Financial Data and Key Metrics Changes - Revenue for Q3 2025 was approximately $622 million, representing a 22.2% increase over the prior year period [3][17] - Adjusted EBITDA for Q3 was $80.1 million, reflecting a 67.5% increase compared to the prior year [3][17] - Consolidated gross margin was $202.8 million, or 32.6% [17] Business Line Data and Key Metrics Changes - Private Duty Services (PDS) revenue was approximately $514 million, a 25.6% increase, driven by 11.8 million hours of care, a volume increase of 12.9% [18] - Home Health and Hospice revenue was approximately $62.4 million, a 15.3% increase, with 9,700 total admissions, 77% of which were episodic [19] - Medical Solutions revenue was $45.1 million, essentially flat from the prior year, with approximately 91,000 unique patients served [20] Market Data and Key Metrics Changes - The episodic payer mix in home health was reported at 77%, with total episodic volume growth of 14.2% compared to the prior year [9][19] - Preferred payer agreements in private duty services increased from 22 to 30, accounting for approximately 56% of total PDS MCO volumes [8] Company Strategy and Development Direction - The company is focused on enhancing partnerships with government partners and preferred payers to create additional capacity and growth [15] - The strategic plan includes modernizing the medical solutions business and managing capital structure while producing positive free cash flow [15] - The integration of ThriveSkill Pediatrics is on target for completion by the end of the year, contributing positively to the company's growth [11] Management's Comments on Operating Environment and Future Outlook - Management noted that the demand for home and community-based care remains strong, with ongoing efforts to address labor market challenges [4][5] - The company anticipates 2025 revenue to exceed $2.375 billion and adjusted EBITDA to exceed $300 million, reflecting a strong outlook despite regulatory challenges [16][24] - Management expressed confidence in the ability to achieve normalized growth rates across all business segments [5][11] Other Important Information - The company achieved 10 rate enhancements in private duty services this year, aligning with legislative goals [7] - Liquidity at the end of Q3 was approximately $479 million, with cash on hand of approximately $146 million [22] Q&A Session Summary Question: Any headwinds for the fourth quarter? - Management indicated that Q4 should be similar to Q3, with some seasonality but no significant headwinds expected [26][27] Question: Can Q3 results be annualized for 2026 earnings? - Management emphasized the focus on finishing 2025 strong and acknowledged the positive momentum in the business [30][31] Question: How has the preferred payer strategy evolved? - Management noted that all preferred payers want more nursing capacity, indicating strong demand for services [40][41] Question: What is the outlook for organic and inorganic growth? - Management expressed interest in expanding Medicaid presence in key states and continuing to pursue acquisitions [52][53] Question: How is the integration of Thrive going? - The integration is on track, with Thrive expected to contribute approximately $100 million in revenue [55][56] Question: What are the implications of state budget uncertainties? - Management indicated that there are directional uncertainties but noted that diversification across states is beneficial [58][59]

Financial Data and Key Metrics Changes - Revenue for Q4 2024 was approximately $520 million, representing an 8.6% increase over the prior year period [8] - Full year 2024 revenue was approximately $2.024 billion, a 6.8% increase over the prior year [9] - Adjusted EBITDA for Q4 was $55.2 million, a 42.6% increase year-over-year, primarily due to improved payer rates and cost reduction efforts [8][9] - Full year 2024 adjusted EBITDA was $183.5 million, a 31.8% increase over the prior year [9] Business Line Data and Key Metrics Changes - Private Duty Services (PDS) revenue for Q4 was approximately $422.2 million, a 10.1% increase, driven by a volume increase of 4% [28][29] - Home Health and Hospice segment revenue for Q4 was approximately $54.4 million, a 0.6% increase, with 76% of admissions being episodic [33][35] - Medical Solutions segment revenue for Q4 was $43.3 million, a 4.8% increase, with revenue per unique patient served at approximately $486, up 5.9% [36] Market Data and Key Metrics Changes - Preferred payer agreements accounted for approximately 50% of total PDS Managed Care Organization (MCO) volumes, up from 47% in Q3 [16] - The company secured twelve private duty services state rate increases for the full year 2024, with significant improvements in Georgia and Massachusetts [13] Company Strategy and Development Direction - The company continues to execute its strategic transformation strategy focused on preferred payers and obtaining adequate rates from government partners [9][11] - Five primary strategic initiatives for 2025 include enhancing partnerships with government partners, identifying cost efficiencies, modernizing the medical solutions business, managing capital structure, and engaging employees [22][24] - The company anticipates a 2025 revenue range of $2.1 billion to $2.12 billion and an adjusted EBITDA range of $190 million [24] Management's Comments on Operating Environment and Future Outlook - Management noted that the demand for home and community-based care remains strong, with ongoing efforts to address labor market challenges [10][11] - The company is optimistic about returning to a normalized growth rate in its business segments, supported by improved caregiver hiring and retention trends [12] - Management expressed confidence in achieving their strategic goals and highlighted the importance of aligning clinical capacity with preferred payers [19][21] Other Important Information - The company had liquidity of approximately $260 million at the end of Q4, with cash on hand of approximately $84 million [40] - The company expects to see continued cash flow benefits as top-line growth and cost management initiatives come to fruition in 2025 [43] Q&A Session Summary Question: Guidance on top-line growth and EBITDA margins - Management characterized their guidance as prudent, expecting continued momentum in 2025 with significant transformation [50][52] Question: M&A pipeline and focus areas - The company is focused on tuck-in M&A in home health and private duty services, with plans to remain within their capital structure [56][58] Question: PDS segment rate growth and gross margin progression - Management indicated confidence in PDS growth rates, with expectations for a return to a $10 to $10.50 spread per hour [62][66] Question: Medical solutions payer strategy and contract conversions - The company is aligning clinical capacity with preferred payers to improve clinical outcomes and cash collections [78][80] Question: Medicaid regulatory changes and policy discussions - Management expressed optimism about being a cost saver for government programs and maintaining strong dialogue with regulatory counterparts [88][90] Question: Revenue guidance for PDS revenue growth - Management expects 3% to 5% total revenue growth in the PDS segment, with a focus on increasing preferred payer agreements [108][110]