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P3 Health Partners(PIII) - 2024 Q3 - Earnings Call Transcript

Financial Data and Key Metrics Changes - The third quarter top line performance included capitated revenue of 357.7millionandtotalrevenueof357.7 million and total revenue of 362.1 million, representing a 26% year-over-year growth driven by a 22% increase in member base to over 128,900 members and a 6% rise in funding year-over-year [35][36] - The medical margin was 540,000or540,000 or 1 on a PMPM basis, while adjusted EBITDA loss for the quarter was 71millionor71 million or 184 on a PMPM basis, impacted by 5millionto5 million to 10 million in elevated medical claims costs and 35millioninretroactiveadjustments[36][39]Cashflowfromoperationsforthequarterwasapproximatelynegative35 million in retroactive adjustments [36][39] - Cash flow from operations for the quarter was approximately negative 20 million, with the company ending Q3 with about 63millionincash[41][56]BusinessLineDataandKeyMetricsChangesThecompanyexperiencedelevatedmedicalutilizationprimarilyinPartBmedicalclaims,withnegativepriorperioddevelopmentcontributingabout63 million in cash [41][56] Business Line Data and Key Metrics Changes - The company experienced elevated medical utilization primarily in Part B medical claims, with negative prior period development contributing about 10 million additional expense during the quarter [39][46] - High-cost claims greater than 50,000rose2350,000 rose 23% year-over-year, with Part B oncological medications leading the increase [48] Market Data and Key Metrics Changes - The Medicare Advantage repricing cycle and benefit design changes are expected to serve as catalysts for profitability in 2025, with anticipated recalibration of CMS benchmarks reflecting ongoing elevated utilization [16][17] - The company noted that many health plan partners are targeting margin recapture, expecting plan benefits to be less robust in 2025, which should lead to decreased utilization [17][30] Company Strategy and Development Direction - The company is executing on a plan involving over 130 million in initiatives aimed at positively impacting EBITDA and cash flow, with benefits expected to begin in Q4 and more prominently in 2025 [9][14] - Key areas of focus include enhancing payer and provider networks, improving operational discipline, increasing operating efficiency, and advancing data and analytics capabilities [15][43] Management's Comments on Operating Environment and Future Outlook - Management acknowledged the challenges faced in 2024 but expressed optimism about the future, emphasizing the importance of value-based care in controlling medical costs and preserving margins [53][30] - The leadership team is focused on setting reliable targets that reflect the current market landscape while providing opportunities for outperformance [42] Other Important Information - The company has trimmed 63 provider tax ID numbers and reduced its payer network by 20% to enhance profitability and simplify operations [23][22] - A partnership with Innovaccer is on track for full implementation in 2025, aimed at improving data visibility and supporting decision-making [26][27] Q&A Session Summary Question: How does the company see its capital availability to execute initiatives? - The company ended the quarter with $63 million in cash, supporting core operations and strategic growth initiatives, while actively monitoring cash burn and focusing on optimizing working capital [57] Question: Is the company pursuing additional capital raise in the fourth quarter? - Currently, the company is not pursuing an immediate capital raise and is evaluating its overall cash position [60] Question: Will 2025 revenues be down due to risk exposure reduction? - There will be a slight reduction in membership associated with revenue reduction due to payer and provider rationalization, but increases from operational improvements are expected to offset this [62][64] Question: Can the company provide specifics on chronic disease improvement opportunities? - The company is focusing on operational efficiency by providing more support to high-value providers and enhancing coding and documentation practices [66][70] Question: Why was there a spike in the medical cost ratio (MCR) this quarter? - The spike was attributed to delayed information from plans, particularly in non-delegated plans, leading to unexpected cost escalations [72][74] Question: Will the MCR remain elevated in Q4 and will there be a sudden step down in Q1 2025? - The company expects immediate effects from benefit design changes starting in January, but specifics on the magnitude of impact will be clearer after open enrollment [75][76] Question: Can the company elaborate on enhancing payer and provider contracts? - The company is looking to change its position in Part D across most contracts and has exited subscale contracts that were not strong performers [78][81] Question: Is the company considering exiting certain markets entirely? - The company plans to exit the Florida market due to its small size and lack of investment potential [83]