agilon health, inc. (NYSE:AGL) Q4 2024 Earnings Conference Call February 25, 2025 4:30 PM ET Company Participants Evan Smith - Senior Vice President of Investor Relations Steven Sell - Chief Executive Officer Jeffrey Schwaneke - Chief Financial Officer Conference Call Participants Stephen Baxter - Wells Fargo Justin Lake - Wolfe Research Jack Slevin - Jefferies Ryan Langston - TD Cowen Amir Farahani - Bernstein Jailendra Singh - Truist Securities Michael Ha - Baird Elizabeth Anderson - Evercore Adam Ron - B ...

Total Care Model and Partnerships - The agilon platform supports the transition to a Total Care Model, integrating technology, processes, and capital to improve healthcare outcomes[19] - The long-term partnership model with community-based physician groups typically spans 20 years, resulting in a growing and recurring revenue stream[20] - The Total Care Model incentivizes physicians to improve quality and efficiency of care, sharing financial surplus when premiums exceed medical costs[24] - The company has entered into long-term professional service agreements with anchor physician groups, typically lasting 20 years, to manage medical costs[26] - The company aims to expand its geographic reach by partnering with community-based physician groups across the United States[42] - The enterprise marketing team develops local branding strategies to support the growth of physician partners and their Medicare patient population[43] Financial and Revenue Models - Global capitation fees from health plan payor contracts are based on a defined percentage of monthly premium payments from CMS for attributed members[31] - By 2025, CMS will transition to compensating physician partners on a per beneficiary per month basis, moving away from fee-for-service compensation[39] - ACO REACH entities must implement a robust health equity plan and maintain 75% control of their governing body by participating providers by 2025[40] - The company’s contracts with payors typically have terms of one to three years, with renewal options and specific termination rights[34] - The company relies on a limited number of key payors, which poses risks if contracts cannot be secured or renewed on favorable terms[128] - The Medicare Advantage (MA) program accounted for nearly all revenues in the previous fiscal year, highlighting dependency on government programs[188] - Changes in CMS reimbursement models and risk-adjustment methodologies could significantly impact revenue and financial results[190] Regulatory Compliance and Legal Risks - The healthcare industry is subject to extensive regulation, and the company must comply with various federal, state, and local laws[61] - The federal government has utilized the FCA to prosecute various alleged false claims and fraud against Medicare and other federal healthcare programs[69] - The DOJ has initiated multiple investigations under the FCA against payors and providers for alleged improper coding, with penalties including treble damages and substantial fines[70][71] - The AKS prohibits remuneration for referrals related to federal healthcare programs, with violations potentially leading to imprisonment and fines up to $100,000 per offense[72][74] - The Stark Law restricts physician referrals for Medicare and Medicaid patients to entities with which they have a financial relationship, imposing civil penalties of up to $15,000 per service for violations[78][79] - The company has structured its business arrangements to comply with the AKS and Stark Law, ensuring that payments to providers are for healthcare services and items[75][81] - The company maintains a compliance program to monitor adherence to federal and state laws, which includes periodic audits and employee training[105] Operational Challenges and Financial Performance - The company has a history of net losses and anticipates that expenses will increase significantly in the future, potentially impacting profitability[117] - Medical expenses incurred on behalf of members may exceed the revenues received, leading to financial losses[124] - The transition to a Total Care Model may present challenges for physician partners, affecting operational efficiency and profitability[118] - The company faces risks related to regulatory compliance, which could impact operational capabilities and financial performance[114] - The company must manage increasing demands on its operational and financial systems as it grows, which may require significant capital expenditures[121] - The company may require substantial additional capital to support its business in the future, which might not be available on acceptable terms[131] Market and Competitive Environment - The healthcare industry is highly competitive, with numerous local provider networks and large payors developing their own managed care services[44] - Increased competition in the healthcare industry may challenge the company's ability to grow at projected rates, particularly as large payors develop their own managed services tools[197] - Consolidation in the healthcare industry could reduce market opportunities and adversely affect the company's financial condition[187] Cybersecurity and Data Management - The company is highly dependent on third-party service providers for critical aspects of data access, collection, storage, and transmission, which may expose it to security vulnerabilities and operational disruptions[151] - Cybersecurity threats have increased due to geopolitical events, including Russia's invasion of Ukraine, potentially leading to retaliatory cyberattacks that could disrupt operations[155] - The company may face reputational damage and regulatory penalties due to potential data security breaches involving sensitive information, including PHI[156] - The ability to attract new physician partners and retain existing members may be adversely affected by cybersecurity incidents and data breaches[157] Economic and Membership Risks - A significant reduction in membership could adversely affect the company's financial condition, cash flows, and results of operations, as compensation is based on a per-member basis[135] - Factors contributing to potential membership reduction include reliance on a limited number of payors and the quality of care provided by physician partners[136] - Public health crises, such as COVID-19, could lead to unexpected changes in healthcare service utilization, impacting financial condition and cash flows[138] - Unfavorable economic conditions may lead to reduced enrollment in MA plans, affecting overall membership, premiums, and fee revenues, which could adversely impact physician practice groups[194] Future Regulatory and Financial Outlook - Future regulations may alter the parameters of Stark Law exceptions, potentially impacting the company's operations and financial condition[82] - The future of the ACA and its underlying programs remains uncertain, impacting long-term business planning[89] - The CMS Innovation Center is testing alternative payment models, including the ACO REACH Model, which may affect financial conditions due to variable state regulations[90] - Changes in CMS methodology for calculating revenue associated with MA members could lead to underpayment relative to incurred expenses, particularly for members with severe or chronic conditions[215] - Annual adjustments by CMS to components determining revenues, such as the fee for service normalization factor and coding intensity adjustment, could further reduce revenues[216]

Revenue Growth - Revenue increased 44% to $1.52 billion in Q4 2024 compared to $1.06 billion in Q4 2023[1] - Total revenue for fiscal year 2024 reached $6.06 billion, a 40% increase from $4.32 billion in 2023[3] - Total revenues for the year ended December 31, 2024, increased to $6,060.5 million, up 40.5% from $4,316.4 million in 2023[21] - Medical services revenue for the fourth quarter of 2024 was $1,519.2 million, compared to $1,053.5 million in the same period of 2023, representing a 43.9% increase[21] Membership Growth - Medicare Advantage membership grew 36% year-over-year to 527,000 members as of December 31, 2024[3] - Full year 2025 guidance anticipates adding approximately 20,000 Medicare Advantage members[1] Financial Performance - Net loss for Q4 2024 was $106 million, a 54% improvement from a net loss of $230 million in Q4 2023[4] - The net loss for the year ended December 31, 2024, was $260.1 million, slightly improved from a net loss of $262.8 million in 2023[23] - The company reported a net loss of $(105,790) thousand for the three months ended December 31, 2024, compared to a net loss of $(230,484) thousand in 2023[31] Cost and Expenses - Total expenses for the year ended December 31, 2024, were $6,352.7 million, a 39.6% increase from $4,548.5 million in 2023[21] - Medical claims and related payables increased to $931.7 million in 2024, compared to $737.7 million in 2023, reflecting a 26.3% rise[21] - General and administrative expenses for the year ended December 31, 2024, totaled $268.9 million, down from $285.8 million in 2023[26] - The company incurred $3.6 million in impairments for the year ended December 31, 2024, compared to no impairments in 2023[23] - Other medical expenses for the twelve months ended December 31, 2024 totaled $213,159 thousand, down from $238,034 thousand in 2023[30] EBITDA and Margins - Adjusted EBITDA loss narrowed to $84 million in Q4 2024 from a loss of $137 million in Q4 2023[4] - Adjusted EBITDA for the twelve months ended December 31, 2024 was $(154,215) thousand, a decrease from $(95,001) thousand in 2023[31] - The medical margin for the three months ended December 31, 2024 was $566 thousand, compared to $(101,853) thousand in the same period of 2023[30] - The company expects Medical Margin to increase in absolute dollars as its platform matures, despite potential fluctuations in Medical Margin per member per month (PMPM)[38] Cash and Debt - Cash and cash equivalents totaled $406 million as of December 31, 2024, with total debt of $35 million[8] - Cash and cash equivalents at the end of 2024 were $193.9 million, up from $114.3 million at the end of 2023[23] Other Financial Metrics - Adjusted EBITDA contribution from ACO model entities expected to be approximately $35-$40 million for fiscal year 2025[10] - The company reported a gross profit of $(38.3) million for the fourth quarter of 2024, compared to $(94.9) million in the same quarter of 2023[25] - For the three months ended December 31, 2024, the company reported a gross profit of $(38,255) thousand, compared to $(94,868) thousand for the same period in 2023[30] - The company incurred interest expense of $6,177 thousand for the twelve months ended December 31, 2024, slightly down from $6,658 thousand in 2023[31] - The weighted average shares outstanding for the year ended December 31, 2024, were 410,966, compared to 408,917 in 2023[21] Non-GAAP Measures - The company emphasizes that Medical Margin and Adjusted EBITDA are non-GAAP financial measures that provide insight into underlying business trends and operational performance[41]

Group 1 - AGL Energy Limited reported strong earnings results for the half year, aligning with expectations [5] - The company is focused on connecting every customer to a sustainable future [5] - Markus Brokhof, the Chief Operating Officer, announced his retirement effective September 15 after five years of service [4]

Core Viewpoint - Three stocks have been added to the Zacks Rank 5 (Strong Sell) List due to downward revisions in earnings estimates Group 1: Company Summaries - Agilon Health, Inc. (AGL) is a healthcare services provider with a current year earnings estimate revised downward by 12.7% over the last 60 days [1] - Ashtead Group plc (ASHTY) is an equipment leasing company with a current year earnings estimate revised downward by 5.1% over the last 60 days [1] - China Coal Energy Company Limited (CCOZY) is a healthcare solutions provider with a current year earnings estimate revised downward by 13.3% over the last 60 days [2]

Group 1 - AB Volvo (publ) has been added to the Zacks Rank 24 (Strong Sell) List, with a 4.7% downward revision in the Zacks Consensus Estimate for its current year earnings over the last 60 days [1] - Agilon Health, Inc. is also on the Zacks Rank 24 (Strong Sell) List, experiencing a 12.7% downward revision in the Zacks Consensus Estimate for its current year earnings over the last 60 days [1] - Apogee Enterprises, Inc. has been noted for a 1.8% downward revision in the Zacks Consensus Estimate for its current year earnings over the last 60 days [2]

Group 1 - Agilon Health, Inc. (AGL) is a healthcare services provider with a Zacks Consensus Estimate for its current year earnings revised 64.1% downward over the last 60 days [1] - The Berkeley Group Holdings plc (BKGFY) is a real estate development company with a Zacks Consensus Estimate for its current year earnings revised 11.4% downward over the last 60 days [1] - Berry Global Group, Inc. (BERY) is a consumer and industrial goods company with a Zacks Consensus Estimate for its current year earnings revised 18.3% downward over the last 60 days [2]

Group 1 - ATI Inc. (ATI) is a specialty materials manufacturing company with a Zacks Consensus Estimate for its current year earnings revised 5.2% downward over the last 60 days [1] - Alliance Resource Partners, L.P. (ARLP) is a natural resource company with a Zacks Consensus Estimate for its current year earnings revised 9.7% downward over the last 60 days [1] - Agilon Health, Inc. (AGL) is a healthcare services provider with a Zacks Consensus Estimate for its current year earnings revised 43.6% downward over the last 60 days [2]

Group 1 - ATI Inc. is a specialty materials manufacturing company with a Zacks Consensus Estimate for its current year earnings revised 5.2% downward over the last 60 days [1] - ATS Corporation is an automation solutions provider with a Zacks Consensus Estimate for its current year earnings revised 12.3% downward over the last 60 days [1] - Agilon Health, Inc. is a healthcare services provider with a Zacks Consensus Estimate for its current year earnings revised 43.6% downward over the last 60 days [2]

Financial Data and Key Metrics Changes - Medicare Advantage (MA) membership increased by 37% year-over-year to 525,000 members, driven by strong same geography growth and expansion of the new partner class [10][25] - Total revenue grew by 28% year-over-year to $1.45 billion, with year-to-date revenues increasing by 39% to $4.53 billion [25][32] - Medical margin for Q3 was a loss of $58 million, compared to a positive margin of $111 million in the previous year [27] - Adjusted EBITDA loss for Q3 was $96 million, compared to a positive $6 million in Q3 2023 [28] Business Line Data and Key Metrics Changes - Third quarter medical service expenses rose to $1.51 billion, a 47% increase compared to the previous year, attributed to the expansion of the 2024 class and higher utilization [25][27] - ACO model entities had a membership of 132,000, slightly ahead of expectations, with adjusted EBITDA of $12 million, down from $18 million in Q3 2023 due to higher utilization [29] Market Data and Key Metrics Changes - The company is raising its full-year membership guidance from 519,000 to 527,000 members and increasing revenue guidance from $6.025 billion to $6.057 billion [10][32] - The company expects to exit two partnerships, which will reduce projected end-of-year 2024 membership by approximately 45,000 to 75,000 members and annualized revenue by about $470 million to $785 million [16] Company Strategy and Development Direction - The company is focusing on improving profitability and execution while managing through a challenging environment, emphasizing the long-term demand for improved cost and quality performance led by primary care doctors [9][21] - Strategic actions include exiting selected partnerships and narrowing the footprint of health plans for 2025, with a focus on risk mitigation strategies for Part D [15][17] - The company aims to improve its market mix exiting 2024, which should provide a stronger foundation for 2025 [18] Management's Comments on Operating Environment and Future Outlook - Management expressed disappointment with current results but remains confident in the core business fundamentals and the demand from payers and physicians [8][12] - The company anticipates that 2025 will represent a turning point, with a projected medical margin step-off point of around $325 million before the impact of strategic actions [33][35] - Management highlighted the importance of quality performance and the need for improved data visibility to enhance operational efficiency [20][75] Other Important Information - The company ended Q3 with cash and marketable securities of $399 million, with an expected cash usage of approximately $165 million for the year [30][31] - The company is lowering its full-year 2024 medical margin midpoint to $225 million, down from the previous guidance of $400 million to $450 million [32] Q&A Session Summary Question: Can you provide details on the repricing of 40% of your business? - Management indicated that the repricing pertains to the 40% of membership up for renewal, with improved economic terms and incentives for quality performance [36] Question: What are the trend numbers for Q3 and Q4? - Management clarified that Q3 cost trend increased from 6% to 9.1%, while Q4 is expected to be 5.2% [39][41] Question: What is the expected cash position at the end of 2024? - The company expects to end 2024 with approximately $365 million in cash, including off-balance sheet cash from ACO entities [45] Question: What is the impact of Part D on medical margin and EBITDA? - Management acknowledged that Part D has a negative impact but did not provide specific numbers, emphasizing the need for better forecasting and risk mitigation [71] Question: What are the operational changes to address risk adjustment issues? - Management noted that gaps in processes were identified, and improvements are being implemented to enhance risk adjustment accuracy for future periods [68][69]