Q3 2024 DocGo Inc Earnings Call

This call is being recorded on Thursday November seven 2024, I would now like to turn the conference over to Michael <unk>, Vice President Investor Relations. Please go ahead.

Speaker Change: Thank you operator before turning the call over to management I would like to make the following remarks concerning forward looking statements. All statements made in this conference call other than statements of historical fact are forward looking statements. The words may will plan potential could goal outlook.

Speaker Change: I anticipate believe estimate expect intend guidance confidence target project and other similar expressions may be used to identify such forward looking statements. These forward looking statements are not guarantees of future performance and we cannot assure you that we will achieve our realize our plans intentions outcomes results or expectations are forward looking.

Speaker Change: Statements are inherently subject to substantial risks uncertainties and assumptions many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward looking statements. These risks uncertainties and assumptions include but are not limited to those discussed in our risk factors and elsewhere.

Speaker Change: <unk> annual report on Form 10-K quarterly reports on Form 10-Q, and other reports and statements filed by <unk> with the SEC to which your attention is directed actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward looking statements. In addition, today's call contains.

Speaker Change: References to non-GAAP financial measures reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are provided directly as part of this call or included in our earnings release or the current report on form 8-K that includes our earnings release, which is posted on our website <unk> dot com as well as <unk>.

Speaker Change: What do you see the.

Speaker Change: The information contained in this call is accurate as of only the date discussed investors should not assume that statements will remain relevant added operative and operative at a later time, we undertake no obligation to update any information discussed in this call to reflect events or circumstances. After the date of this call or to reflect new information or the occurrence of unanticipated.

Speaker Change: Painted a dense except as to the extent required by law.

Speaker Change: At this time it is now my pleasure to turn the call over to Mr. Lee Bienstock CEO of <unk>. Li. Please go ahead.

Lee Bienstock: Thank you Mike and thank you all for joining us today.

Lee Bienstock: We had a strong performance across all customer verticals in the third quarter recording a $138 7 million in revenue and $17 9 million and adjusted EBITDA.

Lee Bienstock: One of the major highlights from the quarter is the tremendous progress we have made building our care gap closure program with multiple payers. We are seeing very strong leading indicators with these programs once again more than doubling the number of assign lies on a sequential basis from Q2 to Q3 and that figure now exceeds five.

Lee Bienstock: 100000 patients.

Lee Bienstock: As of today, we have doubled the average weekly number of care gap visits completed when compared to our last earnings report.

By year end, we project that we will exit the year at a run rate of 1000 visits per week.

Lee Bienstock: And just the last two months, we have built new hubs up and down the west coast to service this demand from San Diego to Los Angeles, Sacramento, and we are also preparing for further expansion in the northeast.

Lee Bienstock: Today, we fine tuned our 'twenty 'twenty four guidance to $620 million to $630 million in revenue and $70 million to $75 million and adjusted EBITDA, while increasing our expectation for cash flow from operations to $90 million to $100 million up from $80 million to $90 million.

Lee Bienstock: Several of our micro related programs have extended beyond our original expectation and we now expect migrant related revenues of $360 million to $390 million in 2024 up from our previous forecast of $320 million to $350 million.

Lee Bienstock: Offsetting that amount is an expected decrease in our non migrant municipal population health programs by an equal amount, which effectively lowers our base business forecast for 2024, consisting of transportation and non migrant mobile health to $240 million to $260 million down from our previous forecast of $280 to $300 million.

Lee Bienstock: I want to be clear.

Lee Bienstock: This adjustment has no impact on our consolidated revenue expectations for 2020 for just the underlying breakdown between migrant and nonmedical related revenues to provide a specific example, or contract with H P D, which wound down by approximately 50% in May was expected to largely conclude in late Q3, now we expect it to end.

Lee Bienstock: In late December as the micro related programs wind down we plan to apply those resources to new non migrant related programs. It is simply a matter of timing.

Lee Bienstock: Regarding 2025 today, we issued consolidated revenue guidance of $410 million to $450 million, which includes an expected migrant related revenue contribution of $50 million I would like to emphasize that our microrna later work in 2000 and twenty-five as health care focused and completely aligned with our population health verticals service offerings.

Lee Bienstock: Like infectious disease screening behavioral health assessments vaccinations and urgent care.

Lee Bienstock: In sum, we are meeting or exceeding our consolidated financial objectives across all three customer verticals and cannot be more excited about both our operational execution during the quarter and the strength of our pipeline.

Lee Bienstock: Once again, we continued to make substantial progress with our cash collections generating approximately $31 million in cash flow from operations during the period.

Lee Bienstock: Our total cash and cash equivalents balance is now over $108 million up from $86 million last quarter and 59 million in Q1 of this year throughout 2023 and in early 'twenty 'twenty four we had a very substantial working capital outlay to support the migrant related programs now that trend is reversed and we are.

Lee Bienstock: Very strong cash flow as a result, and that trend should continue into 'twenty into early 2025.

Lee Bienstock: With our strong balance sheet, we have the resources to support our growth initiatives execute on opportunities in our robust pipeline make additional share repurchases fun, new strategic relationships and repay our line of credit.

Lee Bienstock: As I, usually do I would now like to spend some time covering our three key customer verticals payers and providers municipal population health and hospital systems.

Lee Bienstock: In our payer and provider customer vertical as I mentioned above we are aggressively ramping up our infrastructure to meet the strong reception that we are experiencing for these services.

Lee Bienstock: In the news just last month, one of the largest payers in the country announced a significant drop in its Medicare advantage star ratings, which according to analysts could reduce its 2026 EBITDA by as much as 50%.

Lee Bienstock: This is a crucial topic on the mind of every payer in the country and we believe arc here got closure programs are an ideal solution to help improve plan ratings and potentially have a material positive financial impact for our customers. We know the demand is there now we are laser focused on the build out to support it as previously mentioned we anticipate exiting.

Lee Bienstock: 2024 at a thousand visit per week run rate and our care gap closure program, which will set us up to meet or exceed our goal of 65000 visits in 2025.

Additionally, we started enrolling P. C P patients in Q3 and have agreements in flight with our payer partners that will position us to grow P. C. P patients to our target of 10000 in 2025.

Lee Bienstock: By the end of 2025, we also continue to expect reaching our goal of monitoring 70000 patients in our virtual care management programs.

Lee Bienstock: Our mobile health plan partnerships program create a virtuous cycle, where everyone who participates benefits patients benefit from convenient delivery of high quality care in the home insurers benefit from healthier patients and the opportunity to increase their heated scores and star ratings Endako continues to fulfill our mission of bringing high quality care.

Lee Bienstock: Care to all importantly, these programs also position <unk> to expand to value based care arrangements with our insurance partners over time, which is a key initiative to support our long term growth envision.

Lee Bienstock: To give an example of how our plans are coming to fruition, we've been providing a transitional care management readmission reduction program at a single hospital in Southern California for L. A care a payer that manages $2 5 million lives.

Lee Bienstock: Just on our successful delivery of a greater than 50% emergency Department reduction for this hospitals patients. We just signed an expansion deal with a lake here to provide our transitional care management program at additional hospitals to offer care gap closure services for L. A care members.

Lee Bienstock: And launching mobile health program to help improve the management of some of their most complex high risk member populations.

Lee Bienstock: And our municipal population health vertical we saw a number of positive indicators in Q3, we are preparing to expand our mobile X-ray program for the city of New York. This fall and we extended the street health outreach and wellness contracts for a fourth year, which will enable us to continue operating this award winning mobile health care program for us.

Lee Bienstock: Housed in underserved populations in New York City.

Lee Bienstock: Additionally, just this week, we received an expansion with the new Mexico Department of health, which broadened the scope of our initial contracts preclinical services at their public health offices.

Lee Bienstock: Collectively we continue to leverage our clinical expertise in mobile health care approach to bring care to people outside of traditional health care settings.

In Q3 alone.

Lee Bienstock: We provided treatment across over 215000 medical and behavioral health encounters, including X rays vaccinations urgent care depression screenings and more within this customer vertical within this customer vertical. We've also made considerable progress with our project Prime initiatives, whose goal is to identify law.

Lee Bienstock: Large government contractors with existing projects, who may benefit from sub contracting municipal population population health components of their work to Darko.

Lee Bienstock: We believe this is a very substantial opportunity and we expect to begin generating revenue from this initiative in early 2025.

In our hospital vertical we have a number of small to medium sized contracts that have been signed or very close to being signed which give us. Good line of sight to reach our 2025 growth estimates in.

Lee Bienstock: In addition to new contracts. We have also recently expanded in the northeast with a major customer and continue our build out in the Dallas market. We received exceptional customer feedback from our newly launched contracts in Dover, Delaware, which is great to see and encouraging as we grow our presence in that market.

Lee Bienstock: We have also made significant enhancements to our technology. So that customers can now track a network of providers within our proprietary technology platform. In addition to having the ability to dispatch both medical transportation and mobile health resources. A combination we believe is unique within our industry.

Lee Bienstock: We have long believed that our proprietary technology has potential as a standalone SaaS product that can generate revenues for us in markets, where we do not have a physical presence and we expect that to begin in the fourth quarter.

Lee Bienstock: Before I hand, it over to norm I also wanted to take a moment to discuss the addition of Dr. Steven Classico as our new chair of the board as the former CEO of Jefferson Health and a special adviser at venture capital firms General catalyst. Dr. Classico brings extensive health care experience and a vast network that can help that go in a variety of ways.

Lee Bienstock: He is also a vocal advocate for health care at any address in a pioneering AI tech and pioneering AI technologies that could potentially optimize patient care and increase operational efficiency.

Lee Bienstock: When we look forward to benefiting from his guidance and vast industry knowledge.

Speaker Change: We could not be more excited to have Dr. Classical onboard and we're off to a great great start.

Speaker Change: I will now hand, it over to norm to cover the financial resorts results Norm. Please go ahead.

Norm: Thank you Lee and good afternoon total revenue for the third quarter of 2024 was $138 7, Million% to 26% decrease from the third quarter of 2023, but in line with our expectations driven by the anticipated wind down of Margaret related projects Mobile health revenue for the third quarter of 2024 was $90 7 million.

Norm: Down 35% from the third quarter of 2023, and also driven by the planned wind down in migraine related work as we've discussed on previous earnings calls. These migrant related revenues began to decline sequentially in Q2, reflecting the wind down of some sites in New York City, which began in mid May. These micro related revenues are expected to continue to decline sequentially.

Norm: As we go through the rest of 2024 and into 2025.

Norm: On a year to date basis through September mobile health revenues have increased 20% in 2024.

Norm: Transportation services revenue increased to $48 million in Q3 of 2020 for about 2% higher than the transport revenues. We recorded in the third quarter of 2023, we saw our largest gains in both large markets such as the UK and in some smaller markets like Tennessee in Delaware for the first nine months of 2024 transportation revenues were up nine.

Norm: Percent from the prior year period.

Norm: Historically, we've had periods of growth that were greater than our 15% annual target while more recently, we've been digesting the strong growth. We have several recent contract wins that give us confidence in maintaining our 15% annual revenue growth expectation going into 2025.

Norm: Net income was $4 5 million in Q3 of 2024 compared with net income of $4 6 million in the third quarter of 2023, as we were able to successfully offset the impact of the decline in revenue with significantly improved gross margins.

Norm: Adjusted EBITDA for the third quarter of 2024 was $17 9 million.

Norm: Up from $16 7 million in last year's third quarter. The adjusted EBITA margin was 12, 9% in Q3 up from eight 9% in the third quarter of 2023.

Norm: This was the fourth consecutive quarter of double digit adjusted EBITDA margins.

Norm: Total GAAP gross margin percentage during the third quarter 2024 was 33% up strongly from 27, 2% in the third quarter of 2023. The adjusted gross margin was 36% compared to 29, 5% in the third quarter of 2023 as many of our mobile health projects have matured throughout 2024.

Norm: We've seen solid improvements in subcontractor costs during the third quarter of 2024 subcontracted labor accounted for 33% of total labor cost as compared to 41% in the third quarter of 2023 sub contracted labor has declined sequentially since peaking in the fourth quarter of last year at approximately 44% of.

Norm: Total labor cost.

Norm: During the third quarter of 2024, adjusted gross margin for the mobile Health segment was 38, 8% compared to 28, 8% in the third quarter of 2023 adjusted gross margins for the mobile health segment have now improved for four consecutive quarters in the transportation segment adjusted gross margins were 37% in Q3 2000.

Norm: 24 down from 31, 7% in Q3 of 2023, but transportation margins improved by 160 basis points from their Q2 2024 levels. However, they were still impacted by residual subcontractor cost in one of our markets still as the third quarter came to a close the subcontractor costs had been.

Norm: <unk> eliminated as we were able to fill staffing gaps via newly hired fueled personnel.

Norm: Looking at operating costs SG&A as a percentage of total revenues came to 28, 7% in the third quarter of 2024 higher than the 24, 8% seen in the third quarter of 2023. However in absolute dollar terms operating expenses declined 14% year over year due in part to targeted reductions in force.

Norm: During the first half of 2024 with operating expenses falling to their lowest quarterly levels. Since the first quarter of 2023, we continue to actively manage operating expenses as the margin programs wind down however, given the expectation for a sequentially lower revenues, we expect the SG&A could increase as a percentage of revenues over the next few quarters.

Norm: As reflected in our adjusted EBITDA margin expectation of 8% to 10% in 2025.

The biggest financial highlight for us in the third quarter relates to our balance sheet, where we took another big step forward as of September 30 of 2024, our total cash and cash equivalents, which includes restricted cash was $108 6 million as compared to $85 8 million as of the end of the second quarter of 2024.

Norm: As of the end of Q3, our total cash balance was more than $40 million higher than it was a year earlier the increase in cash was driven by solid collections. During the third quarter, which also resulted in a decline in our accounts receivable when compared to both those of the end of the second quarter and the levels that we saw at the end of 2023 at.

Norm: At quarter end, we had approximately $170 million in accounts receivable from the various migraine programs compared to a $185 million in accounts receivable from the various micro programs as of the end of Q2 as these migrant related programs continue to wind down over the remainder of 2024, our balance sheet is expected to continue to benefit as we collect this AAR and brings.

Norm: Our days sales outstanding or DSO more closely in line with historical levels as we collect older larger invoices and as our cash outflows decrease in line with lower migrant project expenditures, we expect to see a continued increase in our cash balance we now expect to generate cash flow from operations of 90 million to $100 million in <unk>.

Norm: 24 <unk>.

Norm: Given that we've generated $57 million in cash flow from operations through the first nine months of the year.

Norm: We are looking at an additional 33 million to $43 million in cash flow from operations in the fourth quarter.

Norm: For comparison purposes, we generated 37 million in operating cash flow in the second quarter and in another another $31 million in the third quarter, our increased cash balances will allow us to invest in some of the opportunities. We're currently evaluating to grow our business.

Speaker Change: At this point I'd like to briefly turn the call back over to Lee. Thank.

Lee Bienstock: Thank you norm before I turn the call back to the operator for Q&A I wanted to close by sharing that Q3 marked my one year anniversary as CEO of <unk> our.

Lee Bienstock: Our company has accomplished incredible things over the last 12 months, including transporting over $1 1 million patients and facilitating care through more than 820000 mobile health interactions bringing.

Lee Bienstock: Bringing care to this many people is a clear manifestation of our mission to bring high quality highly accessible care to all.

That goes vertically integrated mobile health care offering powered by a best in class proprietary technology platform and compassionate clinical providers has an incredible product market fit we enjoy strong relationships with an enviable roster of customers and how they patient net promoter score of 85 that speaks volumes about the <unk>.

Lee Bienstock: <unk> of our service delivery and have a positive employee centric company culture as evidenced by our awards for workplace excellence.

Lee Bienstock: I know we will continue building on this strong foundation to expand our impact in the months and years ahead.

Speaker Change: And now I'd like to turn the call back to the operator for Q&A operator. Please go ahead.

Speaker Change: Thank you.

Speaker Change: Ladies and gentlemen, we will now begin the question and answer session.

Speaker Change: Do you have a question. Please press star followed by the number one on your Touchtone phone, you'll hear a prompt that your hand has been raised.

Speaker Change: Should you wish to decline from the polling process. Please press star followed by the number two.

Speaker Change: If you are using a speaker phone please lift the handset before pressing any keys.

Speaker Change: Your first question comes from Sarah James of Cantor Fitzgerald. Please go ahead.

Speaker Change: Hi, guys. This is gaby on for Sarah Congrats on the quarter I just wanted to start off with you had a really strong EBITDA beat and can you give a little bit more color on what drove that and it sounds like you have a lot of plans for expansion and that the care grab carryout closure progress is going and going Super well. So is there anything we should worry about on the expense line.

Speaker Change: While you grow that business.

Speaker Change: Yeah.

Norm: Sure Hey, Jamie its norm I'll take the first part of the question.

Speaker Change: So as far as the as far as the EBITDA beat I would point to the gross margin line, we generated a blended gross margin of 36%.

Speaker Change: In the quarter now, while that's not out of the ordinary if you look at if you look at things historically, we've done that before it was the highest margin that we've had since the fourth quarter of 2022, when we had some COVID-19 revenue and other things like that that spike that number up we've always said that our expectation for blended.

Speaker Change: Our blended gross margin to somewhere in the 33% 35% range.

Speaker Change: There are a couple of ins and outs there are things that helped us this quarter some of which were non recurring some of which were just a matter of in the case of all talk about mobile health margins will help margins were 38, 8% and those were those were helped along by the fact that the first.

Speaker Change: First programs. The first sites that were wound down as part of the migrant programs were the ones that were that tended to be at the lower margin. The lower margin sites now that wasn't necessarily by design, but that's sort of the way that played out. So we had a more favorable mix within the migraine program and then in general we had a we had a pretty good mix within within mobile health in general so.

Speaker Change: I would say, where we were we benefit it was from gross margins that were maybe a little bit higher than than we would expect.

That was a big part of it otherwise the SG&A was reasonably well control and as we mentioned down 14% year over year, we've been doing a lot of cost cutting a lot of rationalization.

Speaker Change: Some of that came to came to fruition as well.

Lee Bienstock: Gabrielle It's Lee I'll touch on next year as part of your question. So I think we're going to continue to invest in our in our rapid growth and rapid expansion that we share, particularly in the payer programs are expanding as I mentioned across the west coast and we're always going to be investing very focused in investing next year I'm, putting out a great quality product and a.

Great patient experience and absolutely ensuring that our customers are incredible customers and our payer partners and our municipal partners and our hospital systems are incredibly delighted and happy with our services and we're always going to index towards that and we're going to be investing in that so and that was reflected in our EBITDA percentage range guidance for next year as well those investments are reflected there.

Speaker Change: Okay Awesome. Thank you guys.

Speaker Change: Your next question comes from <unk> Chickering of State said Peng. Please go ahead.

Speaker Change: Hey, good afternoon, guys. Thanks for taking my questions.

Speaker Change: Looking at the 2025 guidance last quarter, you guided to I think $40 million of base business revenues at 10% base margin.

Speaker Change: Now I think you added $50 million of migraine revenues in the guidance.

Speaker Change: Which I think implies that the base business is growing lower and then the margin guidance I believe was a floor of 10% and now it's 8% to 10% sort of range. So I guess the question is sure I guess, what if anything changed from the guidance commentary from the last quarter call.

Lee Bienstock: Absolutely. It's it's Lee I'll take that question. Thank you for it so for next year, we wanted to put out guidance. So that we can give direction on on where next year is going to go and also include what we expect the migrant contribution will be I wanted to also really emphasize that that work is really encompassed in our population health work.

Lee Bienstock: All medical related we are winding down the <unk> site that included some of the ancillary services that will all be wound down by the end of this year. So going into next year, it's going to really focus on services related to infectious disease control in screening vaccinations urgent care depression screenings other behavioral health.

Lee Bienstock: Resources that work that we're providing and that's really what the work is going to be focused on for next year and then we also wanted to share that essentially as that work continues into next year. It continues to utilize resources that eventually we will transition over to the base business growth and so that's what you see there.

Lee Bienstock: As the resources are transitioning away from the micro related work, that's going to continue want to transition over to the base business and all the payer programs in all of the growth opportunities that we're expanding on right now.

Lee Bienstock: So thats what next year, essentially will look like and that also the EBITDA range that I mentioned to Gabby as well on her question that reflects a lot of the investments we're going to be making in the in that expansion, particularly on the payer programs on our PCP program as well as some of the investments, we're making on the municipal and hospital systems side and again that encompasses rapid.

Lee Bienstock: Expansion and also great quality of service and so we incorporated that into our adjusted EBITDA percentage range.

Speaker Change: Okay. So just so I understand this sort of last quarter is 10% on the 400 million now, it's a higher revenue, but lower margin thats because of migraine is basically sort of at a lower margin is taking those resources away and therefore until we generate that away. That's a drag on next year's EBITDA.

Speaker Change: That's correct and then also keep in mind that again, we're investing into the expansion into new markets for some of our payer program partners and we have.

Speaker Change: A multiple number of opportunities national scaling opportunities that you're going to see us a scale in two additional markets next year as well and it is the one I think it's a little bit it's a little bit more nuanced view, we've talked about are our cost cutting programs, where we're trying to rightsize the business to make sure that we keep SG&A at a certain percentage of revenues as we go through.

Speaker Change: This on a very granular bottom up way.

We're finding there are some costs that we might want to keep in place. So that when we talked about investment. It doesn't just mean going out and spending additional money in some cases it means leaving part of our cost structure in place. So that we can with that we can continue to grow. So for example, taking people who were working on the micro programs, who are very very talented and very good people and then moving them over.

Other parts of the organization to help build out the payer programs or some of the other stuff that we're doing so that technically represents.

Speaker Change: Of course, that's already here that it's sticking around but it's being redeployed. So as we look at that as we do our bottom up.

Speaker Change: Granular projected projecting it looks like we should we should build in a little bit of conservatism around where we think the EBITDA marginally.

Okay, Great and then.

Speaker Change: Quick follow up looking at the care graft the carryout closure contracts being signed that's growing rapidly how are those margins versus your corporate averages and as you invest in that business as that can be a drag on margins as that keeps growing thank you.

Speaker Change: Absolutely. So we do price our contracts in line with our historical margins on all of the Payor Carryout closure programs, we're negotiating custom rates and so we are preserving the margins at a gross margin level and endeavoring to do that on the X, but it will cost us money on the expansion like we've seen with previous projects and <unk>.

Speaker Change: This year is when we are doing rapid expansion. It does cost us investment as we're ramping up our training people.

Speaker Change: We're opening up new base is we're making sure that essentially we're overstaffed in some cases to meet ensure the absolute exceptional quality that.

Speaker Change: That we want to deliver for the very large national payers. So we are making sure that it has all the resources it needs to be successful to deliberate spectacular patient experience and then also very meaningful results for the payers and then overtime, we optimize and we take out some of those costs. So all of that is baked in into the guidance and that's kind of.

Speaker Change: The granularity that we wanted to share on the call.

Speaker Change: Great. Thanks, so much.

Speaker Change: Your next question comes from Ryan Macdonald of Needham.

Speaker Change: Please go ahead.

Speaker Change: Hi, Thanks for taking my questions, maybe just first on the clarification on 25 I think in your prepared remarks, you talked about sort of a non migrant municipal population health.

Speaker Change: Business sort of a lower expectation, Nevada, and the $2 40 to $2 60 range versus previous forecast of $2 80 to 300 can you just clarify what you were talking about there.

Speaker Change: So we.

Speaker Change: Ryan it's great to speak with you. So the base business. We shared is going to be in the 240 to $2 60 range, which was revised from what we had shared in previous calls again, reflecting some of the micron related revenues sticking in until the end of this year, whereas we thought it was going to sunset more in the Q3 range.

Speaker Change: In terms of the additional programs allow the programs that we're rolling out now in the municipal health care space related to population health, bringing services again in line with what we've been doing.

Speaker Change: All along at the company bring services to underserved populations uninsured populations to our veterans partnering with the Indian health system with state and municipal population health systems to bring services like mobile X-ray vaccinations behavioral health care infectious disease screening annual wellness visits too.

Speaker Change: Our municipal partners, particularly those that.

Speaker Change: Are really looking for a solution to bring care into underserved communities and those are the same programs that we are scaling right now into next year.

Speaker Change: Got it thanks, Okay. So it's just because of the maybe more accelerated wind down you're going to collect more of that in 'twenty four and less than what you initially expected in 'twenty five.

Speaker Change: Correct.

Speaker Change: You're talking about now in 25 24 that was the $2 40 to $2 60, our range for for for next year, we shared our our revenue expectation is for is 410 to four $4 50.

Speaker Change: Yes, yes, I'm counting all of the programs encompassing all the programs that the company is working on.

Speaker Change: Okay. That's helpful. In terms of the I wanted to ask about the you made a comment about in the payer business.

Speaker Change: With the issues with the star ratings and sort of that creating an opportunity for you to more rapidly scale up in the northeast.

Speaker Change: Can you talk about sort of how the pipeline has grown or expanded since we've sort of got the star rating news and it seems obviously care gap closures I think could be some low hanging fruit.

Speaker Change: For these payers to help improve their ratings in the future, but what sort of direct.

Speaker Change: Kind of response have you gotten from from prospective health plans and payers sort of following that that update.

Speaker Change: Hey, Ryan that's exactly right, so really since that update which came as a flurry through the <unk>.

Speaker Change: Q3 earnings calls or allow the payers that we learned essentially that payers need to close these care gaps there weighing on their on their financials and their weighing on the access to their patients that their patients have and their patients have gaps in care that needs to be addressed otherwise the patients can get sicker.

Speaker Change: Chronic conditions can get more acute and obviously as that happens.

Speaker Change: Horrible for the patients their health outcomes get worse, but also obviously it becomes more expensive for the payers as they are at their members essentially are <unk>.

Speaker Change: Increasing the utilization of the health plan getting sicker and so our modality. Our whole program is to be proactive as to go into those patients' homes and close those care gaps or in many cases, we go into a patient's home as an example, we'll do a diabetic retinal exam or a bone density scan or a colon cancer screening and indeed, we find that the patient is at risk.

Speaker Change: For a break for fall and break or at risk for vision impairment or blindness, and obviously, we're working on making sure that the follow up care as well working with the plans to make sure the follow up care. There. So again the patient condition does not precipitate all of that is perfectly aligned with what really the payers need right now which is to close those care gaps.

Speaker Change: Decreased utilization improve health outcomes, which ultimately will be better financially for them will increase their profitability. So we've seen since that happened we've seen two things we've seen our traction with different payers increase so we're signing newer or adding newer payor partners that we don't have today into the pipeline.

Speaker Change: And we're seeing the payers, we already work with send us more patients to address so we're seeing both that's why we're seeing the acceleration we're investing very heavily into that right now.

Speaker Change: Excellent great to hear thanks for taking my questions.

Speaker Change: Thank you ladies and gentlemen.

Speaker Change: That concludes our question and answer session.

Speaker Change: I will now turn the conference back over to Lee Bienstock CEO for closing remarks. Please go ahead.

Lee Bienstock: Thank you. Thank you so much thank you to everyone for joining us on the call and we look forward to the next one.

Speaker Change: Be well.

Speaker Change: This concludes today's conference. Thank you for attending you may now disconnect your lines.

Speaker Change: Oh.

Speaker Change: Okay.

Speaker Change: Yes.