were previously profitable have maintained their status, albeit with slightly reduced margins. As for the contracts unaffected by rate revisions, there may be a modest contraction in profitability, as mentioned in my earlier remarks. We anticipate recapturing a portion of this decline in ’25.
Jessica Tassan — Analyst
Thank you for the clarification.
Operator
Now, we have a question from David Larsen with BTIG. Please go ahead.
Dave Larsen — BTIG — Analyst
Hello, and happy birthday, Seth. Could you provide insights into the expected pricing increases for 2025 and beyond? Given the current trends in oncology and premium adjustments by various plans, what are your projections for PMPM rate growth? Additionally, considering the previously mentioned price increases and renegotiations, how do you anticipate offsetting the impact of oncology trends on your financial performance? Thank you for your insights.
Please see below for a rewritten version of the text:
As we move forward, especially if 12% becomes the new standard, it is essential to consider the implications. John Johnson, Chief Financial Officer, and Seth may provide additional insights. In both our specific sectors like oncology and cardiology and the broader managed care industry, sustaining an annual healthcare inflation rate of 10% to 12% is not feasible. This is a key focus for our company’s mission. While we are currently projecting a 12% oncology trend for 2025 based on various factors, it is not a long-term norm that we anticipate.
Our approach involves two main components: a standard annual adjustment based on typical trends and a yearly update reflecting population changes. This may result in fluctuating rates, such as the 12%, 14%, or 15% increase seen this year due to significant population shifts. However, we do not expect this to be the ongoing trend.
Seth Blackley, Chief Executive Officer, adds that regardless of market conditions, our goal is to offer superior value compared to competitors. Our ability to provide top-notch clinical expertise, innovative technology, and effective interventions allows us to adjust pricing accordingly. This key value proposition drives our commitment to delivering superior outcomes for our partners.
Regarding potential adjustments in budget reconciliation, there are no direct ties between plan premiums and our fees. While benefiting our partners is always a positive outcome, our contracts do not directly link premium adjustments to our fees.
In the discussion about profitability in 2026, factors such as a $30 million shift from investing in client efficiencies, potential improvements from Performance Suite, and the long-term growth target of 20% are considered. For 2026, it is important to balance the impact of the previous year’s performance and whether growth should be adjusted accordingly. John Johnson explains that the $150 million baseline may be a starting point for growth calculations, but further insights from Seth may provide a more comprehensive perspective on our future profitability goals.
Today, our core mission is to rebuild trust with our stakeholder community. We believe it is crucial to put forth an outlook that is highly achievable. While we are not commenting on the 26% at this time, we are confident in our current progress and our ability to sustain a growth rate of over 20% annually. The impact of the MA headwind on revenue and profitability affects both our Performance Suite and Ticket Services. As we continue to implement Machinify and Op Intelligence, we are optimistic about the early positive results and their potential to improve efficiency and customer satisfaction. This acceleration in implementation will contribute to overall gross margin improvement sooner than initially projected. Demand remains strong heading into 2025, with a slightly faster deal cycle and an expanded pipeline. We are pleased with the current outlook and our progress. Thank you for joining the call.
Analyst: Matt Shea — Needham and Company — Analyst
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