Q4 2023 Aveanna Healthcare Holdings Inc Earnings Call

Operator: Good morning, and welcome to the Aveanna Health Care Holdings 4th Quarter 2023 Earnings Conference Today's call is being recorded, and we have allocated one hour for prepared remarks. At this time, I'd like to turn the call over to Debbie Stewart, Aveanna's chief accountant. Thank you.

Good morning, and welcome to the Avianca Health Care Holdings fourth quarter 2023 earnings Conference call.

Today's call is being recorded and we have allocated one hour for prepared remarks and Q&A at.

At this time I'd like to turn the call over to Debbie Stuart I'll be honest Chief Accounting officer. Thank you you may begin.

Debbie Stewart: Good morning, and welcome to Aveanna's fourth quarter 2023 earnings call. I am Debbie Stewart, the company's Chief Accounting Officer. With me today is Jeff Shaner, our Chief Executive Officer, and Matt Buckhalter, our Chief Financial Officer. During this call, we will make forward-looking statements. Risk factors that may impact those statements and could cause actual future results to differ materially from currently projected results are described in this morning's press release and the reports we file with the SEC. The company does not undertake any duty to update such forward-looking statements.

Good morning, and welcome to I'll be honest fourth quarter 2023 earnings call I am Debbie Stuart the company's Chief Accounting Officer with me today is Jeff Shaner, Our Chief Executive Officer, and Matt Buckhalter, Our Chief Financial Officer.

During this call we will make forward looking statements risk factors that may impact those statements and could cause actual future results to differ materially.

Currently projected results are described in this morning's press release and the reports we file with the SEC.

The company does not undertake any duty to update such forward looking statements.

Debbie Stewart: Additionally, during today's call, we will discuss certain non-GAAP measures that we believe can be useful in evaluating our performance. However, the presentation of this additional information should not be considered in isolation or as a substitute for results prepared in accordance with GAAP. A reconciliation of these measures can be found in this morning's press release, which is posted on our website, Aveanna.com, and in our most recent annual report on Form 10-K, which will be filed with the SEC this afternoon. With that, I will turn the call over to Aveanna's Chief Executive Officer, Jeff Shaner. Jeff?

Additionally, during today's call, we will discuss certain non-GAAP measures, which we believe can be useful in evaluating our performance.

The presentation of this additional information should not be considered in isolation or as a substitute for results prepared in accordance with GAAP. A reconciliation of these measures can be found in this morning's press release, which is posted on our website Aviano dot com and in our most recent annual report on Form 10-K, which will be.

Filed with the SEC this afternoon.

With that I will turn the call over to I'll be honest, Chief Executive Officer, Jeff Schader Jess.

Jeffrey S. Shaner: Thank you, Debbie. Good morning, and thank you for joining us today. We appreciate each of you investing your time this morning to better understand our Q4 and full year 2023 results and how we are moving Aveanna forward in 2024 and beyond. My initial comments will briefly highlight our fourth quarter and full year 2023 results, along with the steps we are taking to address the labor markets and our ongoing efforts with government and preferred payers to create additional capacity. I will then provide insight on how we are thinking about year two of our strategic transformation and our overall outlook for 2024 prior to turning the call over to Matt to provide further details on the quarter and our 2024 outlook, starting with some highlights for the fourth quarter and full year 2023.

Thank you Debbie good morning, and thank you for joining us today.

We appreciate each of you investing your time this morning to better understand our Q4 and full year 2023 results and how we are moving all be on a forward in 'twenty 'twenty four and beyond.

My initial comments will briefly highlight our fourth quarter and full year 2023 results along with the steps we are taking to address the labor markets and our ongoing efforts with government and preferred payors to create additional capacity.

I will then provide insight on how we are thinking about year two of our strategic transformation and overall outlook for 'twenty 'twenty four prior to turning the call over to Matt to provide further details into the quarter and our 2024 outlook.

Starting with some highlights for the fourth quarter and full year 2023.

Jeffrey S. Shaner: Revenue for the fourth quarter was approximately $479 million, representing a 6.1% increase over the prior year period. Fourth quarter adjusted EBITDA was $38.7 million, representing a 30.4% increase over the prior year period, primarily due to the improved payer rate environment, as well as cost reduction efforts taking hold. Finally, full year 2023 revenue and adjusted EBITDA were approximately $1.895 billion and $139.2 million, respectively, representing a 6% and 7.6% respective increase over the prior year. As we have previously discussed, the labor environment represented the primary challenge that we needed to address in 2023 to see Aveanna resume the growth trajectory that we believed our company could achieve. It is important to note that our industry does not have a demand problem.

Revenue for the fourth quarter was approximately $479 million, representing a six 1% increase over the prior year period.

Fourth quarter, adjusted EBITDA was $38 $7 million, representing a 34% increase over the prior year period, primarily due to the improved payor rate environment as well as cost reduction efforts taking hold.

Finally full year 2023 revenue and adjusted EBITDA was approximately 1.8 95 billion and 132, sorry, $139 $2 million, representing a 6% and seven 6% respect respect.

The increase over the prior year.

As we have previously discussed the labor environment represented the primary challenge that we needed to address in 2023 to see aviano resume the growth trajectory that we believed our company could achieve.

It is important to note that our industry does not have a demand problem the demand for home and community based care continues to be strong with both state and federal governments and managed care organizations asking for solutions that can create more capacity.

Jeffrey S. Shaner: The demand for home and community-based care continues to be strong, with both state and federal governments and managed care organizations asking for solutions that can create more capacity. I am proud of our focus and execution in 2023 as we aligned our objectives with those of our preferred payers and government partners. By focusing our clinical capacity on our preferred payers, we achieved year-over-year growth in revenue and adjusted EBITDA. We also experienced improvement in our caregiver hiring and retention trends by aligning our efforts to those payers willing to engage with us on enhanced reimbursement rates and value-based agreements.

I am proud of our focus and execution in 2023, as we aligned our objectives with those of our preferred payers and government partners.

Yeah.

By focusing our clinical capacity on our preferred Payors, we achieved year over year growth in revenue and adjusted EBITDA.

We also experienced improvement in our caregiver hiring and retention trends by aligning our efforts to those payers willing to engage with us on enhanced reimbursement rates and value based agreements.

Jeffrey S. Shaner: While we continue to operate in a challenging labor and inflationary environment, our preferred payer strategy allows us to return to a more normalized growth rate in our business segments. Since our third-quarter earnings call, I am pleased with the continued progress we have made on several of our rate improvement initiatives with both government and preferred payers, as well as the continued signs of improvement in the caregiver labor market, specifically. As it relates to our private duty services business, our goal for 2023 was to execute a legislative strategy that would increase rates by double-digit percentages across our various states, with particular emphasis on California, Texas, and Oklahoma, which represented approximately 25 percent of our total PDS revenue. At year-end 2023, we had successfully obtained double-digit PDS rate increases in eight key states, including Oklahoma. We have also achieved rate wins in the additional 11 states that were either in line with or slightly better than our expectations.

While we continue to operate in a challenging labor an inflationary environment. Our preferred payer strategy allows us to return to a more normalized growth rate in our business segments.

Since our third quarter earnings call I am pleased with the continued progress we have made on several of our rate improvement initiatives with both government and preferred payors.

As well as the continued signs of improvement and the caregiver of labor market.

Specifically.

As it relates to our private Iot services business. Our goal for 2023 was to execute a legislative strategy that would increase rates by double digit percentages across our various states with particular emphasis on California, Texas, and Oklahoma, which represented approximately 25 per se.

Of our total Pds revenue.

At year end 2023, we had successfully obtained double digit P. D S rate increases and eight key states, including Oklahoma.

We have also achieved rate wins and the additional 11 states that were either in line or slightly better than our expectations.

Jeffrey S. Shaner: These combined 19 states represent approximately 55% of our PDS footprint, and we expect to see positive progress into 2024 as we focus on the remaining states. As a point of reference, the majority of the rate increases were effective in the second half of 2023, which will result in a full year benefit in 2024. While we are pleased that our PDS legislative messaging has been well received by state legislatures, we still have much work to do. As an example of the work ahead, our PDN rate request was not included in the California Governor's proposed budget.

These COVID-19 states represent approximately 55% of our P. D S footprint.

And we expect to see positive progress into 'twenty 'twenty four as we focus on the remaining states.

As a point of reference the majority of the rate increases were effective in the second half of 'twenty twenty-three.

Which will result in a full year benefit in 2024.

While we are pleased that our Pds legislated messaging has been well received by state legislatures, we still have much work to do.

As an example of the work ahead.

Our P. D N rate request was not included in the California Governor's proposed budget.

Jeffrey S. Shaner: We believe that we made significant strides with the Governor, Medi-Cal Department leadership, and the California Legislature demonstrating the importance of PDN rate increases and how they support an overall lower health care cost, improved patient satisfaction, and quality outcomes. However, it is clear that we need to further accelerate our preferred payer strategy and government affairs efforts to continue to advocate for children with complex medical conditions. This strategy allows us to become a solution for overcrowded children's hospitals and distraught parents who want their children to be cared for in the comfort of their homes.

We believe that we made significant strides with the Governor Metical Department leadership, and California legislature, demonstrating the importance of PD and rate increases and how they support and overall lower healthcare costs improve patient satisfaction and quality outcomes.

However, it is clear that we need to further accelerate our preferred payer strategy and government affairs efforts to continue to advocate for children with complex medical conditions.

This strategy allows us to become a solution for overcrowded children's hospitals, and distraught parents, who want their children to be cared for in the comfort of their homes.

Jeffrey S. Shaner: We have a proven track record of expanding our preferred payer programs and will enhance our efforts in California similar to our approach in other states. As we look at our preferred payer initiatives in other states, our goal for 2023 was to double our PDS preferred payers from 7 to 14. In the fourth quarter, we added two additional preferred payer agreements, achieving our goal of 14. Our PDS preferred payer volumes remain consistent at 17% of total PDS volumes.

We have a proven track record of expanding our preferred payer programs and will enhance our efforts in California similar to our approach in other states.

As we look at a preferred payer initiatives in other states. Our goal for 2023 was to double our Pds preferred payers from seven to 14.

In the fourth quarter, we added two additional preferred payer agreements achieving our goal of 2014.

Our Pds preferred payer volumes remain consistent at 17% of total PD S volumes.

Jeffrey S. Shaner: We are optimistic that we will continue to execute this strategic initiative into 2024. While we are taking a national approach to our PDS Preferred Payer Strategy, we are placing particular focus in 2024 on the state of California and continuing our positive traction in the state of Texas. Using Texas as a point of reference as of year end, we are approaching 60% of our Texas PDN volumes with a preferred payer and still believe we have an opportunity to further improve this trend to approximately 70% in 2024. We plan to execute a similar playbook in California over the next 18 to 24 months and are optimistic we can achieve positive results, moving to our Preferred Payer Progress in Home Health. Our goal for 2023 was to improve our episodic payer mix by 10% from approximately 60% to above 70% by year-end 2023. We signed a total of eight episodic agreements in 2023 and improved our episodic mix from approximately 60% at the end of 2022 to 74% in Q4.

We are optimistic that we will continue to execute this strategic initiative into 2024.

Well, we are taking a national approach to a P. D. S preferred payer strategy, where we are placing particular focus in 2024 on the state of California, and continuing our positive traction in the state of Texas.

Using Texas has a point of reference as of year end, we are approaching 60% of our Texas P. D N volumes with a preferred payer and still believe we have an opportunity to further improve this trend to approximately 70% in 2024.

We plan to execute a similar playbook in California over the next 18 to 24 months and are optimistic we can achieve positive results.

Moving to our preferred payer progress in home health.

Our goal for 2023 was to improve our episodic payer mix by 10% from approximately 60% to above 70% by year end 2023.

We signed a total of eight episodic agreements in 2023 and improved our episodic mix from approximately 60% at the end of 2022% to 74% in Q4.

Jeffrey S. Shaner: We continue to remain focused on aligning our home health caregiver capacity with those payers willing to reimburse us on an episodic basis and focus on improved clinical and financial outcomes. We are encouraged by our 2023 rate increases, preferred pay agreements, and subsequent recruiting results. Our business is demonstrating signs of recovery as we achieve our rate goals previously discussed. Home and community-based care will continue to grow, and Aveanna is a comprehensive platform with a diverse payer base, providing a cost-effective, high-quality alternative to higher-cost care settings. And most importantly, we provide this care in the most desirable setting, the comfort of the patient's home.

We continue to remain focused on aligning our home health caregiver capacity with those payers willing to reimburse us on an episodic basis and focus on improved clinical and financial outcomes.

We are encouraged by our 2023 rate increases preferred payer agreements and subsequent recruiting results.

Our business is demonstrating signs of recovery as we achieve a rate goal as previously discussed.

Home and community based care will continue to grow and Avianca is a comprehensive platform with a diverse payer base, providing a cost effective high quality alternative to higher cost care settings.

And most importantly, we provide this care in the most desirable setting the comfort of the patients' home.

Jeffrey S. Shaner: Before I turn the call over to Matt, let me comment on our strategic plan and our initial outlook for 2024. As we enter year two of our strategic transformation, we remain highly focused on those initiatives that created positive momentum in 2023. We will continue to focus our efforts on four primary strategies. First, enhancing partnerships with government and preferred payers to create additional caregiver capacity.

Before I turn the call over to Matt, Let me comment on our strategic plan and our initial outlook for 2024.

As we enter year two of our strategic transformation.

We remain highly focused on those initiatives that create a positive momentum in 2023.

We will continue to focus our efforts on four primary strategies first enhancing partnerships with government and preferred payers to create additional caregiver capacity.

Jeffrey S. Shaner: Second, identifying cost efficiencies and synergies that allow us to leverage our growth. Third, managing our capital structure and collecting our cash while producing positive free cash flow. And fourth, engaging our leaders and employees in delivering our Aveanna mission. While executing the above key strategies, we still believe it is important to set expectations that acknowledge the environment that we are operating in and the time it will take to fully transform our company to sustain growth.

Second identifying cost efficiencies and synergies that allow us to leverage our growth.

Third managing our capital structure and collecting our cash while producing positive free cash flow.

And fourth engaging our leaders and employees and delivering our Aviano mission.

While executing the above key strategies, we still believe it is important to set expectations that acknowledge the environment that we're operating in and the time it will take to fully transform our company to sustained growth.

Jeffrey S. Shaner: Accordingly, we currently expect full-year 2024 revenue to be in a range of $1.96 to $1.98 billion and adjusted EBITDA to be in a range of $146 to $150 million. We believe our outlook provides a prudent view considering the challenges we face with the evolving labor market, and hopefully, it proves to be conservative as we execute throughout the year. In closing, I am very proud of our Aveanna team.

Accordingly, we expect we currently expect full year 2020 for revenue to be in a range of 1.96 to 1.98 billion.

And adjusted EBITDA to be in a range of $146 million to $150 million.

We believe our outlook provides a prudent view considering the challenges we face with the evolving labor market and hopefully it proves to be conservative as we execute throughout the year.

In closing.

I am very proud of our Avianca team.

Jeffrey S. Shaner: We offer a cost-effective, patient-preferred, and clinically sophisticated solution for our patients and families. Furthermore, we are the right choice for our payers, referral sources, and government partners. By partnering with preferred payers, we can and will move rate and wage metrics in meaningful ways that support our growth. This strategy allows us to hire, retain, and engage more caregivers in providing the mission of Aveanna every day. With that, let me turn the call over to Matt to provide further details on the quarter and our 2024 outlook.

We offer a cost effective patient preferred and clinical use of sophisticated solution for our patients and families.

Furthermore, we are the right solution for our payers referral sources and government partners.

By partnering with preferred payers, we can and will move rate and wage metrics in meaningful ways that support our growth.

This strategy allows us to hire retain and engage more caregivers and providing the mission of Avianca every day.

With that let me turn the call over to Matt to provide further details on our quarter and our 2024 outlook Matt.

Matt Buckhalter: Thanks, Jeff, and good morning. I'll first talk about our fourth-quarter financial results and liquidity before providing additional details on our initial outlook for 2024. Starting with the top line, we saw revenues rise 6.1% over the prior year period to $479 million. We experienced revenue growth in two of our operating divisions, led by our private duty services and medical solutions segments, which grew by 6.1% and 17.5% compared to the prior quarter. Consolidated gross margin was $148.4 million, or 31%, representing a 15.3% increase over the prior year period.

Jeff and good morning.

I'll first talk about our fourth quarter financial results and liquidity before providing additional details on our initial outlook for 2024.

Starting with the top line, we saw revenues rise six 1% over the prior year period to $479 million.

We experienced revenue growth in two of our operating divisions led by a private duty services.

Medical solutions segments.

Which grew by six 1% and 17, 5% compared to the prior year quarter.

Consolidated gross margin was $148 $4 million or 31%.

Representing a 15, 3% increase over the prior year period.

Matt Buckhalter: Consolidated Adjusted EBITDA was $38.7 million, a 30.4% increase as compared to the prior year, reflecting the improved payer rating environment as well as cost reduction efforts taking hold. Now, we take a deeper look at each of our segments, starting with private duty services. Revenue for the quarter was approximately $383 million, a 6.1% increase, and was driven by approximately 10.1 million hours of care, a volume increase of 5.1% over the prior year. While volumes have improved over the prior year, we continue to be constrained in our top-line growth due to the shortage of available caregivers. Aldo.

Consolidated adjusted EBITDA was $38 $7 million, a 34% increase as compared to the prior year.

Reflecting the improved payor rating environment as well as cost reduction efforts taking hold.

Now taking a deeper look at each of our segments.

Starting with private duty services.

Revenue for the quarter was approximately $383 million.

A six 1% increase and was driven by approximately $10 1 million hours of care.

Volume increased five 1% over the prior year.

While volumes have improved over the prior year.

We continue to be constrained and our topline growth due to the shortage of available caregivers.

Although.

Matt Buckhalter: We are continuing to see signs of improvement in the labor market. Q4 revenue per hour of $38.04 was up 38 cents, or 1%, as compared to the prior year quarter. We remain optimistic about our ability to attract caregivers and address market demands for our services when we obtain acceptable reimbursement rates. Now, turning to our cost of labor in gross margin metrics. We achieved $103.6 million in gross margin, or 27%, a 12.7% increase from the prior quarter. Our cost of revenue rate of $27.76 was sequentially flat from Q3.

We are continuing to see signs of improvement in the labor markets.

Q4 revenue per hour of $38.04 was up 38 cents or 1% as compared to the prior year quarter.

We remain optimistic about our ability to attract caregivers and address market demands for our services when we obtain acceptable reimbursement rates.

Turning to our cost of labor and gross margin metrics.

We achieved $103.6 million of gross margin or 27%.

12, 7% increase from the prior year quarter.

Our cost of revenue rate of $27.76 was sequentially flat from Q3.

Matt Buckhalter: While we continue to experience wage pressures in the labor markets, we did improve our Q4 spread per hour to $10.28, representing a 7.6% increase over the prior year. Moving on to our home health and hospice segment, revenue for the quarter was approximately $54 million, a 1.1 percent decrease over the prior year.

While we continue to experience wage pressures in the labor markets, we did improve our Q4 spread per hour to $10 28.

Representing a seven 6% increase over the prior year.

Yeah.

Moving on to our home health and Hospice segment.

Revenue for the quarter was approximately $54 million, a one 1% decrease over the prior year.

Matt Buckhalter: Revenue was driven by $9,200 in total emissions, with approximately 74% being episodic, and 11,300 total episodes of care, up sequentially from Q3. Medicare revenue per episode for the quarter was $3,064, up 1.8% as compared to the prior year. We continue to focus on right-sizing our approach to growth and the near term by focusing on preferred payers that reimburse us on an episodic basis. This episodic focus has accelerated our margin expansion and improved our clinical outcomes. With episodic admissions over 70%, we have achieved our goals of right-sizing our margin profile and enhancing our clinical offerings. As we enter 2024, we believe our emission growth will normalize in the 3-5% range.

Revenue was driven by 9200 total emissions, but.

With approximately 74% being episodic.

11300 total episodes of care up sequentially from Q3.

Medicare revenue per episode for the quarter was $3064 up one 8% as compared to the prior year.

We continue to focus on right sizing our approach to growth and the near term by focusing on preferred payors reimburse us on an episodic basis.

This episodic focus has accelerated our margin expansion and improved clinical outcomes.

With episodic emissions over 70%, we have achieved our goals of right sizing our margin profile and enhancing our clinical offerings.

As we enter 2024, we believe our admission growth will normalize in the 3% to 5% range.

Matt Buckhalter: We're committed to a disciplined approach to growth while shifting our capacity to those payers who value our clinical resources. We're pleased with our gross margin of 50.9% in Q4, demonstrating our continued focus on cost initiatives to achieve our targeted margin profile. We believe this is the right long-term growth strategy, and we hold a strong belief in this business and its lasting value proposition. Our home health and hospice platform is dedicated to creating value through effective operational management and the delivery of exceptional patient care. Now, to our Medical Solutions segment results for Q4. During the quarter, we produced revenue of $41.3 million, a 17.5% increase over the prior year. Revenue was driven by approximately 90,000 unique patients served, an 8.4% increase over the prior year period, and revenue per UPS of $458.80. Gross margins were 42% for the quarter, up 2.3% over the prior year period, and in line with our targeted margin profile for medical solutions.

We're committed to a disciplined approach to growth, while shifting our capacity to those payors, who value our clinical resources.

We're pleased with our gross margin of 59% in Q4.

Demonstrating our continued focus on cost initiatives to achieve our targeted margin profile.

We believe this is the right long term growth strategy and we hold a strong belief in this business and its lasting value proposition.

Yeah.

Our home health and hospice platform is dedicated to creating value through effective operational management and the delivery of exceptional patient care.

Now sure Medical solutions segment results for Q4.

During the quarter, we produced revenue of $41 $3 million, a 17, 5% increase over the prior year.

Revenue was driven by approximately 90000 unique patients served and eight 4% increase over the prior year period.

And revenue per your P. S a $458.80.

Matt Buckhalter: We continue to implement initiatives to be more effective and efficient in our operations to leverage overhead as we continue to grow, while other enteral providers have decided to exit the market. We see this as an opportunity to expand our national interim presence and to further our payer partnership. In summary, we continue to fight through a difficult labor environment while keeping our patients' care at the center of everything we do. It is clear to us that shifting caregiver capacity to preferred payers who value our partnership is the path forward at Aveanna.

Gross margins were 42% for the quarter up two 3% over the prior year period and in line with our targeted margin profile for medical solutions.

We continue to implement initiatives to be more effective and efficient in our operations to leverage overhead as we continue to grow.

While other providers have decided to exit the market we.

We see this as an opportunity to expand our national presence.

To further our payer partnerships.

In summary.

We continue to fight through a difficult labor environment, while keeping our patients care at the center of everything we do.

Matt Buckhalter: As Jeff stated, our primary challenge continues to be reimbursement rates, although with the positive momentum we've experienced in 2023. We're optimistic that such trends will continue into 2024. As we continue to make progress with the RAID environment, we will pass through wage improvements and other benefits to our caregivers in the ongoing effort to improve volumes. Now, moving to our balance sheet and liquidity. At the end of the fourth quarter, we had liquidity in excess of $232 million, representing cash on hand of approximately $43.9 million. $20 million of availability under our securitization facility and approximately $168 million of availability on our revolver, which was undrawn as of the end of the quarter.

It is clear to us that shifting caregiver capacity to those preferred payors.

Our partnership is the path forward it I'll be honest.

As Jeff stated our primary challenge continues to be reimbursement rates.

With the positive momentum we experienced in 2023.

We're optimistic that such trends will continue into 2024.

As we continue to make progress with the rate environment, we will pass through wage improvements and other benefits to our caregivers.

The ongoing effort to better improve volumes.

Now.

Moving to our balance sheet and liquidity.

At the end of the fourth quarter, we have liquidity in excess of $232 million.

Representing cash on hand of approximately $43 9 million.

Matt Buckhalter: Lastly, we had $32 million in outstanding letters of credit at the end of Q4. I'm proud of the progress we've made in enhancing our overall liquidity throughout the year on the debt services front. We had approximately $1.47 billion of variable rate debt at the end of Q4. Of this amount, $520 million is hedged with fixed rate swaps, and $880 million is subject to an interest rate cap, which limits further exposure to increases in SOFR above 3%. Accordingly, substantially all of our variable rate debt is hedged.

$20 million of availability under our securitization facility.

And approximately $168 million of availability on our revolver, which was undrawn as of the end of the quarter.

Lastly, we have $32 million and outstanding letters of credit at the end of Q4.

I'm proud of the progress we've made in enhancing our overall liquidity throughout the year.

On the debt services front.

We had approximately 1.4 dollars $7 billion of variable rate debt at the end of Q4.

Of this amount $520 million is hedged with fixed rate swaps.

Matt Buckhalter: Our interest rate swaps extend through June 2026, and I register at CAPS through February 2027. One last item I'll mention related to our debt is that we have no material termline maturities until July 2028. Looking at cash flow, cash provided by operating activities was positive $22.7 million for the quarter, and free cash flow was positive approximately $12.5 million.

At 880 million subject to an interest rate cap.

Which limits further exposure to increases in so far above 3%.

Accordingly substantially all of our variable rate debt is hedged.

Our interest rate swaps extend through June 2026.

Our interest rate caps extend through February 2027.

One last item I'll mention related to our debt is.

Is that we have no material term loan maturities until July 2028.

Matt Buckhalter: While Q4 benefited from some timing-related items, which we expect to be moderate headwinds, and to Q1 cash flows, we continue to believe we will be a positive operating cash flow company in 2024. We also expect to see continued cash flow benefits as our top line and cost management initiatives come to fruition. Before I hand the call over to the operator for Q&A, let me take a moment to address our initial outlook for 2024. As Jeff mentioned, we currently expect full-year revenue to be in the range of $1.96 to $1.98 billion, and Adjusted EBITDA to be in the range of $146 to $150 million.

Looking at cash flow.

Cash provided by operating activities was positive $22 $7 million for the quarter.

And free cash flow was positive at approximately $12 $5 billion.

While Q4 benefited from some timing related items, which we expect to be moderate headwinds into Q1 cash flows.

We continue to believe will be a positive operating cash flow company and 2024.

We also expect to see continued cash flow benefits as our topline.

Cost management initiatives come to fruition.

Before I hand, the call over to the operator for Q&A, Let me take a moment to address our initial outlook for 2024.

Matt Buckhalter: As we think about seasonality, we expect our revenue to grow as rate increases are implemented throughout the year and our volumes grow. Accordingly, we expect approximately 20% of our full-year adjusted EBITDA guidance to be recognized in the first quarter, and approximately 44% of our full-year guided adjusted EBITDA to be recognized in the first half of 2024, as most of our annual rate increases typically become effective in the second half of the year. We expect our adjusted EBITDA to ramp as we use it to attract and retain more caregivers at higher volumes. Our EBITDA will also increase as we realize the benefits of our continued cost savings initiatives. In closing, I'm proud of all of our Aveanna team members and their hard work in achieving our 2023 results. I look forward to the continued execution of our 2024 strategic plan and updating you further at the end of Q1. With that, let me turn the call over to the operator.

As Jeff mentioned, we currently expect full year revenue to be in the range of $1 96 to $1 nine 8 billion.

And adjusted EBITDA range of $146 million to $150 million.

As we think about seasonality, we expect our revenue to grow as rate increases are implemented throughout the year and our volumes grow.

Accordingly, we expect approximately 20% of our full year adjusted EBITDA guidance to be recognized in the first quarter and.

And approximately 44% of our full year guide adjusted EBITDA to be recognized in the first half of 2024.

As most of our annual rate increases typically become effective in the second half of the year.

We expect our adjusted EBITDA to ramp as we use those increases to attract and retain more caregivers and drive volumes.

Our EBITDA will also ramp as we realize the benefits of our continued cost savings initiatives.

Operator: Thank you. At this time, we'll be conducting a question and answer session. If you'd like to ask a question, please press star 1 on your. A confirmation tone will indicate your line is in the... You may press star 2 if you'd like to remove your question from the... For participants using speaker equipment, it may be necessary to pick up your handset before pressing the start button, to allow for as many...

In closing I'm proud of all of our ASEAN of team members and our hard work in achieving our 2023 results I look forward to the continued execution of our 2024 strategic plan and updating you further at the end of Q1 with that let me turn the call over to the operator.

Yeah.

Thank you at this time, we'll be conducting a question and answer session. If you'd like to ask a question. Please press star one on your telephone keypad, a confirmation tone will indicate your line is in the question queue.

Operator: If possible, we ask that you each keep to one question and one follow-up. Our first question comes from the line of Brian... Good morning. You have Taji Phillips on for Brian.

You May press star two if you'd like to remove your question from the queue for participants using speaker equipment. It may be necessary to pick up your handset before question Mr. Archie.

Taji Milan Phillips: Thank you for taking my question. So maybe to start, the midpoint of your guidance for 2024. Maybe you can talk about the building blocks that are key assumptions that are built into your margins for 2024 and what would need to happen to see the business outperform your implied guidance. And then lastly, if you can provide as much detail, break down the March, cross, and all three.

To allow for as many questions as possible, we ask that you each keep to one question and one follow up thank you.

Our first question comes from the line of Brian tank.

With Jefferies. Please proceed with your question.

Good morning, you have how are your thoughts on for Brian. Thank you for taking my question.

So maybe to start at the midpoint of your guidance implies that margins will be roughly seven 5% for 2024, maybe can you talk to the building blocks that are our.

Jeffrey S. Shaner: Hey Taji, good morning. Thanks for your question. Taji, I'll start and I'll turn it over to Matt, but I think as we think of our 2024 guidance, you know, we have very good visibility into rates coming out of 2023. So I think first in that story is we've got solid momentum from our 19 rate increases. I think five or six of those rate increases were effective 1-1 of 2024, so we've got nice momentum rolling into the year. We know our home health and hospice final rules, so really good visibility into this year. Obviously, we're now working on a legislative plan for 2024, and most of those come due mid to late year. So, our heads are down on the year and Matt's prepared remarks.

Our key assumptions that are built into your margins for 2024, and what would need to happen to see the business outperform your implied guidance and then lastly, if you can provide as much detail break out the margin expectations across all three segments.

Yeah.

Hey, guys. Good morning. Thanks, Thanks for your question.

I'd tell you I think as it all started and now I'll turn it over to Matt, but I think as we think of our 2020 for guidance.

We have very good visibility into rate coming out of 2023. So I think first first and that story is we've got solid momentum.

Our 19 rate increases I think five or six of those rate increases were effective one one of 24. So we've got nice momentum rolling into the year, we know our home health and hospice final rules. So really good visibility into this year. Obviously, we're now working on Legislative plan for 2024, which most of those come due mid <unk>.

Jeffrey S. Shaner: He talked about 20% of the implied guide we think will be in Q1. We would remind everyone, you know, Q1 is our, from a seasonal standpoint, is our low point. We've got a lot of payroll tax headwinds in Q1, coming out of the holidays, but we're sitting here in early March. We're off to a really nice start to the year.

Late year. So so our heads are down on the year.

And Matt's prepared remarks, he talked about 20% of the implied guide we think will be in Q1, we would remind remind everyone Q1 is our from a seasonal standpoint is our low point, we've got a lot of payroll tax headwinds in Q1 coming out of the holidays.

Jeffrey S. Shaner: We're very pleased with where we are today. So I think you'd see it from our standpoint building throughout the year, Q1 being our low point, but pleased that we still have levers to pull.

Jeffrey S. Shaner: I think big picture, we remain prudent, I'll use the word prudent in our guidance, that we continue to execute against our strategic plan to rebuild the company. Our ultimate goal, Taji, is still to get back to 10% of adjusted EBITDA, and we're still a year or so from that point, but we know the plan, and they're executing as a plan to get us back to that 10% target. And I think you'll see it build throughout the year.

But we're off you know sitting here in early March we are off to a really nice start to the year. We're very pleased on where we are today. So I think you'd see it from our standpoint building throughout the year Q1, being our our low point, but.

Please that we still have levers to pull I think big picture you know.

We we we remain prudent I'll use the word prudent in our in our guidance that we continue to execute against our strategic plan to rebuild the company. Our ultimate goal of <unk> is still to get back to 10%.

Matt Buckhalter: And I think the most important part is, as we said in our comments around our four strategic initiatives for this year, we know exactly what to do, we know how to do it, and it's just about us executing. And I think, as we showed in 2023, that this team knows how to execute against our business plan. So with that, Matt, let me turn to you for more insight on guidance. Yeah, I think that's really well said, Jeff. I think you nailed it.

Adjusted EBITDA and you know, we're still a yourself and from that point.

But we see it we know the players are skewing as a plan to get us back to that 10% target and I think you'll see it build throughout the year and I think the most important part is as we said in our comments around our four strategic initiatives for this year, we know exactly what to do we know how to do it and that's just about us executing and I think as we showed in 2023.

That this team knows how to execute against our business plan. So with that let me turn to you and more inside our guidance, Yes, I think that's really well said, Jeff I think you've nailed. It you know 2020 for guidance I think is a prudent concept and consistent with how we have been performing in a N and leading the broader markets on March.

Matt Buckhalter: 2024 guidance, I think, is a prudent concept and consistent with how we have been performing and leading the broader markets. On margin expansion there, Taji, I don't think you really think anything on gross margin should be different than what you've come to expect with our current business platforms. That'll be consistently in line.

Expansion, there Oh Gee I don't think you really think anything on gross margin to be different than what you've come to expect with our current business platforms. You know that'll be consistently in line.

Matt Buckhalter: Potential for outperform associated with it could be continued overachieving of our preferred payers and overachieving of our state rate increases. However, once again, that doesn't necessarily increase your margin, your gross margin profile, because what we're doing is taking those dollars and reinvesting them back into our caregivers and back into our workforce to really drive those volumes. You know, with those volumes driving, we're leveraging overhead with it, and we're continuing to have cost savings initiatives throughout the organization. We did a really nice job of it in 2023.

Potential for outperform associated with it could be continued over achieving of our preferred payers over achieving of our state rate increases.

Once again that doesn't necessarily increase your margin gross margin profile because what we're doing is taking those dollars and reinvesting them back into our caregivers and back into our workforce to really drive those volumes now what those volumes driving our leveraging overhead with it and we continue to have cost savings initiatives throughout the organization. We did a really nice job of in 2023.

Matt Buckhalter: We're continuing to do so in 2024. We'll nip and tuck where we can, but we're also going to invest in the right areas that will demonstrate better clinical outcomes and, you know, really overachieve for our preferred payer initiatives through value-based care, too. So, in line with where we expect to see that build and EBITDA build throughout the year, and I think that's the way you should think about it.

We're continuing to do in 2024 will nip and tuck, where we can but we're also going to invest in the right areas that will demonstrate better clinical outcomes and really really overachieve for our preferred payer initiatives through value based care too so inline with where we expect to see that build in EBITDA build throughout the year.

I think that's what you should think about it well said.

Okay.

Jeffrey S. Shaner: Yes, just one more question for me, Jeff. Last question, when we think about the labor environment, I make a comment, but how should we be thinking about wage inflation in 2024? Yeah, I think Matt just said it really well, Taji. We still focus on rate, which then drives incremental rate. So I think as you think about our margin profile, Matt said it well, and I will point out in our home health business, our home health and hospice business, you saw 50.9% gross margins for Q4. You know, it's taken us about two years to get that back to 50%. That was our target.

Yes, just one more question for me Jeff.

Last question when we're thinking about the labor environment I really appreciate the commentary in your prepared remarks, but how should we be thinking about wage inflation in 2024.

Yeah, I think Matt just said it really was how as you know we we still focus our focus is on rate, which then drives incremental rate. So I think as you think about our margin profile met Matt said, it well and I will point out in our home health business at home Health and Hospice business, you saw 59% gross margins for Q4.

Yes, it's taken us about two years to get that back to the 50% that was our target I'm really proud of the home health and hospice team for how hard they work to get it there but.

Jeffrey S. Shaner: I'm really proud of the home health and hospice team for how hard they worked to get it there. But I think as we think of margins, gross margins, and Matt said it well, they'll be consistent in 2024, as we saw, you know, kind of the Q3, Q4 run rate. Every rate increase we earn, whether it's a preferred payer or a government, state, or federal agency, we're going to pass that rate or a large portion of that rate through to the caregivers. That is our value proposition to our preferred payers. It's our value proposition to our government partners. So I think you'll agree with gross margins being consistent in the course of the year.

But I think as we think of margins gross margins and Matt said, it well there'll be consistent in 2024 as we saw it kind of Q3 Q4 run rate every rate increase we earn whether it's a preferred payer or a government state.

A state or federal agency, we're going to pass that that rate or a large portion of that right through to the caregivers that is our that is our value proposition to our pay preferred payers, it's our value proposition to our government partners. So I think you'll think of gross margins being consistent in the course of the year and as Matt said, well, where we're really trying to drive the growth levers.

Jeffrey S. Shaner: And as Matt said, we're really trying to drive the growth levers, both in PDS, home health, and hospice, and AMS. So we're really excited to get the top line and also bottom line growth in 24 where we expect it. Thanks, Taji.

Then Pds home health and hospice and Ams. So we're we're real excited to get the top line and also bottom line growth and 24, where we expected it.

Thanks. Thank you. Thank you.

Taji Milan Phillips: Thank you. Thank you. Our next question comes from the line of Ben Hendrix with RBC Capital. Hey, great.

Thank you. Our next question comes from the line of Ben Hendrix with RBC capital markets. Please proceed with your questions.

Benjamin Hendrix: Thanks, guys. I just appreciate all the commentary about preferred payer progress and expectations to go to 70% this year. I was wondering if you could remind us kind of where we are in California and where that could go in the near term in terms of preferred payer relationships on the PDN side. And then separately, kind of in areas where we're not yet seeing that double-digit rate increase in budgets, how much, how do we think about how much of the PDN preferred payer penetration can make up for that shortfall? Thanks. Good morning, Ben.

Hey, great. Thanks, guys just I appreciate all the commentary about the preferred payer Prague.

Progress in Texas and expectations to go to 770%. This year I was wondering if you could remind us kind of where we are in California, and where that could go in the near term in terms of preferred.

Our relationships on the P D inside and then separately.

In areas, where we're not yet seeing that double digit rate increase and budgets.

How much how much how do we think about how much of the P. D N preferred.

Preferred payer penetration can make up for that shortfall.

Jeffrey S. Shaner: Thanks so much and a great question. You know, I think California, we've been heads down. I'll start with the big picture in California and then drill into your question on kind of how we think of California. You know, we've been in the government affairs legislative process in California now for over two years. I think it's no surprise to anyone that California is staring down somewhere between 50 and 80 billion. I know it's a pretty broad, but area deficit this coming year.

Good morning, Thanks, so much and great great question.

I think California, we've been heads down I'll start big broad picture in California, and then drill into your question and.

How do we think about California, you know we've been at the government Affairs.

Legislative process in California, now for over two years.

I think it's no surprise anyone that California's staring down somewhere between 50, and 80 billion I know, it's a pretty broad but area deficit. This this coming year or so.

Jeffrey S. Shaner: So, you know, big, big, big issues and opportunities in California for them to tackle their budget. We've made meaningful progress, significant progress with both the governor, the current governor, his staff, leadership staff, the head of HHA, which is Medi-Cal, Dr. Gawley, as well as the legislature. I think as we think of this moving forward, we think of accelerating our preferred payer strategy to your question, Ben, in California. Unlike Pennsylvania or Texas, that are predominantly 90 plus percent Medicaid MCO for our business, California still is the majority; more than 50 percent of the PDM population in California still is on Medi-Cal, still is a, we are paid by Medi-Cal, they are overseen by Medi-Cal families.

Big Big Big issues and opportunities in California for them to tackle their budget, we've made meaningful progress significant progress with both the governor Governor his staff leadership staff the head of Hh Ace, which is medical Dr. Dr Golly as well as the legislature.

I think as we think of this moving forward, we think of accelerating our preferred payer strategy to your question Ben in California.

Unlike Pennsylvania, or Texas that is predominantly 90 plus percent Medicaid MCR for our business, California is still the majority more than 50% of the PD <unk> population in California still is on Medicaid still has a we are paid by Medicare They are overseen by Medicare families.

Jeffrey S. Shaner: What we have seen, though, in the last two years as California's wage and hyperinflation have played out, families have found their ways to either what's called a whole child model program, which is a specific California program, as well as some of the commercial plans in California and some of the Medicaid MCO plans that are established in California. So we are seeing families find their way, and I think it's nothing more specific than they just realize to get their children coverage, both acute care coverage and home, they need to get on an MCO plan or a whole child model plan. So we are seeing a shift in our population in 23 and as we enter 24. Now, it is still less than 50 percent of the population, so we're pleased that we get to accelerate our preferred payer strategy in California. We are not going to give up on our legislative strategy. We're going to continue to double down on our legislative strategy because, at the end of the day, $44.12 is what we're reimbursing California for Medi-Cal. That's not enough. It's not competitive with higher wages on the Medi-Cal program.

What we have seen though in the last two years as California wage and hyperinflation that played through is that families have found their ways to either let's call. The whole child model program, which is a specific california as well as some of the commercial plans in California, and some of the Medicaid MCR.

Players that are established in California. So we are seeing families find their ways.

I think it's nothing more specific than they just realized to get their children coverage, both acute care coverage at home they need to get to a MTO.

Our plan or our whole child model play and so we are seeing a shift in our population in 'twenty three and as we enter 24 now it is still less than 50% of the population. So we're pleased that we get to accelerate our preferred payer strategy in California.

Not going to give up on our legislative strategy, we're going to continue to double down a legislative strategy because at the end of the day.

At $44.12 is what we're reimbursed in California for Medicare Thats not enough, it's not competitive to higher wages on the Medicare program. So we're going to continue to do both.

Jeffrey S. Shaner: So we're going to continue to do both. Then you asked for a specific metric. We have not shared that publicly yet. And I think over the course of 2024, we'll reevaluate that. But we're excited that we have two levers to pull in California, not just a government affairs strategy, but we're going to use our Texas strategy, our Pennsylvania strategy, and accelerate it in California. And I will say, out of the 14 preferred payers we have today, I think two or three of them today are based in California. So a couple of our preferred payers today are already in the state of California, and they pay us well above the Medicaid PDN rate.

Then you asked for a specific metric we have not shared that publicly yet.

And and I think over the course of 2024, we'll reevaluate that but we're excited that we have two levers to pull in California, and not just the government affair strategy, but we're going to use our Texas strategy, Our Pennsylvania strategy May have states and accelerated in California, and I will say out of the 14 preferred payers we have today.

I think it's two or three of them today are based in California. So so a couple of our preferred payers today are already in the state of California, and they pay us.

Well above the Medicaid PDL right. So hopefully that's helpful. Ben.

Jeffrey S. Shaner: So hopefully that's helpful, Ben. Yeah, thank you very much. Anything else, Spence? I think that's it for me.

Yeah. Thank you very much.

Anything else Ben.

Yeah.

I think that's it for me for now thank you.

Benjamin Hendrix: Our next question comes from the line of Raj Kumar with David... Hey, this is Raj on for Scott Fidel. A quick question on just when we think about 23 and all the momentum game across the three business lines, where do you see the most upside? Raj, good morning, and thank you.

Thanks Beth.

Thank you. Our next question comes from the line of Raj Kumar with Stephens Inc. Please proceed with your question.

And Roger on for Scott Fidel.

Question on I'm, just you know when we think about 'twenty three and all of the momentum game across the three business lines, you know, where where do you see the most upside in 2024, among the three business lines.

Good morning, and thanks, Great question.

Jeffrey S. Shaner: You know, I think all three of our business lines have the ability to grow materially and produce great, great results. As Matt mentioned, we've really been focused the last 18 months on cost efficiencies and cost synergies. So we've got our corporate overhead to a place where we think we are in a really nice place to oversee a business, but to do it at good leverage. I think the business that you will probably hear us be most proud of is the rebound of our home health and hospice business. You know, I think everyone can see that a year and a half ago, we were in a difficult spot in our home health and hospice business.

All three of our business lines have the ability to grow materially.

And produce great great results as Matt mentioned, we've really been focused the last 18 months on.

Cost efficiencies cost synergies. So we've got a corporate overhead some place where we think we are in a.

A really nice place to to oversee a business, but to do it at good leverage.

Thank the business that you will hear us be probably most proud of is the is the rebound of our home health and hospice business you know.

I think everyone saw a year and a half ago. We were we were in a difficult spot in our home health hospice business and we're still still finishing the integration of four companies still transitioning to homecare homebase getting arms around clinical outcomes and financial outcomes.

Jeffrey S. Shaner: And we're still finishing the integration of four companies, still transitioning to home care, home base, getting our arms around clinical outcomes and financial outcomes. Where we sit today, entering 2024, we are just focused on growing the business and producing great clinical outcomes, and both, not either, but both, and really proud of Shane and Mary and the entire team who lead our home health and hospice team. They have absolutely turned that business around for us, and we are in a great place as we enter 2024. We have great momentum in our PDS business. We have great momentum in our AMS business for 2023, but turning around our home health and hospice business was one of our top five priorities in the company, and I'm just incredibly proud of that team and the discipline that we have instilled to not try to be a solution for everyone in home health and hospice but to be a solution for those payers that are willing to reimburse them on an episodic basis. I think you heard Matt talk about north of 70% We ended the year at 74% episodic.

Where we sit today entering 2024, we are just focused on growing the business and producing great clinical outcomes, both not either by both and really proud of Shane and Marion and the entire team who lead our home health and hospice team. They have absolutely turned that business around for us they've got us in a great places we.

Enter 2024.

We have great momentum met them at our Pds business, we have great momentum in our Ams business in 'twenty, three but turning around our home health and hospice business was one of our top five priorities in the company and just incredibly proud of.

That team and the discipline that they that we've instilled to not try to be a solution for everyone in home health hospice, but to be a solution for those payers that are willing to reimburse on an episodic basis and I think you heard Matt talk about north of 70% is where we want to be we ended the year at 74% episodic that's exactly where we want it.

And that business and so really proud of that team as we as we as we run into 2020 for Russia.

Jeffrey S. Shaner: That's exactly where we want to be in that business and so really proud of that team as we run into 2024. Great, and as my follow-up, I'm just kind of thinking about just cash flow and the framing of..., being free cash or operating cash flow positive. How would you kind of frame the working capital dynamic? For http://TheBusinessProfessor.com. Yeah, great question.

Okay, great and as my follow up I'm, just kind of thinking about just cash flow and you know with the framing of you know being.

Being a free cash or operating cash flow positive how would you kind of frame the working capital dynamics in 2024 and.

And you know the ability to further expand.

Upon the EBIT conversion rate to operating cash flow.

Matt Buckhalter: And kind of combining the idea of cash flow and liquidity here, all in one, you know. I think we'll experience, I know we'll experience moderate headwinds in Q1, you know. We addressed that in the script as well. But then we also have just normal seasonality that occurs for us in Q1, in the business itself, with just EBITDA, with headwinds of state taxes, and just a little bit of re-engagement with the workforce right out of the holidays as well. And then just our third priority liability season, TPL season, which just extends the DSO out a few days and Q1, that kind of rebounds back into Q2 and Q3 as that cash starts coming in.

Yeah, Great question and kind of combining the idea of cash flow and liquidity here all in one.

I think we will experience I know well experienced moderate headwinds in Q1, we addressed that in the script as well.

But then we also have just normal seasonality that occurs for us in Q1.

The business itself with just EBITDA with headwinds of state taxes, just a little bit of re engagement with the workforce right out of the holidays as well and then just third party liability sees a GPL season. We're just extends the sell out a few days and Q1 that kind of rebounds back into Q2, and Q3 is that cash starts coming in and so youll see a dip.

Matt Buckhalter: And so you'll see a dip in Q1 a little bit as it starts to then add it back in Q2 and Q3. We look forward to, you know, increasing our overall liquidity in 2024. You know, it's a great opportunity for us to do so. What we'll do with that, we'll see how, you know, that kind of plays out. You know, we are interested in the idea of small M&A tuck-ins where appropriate and when appropriate in the market. We continue to look at deals when they come up, but that's probably more in the back half of this year or into 2025. Right now, we're going to focus on operating our business effectively and efficiently, you know, converting that EBITDA into cash and growing our overall liquidity position. That's well said, Matt.

In Q1, a little bit as it starts to then add it back in Q2 and Q3, we look forward to increasing our overall liquidity.

In 2024, it's a great opportunity for us to do so.

What we'll do with that we will see how that kind of plays.

Plays out and we are interested in the idea of small M&A tuck ins, where appropriate and when appropriate in the market. We continue to look at deals when they come up but that's probably more in the back half of this year or into 2025 right now we're going to focus on operating our business effectively efficiently converting that EBITDA into cash and.

Growing our overall liquidity position as well said, Matt and one thing I'll add is as you know theres been a tremendous amount of conversation nationally over the last 22 days on change healthcare in United Healthcare I Couldnt be more proud of met our team our billing leadership team, although lavina doesn't bill claims directly through change.

Jeffrey S. Shaner: And the last thing I'll add is, you know, there's been a tremendous amount of conversation nationally over the last 22 days about Change Healthcare and UnitedHealthcare. I couldn't be more proud of Matt, our team, and our billing leadership team. Although Aviana doesn't bill claims directly through Change Healthcare directly, some of our vendor partners do, and our team has done an amazing job of getting bills out the door, ensuring that Aviana continues to be paid for the great work that we have done.

Care directly some of our vendor partners do in and our team has done an amazing job of getting bills out the doors, ensuring that avianca continues to be paid for the great work that we've done and you know it's been a lot of ours has been a lot of overtime its been a lot of work and work Arounds, but.

Jeffrey S. Shaner: And, you know, it's been a lot of hours and it's been a lot of overtime, and there have been a lot of work and workarounds, but, you know, it's a relatively low impact on Aviana, specifically the change issue, but our team has worked incredibly hard the last three weeks to ensure that our liquidity, our cash flow, is solid, and I'm proud to say that it is. And so kudos to our RCM billing teams who've really just worked to make that a reality for Aviana. Thank you, Raj. Thank you. Thank you. Our next question comes from the line of Peter Chickering with. Hi there, You've got Kieran Ryan on Torpedo.

It's a relatively low impact to avianca specific the change issue, but our team has worked incredibly hard the last three weeks to ensure that our liquidity our cash flow is solid and I'm proud to say that it is and so kudos to kudos to our RCM billing teams who've really just worked to make them make that a reality for avianca.

Thank you Raj and for all the color.

Okay.

Thank you. Our next question comes from the line of Peter Chickering with Deutsche Bank. Please proceed with your question.

Hi, there and you've got a cure and Ryan on for Peter Thanks for taking the questions apologies.

Operator: Thanks for taking the questions. Apologies if you touched on a few of these things. I just wanted to confirm a couple points.

Apologies if you've touched on a few of these things just wanted to confirm a couple of points.

Kieran Ryan: First off, on the margin expansion for 2024 guidance implies 20 basis points. Is it fair to say from your commentary that we should expect that to come through the SG&A line with maybe some potential for outperformance on gross margin? But, you know, as far as what's guided, that's most likely to come in SG&A, correct?

First off on the on the margin expansion for 2024 guidance implies 20 basis points is it fair to say from from your commentary that we should expect that to come through the SG&A line with maybe some potential for outperformance on gross margin, but you know as far as what's guided that that's most likely to come in SG&A.

Correct.

Matt Buckhalter: Yeah, I think more than Karen, yes, I think the answer is that yes, we have set up our infrastructure to allow us to be able to grow and leverage our growth. And I think if you take the Q3, Q4 performance of the company and transform that into 2024, it probably gives you a better idea of where our gross margins would be, specifically because of the comments around home health and hospice and their improvement. But, but, Karen, I think, our feedback would be that, you know, there's moderate minimal to moderate improvement and opportunity and gross margin, where we think we'll be able to overperform in the year is really growth, our ultimate revenue growth rate, volume growth rates, rate improvements that we achieve within the course of the year, and driving, you know, driving that through the adjusted EBITDA line.

Yeah, I think Karen Yes, I think the answer is that yes, we have set up our infrastructure to allow us to be able to grow and leverage our growth.

And I think if you I think if you take the Q3 Q4 performance of the company and transform that into 2024. It probably gives you a better idea of where our gross margins would be specifically because of the comments around home health and hospice and their improvement, but but yes, I think I think our our feedback would be that you know, there's there's moderate minimal to moderate.

Improvement in and opportunity in gross margin, where we think we'll be able to over perform in the year is really growth our ultimate revenue growth rate volume growth rates rate improvements that we win within the course of the year and driving driving that through the EBITDA adjusted EBITDA line.

Matt Buckhalter: Matt, anything you'd add to that? I think you nailed it, you know, gross margins kind of flat on our H2 results from 2023, kind of reengaging that through 2024. Obviously, a little bit of seasonality in here in the front half of the year, specifically Q1, which is some, you know, state tax and implications that come up. But then from there, just good old fashioned leveraging overhead, nipping and tucking where appropriate, you know, taking some costs out where appropriate, but I think that's where you'll see that, you know, 20 basis point margin expansion on the bottom line. Got it. Thank you. And then, lastly... As we think about where, Matt Borsch, Scott Fidel, Albert Rice, Joanna Gajuk, Raj Kumar, David Afshar, Shannon Drake, Thanks.

Add to that.

Alright. Thank you noted gross margins kind of flat on our H two results from 'twenty to 'twenty three kind of re engaging that through 2020 for obviously a little bit of seasonality in here in the front half of the year, specifically Q1 with just some state tax implications that occur, but then from there just good old fashion, leveraging ever had nipping and tucking, where appropriate taking some cost out.

Where appropriate, but I think that's where you'll see that 20 basis point margin expansion on the bottom line.

Got it. Thank you and then lastly, just.

As we think about where revenues in PD escrow in 2020 core wherever that shakes out say somewhere in that 4% to 5% range, maybe how should we think about the contribution from volumes first right.

24.

Matt Buckhalter: Yeah, historically, you know, we would have told you that, you know, the rate would have been 1%, you know, for an entire year out there. I think you can look at 2023 and see that, you know, we grew 3.8% on the rate and 3.5% on the volume to be just north of 7. I think you kind of nailed it in that 4 to 5% range is a good range for us. We had a very successful year with 19 state rate increases, 8 of them being double digits, you know, as well as our preferred payers being 17% of our total PDS volume. You know, we're going to continue that engagement into 2024, but I think I would take it and draw it right down the middle and say half of it will be rate, half of it will be volume. There's a chance to outperform, of course, if we're able to lean in and pull in additional preferred payers through it, but splitting it, you know, kind of 50-50 is where I would model it out.

Yeah. Historically, you know we would have told you that.

Rate would have been 1% for an entire year out there I think you can look at 2023 and see that we grew three 8% on a range of three 5% on the volume to be just north of seven I think you've kind of nailed it in that 4% to 5% range is a good range for US we had a very successful year with 19 state rate increases eight of them being double digits.

You know as well as our preferred payers being 17% of our total Pds volume, we're going to continue that engagement into 2024, and I think I would take it and draw it right down the middle and say half of it will be rate half of it will be volume, there's a chance to outperform of course, if we're able to lean in and pull in additional preferred payers through it but splitting it kind of 50.

50 is where I would model it out.

Kieran Ryan: Thanks a lot. Thanks, Keir. Ladies and gentlemen, there are no other questions at this time. I'll turn the floor back to Mr. Shaner. Thank you, Melissa, and thank you, everyone, for your interest in our Aveanna story. We look forward to updating you on our continued progress at the end of Q1. Thank you, and have a great day. Thank you. This concludes today's conference, time.

Thanks, a lot.

Thanks, Karen.

Yeah.

Thank you ladies and gentlemen, there are no other questions at this time I'll turn the floor back to Mr. Sander for any final comments.

Thank you Melissa and thank you everyone for your interest and all the other story, we look forward to updating you on our continued progress at the end of Q1, Thank you and have a great day.

Thank you. This concludes today's conference you may disconnect. Your lines at this time. Thank you for your participation.