Financial Data and Key Metrics Changes - Total revenue for Q1 2025 was $373 million, a 4% decrease from the prior year, primarily due to a decrease in membership [12][17] - Membership decreased by 8% year over year, aligning with the company's strategy to exit unprofitable plans [16][12] - Per member funding increased by 8% to $10.63 on a PMPM basis compared to the full year 2024, reflecting improved disease burden capture [12][17] - Adjusted operating expenses decreased by 18% sequentially and 11% year over year, indicating effective cost management [8][18] - Adjusted EBITDA for Q1 was a loss of $22 million, with a normalized loss of $13 million after accounting for a single underperforming contract [18][19] Business Line Data and Key Metrics Changes - The ACO reach population now accounts for approximately 15% of total membership, with a 60% increase in ACO membership over the past year [16][13] - The complex care program is projected to deliver over $30 million in savings for 2025 through improved care coordination [11][25] - Medical margin for Q1 was approximately $17 million or $49 PMPM, down from $37 million or $96 PMPM in Q1 2024 [17] Market Data and Key Metrics Changes - Three of the four markets achieved breakeven or better in Q1, with expectations for continued improvement [6][28] - Increased funding across markets by 8% on a PMPM basis indicates better disease burden capture [7][29] - The company is experiencing a steady ramp in converting groups into the Tier one category, with Oregon's Tier one enrollment expected to reach 60% by Q3 [11] Company Strategy and Development Direction - The company is executing a $130 million operating improvement plan, with a focus on operational efficiency, contracting, and execution [8][20] - Strategic initiatives are aimed at enhancing care enablement and improving provider engagement [10][24] - The company is actively renegotiating payer contracts to reduce exposure and improve funding [9][48] Management's Comments on Operating Environment and Future Outlook - Management remains confident in meeting full-year targets, citing improvements in operational metrics and payer collaboration [20][28] - The company is seeing positive impacts from benefit design changes, contributing to improved financial performance [29] - Despite industry headwinds, the company is reaffirming its guidance based on positive progress from various initiatives [28] Other Important Information - The company ended the quarter with approximately $40 million in cash, indicating a strong liquidity position [21] - The implementation of the Innovaccer system is on schedule, expected to enhance data infrastructure and analytics capabilities [26] Q&A Session Summary Question: Progress on the $130 million EBITDA initiative - The company achieved about 15% of the OpEx savings in Q1, with more benefits expected in the latter half of the year [34] Question: Engagement and satisfaction trends with the RESTORE program - The engagement strategy is working well, with key providers becoming ambassadors for the program [37] Question: Details on the outlier payer causing issues - The outlier payer accounts for no more than 22% of overall revenue, and the company is collaborating to rectify performance issues [41][42] Question: Trends in Medicare Advantage - The company is seeing improvements in utilization metrics, contrary to some public commentary about worsening trends [55] Question: Performance in the underperforming market - The underperforming market is associated with the outlier payer, but other payers in the same market are performing well [58][59]

Summary of Astrana Health (ASTH) Conference Call Company Overview - **Company**: Astrana Health - **Industry**: Healthcare Delivery - **Business Model**: Partners with physicians to create managed healthcare networks, focusing on value-based arrangements with payers [4][6] Key Business Metrics - **Physician Partnerships**: Over 12,000 physicians [4] - **Patient Base**: Approximately 1,100,000 patients in value-based arrangements [5] - **Revenue Growth**: Reported a 53% year-over-year revenue growth in Q1 [7] - **Profitability**: Continues to grow profitability and generate cash [7] Recent Acquisition - **Acquisition of Prospect Health**: - **Transaction Value**: $745 million [8] - **Network Size**: 14,000 physicians serving around 600,000 patients [10] - **Geographic Focus**: Primarily Southern California [10] - **Financials**: Prospect generated $94 million in adjusted EBITDA and $1.2 billion in revenue in 2024 [13] - **Synergies Expected**: $12 to $15 million in cost-related synergies within the first 12 to 24 months [14] Integration and Risks - **Integration Experience**: Previous successful acquisitions have built operational capabilities for seamless integration [19] - **Potential Risks**: Concerns about provider network retention during integration; however, positive reception from physicians has been noted [22][24] - **Operational Risks**: Minimal due to similarities in operational models and existing technology platforms [21] Medicare and Market Trends - **Medicare Advantage**: Represents about 60% of Astrana's business; company is not seeing the same negative trends reported by competitors [39][40] - **Risk Adjustment**: Astrana's risk scores are stable and have improved, positioning the company favorably against upcoming reforms [41][42] - **Market Outlook**: Anticipates a material tailwind from Medicare Advantage rate adjustments [50] Medicaid Insights - **Revenue Impact**: Approximately $2.6 billion in revenue, with 28% from Medicaid; potential for a 20-30% reduction in Medicaid members due to stricter eligibility checks [57][58] - **Profitability**: Medicaid is the lowest margin business but still profitable [57] Commercial Business - **Growth Strategy**: Focus on partnerships with Anthem Blue Cross to build co-branded clinics [67] - **Risk Management**: Historically avoided full risk in commercial due to scale concerns, but may explore this in the future [68] Future Guidance - **2027 EBITDA Target**: $350 million, with conservative growth assumptions [69] - **Confidence in Projections**: Strong belief in achieving guidance based on current operational strategies and market conditions [72] Conclusion - **Long-term Vision**: Astrana aims to demonstrate the viability of running a profitable value-based care company while expanding its footprint in California and beyond [73][75] - **Market Position**: Positioned as a leading player in the healthcare delivery space with a focus on quality and cost-effective care [75]

UnitedHealth Group Conference Call Summary Company Overview - **Company**: UnitedHealth Group (UNH) - **Date of Call**: May 13, 2025 Key Points and Arguments Leadership Transition - Acknowledgment of Andrew Witty's leadership during challenging times and his transition to a senior advisor role [4] - The new CEO expresses confidence in the leadership team and the company's ability to overcome internal and external challenges [5][6] Performance and Guidance - The company has faced performance setbacks due to both external and internal challenges, but these issues are largely within their control [5] - Optimism about future performance, with a focus on resolving current issues with urgency and rigor [6] - The company is adjusting its guidance to focus on necessary actions for future success [6] Strategic Focus - Emphasis on value-based care approaches that are integrated and holistic to address the fragmented healthcare system [7] - Commitment to modernization and innovation within the healthcare system [7] Cost Pressures and Utilization Trends - Three principal categories affecting performance: 1. Greater than expected impact from the health status of new members in UnitedHealthcare 2. Acceleration of utilization within Medicare Advantage 3. Broadening of higher utilization trends to other areas [9][10] - The company is incorporating these trends into their 2026 Medicare Advantage bids and pricing strategies [10] Long-term Growth Expectations - The company aims to return to a long-term growth target margin range of 13% to 16% [11] - Current performance is below target margins, but there is an expectation to improve in 2026 [30] Optum Health Insights - Optum is experiencing challenges with new patient populations and their health statuses, which are being actively addressed [33][34] - Engagement with patients is ongoing, with a focus on understanding their needs to improve care delivery [34] Value-Based Care - The value-based care model is seen as a strong platform for managing populations effectively and improving overall health outcomes [42][44] - The company believes that value-based care will become the predominant approach across the healthcare system [44] Additional Important Content - The call included a Q&A session where analysts inquired about the impact of external trends and the internal organization on performance [14][22] - There is a recognition of the need for precision and urgency in executing the company's strategies [15][16] - The company is optimistic about the capabilities and quality of its workforce to address both external and internal challenges [16][17] This summary captures the essential insights and strategic directions discussed during the UnitedHealth Group conference call, highlighting the company's focus on overcoming challenges and pursuing growth through value-based care and innovation.

Financial Data and Key Metrics Changes - Astrana Health reported total revenue of $620.4 million for Q1 2025, a 53% increase compared to the prior year period [9][21] - Adjusted EBITDA for the quarter was $36.4 million, reflecting continued success in growing membership and managing cost trends effectively [9][21] - Net income attributable to Astrana for the quarter was $6.7 million, with an EPS of $0.14 per share [21] - The company closed the quarter with $260.9 million in cash and short-term investments [22] Business Line Data and Key Metrics Changes - The Care Partners segment grew 57% year over year, contributing $600 million to total revenue [9] - Approximately 38% of members are now in full risk contracts, up from 5.5% a year ago, accounting for 75% of capitated revenue [11] - CHS contributed $95 million in revenue for the quarter, in line with expectations [9][14] Market Data and Key Metrics Changes - Membership in the Care Partners segment reached 910,000 as of Q1 2025 [11] - In Nevada, the risk-bearing network achieved breakeven, with membership growing 40% and clinic visit volume increasing by 35% year over year [12] - Texas is on track to reach profitability in late 2025, with ongoing transformation efforts [12] Company Strategy and Development Direction - The company focuses on four strategic pillars: sustainable membership growth, alignment of patient outcomes with financial performance, improving care quality while managing costs, and driving operational excellence through a proprietary care enablement platform [6][8] - The integration of CHS onto the Astrana platform is complete, with over $10 million in G&A efficiencies identified [13][28] - The planned acquisition of Prospect Health is expected to significantly expand the provider network in Southern California, serving approximately 1.7 million members in value-based arrangements [15][16] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the ability to deliver sustainable, profitable growth despite current market conditions [22][23] - The 2026 Medicare Advantage rate notice is seen as a positive signal for the business, reinforcing a stable reimbursement outlook [17][18] - Management remains optimistic about the overall trend guidance for the year, despite challenges in the Medicaid sector due to higher ER and lab utilization [10][36] Other Important Information - The company generated $13.6 million in free cash flow for the quarter, with a non-recurring debt issuance cost of $5 million [22] - The expected pro forma net leverage post-acquisition of Prospect is approximately 3.4 times, with a goal to deleverage below three times within twelve months [22] Q&A Session Summary Question: Details on CHS integration progress - Integration of CHS is complete, with staff onboarded to the platform and over $10 million in G&A efficiencies identified [26][28] Question: Status of the Prospect deal and Medicare Advantage exposure - The Prospect acquisition is awaiting regulatory approvals, with integration activities underway to prepare for onboarding 600,000 members [29][32] Question: Medicaid trends and utilization impacts - Medicaid trends are above average due to increased ER and lab utilization, but management is comfortable with the overall trend guidance for the year [34][36] Question: Revenue guidance for Q2 and factors affecting it - Revenue guidance for Q2 is slightly lower than expected due to seasonality and the timing of full risk member conversions [40][42] Question: MSSP shared savings booked in Q1 - No MSSP shared savings were booked in Q1, with expectations to book in the latter half of the year [78] Question: Concerns about the Prospect Medical transaction - Management remains confident in the $81 million adjusted EBITDA contribution from Prospect, based on audited financials [91][94] Question: Medical trend visibility and oncology costs - The company anticipates a full-year medical trend of 4.5%, with no significant spikes in oncology costs observed [96][97] Question: Impact of tariffs on business - The company has minimal exposure to Part D risk, and potential tariff impacts are not expected to significantly affect operations [99][100]

Financial Data and Key Metrics Changes - For Q1 2025, total revenue was $1.53 billion, down from $1.6 billion in Q1 2024, primarily due to market and partnership exits, partially offset by premium growth [21] - Membership at the end of Q1 2025 was 491,000, a decrease from 523,000 in Q1 2024, reflecting a cautious approach to growth and partner exits [19] - Medical margin for Q1 2025 was $128 million, down from $157 million in Q1 2024, driven by elevated utilization and costs [21][22] - Adjusted EBITDA for Q1 2025 was $21 million, compared to $29 million in Q1 2024, reflecting ongoing elevated cost trends [23] Business Line Data and Key Metrics Changes - ACO REACH membership decreased to 114,000 in Q1 2025 from 131,000 in Q1 2024, primarily due to exiting an underperforming partnership [20] - Medical costs for Q1 2025 were in line with expectations, driven by elevated utilization and flu-related costs [22] - The medical cost trend for year two plus markets was 5.5% in Q1 2025, down from 6.7% in Q1 2024 [24] Market Data and Key Metrics Changes - The Medicare Advantage market continues to expand, with CMS data showing a year-over-year growth trend of 3.9% [10] - Overall market trends in 2025 remain consistent with the prior year, with an expected full-year trend of 5.3% [9] Company Strategy and Development Direction - The company is focused on disciplined growth, reducing exposure to costs outside of its control, and enhancing clinical and operational capabilities [6][12] - Investments in technology and clinical programs are expected to drive competitive advantages and improve quality outcomes [13][14] - The company anticipates a more favorable environment in 2026, supported by improved payer bids and final rate notices from CMS [11][18] Management's Comments on Operating Environment and Future Outlook - Management expressed optimism about the final rate notice from CMS for 2026, which is expected to address high cost and utilization trends [6][18] - The company is taking a cautious approach to membership growth, with expectations for retroactive membership assignments in Q2 [5][19] - Management highlighted the importance of early identification and management of chronic diseases as a key focus of their model [7][10] Other Important Information - The company ended Q1 2025 with $369 million in cash and marketable securities, expecting to use approximately $110 million of cash in 2025 [27] - The company is maintaining a disciplined approach to capital allocation to support business objectives while aiming for cash flow breakeven in 2027 [27] Q&A Session Summary Question: Impact of V-28 risk model transition on value-based care companies - Management indicated that the risk adjustment perspective for 2025 is in line with expectations, with a 2% net increase year over year, despite a 3% headwind from V-28 [33][34] Question: Contribution from previously exited areas - Management noted that unfavorable development from exited markets would not impact 2025 significantly, with minimal remaining IBNR [37][38] Question: 2026 MA final rate notice and its flow-through - Management confirmed that 40% of membership was repriced for January 2025, with expected benefits from the average 9% increase across the network [41][42] Question: Risk scores and patient movement - Management clarified that the 2% increase in risk adjustment is on a same member basis, with some movement between payers noted but not significantly affecting care models [49][52] Question: Expectations for 2026 MA bit cycle - Management expressed optimism about the 2026 environment, with a focus on quality incentives and clinical cost-saving initiatives tracking well [58][61] Question: Medical cost trends and visibility on completed claims - Management stated that medical cost trends were in line with expectations, with improved visibility from the new financial data pipeline [65][66] Question: Potential membership reduction due to Part D - Management indicated that they are making progress in reducing Part D exposure and do not anticipate a reduction in membership for 2026 [75][76] Question: Clinical programs and their impact - Management confirmed that while 2025 is an investment year for new clinical programs, benefits are expected to materialize in 2026 and beyond [104][106]

Financial Data and Key Metrics Changes - The company reaffirmed its full-year guidance, indicating a strong start to 2025 with Q1 results ahead of expectations [7][14] - Adjusted EPS guidance for the year is approximately $16.25, with an expected insurance segment benefit ratio of 90.1% to 90.5% [15][14] - G&A costs for the quarter were slightly better than expectations, attributed to the timing of costs expected to be incurred in the second and third quarters [11][14] Business Line Data and Key Metrics Changes - No changes to membership guidance for 2025, with strong performance in the Open Enrollment Period (OEP) and a positive outlook for the rest of the year [9] - Significant progress in closing care gaps, with expectations to reduce gaps in care by 25% year over year and medication adherence campaigns showing a 30% to 50% reduction in members with weight refills [10][11] - CenterWell and Medicaid businesses are experiencing robust patient and membership growth, with 30 new centers added through acquisition and partnership [12][14] Market Data and Key Metrics Changes - The company is seeing strong year-to-date performance in markets with high concentrations of members, particularly in Florida, Illinois, and Texas [41] - Medicaid is performing in line with expectations, with approximately 100,000 growth year-to-date, aligning with the anticipated growth of 175,000 to 250,000 for the year [74][75] Company Strategy and Development Direction - The company is focused on operational efficiencies, increasing flexibility, and improving member outcomes while positioning for long-term success [14] - Emphasis on capital allocation and growth in CenterWell and Medicaid, with a focus on unlocking substantial value over the mid to long term [16][12] - The integration between the insurance segment and CenterWell is aimed at delivering better health outcomes and improving STARS performance [59][60] Management's Comments on Operating Environment and Future Outlook - Management noted that while challenges remain, there are no surprises in the external environment, and they are executing against controllable factors [7][8] - The company is optimistic about the underlying progress of the business, despite external regulatory headwinds [49][51] - Management expressed confidence in the ability to manage medical costs and G&A effectively while focusing on STARS outcomes [51][92] Other Important Information - The company is actively monitoring changes in consumer behavior due to the Inflation Reduction Act (IRA) [7] - Management highlighted the importance of the upcoming investor conference to provide clarity on earnings power and progress tracking [8][16] Q&A Session Summary Question: How much of your investments moved out of Q1? - Management indicated that most of the impact of incremental investments flowed through the MLR in Q1, with expectations for higher levels in the second through fourth quarters [19][20] Question: Update on the path to the 3% MA margin target? - Management reiterated focus on achieving a 3% margin, with timing tied to STARS outcomes, but no significant changes from previous communications [22][23] Question: Update on STARS initiatives and bids? - Management expressed confidence in progress made on STARS initiatives and ongoing bid processes, emphasizing a balanced approach to membership and margins [25][30] Question: Experience in Part D relative to expectations? - Trends in Part D are consistent with expectations, with mid-single-digit growth on the medical side and low double-digit growth on the pharmacy side [34][35] Question: Visibility on risk adjustment and Group MA? - Management reported strong membership changes and performance in Group MA, with no significant changes in behavior due to recent repricing activity [40][42] Question: Comments on Medicaid visibility and utilization? - Medicaid is performing in line with expectations, with strong growth and modest margin improvements anticipated [72][75] Question: Clarification on GAAP EPS and valuation adjustments? - Management clarified that the adjustment in GAAP EPS guidance is unrelated to structural impairment and is a complex calculation [88][94]

Financial Data and Key Metrics Changes - The company revised its adjusted earnings per share outlook for 2025 to $26 to $26.50, reflecting performance challenges primarily in its Medicare businesses [7][29] - The consolidated revenue outlook remains at $450 billion to $455 billion, with expectations for UnitedHealthcare and Optum Rx revenues to exceed initial views, offsetting a reduced outlook for Optum Health [30][31] - The full year medical care ratio is now expected to be 87.5% plus or minus 50 basis points, indicating higher utilization across senior populations [31] Business Line Data and Key Metrics Changes - UnitedHealthcare's Medicare Advantage business is projected to serve an additional 800,000 people in 2025, while Optum Health aims to add 650,000 net new patients to value-based care arrangements [16][43] - Optum Rx revenues grew by 14%, exceeding $35 billion for the quarter, with script growth of 3% driven by customer retention and new customer wins [44] Market Data and Key Metrics Changes - The company noted a significant increase in care activity in its Medicare Advantage business, with first quarter indications suggesting care activity increased at twice the rate anticipated [10][29] - The company experienced a sharp increase in elective care activity, particularly in the group Medicare Advantage segment, attributed to higher member premiums driven by Medicare funding cuts [36][66] Company Strategy and Development Direction - The company is focusing on improving engagement with complex patients and enhancing clinical workflows to transition effectively to the new CMS risk model [15][39] - The company continues to innovate in its service offerings, such as the HouseCalls program, which provides in-home clinical visits to seniors [21][22] - The company emphasizes the importance of transparency and affordability in healthcare, aiming to reduce costs for consumers while maintaining high-quality care [28][132] Management's Comments on Operating Environment and Future Outlook - Management expressed disappointment with current performance but remains committed to improving results throughout 2025 and into 2026, targeting long-term earnings per share growth of 13% to 16% [46][47] - The management acknowledged the challenges posed by recent Medicare funding cuts and the need to better anticipate and address second-order effects in the market [90][96] Other Important Information - The company is actively engaging with state customers to address Medicaid funding issues and is optimistic about recent rate adjustments aligning more closely with member acuity [41][130] - The company is concerned about legislative changes affecting pharmacy benefit managers (PBMs) and their potential impact on patient access to medications [126][127] Q&A Session Summary Question: Medicare Advantage cost trend expectations - Management indicated that care levels were anticipated to be consistent with 2024 but have seen a significant increase in the first quarter, particularly in physician and outpatient services [49][55] Question: Connection between primary care visits and Optum Health performance - Management clarified that while primary care visits have increased, the challenges in Optum Health are due to the profile of new value-based patients and the impact of the V28 phase [58][68] Question: Impact of elevated care on group Medicare Advantage - Management confirmed that the elevated care activity is primarily observed in community and group Medicare Advantage, influenced by premium increases [98][102] Question: Long-term growth rate recovery - Management expressed confidence in returning to long-term growth rates, supported by improved 2026 rates and ongoing engagement with state partners [106][110] Question: Medicare Advantage margins and timeline for recovery - Management stated that margins for Medicare Advantage are still within targeted ranges for 2025, with expectations to return to historical planning targets in 2026 [114][118] Question: Policy implications of PBM reform and Medicaid funding - Management highlighted their leadership in transparency and affordability in the PBM space and emphasized the importance of maintaining access to medications for patients [122][130]

Financial Data and Key Metrics Changes - Membership growth from Q4 2023 to Q4 2024 was 13% with revenue increasing by 7% to $371 million in Q4 2024, and annual revenue for 2024 reached $1.5 billion, representing an 18% year-over-year growth [9][17] - The fourth quarter medical margin was $7 million, a decrease year-over-year due to elevated utilization trends, while adjusted EBITDA for the quarter was a loss of $68 million [9][19] - Full year adjusted EBITDA loss was $167.2 million for 2024, compared to a loss of $85.5 million in the prior year, with a per member per month adjusted EBITDA loss of $147, a $45 change from the prior year [19] Business Line Data and Key Metrics Changes - The company reported a full year medical margin of $85.5 million, a decrease of approximately 37% year-over-year, driven by elevated medical expenses, particularly Part D expenses [18] - Capitated revenue increased by 2.5% year-over-year on a per member per month basis [17] Market Data and Key Metrics Changes - The company noted that the macro environment in the Medicare sector is improving, with positive early indicators for 2025 and favorable payer bids in CMS's 2026 advance notice [7][8] - The company expects an incremental medical margin benefit of $30 to $35 per member per month from benefit design changes [8] Company Strategy and Development Direction - The company is focused on strengthening its business for near-term profitability, with programmatic initiatives representing over $130 million of adjusted EBITDA opportunity on schedule [6] - The growth strategy emphasizes deliberate and profitable growth, with expectations to achieve profitability in 2025 [10] - The company is enhancing its senior leadership team with key hires to support its strategic initiatives [8][14] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the meaningful progress towards long-term sustainable growth, with a focus on maintaining a strong control environment established in 2024 [20][21] - The company reaffirmed its 2025 guidance for revenues between $1.35 billion and $1.5 billion, with adjusted EBITDA expected to range from negative $35 million to positive $5 million [10][21] Other Important Information - The company has made significant investments in field operations for 2025 and introduced the P3 Restore program aimed at reducing physician burnout [13][14] - The company has successfully remediated seven previously identified material weaknesses in internal controls [20] Q&A Session Summary Question: Can you elaborate on the timing around reaching potential profitability? - Management indicated that the guidance for 2025 includes a 7.5% increase in revenue year-over-year and a $16 PMPM improvement in medical costs, with operational efficiencies contributing to the profitability target [31][32] Question: What are the expectations for cash in 2025? - The company ended 2024 with a cash balance of $38.8 million, with an additional $15 million received in January 2025, bringing the effective starting cash position to about $54 million [35][36] Question: Did Q4 results come in line with expectations? - Management acknowledged that Q4 results were impacted by one-time negative items totaling about $17 million, which should be excluded from total Q4 EBITDA numbers [41] Question: What are the trends in utilization? - Management reported slight improvements in utilization trends, with decreases in MIDS per 1,000 and emergency department visits per 1,000, although unit costs remained elevated [25][56] Question: Can you elaborate on the improving trends in the Medicare environment? - Management highlighted that benefit design changes from 2024 to 2025 are expected to reduce utilization, contributing to a more favorable environment [69]

Financial Data and Key Metrics Changes - Total revenue for 2024 was $11,300,000,000, representing a 28% year-over-year growth, with Q4 revenue of $3,100,000,000 reflecting a 29% increase from the prior year [10][25] - Adjusted EBITDA for the full year 2024 was $588,000,000, showing a 16% growth year-over-year, while Q4 adjusted EBITDA was $167,000,000, growing 17% compared to Q4 2023 [11][27] - The company increased its revenue and adjusted EBITDA guidance for 2025, expecting total revenue between $11,600,000,000 and $12,100,000, and adjusted EBITDA between $545,000,000 and $560,000,000 [30][31] Business Line Data and Key Metrics Changes - Pharmacy Solutions revenue for 2024 was $8,800,000,000, a 34% increase year-over-year, with Q4 revenue of $2,400,000,000 growing 34% compared to Q4 2023 [10][25] - Provider Services revenue for 2024 was $2,500,000,000, reflecting a 9% growth year-over-year, with Q4 revenue of $656,000,000, an 11% increase from the prior year [10][25] - Home Health Care revenue grew 17% year-over-year in Q4, while Community and Rehab Care revenue increased by 8% [20][26] Market Data and Key Metrics Changes - The company reported a 13% lower healthcare cost for patients in skilled nursing facilities and a 31% reduction for patients in assisted living, indicating effective cost management and care delivery [14] - The company achieved high customer satisfaction scores, with a net promoter score of 98 for Onco360 and 100 for CareMed, reflecting strong service quality in specialty pharmacy [12][16] Company Strategy and Development Direction - The company is focused on operational efficiencies and quality improvements, aiming to deepen its reach to more patients and enhance service delivery across pharmacy and provider businesses [10][23] - The divestiture of the Community Living business is expected to streamline operations and enhance growth rates in remaining segments, with a strategic focus on home health care, rehab, and personal care [22][23] - The company continues to invest in technology and automation to drive efficiencies and improve service delivery across all business lines [16][48] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in sustaining double-digit growth rates, emphasizing a strong operational infrastructure and a focus on quality and efficiency [60][63] - The company is optimistic about the reimbursement environment for home health and hospice services, anticipating enhanced rates due to improved quality metrics [51][56] - Management acknowledged potential risks from the IRA but remains confident in the company's diversified growth drivers to absorb any impacts [87] Other Important Information - The company has launched 12 limited distribution drugs (LDDs) in 2024, with plans for an additional 16 to 18 launches in the next 12 to 18 months, indicating a robust pipeline in specialty pharmacy [18] - The company has implemented over 100 procurement and automation programs to drive process improvements and cost efficiencies [16][48] Q&A Session Summary Question: Comments on limited distribution drug business and competitive landscape - Management noted no significant changes in the market, with a trend towards more niche therapies and a narrowing of pharmacy networks, which has benefited the company [34] Question: Growth trajectory for the infusion business - Management expects the infusion business to grow above 20% in 2025, driven by operational improvements and a focus on specialty care [40] Question: Cumulative savings from internal efficiency initiatives - Management highlighted ongoing efforts in process optimization and automation, contributing to EBITDA growth and reinvestment in the business [49] Question: Outlook for home health and hospice development - Management aims to double home health and hospice revenue in the next five years, supported by a favorable reimbursement environment [51] Question: ACO arrangements and their impact - Management views ACO participation as an upside opportunity, with expectations for shared savings based on positive outcomes [74] Question: Specialty pricing and revenue growth sustainability - Management reported stability in specialty pricing and a diverse portfolio that supports continued revenue growth [77]

Table of Contents Index to Financial Statements As filed with the Securities and Exchange Commission on October 6, 2023 Registration Statement No 333-274162 UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 AMENDMENT NO. 1 TO FORM S-1 REGISTRATION STATEMENT UNDER THE SECURITIES ACT OF 1933 Marpai, Inc. (Exact name of Registrant as specified in its charter) (State or other jurisdiction of incorporation or organization) Delaware 8090 86-1916231 (Primary Standard Industrial Classification ...