Q3 2025 agilon health inc Earnings Call
Speaker #1: Good afternoon and thank you all for attending the Agilon health Third Quarter 2020 Earnings Conference Call . My name is Erica and I will be your moderator for today .
Speaker #1: All lines will be muted during the presentation portion of the call with an opportunity for questions and answers at the end . I would now like to pass the conference over to your host , Evan Smith investor Relations at Agilon health, inc. .
Speaker #1: Thank you . You may proceed . Evan .
Speaker #2: Thank you . Operator . Good afternoon and welcome to the call . With me is Executive Chairman Ron Williams and our CFO , Jeffrey Schwaneke .
Speaker #2: Following our prepared remarks , we will conduct a Q&A session . Before we begin , I would like to remind you that our remarks and responses to questions may include forward looking statements .
Speaker #2: Actual results may differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with our business.
Speaker #2: These risks and uncertainties are discussed in our SEC filings . Please note that we assume no obligation to update any forward looking statements .
Speaker #2: Additionally , certain financial measures we will discuss in this call are non-GAAP financial measures . We believe that providing these measures helps investors gain a better and more complete understanding of our financial results , and is consistent with how management views our financial results .
Speaker #2: A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures is available in the earnings press release and Form 8-K filed with the SEC .
Speaker #2: And with that , let me turn the call over to Ron . Thank you . Evan .
Speaker #3: Good afternoon , everyone , and thank you for joining us . I'm pleased to be with all of you today for the third quarter .
Speaker #3: We reported revenue of $1.44 billion, a medical margin of negative $57 million, and adjusted EBITDA of negative $91 million. We are also reinitiating 2025 guidance.
Speaker #3: While the quarter benefited from the execution of our clinical and quality programs , as well as cost discipline , we nevertheless were impacted by lower than expected in year wrath contribution as well as continued high costs from exited markets .
Speaker #3: As we look forward , we believe 2026 is shaping up to be a strong stepping stone in our transformation with positive development in the first half .
Speaker #3: The enhanced financial data pipeline ramping to 80% in membership and part D exposure potentially moving below 30% . We believe we are establishing a solid 2026 baseline .
Speaker #3: We expect to have improved forecasting and lower volatility , as well as significant internal and market driven tailwinds . These tailwinds include our burden of illness and clinical pathways initiatives driving broader identification and diagnosis of high risk conditions , increased incentives for our quality performance , and more disciplined and favorable contracting .
Speaker #3: This is further supported by more favorable payer bids , including increased premiums maximum out of pocket and deductibles benefiting Agilent Financial performance . And last , we believe we are establishing a more efficient platform to drive additional operating leverage and have reduced our operating costs by $30 million with increased visibility .
Speaker #3: We have reinstated our 2025 guidance at the midpoint , we expect revenue of 5.82 billion , medical margin of 5 million , and adjusted EBITDA of -258 million , which includes the impact of lower than expected risk scores for 2025 and costs related to exited markets .
Speaker #3: Partially offset by positive development in first half . Medical costs . Strong performance in ACO reach and continued operating cost discipline . Jeff will provide more detail in a moment .
Speaker #3: Our focus is on executing a strong finish to 2025 and a quick start in 2026 . Our organization is executing with precision and purpose .
Speaker #3: Our strategic initiatives are tightly aligned with our mission and partners and centered on embedding urgency , focus , operational rigor , clinical excellence and data driven executional accountability across the enterprise , which we believe will translate into improved performance in 2026 .
Speaker #3: Through investment in technology and efforts to expand our access to richer and more timely data , Agilent is leveraging data analytics and AI driven insights to support delivery with a focus to improve the visibility and predictability of our financial performance through our enhanced data pipeline , which went live in the first quarter .
Speaker #3: We now have more timely direct payer data feeds with validated and highly correlated member level clinical and claims data , as well as member level risk scores on approximately 80% of our members .
Speaker #3: We expect the increased visibility and alignment of our financial and operational data will enable us to more quickly identify and drive improvements . We remain extremely focused on the performance optimization initiatives we previously laid out .
Speaker #3: These are centered on improving the near-term profitability of the business , allowing us to drive improved medical margin , adjusted EBITDA and cash flow performance in 2026 .
Speaker #3: With respect to improved contract economics , we are currently in active negotiation with our payer partners for 2026 based on our discussions to date , we are making strong progress on several fronts .
Speaker #3: First , further reduction in part D exposure . Second , in expansion of quality incentives . Third , improved economic terms for part C .
Speaker #3: And fourth , we expect to continue narrowing of risk from supplemental benefits through better information based on the public commentary and initial review of payer bids .
Speaker #3: We expect more favorable bid design focused on Ma profitability , including improved pricing , reduced benefits , increased deductibles , and maximum out of pockets , which is expected to have a positive impact on medical margin in 2026 .
Speaker #3: We are also taking a very disciplined approach to contracting and for those payers with benefit designs and pricing that are inconsistent with market dynamics , we are prepared to take decisive action .
Speaker #3: While this may result in reduced membership , we are focussed on profitable growth and earning the appropriate economics for the value we are delivering .
Speaker #3: With respect to quality or stars , approximately 75% of health plan star ratings are directly impacted by the PCP , making our success in delivering four stars in a majority of our markets .
Speaker #3: Critical for payers . Our programs enable care gap closure rates that exceed the overall Ma average on key star measures , such as cancer screening and chronic condition management .
Speaker #3: To further enhance our star's performance , we are leveraging our enhanced analytics capabilities and collaborating with our partners to further improve conditional identification , diagnosis and screening , leading to documenting and closing of gaps in care through treatment such as medication adherence .
Speaker #3: In early October , CMS released the 2026 star ratings , which will impact 2027 . Approximately 75% of Agilent members are expected to be in four plus star plans in increase from 71% in 2026 .
Speaker #3: Payment year . This also compared favorably to 65% in the overall Medicare Advantage market . In addition , for the 2026 star ratings , Agilent achieved a consolidated average of 4.2 stars across our markets .
Speaker #3: This supports our efforts for improved payer economics that are better aligned with Agilent strong quality performance . Our boy program is also contributing to improvements in early and accurate identification , assessment and documentation of a patient's comprehensive health conditions by connecting the burden of illness assessment to our quality and care delivery programs , we can more effectively manage high acuity , chronic disease categories like heart failure .
Speaker #3: We are on track for our palliative program in clinical pathways based on the performance . To date , we believe this will positively contribute to our financial results in 2026 .
Speaker #3: As a reminder , these patient focused , physician driven and technology enabled clinical pathways have been developed in collaboration with our physician partners and national experts .
Speaker #3: They enable our teams to close care gaps by looking at some of the highest prevalence chronic conditions , which affect our patient population .
Speaker #3: With respect to our heart failure pathway , we are seeing encouraging results by identifying and diagnosing these conditions earlier in the outpatient setting .
Speaker #3: Our physician partners are better able to manage the progression of each illness and improving the quality of care for the patient . We have reduced new inpatient heart failure diagnosis rates from 18% in 2024 to 5% in 2025 .
Speaker #3: Across our Ma population , in markets where our virtual pharmacy solutions are active , about 50% of patients with heart failure and reduced ejection fraction are receiving guideline directed medication therapy .
Speaker #3: This is approximately 30% higher than the average . Similarly , when virtual pharmacy solutions are combined with transitions of care cardiology , we have seen 30 day readmission rates fall below 5% as compared to the national average of approximately 20% .
Speaker #3: This performance is expected to continue as we expand the programming , and we move into 2026 . As more partners fully implement the program with national palliative care program , we continue to make progress in our education market penetration and enrollment by focusing on providing care in a hospice or home setting .
Speaker #3: We see better care satisfaction for the member and their families and less hospital admissions as we move into 2026 . In addition to existing programs , we are beginning to expand our COPD and dementia pilots and anticipate further adoption in the quarter .
Speaker #3: We have also taken steps to optimize our cost structure to align with current market dynamics, including a more balanced near-term growth outlook.
Speaker #3: The leadership team is working to strategically realign our organizational structure. We have made thoughtful decisions to streamline certain teams while simultaneously investing in other areas that will help drive our next chapter of innovation through the centralization of certain functions.
Speaker #3: Implementation of technology and alignment with our PCP partners, we have reduced our headcount and streamlined our capital requirements in third-party costs, all to gain greater operating leverage from the platform and support our growth objectives.
Speaker #3: These operating expense initiatives are expected to reduce our costs by approximately 30,000,000 in 2026 . Finally , while we are making progress in our search for a CEO , with the skills , experience and relationships that are aligned to our new path , we remain committed to moving decisively .
Speaker #3: Now to enhance performance and agile position for sustainable value creation . Thank you for your continued support during this transition period . With that , I'll turn it over to Jeff .
Speaker #2: Thanks , Ron , and . good afternoon .
Speaker #4: As Ron touched on , 2025 is a transformational year . We are advancing strategic initiatives that we started putting in place last year to improve our contract economics , reduce our risk and optimize our cost structure .
Speaker #4: We believe the increased visibility gained from the enhanced data pipeline advances we have made in our boy and Clinical pathways programs . A $30 million reduction in operating expenses and a more disciplined approach to growth is expected to have positive impact in 2026 .
Speaker #4: For today's discussion , I will cover four key areas . First , I will walk through our third quarter results . Second , I will provide details on our reinstated 2025 guidance and a bridge to our jumping off point for 2026 .
Speaker #4: Third , I will provide color on the significant number of tailwinds we believe will support improvement in our 2026 performance . And finally , I will discuss the strength of our capital position based on our expectations for 2026 and a more disciplined near-term growth outlook .
Speaker #4: Moving to our financial performance for the third quarter , starting with membership , Medicare Advantage membership at the end of Q3 2025 was 503,000 members , compared to 525,000 members in Q3 2020 .
Speaker #4: For our ACO reach membership for Q3 was 115,000 members , compared to 132,000 members in the same period of 2020 . For as we discussed previously , our decision to take a measured approach to membership growth has resulted in a slight year over year decline driven by previously disclosed partner exits and a smaller 2025 class .
Speaker #4: Total revenue for the third quarter of 2025 was 1.44 billion , compared to 1.45 billion in the same period of 2020 . For our year over year revenue , comparison continues to be impacted by lower than expected risk adjustment , as well as the impact from market and payer contract exits .
Speaker #4: During the third quarter , we received the remainder of the 2024 risk adjustment data and substantially all the midyear 2025 risk adjustment data from our payer partners .
Speaker #4: This indicated the 2025 risk adjustment for the remaining 28% of members . We did not include in our prior results was lower than the average .
Speaker #4: The third quarter reflects the impact of lower than expected revenue associated with 2025 risk adjustment scores of $73 million , including a nine month true up of approximately $50 million for the remaining 28% .
Speaker #4: We now estimate the full year impact to medical margin for lower than expected risk adjustment is approximately $150 million . The larger than average impact for the remaining 28% was primarily driven by one payer , representing a new market in 2024 , where we also did not have data for 2023 .
Speaker #4: This payer is now in our data pipeline , which provides us with confidence in establishing our risk adjustment baseline and potential for 2026 .
Speaker #4: In addition , exited markets negatively impacted the quarter by $20 million . First half cost trends continued to develop favorably and were approximately 5.7% .
Speaker #4: We took a prudent approach in the current quarter and recorded cost trends at a little over 6% . As we have previously stated , we have limited , paid , claims visibility at this point post quarter close medical margin this quarter was -57 million compared to 58 million in Q3 2020 .
Speaker #4: For the current quarter , reflects continued elevated cost trends in line with our expectations for the year . In addition , this includes the previously mentioned risk adjustment and exited market impact adjusted EBITDA for the quarter was -91 million compared to -96 million in the third quarter of 2020 .
Speaker #4: For the third quarter reflects the items I already highlighted , partially offset by lower geography , entry costs and benefit from continued operating cost discipline .
Speaker #4: We are very pleased with our strong ACO reach performance during the quarter , including our final 2024 reconciliation , adjusted EBITDA related to this program this quarter was ahead of expectations at $18 million .
Speaker #4: ACO reach continues to demonstrate the value creation Agellon can deliver and is shaping the way we are transforming our Ma business , reducing our exposure for things outside of our control like part D and supplemental benefits .
Speaker #4: While focusing on improved economics and incentives for Agilent quality , clinical and medical cost performance . On the balance sheet , we ended the quarter with $311 million in cash and marketable securities and $172 million of off balance sheet cash held by our ACO entities .
Speaker #4: Next , let's move to our medical cost trend , outlook and reinstated 2025 guidance . Managing medical cost trends remains a top priority for the first half of 2025 .
Speaker #4: Medical cost trends have been stable , but elevated in areas such as inpatient and part B oncology drugs and restated favorably relative to our expectations .
Speaker #4: We anticipate the medical cost trend to remain in line with our expectations . Now moving to guidance with greater visibility as we head into the year end , we are reinstating our full year 2020 guidance .
Speaker #4: I will also provide some color on our expectations for 2026 , based on our actions to date and initial review of payer bids and contracting efforts for the full year 2025 , we expect Medicare Advantage membership in the range of 530,000 to 506,000 , with ACO model membership projected to be between 113,000 to 115,000 .
Speaker #4: We expect revenue for 2025 to be in the range of 5.81 billion to 5.83 billion , reflecting the impact of membership shifts and improved revenue yield from payer contracts .
Speaker #4: The revenue outlook also reflects lower than expected 2025 risk adjustment performance of approximately $150 million prior year development to date of $70 million , and exited markets of approximately $60 million .
Speaker #4: Full year medical margins are projected to be between -5 million to 15 million and adjusted EBITDA guidance range of -270 million to -245 million .
Speaker #4: We expect to end the year with approximately $310 million of cash on our balance sheet , including approximately 65 million held off balance sheet by our ACO entities .
Speaker #4: We have provided a bridge in the earnings presentation we issued today that walks from the current guide for 2025 to our jumping off point for 2026 .
Speaker #4: The expected 135 million medical margin jumping off point for 2026 includes approximately $150 million of lower than expected risk adjustment contribution for 2025 .
Speaker #4: Now , let me provide some color on 2026 . While we are not prepared to provide specific 2026 guidance at this time , I want to walk through why we are optimistic about next year , as illustrated on slide seven of our earnings presentation , we see several tailwinds , including macro factors like the 9% benchmark rate increase , better aligned payer contracts , and the disciplined cost actions .
Speaker #4: Ron outlined that we believe will both drive material improvement in our performance in 2026 and establish a path for consistent improvement as we move beyond next year .
Speaker #4: First , in the third quarter , we completed restructuring actions to improve our operating expenses . We rationalized other medical expenses , including better alignment of incentives with our PCP partners , reduced overhead and vendor costs in line with our current revenue run rate and more balanced growth outlook .
Speaker #4: We estimate that this will drive $30 million in cost and adjusted EBITDA benefit in 2026 , with additional opportunities for savings in 2027 .
Speaker #4: Second , we have taken a more disciplined approach to payer contacting , which includes incremental percentage of premium and enhanced quality incentives from payers for the value we deliver .
Speaker #4: This is expected to drive revenue growth on a pmpm basis , potentially greater than the 9% CMS final rate notice for 2026 . We have reviewed payer bids across our markets and on average , we see payers bidding for profitability with benefit design changes including increases in premiums , deductibles and maximum out-of-pocket expenses and a reduction in supplemental benefits .
Speaker #4: This is expected to be a positive offset to cost trend in 2026 . As a 2025 included a 1% benefit from payer bids .
Speaker #4: As part of our disciplined contracting strategy , we are taking decisive Action market by market , with payer contracts that do not meet a minimum threshold for profitability .
Speaker #4: While our contracting for 2026 is not final . If we cannot come to appropriate economic terms in certain markets , we may not contract with specific payers in these markets as part of our discussions , we may also transition some of these members to a care coordination fee with additional performance incentives depending on the outcome .
Speaker #4: This may reduce our overall membership in 2026 , though this impact may be mitigated if a member shifts to another payer with more favorable economics for Agilent or moves to a coordinated care fee arrangement , this disciplined approach is expected to be favorable to medical margin and adjusted EBITDA in 2026 and beyond .
Speaker #4: Our contracting efforts also include additional steps to reduce variability in our performance by effectively managing multi-year contract terms to reduce our exposure to macro cost trend volatility , interim payor benefit design changes and pricing that may be detrimental to our capitated economics .
Speaker #4: This includes reducing our payer contract , term length if needed , or adding additional material adverse change clauses to the contracts . In addition , while our exposure to part D in 2025 was primarily related to , carved out or exited markets , we are continuing to further reduce our exposure with respect to Doi .
Speaker #4: We are confident that the enhanced data pipeline , which now includes the outlier payer from the remaining 28% of our members AI advances for high risk member identification and diagnosis in our BOE program and execution on clinical pathways will deliver results over and above the final year of 28 .
Speaker #4: Our confidence is based on a review of validated codes in our data pipeline and our ability to deliver results above the impact of B28 last on our cash outlook .
Speaker #4: With the anticipated performance improvement in 2026 from our initiatives and the macro factors I just walked through, combined with our focus on working capital management, we expect to end 2025 with approximately $310 million in cash and 2026 with at least $100 million in cash.
Speaker #4: On our balance sheet , including cash held in our ACO reach entities . Before I close , given our current stock price , we anticipate pursuing a reverse stock split and expect to seek stockholder approval at our annual general meeting in 2026 .
Speaker #4: In summary , while we continue to operate in a challenging environment , the actions we are taking to refine our strategy , improve operational execution and financial visibility , and strengthen our financial position are expected to have a positive impact on our performance in 2026 and beyond .
Speaker #4: Confident in the value we bring to our members , PCP partners and payers , and our ability to navigate the near-term headwinds while positioning Agilent for long term success .
Speaker #4: With that , operator let's move to the Q&A portion of the call .
Speaker #1: Thank you . We will now begin the question and answer session . And if you would like to ask a question , you can do so by pressing star followed by the number one on your telephone keypad .
Speaker #1: If you change your mind and would like to remove that request , you can do so by pressing star , followed by two .
Speaker #1: And as a reminder , that is star followed by the number one to register for a question . The first question we have from the phone lines comes from Michael Harr with Baird .
Speaker #1: Your line is now open .
Speaker #5: Hi . Thank you so much . I see on your slide that you have ACR reach as a negative impact for next year .
Speaker #5: And I know the risk corridors are narrowing next year to 10% . Savings rate . I think at 13% if on our back of the envelope math , we're getting somewhere around 10 to 15 million of EBITDA impact is that the right ballpark to frame it is that is that what you're highlighting ?
Speaker #5: Your slide ? Are you able to offset it ? Does this narrowing of the savings rate create any friction with your ACH partners ?
Speaker #4: . Thanks , Michael , for the question . This is Jeff . I actually think the rebaselining of the the risk adjustment . It's actually more meaningful for us .
Speaker #4: And so yes , what we are reflecting here is that there are several changes to the ACO reach program . And I think we've commented about this before that we do expect lower economics from the program while still contributing .
Speaker #4: I would say very good margin . And , you know , we're reviewing our ACOs right now . And determining what models actually better .
Speaker #4: And I think we've made the decision on some of our ACOs to move them to the Mssp program , as we think about 2026 , because the the economics would be better in that program .
Speaker #4: Not going to really size the impact right now . You know , we're getting a little ahead here on the on the 26 guide .
Speaker #4: But you are correct . It's really driven by those changes .
Speaker #1: Thank you . We will now move on to the next question . We have Jack Slevin with Jefferies on the line . Please go ahead .
Speaker #6: Hey guys . Thanks for taking the question and appreciate all the color included in the deck and the release . I guess this might be a little high level .
Speaker #6: Because I acknowledge it's a bit early , but I just wanted to frame some of your commentary around potential further exits from payer contracts .
Speaker #6: And maybe I'll just just broaden it out to to say , you know , are you contemplating , I guess , one market exits on the table at this point , or is it really just specific payers ?
Speaker #6: And then two , if there's any way to get a sense of the order of magnitude that that might be at play here , just trying to frame out sort of what we might be looking at going forward .
Speaker #6: And any , any thoughts or sort of qualitative color would be really helpful . Thanks .
Speaker #4: Yeah , yeah . Thanks , Jack , for the question . You're right . It is a little early . We're kind of midstream on the on the contracting here .
Speaker #4: As we think about 2026 . I think the takeaway , you know , for you would be listen , we are taking a very disciplined approach and where the economics don't make sense for the value that we're delivering , ultimately we don't we don't have to do business with that payer .
Speaker #4: Some of those members may move to another payer in that market . And and we or we may enter into a care management deal , a care coordination fee with upside for quality and things like that .
Speaker #4: I think the point I would take away is any potential reduction in membership would would be beneficial to the medical margin and the EBITDA for Agilent .
Speaker #4: And that's really what we're we're focused on . So unfortunately , I can't I can't size it for you right now . But any any reduction would ultimately be to the benefit of the bottom line .
Speaker #3: Yeah , I would just add , Ron here that we have been very clear with the payers about the value that our physician partners create , both in terms of the stars program as well as closing gaps in care .
Speaker #3: And I think we've been very clear that we are contracting for tomorrow and not the historical relationship that we've had in a more normalized trend, more normalized utilization.
Speaker #3: I think the good news is that we've been working with some of our partners who understand this , who are exhibiting a attitude that supportive of the kinds of objectives that we have .
Speaker #3: But we're very clear . This is about being profitable and achieving the kind of that that we want . And we we're we're committed to working through that .
Speaker #1: Thank you . We now have Dhirendra Singh with Jewish Securities . You may proceed .
Speaker #6: Hi . This is .
Speaker #7: Peyton Engdahl on for Jailendra . Thank you for taking my question . I guess just to start , is there any type of update you can provide on the CEO search and how that's going ?
Speaker #7: And if you guys have made a decision between , internal and external candidates .
Speaker #3: Yeah, I would say that I've been managing a good deal of time. I think I'm pleased to say that we have some very good candidates coming forward.
Speaker #3: The process is open to all candidates who are interested in applying for the opportunity . And I would say that we feel good about where we are in pace and timing .
Speaker #3: I certainly wouldn't forecast they conclusion here . I think the most important thing for you to know is that while we don't have a permanent CEO , I am 100% focused on what spending .
Speaker #3: I meet regularly on a daily basis . The office of the Executive Chairman meets every day . We focus on the critical priorities and objectives with the goal of having a very strong finish to the year and a strong start for next year .
Speaker #3: So while no timeline on the process , this is not caretaking . This is active engagement and focused execution .
Speaker #7: And if you don't mind , if I could squeeze in just a quick follow up . Thank you for all the color on the medical cost trends .
Speaker #7: Is there just anything to call out in terms of what you saw in Q3 , in areas that were maybe high or cooling off a little bit , and then also if there's any color you can provide into Q4 .
Speaker #4: Yeah , I think it's it's the same , same issues . We've highlighted in the past quarters , really . It's inpatient part B drug spend specifically on oncology inpatient continues to run .
Speaker #4: A little bit a little bit high as well . I think those have been consistent over the last several quarters . So nothing new here .
Speaker #4: nothing Thanks .
Speaker #4: I would say that the first half medical cost trends have all restated favorably . So q1's come down , Q2 has come down since we last spoke , which is good , and it's just a little bit over the mid 5% range .
Speaker #4: And again for Q3 we just took a what I call relatively conservative approach in the low 60s . Ultimately , we don't have a lot of paid claims for that .
Speaker #4: And so we'll have to see how that plays out as we get into the fourth quarter .
Speaker #7: All right . Thank you .
Speaker #1: Your next
Speaker #1: from Ryan Langston with TD Cowen . Your line is open .
Speaker #8: Good afternoon . I think I heard you say there's about 65 million currently at the ACO entity level . I guess . Is there a minimum amount of cash you need to have allocated to the reach entities ?
Speaker #8: And in the year-end 2026, what is the contemplated balance for cash at the ACO reach level?
Speaker #4: Yeah . So actually at the end of the quarter , we had we had 172 million in the reach entities . And settlements that happen in the fourth quarter .
Speaker #4: there's cash That was new to us in 2024 . We did not have data for them in 2023 . So I think that made the estimation .
Speaker #4: And so the way we think about it is once those settlements are processed in Q4 , we'll roughly be at the 60 , $65 million .
Speaker #4: And as you think about the year end balance , the 310 million we quoted , it includes that that 65 million . So we expect in the year roughly 310 .
Speaker #4: That includes 65 million from reach , I would say there's no requirement to hold those dollars in the reach entities . It's more from a tax perspective because they're outside of our consolidated umbrella .
Speaker #4: There's there's some tax efficiencies gained by by leaving it there . And then monetizing that over time . But but we have access to that .
Speaker #4: If we needed it .
Speaker #8: Okay . Great . And then on the sort of higher than average impact on the risk revenue for the remaining 28% of the enrollment , I guess , was there any particular reason you expected these members to have higher scores ?
Speaker #8: Was it accrual driven and complete coding ? Just trying to understand the potential implications for 2026 . Thank you
Speaker #8: .
Speaker #4: Yeah , I think we highlighted that in the prepared remarks . It's really I would say the the higher than average is really driven by one payer .
Speaker #4: I would call it more more challenging , obviously , because you have to have 23 and 24 to really determine the increase in actual risk scores .
Speaker #4: The good news is that that payers now on our enhanced data pipeline and what I will say is sitting here today , we actually have the ability to calculate member level risk scores .
Speaker #4: We did not have that ability a year ago . And so as you think about what happened in the second quarter , we were able to calculate member level risk scores that tied or that agreed highly correlated with the midyear data from CMS .
Speaker #4: And the final year risk scores as well . And so we're in a much better position this year to calculate member level risk scores .
Speaker #4: That's all been driven by the process change associated with the enhanced data pipeline . So we feel pretty good a solid foundation in order to , I would say , set a foundation for this year .
Speaker #4: And obviously project forward as we think about a 2026 guide .
Speaker #8: Got it . Thank you .
Speaker #1: We now have Justin Lake with Wolfe Research on the line .
Speaker #9: Hi , this is Dean Rosales on for Justin . Is there any color you can give on what CMS is estimating for fee for service trend in 25 within the ACO reach program .
Speaker #9: And then my second question is in your earnings presentation , you stated that you expect payer bids to act as a tailwind in 26 .
Speaker #9: Is there any color on the benefit designs that you're seeing that you could share ? Would
Speaker #9: you say reduction of benefit is largely consistent across that we have your payers ? Thank you .
Speaker #4: Yeah . First , I'll handle the reach question . The latest data . I think we have is fee for service cost trends are 8.5% .
Speaker #4: And so that's the latest information we have on the cost trends in the in the fee for service business . And then as far as the bid detail is different by payer , is what I would say .
Speaker #4: And and obviously everybody , everybody kind of reads the , the the public announcements from all of our , our payer partners . But but generally I would say it's different .
Speaker #4: But broadly across our network , what we've seen is really pricing for margin . And it's , you know , maximum out of pockets .
Speaker #4: It's all the things and the levers that the payers have in the bid design . And so across our book generally , I would say what we see is pricing for margin , which we believe is going to be a tailwind for us as we head into 26 .
Speaker #4: So not all payers are the same , but across our our footprint and our network , it's it's going to be a positive for next year .
Speaker #9: Thank you so much .
Speaker #1: We now have a question from the line of Craig Jones with Bank of America .
Speaker #10: Thank you. So looking at your palliative and heart failure programs, I think you've rolled out about most of your geographies now for 2025.
Speaker #10: What kind of savings do you expect from those either pmpm or millions . And then as we think about these test programs going forward , once you kind of get it in your geographies , is this sort of like a one time boost that then kind of oscillates up and down based on participation ?
Speaker #10: Or is it sort of an annual continued margin accretion ? Thanks .
Speaker #4: Yeah , I would say just to go back , you know , we implemented a lot of these clinical programs , I would say late in 2024 , early in 2025 .
Speaker #4: So there's certainly is a ramp period . And some of that benefit will , you accrue to 2026 given the long tail nature of our business ?
Speaker #4: You know we're not going to get into any specific pmpm savings . But I think Ron highlighted in his prepared remarks some of the outcomes that we're seeing from those programs that have been very successful .
Speaker #4: Ultimately , it is it is reducing medical expense and improving . I would say the identification of disease burden for our members so that we can get them into the appropriate treatment programs .
Speaker #4: And so we look to , I would say , continue the evolution of these programs as we exit 25 into 26 . And they will be permanent programs .
Speaker #4: So they will continuously drive value . And we would continue to iterate on these programs to continue to to make them successful .
Speaker #3: Yeah , probably the only thing I would add is that we will continue to enrich the data sets and the AI algorithms that we use to identify potential suspects and the burden of illness and patients that has not yet been detected , along with other diagnostic techniques that our medical groups have invested in .
Speaker #3: And we've supported . So I think you can expect that this will continue some level of progression into the future , while at the same time we expect to ramp up other programs that our medical groups have determined represent good clinical care for their patients .
Speaker #10: Okay , great . Thank you .
Speaker #1: He have Daniel with Citi . Please go ahead .
Speaker #11: Hi , guys . Thanks for taking the question . I think you've covered the changes you're making to payer contracting . Well , but correct me if I'm wrong .
Speaker #11: I may have misheard this . I think I heard in your prepared remarks that you're also altering how your contracting on the provider side .
Speaker #11: Can you just provide a little bit more detail on how , if at all , your your provider contracts are changing , particularly with regard to risk sharing and how this may shift receptivity on the provider side to to contracting .
Speaker #11: Thanks .
Speaker #4: Yeah . On the provider side , we're not changing any of the contracts . On the provider side , I think what you're referring to is there was a comment about the $30 million of operating savings , really executed on for next year .
Speaker #4: I think part of that was aligning the incentives with our physician partners . So we did take a fresh look at incentive alignment .
Speaker #4: And that was a component of of that $30 million .
Speaker #11: Okay . Can you provide a bit more detail on what that means in practice ? What incentives , alignment , how incentives are changing ?
Speaker #4: You know , probably not here . I mean , it wasn't a substantial piece of the 30 , 30 million is what I would say .
Speaker #4: And so as you think about that , $30 million , I would say half was generally corporate , what I'd call corporate overhead costs .
Speaker #4: And then the other half would have been , I would say more market operating costs that we were looking at . So the physician incentive piece was , was relatively small .
Speaker #11: Got it . Thank you .
Speaker #1: Thank you . We now have a question from Andrew Mock with Barclays .
Speaker #12: Hi . Good afternoon . I wanted to follow up on the payer contract discussion . When you see benefit misalignment with your payer partners , is that concentrated more in small regional health plans or large national carriers ?
Speaker #12: And how much of your current membership is already contracted for next year , and how much is still outstanding ? Thanks .
Speaker #4: Yeah , I guess what I would say is it's a it's a market by market item , right ? So it's not just broadly across one payer .
Speaker #4: This payer . You have to go into each specific market and understand the benefit designs that impact us . And ultimately , you know , as part of our contracting process , we get the bid information .
Speaker #4: We analyze that and that that is a key component of our our request on economics . As you can imagine . And so so I would say it's a little more nuanced than kind of what you're what you're saying .
Speaker #4: And then the second part of your question , what was that ?
Speaker #12: How much of your membership is already contracted for next year ? When you when you think about what's left outstanding .
Speaker #4: Yeah , I would say it's kind of hard to put a pin on exactly how much is where the ink is dry , if you will .
Speaker #4: I think we've come to general business terms with a remember we had about 50% of our contracts open for renewal . We've come to , I'd say , relative agreement on a substantial portion of that .
Speaker #4: But obviously you have to dot the I's and cross the T's , and that matters . And so , you know , I would hesitate to say , say right now , at this point , how much .
Speaker #4: But obviously we're going to work through the bulk of this in the fourth quarter , and we'll have an update for you when we do our year end call .
Speaker #3: Yeah . The only thing I would add is that the negotiations have really been extensively supported by our physician partners , because they are in that community .
Speaker #3: They have the relationship with the patient , and so they have been really actively at the table with us in markets to assist in delivering the important messages to payers who may not have heard us as clearly as we had hoped .
Speaker #12: Great . And if I could sneak in one one additional question , I'd love to follow up on Starz . Appreciate the comment .
Speaker #12: That bonus year 2027 star scores will increase , but as we think about bonus year 2026 and some of the volatility , there to the extent some of your payer partners have a reduction in Starz , can you help us understand whether this headwind flows downstream to you or are you getting a fair premium increase to offset that ?
Speaker #12: Starz headwind ? Thanks .
Speaker #4: Yeah , obviously that's that's another key component of of what we're talking about when we're doing our contracting . So again , I would say we are looking for total overall economics .
Speaker #4: That makes sense for our partners in Agilent . And that's what we're focused on . And that's when we said we're taking a disciplined approach that's you know , that that would be part of that equation .
Speaker #12: All right . Thank you .
Speaker #1: We now have Matthew share with me time on the line.
Speaker #6: Hey , thanks for taking the question . I wanted to hit on the clinical programs again and the broader COPD and dementia rollout .
Speaker #6: What is the staging or timing of going from a pilot to permanent program look like ? And based on your success with palliative , how long do these broader launches tend to take to ramp towards meaningful savings ?
Speaker #6: With that , I guess , given the early success from your existing programs and some of your commentary , do you plan on rolling out incremental programs or piloting new specialty areas in 2026 , or how should we think about clinical programs sort of evolving from here ?
Speaker #4: Yeah , I would say you're heading down the correct path , meaning the first thing we typically do is pilot some of these programs and validate that , you know , ultimately it's improving the care for the member .
Speaker #4: And so we would pilot those , you know , you have to have enough data . Obviously , to to to make sure that that's happening .
Speaker #4: So I'd say the pilot phase is , is , you know , a relatively 6 to 8 months could be longer . But then ultimately we would we would roll that out .
Speaker #4: And of course , it's you can't roll it out to everyone at all times . Right . And so we roll it out market by market , starting with the , with the markets that we believe would would provide the most value .
Speaker #4: And so yes , I would say we plan to take the pilots of copy and dementia . And I think we're going to roll those out to more markets in 2026 .
Speaker #4: And then yes , obviously potential new pilots are on the table . And we're thinking about those as we as we think about our our 2026 guide and what we're planning on doing for next year .
Speaker #3: Yeah , all of these programs are developed in consultation with our partners . And we have a network advisory board where the leaders of the principal medical groups come and advise , review the evidence and support and endorse these types of initiatives as good patient care for their members .
Speaker #3: And so we do have some teed up , as Jeff described . And we feel like as we've implemented congestive heart failure , we've learned a lot about that process of diffusion of both the clinical evidence technology training and support of the physicians .
Speaker #1: Thank you . We have the next question on the line from David Larson with Btig . You may proceed when you're ready .
Speaker #13: Hi . This is Jenny Chen on for David . Thanks for taking my question . I just wanted to ask about the big beautiful Bill act .
Speaker #13: Do you expect that on the Medicare side to have any impact on your business at all ? And if you do what you expect , those impacts to be ?
Speaker #13: Thank you .
Speaker #4: Yeah . We don't expect it to have a meaningful impact on on the business and we'll just leave it at that .
Speaker #1: Thank you . Just as a reminder , I star , followed by one to register for a question . And we now have Amir Barney with Evercore on the line .
Speaker #5: Hey guys . Good afternoon . Thanks for taking my question . So you might as one of your largest payer partners , I believe , and , you know , looks like they're focused on benefit stability for 26 .
Speaker #5: So I guess I'm trying to , you know , get a sense for how you think this impacts your medical costs for next year .
Speaker #5: Some numbers around that would be very helpful . And if I could squeeze a quick follow up , what do you see as the minimum working capital for your business ?
Speaker #5: Thank you .
Speaker #4: Yeah . So real quick I think I think we've kind of covered this . Maybe the first question as far as Humana , I think we've kind of covered this in the contracting phase , which is ultimately we you know , we get the benefits for each of our markets .
Speaker #4: We get the plan designs and we analyze that . And that's part of our overall contracting efforts . Looking for the economics that we make , you know , that we think makes sense for us .
Speaker #4: And so I would say , you know , that's just one you're just talking specifically about one payer . But the process is is the same across all payers .
Speaker #4: And so I think that's , that's , you know , that's that's where we are from that standpoint . It's part of the overall contracting process and the economics .
Speaker #4: We look for . And your second question on minimum working capital , I don't know what you're trying to really get at there .
Speaker #4: I don't have a number off the top of my head for what you're trying to pinpoint , but we can certainly follow up .
Speaker #5: Okay . Sure . Thank you .
Speaker #1: Thank you . Just one final reminder . If you would like to ask any questions to please press star . Then one on your telephone keypad .
Speaker #1: Now . I can confirm that does conclude the question and answer session here . And I would like to hand it back to Ron Williams for some final closing comments .
Speaker #3: Well , thank you for joining us today . Agellon will close 2025 with a sharpened focus and momentum driven by a suite of high impact initiatives that are fundamentally reshaping our operating discipline and Executional rigor .
Speaker #3: I want to thank our employees and our partners who may be listening and also want to thank you for your dedication and partnership with us .
Speaker #3: You're playing a crucial role in the healthcare industry , helping transform healthcare through our employees and empowering our primary care physicians to focus on the entire health of their patients .
Speaker #3: We will continue to fulfill this mission with our employees. Thank you. Have a good evening.
Speaker #1: Thank you . I can confirm that . Does conclude the Agilon health, inc. third quarter 2020 earnings conference call . Thank you all for your participation .