Financial Data and Key Metrics Changes - Revenue for Q1 2025 was approximately $559 million, representing a 14% increase over the prior year period [5][18] - Adjusted EBITDA for Q1 2025 was $67.4 million, reflecting a 93.1% increase year-over-year, primarily due to improved pay rates and cost-saving initiatives [5][18] - Consolidated gross margin was $183.6 million, or 32.8% [18] Business Line Data and Key Metrics Changes - Private Duty Services (PDS) revenue was approximately $460 million, a 16.5% increase, driven by 10.9 million hours of care, a volume increase of 6.1% [19] - Home Health and Hospice revenue was approximately $56.7 million, a 3.9% increase, with 77% of admissions being episodic [20][21] - Medical Solutions revenue was $42.5 million, a 3.6% increase, with revenue per unique patient served at approximately $477, up 6.9% [23] Market Data and Key Metrics Changes - Preferred payer agreements accounted for approximately 54% of total PDS Managed Care Organization (MCO) volumes, up from 50% in the previous quarter [11] - The company aims to increase the number of PDS preferred payer agreements from 22 to 30 by the end of 2025 [10] Company Strategy and Development Direction - The company is focusing on five primary strategic initiatives: enhancing partnerships with government and preferred payers, identifying cost efficiencies, modernizing the medical solutions business, managing capital structure, and engaging employees [15] - The company anticipates 2025 revenue to exceed $2.15 billion and adjusted EBITDA to exceed $207 million, reflecting an improved outlook [16][28] Management's Comments on Operating Environment and Future Outlook - Management noted that the labor environment remains a primary challenge, but demand for home and community-based care continues to be strong [7] - The company is optimistic about achieving its legislative goals for reimbursement rate improvements in at least 10 states [9] - Management expressed confidence in the continued positive momentum from preferred payer agreements and rate enhancements [14] Other Important Information - The company is on track to close the acquisition of ThriveSkilled Pediatrics, which is expected to enhance its preferred payer and government affairs strategies [16][60] - The company reported liquidity of approximately $266 million at the end of Q1 2025, providing room for operational investments [26] Q&A Session Summary Question: Update on targeted states for rate increases and preferred payers - Management reported five government affairs rate increases and two preferred payer wins in Q1, with expectations to achieve 10 GA rate increases by year-end [31][32] Question: Insights on operating cash flow and EBITDA conversion - Management indicated that Q1 cash outflow was better than anticipated, with expectations for operating cash flow to improve throughout 2025 [35] Question: Details on one-time EBITDA benefits - Management highlighted strong cash collections and retro rate increases contributing to an $11 million EBITDA benefit in Q1 [40][41] Question: Contribution of Thrive acquisition to revenue and earnings - Management stated that the Thrive acquisition aligns with the company's cultural and strategic goals, but it has not yet been included in guidance due to timing [56][60] Question: Updates on Medicaid policy and advocacy efforts - Management noted positive bipartisan support for Medicaid program integrity and ongoing discussions with federal counterparts [62][64] Question: Size of rate enhancements and outlook for wage increases - Management clarified that the five government affairs rate wins were meaningful, with expectations for future GA rate increases to be in the single digits [68][70]