Q4 2025 Evolent Health Inc Earnings Call

February 24, 2026

Speaker #2: Your host for today's call are Evolent R. Seth Blackley, Chief Executive Officer and Mario Ramos, Chief Financial Officer. This call will be archived and available later this evening and for the next week via the webcast on the company's website in the section titled Investor Relations.

Speaker #2: This conference call will contain forward-looking statements under U.S. federal laws. These statements are subject to risks and uncertainties that could cause actual results to differ materially from historical experience or present expectations.

Speaker #2: A description of some of these risks and uncertainties can be found in the company's reports that are filed with the Securities and Exchange Commissions, including cautionary statements including in our current and periodic filings, for additional information on the company's results and outlook, please refer to our third quarter press release issued earlier today.

Operator: For additional information on the company's results and outlook, please refer to our Q3 press release issued earlier today. Finally, as a reminder, reconciliations of non-GAAP measures discussed during today's call to the most directly comparable GAAP measures are available in the summary presentation available in the investor relations section of our website or in the company's press release issued today and posted in the investor relations website, ir.evolent.com, and the Form 8-K filed by the company with the SEC earlier today. In addition to reconciliations, we provide details on the numbers and operating metrics for the quarter in both our press release and supplemental investor presentation. Now, I will turn the call over to Evolent CEO, Seth Blackley.

Speaker #2: Finally, as a reminder, reconciliations of non-GAAP measures discussed during today's call to the most directly comparable GAAP measures are available in the summary presentation available in the Investor Relations section of our website, or in the company's press release issued today and posted in the Investor Relations website ir.evolent.com, and the Form 8-K filed by the company with the SEC earlier today.

Speaker #2: In addition to reconciliations, we provide details on the numbers and operating metrics for the quarter in both our press release and supplemental investor presentation.

Speaker #2: And now I will turn the call over to Evolent CEO, Seth Blackley. Good evening, and thank you for joining us. Earlier today, we released strong Q4 results.

Seth Blackley: Good evening, and thank you for joining us. Earlier today, we released strong Q4 results, with revenue and Adjusted EBITDA both landing in the upper half of our guidance range. Our performance reflects disciplined execution and continued momentum across our 3 value creation pillars of strong organic growth, expanding profitability, and disciplined capital allocation. Before I get into detailed updates on each pillar, I wanna comment on our outlook for 2026 and the overall state of the union at Evolent. First, Evolent is retaining and growing its customers. In addition, we're adding market share through new partners, and we're forecasting the business will grow by approximately 30% in 2026. These factors point to a large market opportunity and validate that we believe Evolent is the leading solution to support payers as they balance quality and affordability in specialty care.

Speaker #2: With revenue and adjusted EBITDA both landing in the upper half of our guidance range. Our performance reflects disciplined execution and continued momentum across our three value creation pillars of strong organic growth, expanding profitability, and disciplined capital allocation.

Speaker #2: Before I get into detailed updates on each pillar, I want to comment on our outlook for 2026 and the overall state of the union at Evolent.

Speaker #2: First, Evolent is retaining and growing its customers. In addition, we're adding market share through new partners and we're forecasting the business will grow by approximately 30% in 2026.

Speaker #2: These factors point to a large market opportunity and validate that we believe Evolent is the leading solution to support payers as they balance quality, affordability, and specialty care.

Speaker #2: Oncology, in particular, remains a challenge for health plans seeking to balance affordability and quality, with very high trends expected for many years to come.

Seth Blackley: Oncology, in particular, remains a challenge for health plans seeking to balance affordability and quality, with very high trends expected for many years to come. For 2026, we expect that approximately 65% of our company revenue will come from oncology, up from 36% in 2025. We expect our oncology product to continue to be the core of our growth in years to come. You think about why our oncology product is growing so rapidly. We believe it's the combination of very high annual trend that our health plans are experiencing and the incredible opportunity to reduce clinical variability. As an example of clinical variability in oncology, our analysis suggests that for one tumor type, which is second-line treatment for non-small cell lung cancer, oncologists today follow more than 200 different prescribing patterns.

Speaker #2: For 2026, we expect that approximately 65% of our company revenue will come from oncology, up from 36% in 2025, and we expect our oncology product to continue to be the core of our growth in years to come.

Speaker #2: If you think about why our oncology product is growing so rapidly, we believe it's the combination of very high annual trend that our health plans are experiencing and the incredible opportunity to reduce clinical variability.

Speaker #2: As an example of clinical variability in oncology, our analysis suggests that for one tumor type—which is second-line treatment for non-small cell lung cancer—oncologists today follow more than 200 different prescribing patterns.

Speaker #2: Variation is we believe it's not supported by the evidence and it can result in substandard outcomes for patients and unwarranted costs for the system.

Seth Blackley: Variation is, we believe, is not supported by the evidence, and it can result in substandard outcomes for patients and unwarranted costs for the system. Evolent's value to our customers is our proven ability to engage with treating oncologists and guarantee the quality and cost benefits from reducing this variability. This market dynamic, as well as our large new business pipeline, makes Evolent well-positioned to see outsized growth in the years ahead. Further, we've been able to successfully renegotiate contracts and convert them into the new enhanced Performance Suite model, which includes revenue rate adjustments for certain medical expense factors outside of our control, as well as MER corridors to protect the downside....

Speaker #2: Evolent's value to our customers is our proven ability to engage with treating oncologists and guarantee the quality and cost benefits from reducing this variability.

Speaker #2: This market dynamic, as well as our large new business pipeline, makes Evolent well-positioned to see outsized growth in the years ahead. Further, we've been able to successfully renegotiate contracts and convert them into the new enhanced performance suite model which includes revenue rate adjustments for certain medical expense factors outside of our control, as well as MER corridors to protect the downside.

Speaker #2: When we embarked on the effort to move our contracts to the enhanced performance suite model, there were a lot of questions from investors about our ability to successfully achieve this change while retaining customers and continuing to grow.

Seth Blackley: When we embarked on the effort to move our contracts to the enhanced Performance Suite model, there were a lot of questions from investors about our ability to successfully achieve this change while retaining customers and continuing to grow. The fact that we now have approximately 90% of the Performance Suite revenue under this new model, have retained all of our key customers, and have signed two major new customers this past year under the enhanced model, answers that question in an emphatic way. As we mentioned at the outset of this renegotiation process, our expectation for margins for the enhanced Performance Suite model will be approximately 10%, as opposed to 15% under the old model. As we've rolled out this model, we're seeing opportunities to target margins higher than 10% in some cases, if we feel comfortable with the additional downside exposure.

Speaker #2: The fact that we now have approximately 90% of the performance suite revenue under this new model have retained all of our key customers and have signed two major new customers this past year under the enhanced model answers that question in an emphatic way.

Speaker #2: As we mentioned at the outset of this renegotiation process, our expectation for margins for the enhanced performance suite model will be approximately 10% as opposed to 15% under the old model.

Speaker #2: As we've rolled out this model, we're seeing opportunities to target margins higher than 10% in some cases, if we feel comfortable with the additional downside exposure, and another contract's there are opportunities to eliminate almost all the downside exposure if we will accept a lower maximum margin.

Seth Blackley: In other contracts, there are opportunities to eliminate almost all the downside exposure, if we will accept a lower maximum margin. While we make these trade-off determinations as part of a disciplined underwriting process around each contract, our existing mature contracts will tend to run above 10%. As we expand, we'll target future Performance Suite opportunity for the entire book around a range of 7% to 10%, as we continue to prioritize Adjusted EBITDA and cash flow predictability over maximum margin. Still, as Mario will discuss, getting to a target margin of 7% to 10% would create a very significant tailwind for the business in the years to come.

Speaker #2: While we'll make these trade-off determinations as part of a disciplined underwriting process around each contract, our existing mature contracts will tend to run above 10%.

Speaker #2: But as we expand, we'll target future performance suite opportunity for the entire book around a range of 7 to 10 percent as we continue to prioritize adjusted EBITDA and cash flow predictability over maximum margin.

Speaker #2: Still, as Mario will discuss, getting to a target margin of 7 to 10 percent would create a very significant tailwind for the business in the years to come.

Speaker #2: Turning to the outlook for 2026, specifically, we're forecasting 2.5 billion dollars of revenue at the midpoint, representing revenue growth of approximately 30%, and our adjusted EBITDA guide is a 125 million dollars at the midpoint.

Seth Blackley: Turning to the outlook for 2026, specifically, we're forecasting $2.5 billion of revenue at the midpoint, representing revenue growth of approximately 30%. Our Adjusted EBITDA guide is $125 million at the midpoint. The Adjusted EBITDA outlook has 2 significant impacts embedded for 2026, ahead of the potential tailwind I described earlier. Both of these impacts hit primarily in the first half of 2026. We believe that our run rate Adjusted EBITDA in Q4 of 2026 will be over $150 million.

Speaker #2: The adjusted EBITDA outlook has two significant impacts embedded for '26 ahead of the potential tailwind I described earlier. Both of these impacts hit primarily in the first half of 2026, and we believe that our run rate adjusted EBITDA in the fourth quarter of 2026 will be over 150 million dollars.

Speaker #2: Those two factors impacting 2026 adjusted EBITDA are as follows. First, our 2026 performance suite launches are expected to generate approximately 900 million dollars of 2026 revenue, with go-live dates in Q1 and Q2 representing 37% of total 2026 revenue.

Seth Blackley: Those two factors impacting 2026 Adjusted EBITDA are as follows: First, our 2026 Performance Suite launches are expected to generate approximately $900 million of 2026 revenue, with go-live dates in Q1 and Q2, representing 37% of total 2026 revenue. The 2026 Performance Suite cohort revenue estimate has increased from our previous estimate a few months ago, $550 million, driven by large shifts in our customer membership and by scope expansion of one of the new contracts. At the same time, we saw several of our legacy cohort Performance Suite partners lose significant membership in open enrollment, so our total revenue forecast continues to center around $2.5 billion, despite outsized growth from the 2026 cohort.

Speaker #2: The 2026 performance suite cohort revenue estimate has increased from our previous estimate a few months ago of 550 million dollars driven by large shifts in our customer membership and by scope expansion in one of the new contracts.

Speaker #2: At the same time, we saw several of our legacy cohort performance suite partners lose significant membership in open enrollment, so our total revenue forecast continues to center around 2.5 billion despite outsized growth from the 2026 cohort.

Speaker #2: In addition to the increase of new revenue, we decided to take a more conservative guided guidance approach given the size of these new contracts in 2026.

Seth Blackley: In addition to the increase of new revenue, we've decided to take a more conservative guidance approach, given the size of these new contracts in 2026. Mario will provide further color on the impact and the timing of those contracts in his comments. The second major factor impacting Adjusted EBITDA for 2026 is that the One Big Beautiful Bill has eliminated approximately $40 million of contribution from expected exchange membership disenrollment and customer plan closures. That impact is at the very highest end of the range we estimated at the end of last year, and with one of our largest customers seeing reduced exchange membership up to 60%, and our next largest exchange membership booked down approximately 40%.

Speaker #2: Mario will provide further color on the impact and the timing of those contracts in his comments. The second major factor impacting adjusted EBITDA for 2026 is that the one big beautiful bill has eliminated approximately 40 million dollars of contribution from expected exchange membership disenrollment and customer plan closures.

Speaker #2: That impact is at the very highest end of the range we estimated at the end of last year, and with one of our largest customers seeing reduced exchange membership by up to 60% and our next largest exchange membership book down approximately 40%.

Speaker #2: Some of this reduction is as a result of the lost subsidies, but we're seeing more of it from decisions the specific plans that our customer base made to shrink exposure to the exchange risk pool.

Seth Blackley: Some of this reduction is as a result of the lost subsidies. We're seeing more of it from decisions the specific plans that our customer base made to shrink exposure to the exchange risk pool. You can see the combined effect of these two items on page 8 of the pack. Finally, we've been aggressive on efficiency by getting the benefits of AI and other automation across 2025. As we previously communicated, we did slightly exceed the $20 million Q4 2025 annualized savings number we had talked about on previous earnings calls. We're continuing our cost efforts in 2026, now targeting SG&A, AI, and other automation savings. These efforts included a large RIF, already announced just a few weeks ago.

Speaker #2: You can see the combined effect of these two items on page eight of the pack. Finally, we've been aggressive on efficiency by getting the benefits of AI and other automation across 2025.

Speaker #2: As we previously communicated, we did slightly exceed the 20 million dollar Q4 2025 annualized savings number we had talked about on previous earnings calls.

Speaker #2: And we're continuing our cost efforts in 2026, now targeting SG&A, AI, and other automation savings. These efforts included a large RIF already announced just a few weeks ago.

Speaker #2: Our 2026 cost structure efforts modestly improve H1 2026 EBITDA but ramp fully by the second half of the year. Mario will share more details on the 2026 cost plan in his section.

Seth Blackley: Our 2026 cost structure efforts modestly improve H1 2026 EBITDA, but ramp fully by the second half of the year. Mario will share more details on the 2026 cost plan in his section. Despite these aggressive cost actions, we decided to budget the year and guide around a multi-year opportunity. Accordingly, we have protected a number of product, technology, and sales investments in the P&L that weigh on 2026, but we believe will have a positive impact over time. While we're pleased with our revenue growth, we understand our first half 2026 EBITDA is disappointing on the surface due to the One Big Beautiful Bill impact, as well as the addition of our new contracts.

Speaker #2: Despite these aggressive cost actions, we decided to budget the year and guide around a multi-year opportunity. Accordingly, we have protected a number of product technology and sales investments in the P&L that weigh on 2026, but we believe will have a positive impact over time.

Speaker #2: While we're pleased with our revenue growth, we understand our first half 2026 EBITDA is disappointing on the surface due to the one big beautiful bill impact as well as the addition of our new contracts.

Speaker #2: But as I mentioned, we're confident in the ramp across 2026, and we believe we'll have a very large multi-year tailwind for the business as our 2026 contracts mature and the exchange is likely to return to growth over time.

Seth Blackley: As I mentioned, we're confident in the ramp across 2026, and we believe we'll have a very large multi-year tailwind for the business as our 2026 contracts mature and the exchanges likely return to growth over time. Now, let me turn back and give you a few more detailed updates on each pillar, starting with our first pillar of organic growth. Today, we're sharing the expansion of a previously announced partnership, and we're disclosing another new contract signing. First, we're excited to share that the large oncology partnership we announced in November is with Highmark. We're obviously thrilled to have been selected by such a marquee plan. Since November, we have also expanded the partnership to additional geographies and capabilities.

Speaker #2: Now let me turn back to give you a few more detailed updates on each pillar, starting with our first pillar of organic growth. Today, we're sharing the expansion of a previously announced partnership, and we're disclosing another new contract signing.

Speaker #2: First, we're excited to share that the large oncology partnership we announced in November is with Highmark. We're obviously thrilled to have been selected by such a marquee plan.

Speaker #2: Since November, we have also expanded the partnership to additional geographies and capabilities. This contract is expected to go live on May 1st, and we expect it will contribute over 550 million dollars of revenue in 2026 and over 800 million dollars in 2027.

Seth Blackley: This contract is expected to go live on 1 May, and we expect it will contribute over $550 million of revenue in 2026, and over $800 million in 2027. As we will discuss in more detail later in the call, the structure for this contract is, like Aetna, under our enhanced Performance Suite model. Finally, we feel there are several exciting expansion opportunities at Highmark across new lines of business for oncology and across all lines of business for new specialties, and we look forward to earning that opportunity through strong performance with this initial launch. Second, we're announcing today that we have launched our Performance Suite in oncology in an additional state with an existing national partner. Beyond these signings and the robust pipeline I mentioned earlier, we're seeing very high renewal rates as well.

Speaker #2: As we will discuss in more detail later in the call, the structure for this contract is, like Aetna, under our enhanced performance suite model.

Speaker #2: Finally, we feel there are several exciting expansion opportunities with Highmark across new lines of business for oncology, and across all lines of business for new specialties.

Speaker #2: And we look forward to earning that opportunity through strong performance with this initial launch. And second, we're announcing today that we have launched our performance suite in oncology in an additional state with an existing national partner.

Speaker #2: Beyond these signings and the robust pipeline I mentioned earlier, we're seeing very high renewal rates as well. Across 2025, we've retained specialty TNS logos covering over 98% of 2025 revenue, and through a turbulent industry cycle, we have successfully moved our key performance suite relationships to the enhanced performance suite model.

Seth Blackley: Across 2025, we've retained specialty TNS logos covering over 98% of 2025 revenue. Through a turbulent industry cycle, we have successfully moved our key Performance Suite relationships to the enhanced Performance Suite model. Said simply, our current customers are opting to stay and expand with us, even as we require more protected terms, and we're adding market share through new logo signings. We feel all of this data points to the value we can create and to the durability of our company. Turning to our second pillar of profitability, we continue to focus on both medical and operating expenses as described earlier. I did want to add several additional pieces of data here.

Speaker #2: Said simply, our current customers are opting to stay and expand with us, even as we require more protective terms. And we're adding market share through new logo signings.

Speaker #2: We feel all of this data points to the value we can create and to the durability of our company. Turning to our second pillar of profitability, we continue to focus on both medical and operating expenses as described earlier.

Speaker #2: I did want to add several additional pieces of data here. In 2025, our medical expense ratio, or MER, came in slightly better than expectations at 89%, excluding our Evelint Care Partners business, representing an improvement of just under 700 basis points versus 2024.

Seth Blackley: In 2025, our medical expense ratio, or MER, came in slightly better than expectations at 89%, excluding our Evolent Care Partners business, representing an improvement of just under 700 basis points versus 2024, even amid another year of high trend. We believe this performance reflects strong execution in pathway management, physician engagement, and alignment with our partners. Mario will walk you through how we're thinking about our 2026 MERs for both new business and the legacy cohort. I think you'll see that we're making two basic assumptions for the year. First, we estimate the 2026 cohort will run at 103%, inclusive of new reserves, and the total cohort will run at approximately 93%.

Speaker #2: Even amid another year of high trend. We believe this performance reflects strong execution and pathway management, physician engagements, and alignment with our partners. Mario will walk you through how we're thinking about our 2026 MERs for both new business and the legacy cohort.

Speaker #2: But I think you'll see that we're making two basic assumptions for the year. First, we estimate that 2026 cohort will run at 103%, inclusive of new reserves.

Speaker #2: And the total cohort will run at approximately 93%. We're assuming that 2026 oncology trend will remain high, in line with the 2025 trend. In total, we believe these assumptions are conservative and set us up to meet or beat our numbers across the year.

Seth Blackley: We're assuming that 2026 oncology trend will remain high, in line with the 2025 trend. In total, we believe these assumptions are conservative and set us up to meet or beat our numbers across the year. In our final pillar of capital structure, I'm pleased that we ended the year with strong cash generation. That, combined with the strategic divestiture of our Evolent Care Partners asset, enabled us to end the year with net debt of $782 million, below our expected range of $805 to $840 million. With no maturities until late 2029, we believe our balance sheet strength supports near-term leverage and a clear path to long-term deleveraging. Before I hand it to Mario, let me say a few words about the macro environment.

Speaker #2: In our final pillar of capital structure, I'm pleased that we ended the year with strong cash generation. That, combined with the strategic divestiture of our Evelint Care Partners asset, enabled us to end the year with net debt of 782 million dollars, below our expected range of 805 to 840 million dollars.

Speaker #2: With no maturities until late 2029, we believe our balance sheet strength supports near-term leverage and a clear path to long-term delivery. Before I hand it to Mario, let me say a few words about the macro environment.

Speaker #2: We've been saying for several quarters now that the demand for Evelint services has never been greater. We believe this has borne out in our new business wins as we take share and grow our customer footprint.

Seth Blackley: We've been saying for several quarters now that demand for Evolent services has never been greater. We believe this is borne out in our new business wins as we take share and grow our customer footprint, and this reality continues to be true. The managed care industry, our core customer base, is in the middle of a multi-year margin recovery cycle. To manage their own profitability targets, we see health plans are turning to companies like Evolent that have proven solutions to lower costs while improving quality for their members. At the same time, as we're expanding our business with new partners, the industry is navigating through a period of contracting membership, which presents near-term headwinds for our business as well. We believe we have a clear strategy for navigating through this dynamic moment.

Speaker #2: And this reality continues to be true. The managed care industry, our core customer base, is in the middle of a multi-year margin recovery cycle.

Speaker #2: To manage their own profitability targets, we see health plans are turning to companies like Evelint that have proven solutions to lower costs while improving quality for their members.

Speaker #2: At the same time, as we're expanding our business with new partners, the industry is navigating through a period of contracting membership. Which presents near-term headwinds for our business as well.

Speaker #2: We believe we have a clear strategy for navigating through this dynamic moment. First, we will use this moment to seek to capture share, expanding our customer footprint under strong terms.

Seth Blackley: First, we will use this moment to seek to capture share, expanding our customer footprint under strong terms. Demand for our product is such that we can be selective in our partnerships and highly disciplined in our underwriting. Second, we will use our scale and customer volume to drive operating efficiency within our products, enabling us, we believe, to deliver margin expansion over time. We've committed to using technology and AI from our Machinify asset acquisition to get to our long-term goal to automatically approve 80% of baseline authorization volume across our products, an outcome that we believe will improve patient and provider experience while driving down our cost structure. We made great progress on this front in 2025, seeing our imaging auto authorization rates in key test areas go up dramatically in areas where we deployed this technology.

Speaker #2: Demand for our product is such that we can be selective in our partnerships and highly disciplined in our underwriting. Second, we will use our scale and customer volume to drive operating efficiency within our products, enabling us, we believe, to deliver margin expansion over time.

Speaker #2: We've committed to using technology and AI from our machineified asset acquisition to get to our long-term goal to automatically approve 80% of baseline authorization volume across our products, an outcome that we believe will improve patient and provider experience while driving down our cost structure.

Speaker #2: We make great progress on this front in 2025, seeing our imaging auto authorization rates and key test areas go up dramatically. In areas where we deployed this technology.

Speaker #2: For example, through this optimization, our real-time auto authorization rate per chest CT scans rose by over 11 points, and cervical spine MRI rose by 16 points.

Seth Blackley: For example, through this optimization, our real-time auto authorization rate for chest CT scans rose by over 11 points, and cervical spine MRI rose by 16 points. In 2026, we'll be deploying additional AI capabilities that will provide additional auto authorization increases. Third, we'll continue to innovate our product and its value for our customers to ensure that we are the leading specialty platform in the market. As an example of our product investments, one of our Blue Cross partners recently published data showing an approximately 40% reduction in hospitalizations and ER visits for patients who use our new cancer navigation solution. Fourth, and finally, we will achieve these goals within the context of our current balance sheet, continue to prioritize debt paydown as our primary capital allocation focus.

Speaker #2: In 2026, we'll be deploying additional AI capabilities that will provide additional auto authorization increases. Third, we'll continue to innovate our product and its value for our customers to ensure that we are the leading specialty platform in the market.

Speaker #2: As an example of our product investments, one of our Blue Cross partners recently published data showing an approximately 40% reduction in hospitalizations and visits from patients who use our new cancer navigation solution.

Speaker #2: And fourth and finally, we will achieve these goals within the context of our current balance sheet, continue to prioritize debt pay down as our primary capital allocation focus.

Speaker #2: I do believe we have the right plan, an incredible board and team, and the right product to meet this moment, and I remain highly confident in Evolent's future.

Seth Blackley: I do believe we have the right plan, an incredible board and team, and the right product to meet this moment. I remain highly confident in Evolent's future. As I hand it to Mario to go over the numbers, I will just note that Mario's been at Evolent across the last 90 days. He's already had a huge positive impact on the company. I'm highly confident in his leadership and approach going forward. Mario?

Speaker #2: As I hand it to Mario to go over the numbers, I will just note that Mario has been at Evelint across the last 90 days.

Speaker #2: He's already had a huge positive impact on the company. And I'm highly confident in his leadership and approach going forward. Mario? Thank you, Seth.

Mario Ramos: Thank you, Seth. I'm excited to be here and energized by the opportunity ahead. Let me begin with Q4 2025 financial performance. Q4 revenue totaled $469 million, and Adjusted EBITDA was $37.8 million, which exceeded the midpoint of guidance. After adjusting for our ACO divestiture, baseline fiscal year 2025 revenue was $1.77 billion, and Adjusted EBITDA would have been approximately $141 million. Next, let's review our 2025 medical expense ratio, or MER, which represents Performance Suite claims as a percentage of Performance Suite revenue. For the full year, MER was 89%, excluding ECP, with oncology trend tracking in line with expectations. In the Q4, MER was 95%, excluding ECP, driven primarily by out-of-period true-ups as we recognized a full year of savings shared with clients.

Speaker #2: I'm excited to be here and energized by the opportunity ahead. Let me begin with Q4 2025 financial performance. Q4 revenue totaled 469 million, and adjusted EBITDA was 37.8 million, which exceeded the midpoint of guidance.

Speaker #2: After adjusting for our ACO divestiture, baseline fiscal year 2025 revenue was 1.77 billion, and adjusted EBITDA would have been approximately 141 million. Next, let's review our 2025 medical expense ratio, or MER, which represents performance suite claims as a percentage of performance suite revenue.

Speaker #2: For the full year, MER was 89%, excluding ECP. With oncology trend tracking in line with expectations. In the fourth quarter, MER was 95%, excluding ECP.

Speaker #2: Driven primarily by out-of-period true-ups, as we recognized a full year of savings shared with clients. While these timing items temporarily elevated MER, underlying medical trend remained stable throughout the year.

Mario Ramos: While these timing items temporarily elevated MER, underlying medical trend remained stable throughout the year, demonstrating the consistency of our results and reinforcing our strong momentum heading into 2026. I know we have not discussed MER in great length in the past. However, given that Performance Suite revenue will represent more than two-thirds of our business in 2026 and beyond, MER will become the most transparent and consistent way to evaluate performance. We will provide you with greater visibility into changes in MER going forward. Turning to 2025 expenses, outside of the MER calculation, such as non-claims cost of revenue and SG&A, non-claims expenses totaled approximately $765 million for the year and approximately $190 million for the quarter.

Speaker #2: Demonstrating the consistency of our results and reinforcing our strong momentum heading into 2026. I know we have not discussed MER in great length in the past.

Speaker #2: However, given that performance suite revenue will represent more than two-thirds of our business in 2026 and beyond, MER will become the most transparent and consistent way to evaluate performance so we will provide you with greater visibility into changes in MER going forward.

Speaker #2: Turning to 2025 expenses, outside of the MER calculation, such as non-claims cost of revenue and SG&A, non-claims expenses totaled approximately 765 million for the year, and approximately 190 million for the quarter.

Speaker #2: Our quarterly non-claims cost was lower as a result of cost initiatives and lower expense accruals and more than offset the elevated MER for the quarter.

Mario Ramos: Our quarterly non-claims cost was lower as a result of cost initiatives and lower expense accruals, and more than offset the elevated MER for the quarter. We expect non-claims costs to be meaningfully lower in 2026 as efficiency initiatives continue to materialize. More detail on that shortly. Turning to cash flow on the balance sheet, our cash flow from operations was $39 million, and total net change in cash and cash equivalents increased by $48 million, bringing year-end cash to $152 million. We finished the year with net debt of $782 million, below the range we discussed during the last call. Please note that this did include a $50 million overpayment from a client, which when repaid will negatively impact 2026 cash flow.

Speaker #2: We expect non-claims costs to be meaningfully lower in 2026 as efficiency initiatives continue to materialize. More detail on that shortly. Turning to cash flow and the balance sheet, our cash flow from operations was 39 million.

Speaker #2: And total net change in cash and cash equivalents increased by 48 million. Bringing year-end cash to 152 million. We finished the year with net debt of 782 million, below the range we discussed during the last call.

Speaker #2: Please note that this did include a 15 million overpayment from a client which, when repaid, will negatively impact 2026 cash flow. Finally, we recorded a large non-cash goodwill impairment due to market valuation declines which has no impact on EBITDA or cash flow.

Mario Ramos: Finally, we recorded a large non-cash goodwill impairment due to market valuation declines, which has no impact on EBITDA or cash flow. Let me now turn to our outlook, where there are four main topics shaping 2026. First, we expect strong Performance Suite growth, with revenue reaching an all-time high. While this increase in revenue creates a powerful foundation for EBITDA acceleration, it also creates a temporary headwind in 2026 due to our reserving methodologies and the timing of implementation of the new contracts. Second, specialty TNS 2026 performance is experiencing a significant headwind from exchange membership declines consistent with the entire industry. Excluding this impact, we expect the specialty TNS business to deliver modest underlying growth in 2026. Finally, I will also discuss Administrative Services as well as the impact of our cost reduction efforts.

Speaker #2: Let me now turn to our outlook where there are four main topics shaping 2026. First, we expect strong performance suite growth with revenue reaching an all-time high.

Speaker #2: While this increase in revenue creates a powerful foundation for EBITDA acceleration, it also creates a temporary headwind in 2026 due to our reserving methodologies and the timing of implementation of the new contracts.

Speaker #2: Second, specialty TNS 2026 performance is experiencing a significant headwind from exchange membership declines consistent with the entire industry. Excluding this impact, we expect the specialty TNS business to deliver modest underlying growth in 2026.

Speaker #2: Finally, I will also discuss administrative services as well as the impact of our cost reduction efforts. With these items in mind, let me dive into our revenue and adjusted EBITDA guidance for the year.

Mario Ramos: With these items in mind, let me dive into our revenue and Adjusted EBITDA guidance for the year. Overall, our revenue outlook is $2.4 to 2.6 billion, driven primarily by new Performance Suite launches, reflecting both higher membership and a more favorable PMPM mix towards Medicare. We have a bridge on page 7 of the earnings deck showing the key drivers of 2026 revenue compared to 2025. The significant Performance Suite revenue increase from new contracts to be launched during the year is partially offset by approximately $100 million of lost revenue from existing Performance Suite clients due to exchange-related membership contraction and some plans exiting unprofitable markets. We also continue to see solid TNS revenue growth across both existing and new accounts.

Speaker #2: Overall, our revenue outlook is 2.4 to 2.6 billion, driven primarily by new performance suite launches. Reflecting both higher membership and a more favorable PM/PM mix towards Medicare.

Speaker #2: We have a bridge on page 7 of the earnings deck showing the key drivers of 2026 revenue compared to 2025. The significant Performance Suite revenue increase from new contracts to be launched during the year is partially offset by approximately $100 million of lost revenue from existing Performance Suite clients due to exchange-related membership contraction and some plans exiting unprofitable markets.

Speaker #2: We also continue to see solid TNS revenue growth across both existing and new accounts. However, this growth was more than offset by the decline in exchange membership associated with the implementation of the one big beautiful bill.

Mario Ramos: However, this growth was more than offset by the decline in exchange membership associated with the implementation of the One Big Beautiful Bill. As Seth noted, while we did experience sufficient organic growth to offset the decline from a membership standpoint, there was unfavorable mix shift within these members, which contributed to a reduction in blended PMPM and total revenue. Finally, we did experience some churn in our administrative services business, notably related to one customer who was acquired by a large national plan that subsequently insourced our services. As we've noted before, the administrative services business represents a legacy portion of our portfolio, and we continue to manage it efficiently while focusing our strategic efforts on the higher growth Performance Suite and specialty TNS businesses. We do not believe our remaining administrative services contracts have that same acquisition-related risk that impacted us in 2025.

Speaker #2: As Seth noted, while we did experience sufficient organic growth to offset the decline from a membership standpoint, there was unfavorable mix shift within these members which contributed to a reduction in blended PM/PM and total revenue.

Speaker #2: Finally, we did experience some churn in our administrative services business. Notably related to one customer who was acquired by a large national plan that subsequently insourced our services.

Speaker #2: As we've noted before, the administrative services business represents a legacy portion of our portfolio. And we continue to manage it efficiently while focusing our strategic efforts on the higher growth performance suite and specialty TNS businesses.

Speaker #2: We do not believe our remaining administrative services contracts have that same acquisition-related risk that impacted us in 2025. Let's now turn to our 2026 adjusted EBITDA guidance.

Mario Ramos: Let's now turn to our 2026 Adjusted EBITDA guidance. Our Adjusted EBITDA outlook for the year is $110 million to $140 million. Page 8 of the earnings deck provides a bridge summarizing the key drivers of the year-over-year changes in Adjusted EBITDA at the midpoint of guidance. I will walk through each of the components now. Starting with the Performance Suite and assuming the midpoint of guidance, we expect the existing Performance Suite business to contribute $35 million of additional profitability despite the decline in revenue discussed earlier. This improved performance is driven by the continued realization of savings from our clinical programs, our clients' rationalization of underperforming markets, and the impact of the contract amendments Seth described earlier.

Speaker #2: Our adjusted EBITDA outlook for the year is 110 to 140 million. Page 8 of the earnings deck provides a bridge summarizing the key drivers of the year-over-year changes in adjusted EBITDA at the midpoint of guidance.

Speaker #2: And I will walk through each of the components now. Starting with the performance suite and assuming the midpoint of guidance, we expect the existing performance suite business to contribute 35 million of additional profitability despite the decline in revenue discussed earlier.

Speaker #2: This improved performance is driven by the continued realization of savings from our clinical programs, our clients' rationalization of underperforming markets, and the impact of the contract amendments Seth described earlier.

Speaker #2: On the other hand, while our new launches will drive meaningful adjusted EBITDA acceleration over time as they scale, they are creating a 25 million headwind to 2026 adjusted EBITDA at the midpoint of guidance.

Mario Ramos: While our new launches will drive meaningful Adjusted EBITDA acceleration over time as they scale, they are creating a $25 million headwind to 2026 Adjusted EBITDA at the midpoint of guidance, reflecting the timing of implementation and our conservative reserving approach. This represents a shift from our prior expectation of roughly break-even performance in 2026 and is driven by two key factors. First, we have an appropriately conservative approach to reserving for new contracts, despite our significantly improved processes and new contract protections. Over time, we expect this headwind to dissipate as reserves are released, but this does create some pressure in the first few months of the new contracts. Second, the losses of the mid-year launches are higher than expected because of higher-than-expected membership volumes.

Speaker #2: Reflecting the timing of implementation and our conservative reserving approach. This represents a shift from our prior expectation of roughly break-even performance in 2026 and is driven by two key factors.

Speaker #2: First, we have an appropriately conservative approach to reserving for new contracts despite our significantly improved processes and new contract protections. Over time, we expect this headwind to dissipate as reserves are released but this does create some pressure in the first few months of the new contracts.

Speaker #2: Second, the losses of the mid-year launches are higher than expected because of higher-than-expected membership volumes. This is offsetting some of the positive lift from other new contracts that are launching very early in the year.

Mario Ramos: This is offsetting some of the positive lift from other new contracts that are launching very early in the year. As you can see on page 9 of the earnings deck, the new contracts will temporarily raise our 2026 medical expense ratio. As a result, we expect MER to be approximately 93% at the midpoint of 2026 guidance, compared to 89%, excluding ACP, in 2025. We do expect MER to rise at the start of the year due to higher reserve requirements associated with new contracts being implemented on 1 January. We see MER continuing to climb and peaking in Q3 as we onboard Highmark and further strengthen claims reserves, as well as experience normal seasonality.

Speaker #2: As you can see on page 9 of the earnings deck, the new contracts will temporarily raise our 2026 medical expense ratio. As a result, we expect MER to be approximately 93% at the midpoint of 2026 guidance.

Speaker #2: Compared to 89% excluding ACP in 2025. We do expect MER to rise at the start of the year due to higher reserve requirements associated with new contracts being implemented on January 1st.

Speaker #2: We then see MER continuing to climb and peaking in the third quarter as we onboard Highmark and further strengthen claims reserves as well as experience normal seasonality.

Speaker #2: From there, we expect MER to steadily improve through year-end as we realize modest in-year savings from our clinical programs and realize other favorable accruals in Q4.

Mario Ramos: From there, we expect MER to steadily improve through year-end as we realize modest in-year savings from our clinical programs and realize other favorable accruals in Q4. Overall, this progression provides a clear and positive path towards sustained margin expansion as our new contracts mature. It is important to note that our underlying medical claims are expected to remain roughly consistent throughout the year. We're not assuming a rapid clinical improvement in 2026, even as our teams work to drive performance gains. Due to our new contract reserving methodology and the expected progression of MER throughout the year, we anticipate that EBITDA will be 70% weighted towards the back half of 2026. In addition, at the midpoint of our guidance, we expect $20 million in Adjusted EBITDA in Q1, with a $10 to 15 million sequential improvement per quarter in both Q3 and Q4.

Speaker #2: Overall, this progression provides a clear and positive path towards sustained margin expansion as our new contracts mature. It is important to note that our underlying medical claims are expected to remain roughly consistent throughout the year.

Speaker #2: We're not assuming a rapid clinical improvement in 2026, even as our teams work to drive performance gains. Due to our new contract reserving methodology, and the expected progression of MER throughout the year, we anticipate that EBITDA will be 70% weighted towards the back half of 2026.

Speaker #2: In addition, at the midpoint of our guidance, we expect 20 million in adjusted EBITDA in the first quarter with a 10 to 15 million sequential improvement per quarter in both Q3 and Q4.

Speaker #2: This pattern is fully aligned with the timing of our contract implementations. The reserve dynamics in the early part of the year and the growing benefit of our operating initiatives as the year progresses.

Mario Ramos: This pattern is fully aligned with the timing of our contract implementations, the reserve dynamics in the early part of the year, and the growing benefit of our operating initiatives as the year progresses. As our newly launched contracts mature and our clinical and operational programs take hold, we believe we are well positioned to deliver this earnings trajectory with increasing momentum across 2026 and beyond. It is also worth noting, as we discuss 2026 guidance, that our new contracts include significant downside protections. Because we are reserving these contracts at elevated MER levels, we believe our downside exposure in 2026 is very limited. Our Performance Suite MER is the most direct indicator of how the business is progressing throughout the year and how we are tracking relative to expectations, despite some occasional in-year volatility.

Speaker #2: As our newly launched contracts mature, and our clinical and operational programs take hold, we believe we are well positioned to deliver this earnings trajectory with increasing momentum across 2026 and beyond.

Speaker #2: It is also worth noting as we discuss 2026 guidance that our new contracts include significant downside protections. And because we are reserving these contracts at elevated MER levels, we believe our downside exposure in 2026 is very limited.

Speaker #2: Our performance suite MER is the most direct indicator of how the business is progressing throughout the year and how we are tracking relative to expectations despite some occasional in-year volatility.

Speaker #2: While MER can already be derived from our 10-K, we will be introducing enhanced disclosures to provide even greater transparency for investors. Moving on to specialty TNS, one of the major factors affecting 2026 EBITDA is the contraction in exchange membership resulting from the $1 Big Beautiful Bill.

Mario Ramos: While MER can already be derived from our 10-K, we will be introducing enhanced disclosures to provide even greater transparency for investors. Moving on to specialty TNS. One of the major factors affecting 2026 EBITDA is the contraction in exchange membership resulting from the One Big Beautiful Bill. This creates a one-time $40 million headwind to specialty TNS revenue in 2026, consistent with the high-end possibility of a 40% decline in exchange membership we discussed on our last call, net of acuity shifts. While future changes in subsidies or exchange enrollment, either before or after the midterms, could provide upside, our current outlook reflects the full impact of this contraction. Excluding the impact of exchange membership, TNS, at the midpoint of guidance, is expected to contribute $5 million of incremental revenue and margin in 2026, driven by growth in membership.

Speaker #2: This creates a one-time $40 million headwind to specialty TNS revenue in 2026 consistent with the high-end possibility of a 40% decline in exchange membership we discussed on our last call, net of acuity ships.

Speaker #2: While future changes in subsidies or exchange enrollment either before or after the midterms could provide upside, our current outlook reflects the full impact of this contraction.

Speaker #2: Excluding the impact of exchange membership, TNS at the midpoint of guidance is expected to contribute $5 million of incremental revenue and margin in 2026 driven by growth in membership.

Speaker #2: Unfortunately, this new membership growth is unfavorable from a revenue mix standpoint, so it is not sufficient to offset exchange-related membership losses. However, this does show how demand continues to grow for our specialty TNS solutions.

Mario Ramos: Unfortunately, this new membership growth is unfavorable from a revenue mix standpoint, it is not sufficient to offset exchange-related membership losses. However, this does show how demand continues to grow for our specialty TNS solutions. Finally, Administrative Services churn, as mentioned earlier, is meaningful but is being more than offset by a $50 million year-over-year workforce reduction and efficiencies gained across the enterprise. This includes the $20 million saving we realized by Q4 2025 that Seth mentioned earlier. Speaking of expense reductions, let me provide additional clarity on those ongoing efforts, which is a big area of focus for our team going forward, and discuss how they will flow through our 2026 financials. With the previously mentioned expectation of 93% MER for Performance Suite, we project approximately $1.7 billion of medical claims expense for the year.

Speaker #2: Finally, administrative services churn, as mentioned earlier, is meaningful but is being more than offset by a $50 million year-over-year workforce reduction and efficiencies gained across the enterprise.

Speaker #2: This includes the $20 million saving we realized by Q4 2025 that Seth mentioned earlier. Speaking of expense reductions, let me provide additional clarity on those ongoing efforts which is a big area of focus for our team going forward and discuss how they will flow through our 2026 financials.

Speaker #2: With the previously mentioned expectation of 93% MER for performance suite, we project approximately $1.7 billion of medical claims expense for the year. The remaining expense base which includes cost of revenue excluding medical claims but including medical device costs and SGNA is expected to be approximately $675 million at the midpoint of guidance.

Mario Ramos: The remaining expense base, which includes cost of revenue, excluding medical claims, but including medical device costs and SG&A, is expected to be approximately $675 million at the midpoint of guidance. The $675 million reflects a $90 million reduction from 2025 levels. Approximately $40 million of the decrease is driven by the divestiture of Evolent Care Partners, while the remaining $50 million reflects the impact of our efficiency initiatives already in motion, including targeted cost actions taken across the organization. If I put it all together, I expect our Q4 run rate EBITDA to be at least $150 million.

Speaker #2: The $675 million reflects a $90 million reduction from 2025 levels. Approximately $40 million of the decrease is driven by the divestiture of Evelyn Care Partners while the remaining $50 million reflects the impact of our efficiency initiatives already in motion including targeted cost actions taken across the organization.

Speaker #2: So if I put it all together, I expect our Q4 run rate EBITDA to be at least 150 million. Should we achieve the performance suite 7 to 10 percent target margin on the forecasted 2.2 billion annualized performance suite revenue exiting 2026, we expect to generate roughly $160 to $220 million in total margin.

Mario Ramos: Should we achieve the Performance Suite 7% to 10% target margin on the forecasted $2.2 billion annualized Performance Suite revenue exiting 2026, we expect to generate roughly $160 million to $220 million in total margin. This is roughly $30 million to $100 million higher than the approximately $125 million of Performance Suite contribution that is in the midpoint of the 2026 guide. We believe this potential tailwind is the most important factor that will drive shareholder returns over the coming years. As you can see on page 6 of the pack, the enhanced Performance Suite contract structure can create asymmetric upside for shareholders over time.

Speaker #2: This is roughly 30 to 100 million higher than the approximately $125 million of performance suite contribution that is in the midpoint of the 2026 guide.

Speaker #2: We believe this potential tailwind is the most important factor that will drive shareholder returns over the coming years. Finally, as you can see on page 6 of the pack, the enhanced Performance Suite contract structure can create asymmetric upside for shareholders over time.

Speaker #2: Specifically, if you look at the new launches for 2026, we are forecasting these new contracts to run at 103% MER for the year at the midpoint of the guidance.

Mario Ramos: Specifically, if you look at the new launches for 2026, we are forecasting these new contracts to run at a 103% MER for the year at the midpoint of the guidance. In the event of a 7% MER degradation to a 110% MER, that would drive a negative $13 million EBITDA impact. However, a 7% improvement to just 96% MER, or getting less than half of our target margin, would drive a $57 million EBITDA improvement. Please note that because we expect Adjusted EBITDA to build throughout the year, our leverage ratios will be higher earlier on and should begin to decline meaningfully in the second half. It is important to note that we are confident our current balance sheet and debt terms provide ample flexibility to manage this temporary dynamic as we ramp these large new contracts.

Speaker #2: In the event of a 7% MER degradation to 110% MER, that would drive a negative $13 million EBITDA impact. However, a 7% improvement to just $96% MER or getting less than half of our target margin would drive a $57 million EBITDA improvement.

Speaker #2: Please note that because we expect adjusted EBITDA to build throughout the year, our leverage ratios will be higher earlier on and should begin to decline meaningfully in the second half.

Speaker #2: It is important to note that we are confident our current balance sheet and debt terms provide ample flexibility to manage this temporary dynamic as we ramp these large new contracts.

Speaker #2: Turning to cash flow, an item we're watching very closely, we anticipate generating at least 10 to 20 million in cash flow from operations after paying approximately $60 million.

Mario Ramos: Turning to cash flow, an item we're watching very closely, we anticipate generating at least $10 to 20 million in cash flow from operations after paying approximately $60 million in cash and interest expense. Part of the decrease from 2025 is the client overpayment from Q4 that we mentioned earlier, as well as $11 million of previously classified dividends, which are now reclassified as interest expense and moved into cash flow from operations. We also expect to invest between $25 to 30 million in software development and CapEx in 2026. With these financial considerations in mind, let me close with a brief comment on the organization. I want to acknowledge the exceptional work of the Evolent team and where we stand as a company.

Speaker #2: Cash and interest expense. Part of the decrease from 2025 is the client overpayment from Q4 that we mentioned earlier. As well as $11 million of previously classified dividends which are now reclassified as interest expense and moved into cash flow from operations.

Speaker #2: We also expect to invest between $25 to $30 million in software development and CapEx in 2026. With these financial considerations in mind, let me close with a brief comment on the organization.

Speaker #2: I want to acknowledge the exceptional work of the Evolent team and where we stand as a company. While there is a significant amount of work ahead, I believe we're well positioned to execute at a high level and accelerate growth as our new partnerships come online throughout 2026.

Mario Ramos: While there is a significant amount of work ahead, I believe we're well positioned to execute at a high level and accelerate growth as our new partnerships come online throughout 2026. We have a strong foundation, a disciplined financial plan, and a team fully aligned around delivering for our partners and driving sustainable value for our shareholders. I'm confident in our ability to navigate the near-term challenges and to capitalize on the substantial opportunity in front of us. With that, operator, we can open the line for questions.

Speaker #2: We have a strong foundation of disciplined financial planning and a team fully aligned around delivering for our partners and driving sustainable value for our shareholders.

Speaker #2: I'm confident in our ability to navigate the near-term challenges and to capitalize on the substantial opportunity in front of us. With that, operator, we can open the line for questions.

Speaker #1: Thank you. We will now begin the question and answer session. To ask a question, you may press star, then 1 on your touchstone phone.

Operator: Thank you. We will now begin the question-and-answer session. To ask a question, you may press star, then one on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then two. In the interest of time, please limit yourself to one question only. For additional questions, you may reenter the queue. The first question will come from Charles Rhyee with TD Cowen. Please go ahead.

Speaker #1: If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then 2.

Speaker #1: In the interest of time, please limit yourself to one question only. For additional questions, you may re-enter the queue. The first question will come from Charles Ree with P.D. Cowan.

Speaker #1: Please go ahead.

Speaker #2: Hi. This is Lucas on for Charles. Thanks for taking the question. Can you help us understand a little bit more about the rationale and what's driving the conservative approach to reserving presumably this is for the CVS contract?

[Company Representative] (TD Cowen): Hi, this is Lucas on for Charles. Thanks for taking the question. Can you help us understand a little bit more about the rationale and what's driving the conservative approach to reserving? Presumably, this is for the CVS contract. It's our understanding that initially you guys are reserving for a 0% MER because your fees match the expected acuity of the population you're about to serve. But here we're looking at a MER of 103%. I guess, can you help us understand, you know, what's driving this? You said new membership is expected to drive this MER higher. It's also our understanding that the enhanced contract allows you to retrospectively, you know, adjust the fees for this change in acuity.

[Analyst] (TD Cowen): Hi, this is Lucas on for Charles. Thanks for taking the question. Can you help us understand a little bit more about the rationale and what's driving the conservative approach to reserving? Presumably, this is for the CVS contract. It's our understanding that initially you guys are reserving for a 0% MER because your fees match the expected acuity of the population you're about to serve. But here we're looking at a MER of 103%. I guess, can you help us understand, you know, what's driving this? You said new membership is expected to drive this MER higher. It's also our understanding that the enhanced contract allows you to retrospectively, you know, adjust the fees for this change in acuity.

Speaker #2: It's our understanding that initially you guys are reserving for a 0% MER because your fees match the expected acuity of the population you're about to serve.

Speaker #2: But here we're looking at an MER of 103%. I guess, can you help us understand what's driving this? You said new membership is expected to drive this MER higher.

Speaker #2: It's also our understanding that the enhanced contract allows you to retrospectively adjust the fees for this change in acuity. I guess, why is that still driving a loss here if that makes sense?

[Company Representative] (TD Cowen): I guess, why is that, still driving a loss here, if that makes sense?

[Analyst] (TD Cowen): I guess, why is that, still driving a loss here, if that makes sense?

Speaker #3: Yeah. So the first thing I'll point out is when we have new contracts, we do reserve, and we have a different level of reserves and ongoing business.

Mario Ramos: Yeah. The, you know, the first thing I'll point out is when we have new contracts, we do reserves, and we have a different level of reserves in ongoing business. That's a big part of what you're seeing with the ramp-up, and we have $900 million of new business revenue this year. It's, it's a, it's very meaningful part of our profitability. These initial reserves are more conservative. In the beginning, there are lots of new data flow, implementation that can impact the profitability of the claims coming through. This framework is not new. It's something we've developed over the last couple of years, and follows GAAP.

Speaker #3: So that's a big part of what you're seeing with the ramp-up. And we have 900 million of new business revenue this year. So it's very meaningful part of our profitability.

Speaker #3: These initial reserves are more conservative. In the beginning, there are lots of new data flow implementation that can impact the profitability and the claims coming through.

Speaker #3: So this framework is not new. It's something we've developed over the last couple of years. So and follows gap. The other piece is you can see on the EBITDA bridge is when we do that and we ramp up IBNR, there is an explicit margin that's added.

Mario Ramos: The other piece, as you can see on the EBITDA bridge, is when we do that and we ramp up IBNR, there is an explicit margin that's added. It's about $13 million, and that's just, again, a good reserve accounting that we have. That's why the new contracts typically have that impact.

Speaker #3: It's about 13 million dollars. And that's just, again, good reserve accounting that we have. And that's why the new contracts typically have that impact.

Speaker #1: The next question will come from John Stancil with J.P. Morgan. Please go ahead.

Operator: The next question will come from John Stansel with JPMorgan. Please go ahead.

Speaker #4: Great. Thanks for taking my question. Wanted to quickly hone in. I know it's early, but given kind of some of your early indicators, what you're seeing with new membership early on this year behavior, anything kind of different than you saw last year?

John Stansel: Great, thanks for taking my question. Wanted to quickly hone in. I know it's early, but given kind of some of your early indicators, what you're seeing with new membership early on this year, behavior, anything kind of different than you saw last year? I know last year kind of progressed in line with your trends. Thanks.

Speaker #4: I know last year kind of progressed and went up through trends. Thanks.

Speaker #5: Yeah. Hey, John. It's Seth. I'll take that one. So let's start with exchanges. I think I mentioned on the call, we're assuming about a 40% reduction and the early indicators we're getting from our client base are consistent with that.

Seth Blackley: Yeah. Hey, hey, John, it's Seth. I'll take that one. Let's start with exchanges. I think, you know, mentioned on the call, we're assuming about a 40% reduction, and the early indicators we're getting from our client base are consistent with that, and we're obviously in touch, close touch with our clients. That number is obviously very different than if we had a different footprint of clients. I think more of that decline is from our clients proactively choosing to step away from risk pools as opposed to, you know, members not renewing because of subsidy changes or something like that. I think, again, that one feels like a reasonably conservative assumption. We won't know for sure until in Q2 how the members fully enroll or not, but I think that's it on exchanges. We're trying to be quite conservative.

Speaker #5: And we're obviously in touch, close touch with our clients. That number is obviously very different than if we had a different footprint of clients.

Speaker #5: I think more of that decline is from our clients proactively choosing to step away from risk pools as opposed to members not renewing because the subsidy changes or something like that.

Speaker #5: And I think, again, that would feel like a reasonably conservative assumption. We won't know for sure until in Q2 how the members fully enroll or not.

Speaker #5: But I think that's it on exchanges. We're trying to be quite conservative on MA. I would say it's mixed. We have a couple of clients who exited a bunch of markets and lost membership materially.

Seth Blackley: MA, I'd say it's, you know, mixed. We have a couple clients who exited a bunch of markets and lost membership materially. We have a couple clients who gained a lot of membership net. It was sort of a push for us, across the year. Medicaid has been kind of, status quo and not much change there.

Speaker #5: We have a couple of clients who gained a lot of membership net. It was sort of a push for us across the year. And then Medicaid has been kind of status quo and not much change there.

Speaker #1: The next question will come from Daniel Grosslight with Citi. Please go ahead.

Operator: The next question will come from Daniel Grosslight with Citi. Please go ahead.

Daniel Grosslight: Hi, thanks for, thanks for taking the question. Just a housekeeping question to begin with. It looks like stock-based comp has been, you know, pretty variable over the past few quarters. I'm just curious.

Speaker #6: Hi. Thanks for taking the question. Just a housekeeping question to begin with. It looks like stock-based comp has been pretty variable over the past few quarters.

Speaker #6: I'm just curious how we should be modeling that. And then my real question is on capital deployment for 26. Just given the limited free cash flow that you do have available, and it does seem like you are focused on deleveraging.

Seth Blackley: ... how we should be modeling that. My real question is on capital deployment for 2026, just given the limited free cash flow that you do have available, and it does seem like you are focused on deleveraging. If you just look at the debt markets right now, especially for you guys, you seem to be particularly dislocated, let's call it. Your debt is trading at a significant discount. I'm curious what your propensity is to go into the open market and buy down debt. Obviously, you know, you have to be careful about messaging all that, but curious on how you're thinking about liability management, given how steep of a discount your debt is trading at.

Daniel Grosslight: ... how we should be modeling that. My real question is on capital deployment for 2026, just given the limited free cash flow that you do have available, and it does seem like you are focused on deleveraging. If you just look at the debt markets right now, especially for you guys, you seem to be particularly dislocated, let's call it. Your debt is trading at a significant discount. I'm curious what your propensity is to go into the open market and buy down debt. Obviously, you know, you have to be careful about messaging all that, but curious on how you're thinking about liability management, given how steep of a discount your debt is trading at.

Speaker #6: If you just look at the debt markets right now, especially for you guys, you seem to be particularly dislocated, let's call it. And you're trading your debt is trading at a significant discount.

Speaker #6: So I'm curious what your propensity is to go into the open market and buy down debt. Obviously, you have to be careful about messaging all that.

Speaker #6: But curious on how you're thinking about liability management given how steep of a discount your debt is trading at.

Speaker #3: Yep. So on the stock comp, I wouldn't change your assumptions. I think we're going to be in line with what you guys have seen in the past for the year.

Mario Ramos: Yep. On the stock comp, I wouldn't change your assumptions. I think we're gonna be in line with what you guys have seen in the past for the year. You know, it's a good question. We see the same thing. We're obviously very aware of how our convert is trading. You know, it's not. Right now, we're focusing on deleveraging by making sure we can execute. We also have, as I said, a very good, strong, flexible balance sheet, even though leverage is higher than we would like. We also have some cash and undrawn capacity.

Speaker #3: It's a good question. We see the same thing. We're obviously very aware of how our convergence trading it's not right now, we're focusing on deleveraging by make sure we can execute.

Speaker #3: We also have as I said, a very good, strong, flexible balance sheet even though leverage is higher than we would like. And we also have some cash and undrawn capacity.

Speaker #3: So, we feel like we're in a good position, but it is difficult, just given the dynamic of the ramp-up this year, to go out and do much other than what we're doing, which is focused on the business.

Mario Ramos: We feel like we're in a good position, but it is difficult, just given the dynamic of the ramp-up this year, to go out and do much other than what we're doing, which is focus on the business. Obviously, if there are any opportunities to do good liability management and add shareholder value that way, we will look at it and weigh that against other things like cash on the balance sheet. We are very aware of that dynamic, Daniel. Thank you.

Speaker #3: Obviously, if there are any opportunities to do good liability management—not shareholder value that way—we will look at it and weigh that against other things, like cash on the balance sheet.

Speaker #3: But we are very aware of that dynamic, Daniel. Thank you.

Speaker #1: The next question will come from Jalendra Singh with Truist Securities. Please go ahead.

Operator: The next question will come from Jailendra Singh with Truist Securities. Please go ahead.

Speaker #6: Thank you. And thanks for taking my questions. First, a quick clarification. Just trying to reconcile your comment about second half. At one point, you said that you expect fourth quarter run rate to be around 150 million.

Jailendra Singh: Thank you. Thanks for taking my questions. First, a quick clarification. Just trying to reconcile your comment about second half. At one point, you said that you expect Q4 run rate to be around $150 million, but you're also expecting 70% of 2026 EBITDA to come in second half, which would imply much higher run rate. Is there something, a dynamic between Q3 and Q4 we should be aware of, or are there some non-recurring items second half, which should not be part of annual run rate? That's, you know, a quick clarification, if you can. My main question is around, can you talk about your oncology cost and expectations for 2026?

Speaker #6: But you're also expecting 70% of '26 EBITDA to come in the second half, which would imply a much higher run rate. Is there some dynamic between Q3 and Q4 we should be aware of?

Speaker #6: Or are there some non-recurring items in the second half which should not be part of annual run rates? That's a quick clarification, if you can. But my main question is: can you talk about your oncology cost and expectations for '26?

Speaker #6: And if you can update, how did you end up on 25 compared to your 12% expectation you had for the year?

Jailendra Singh: If you can update, like, how did you end up on 25 compared to your 12% expectation you had for the year?

Speaker #3: Sure. Yeah. That's a very good question. Yes. There are some reversals in the reserve in the fourth quarter and contractual impacts. Not a huge amount, but that's why there's a little bit of a difference between the implied Q4 number that you may be calculating and what Seth said is the implied run rate at that point.

Mario Ramos: Sure. Yeah, that's a very good question. Yes, there are some reversals in the reserve in Q4 and contractual impacts. Not a huge amount, but that's why there's a little bit of a difference between the implied Q4 number that you may be calculating and what Seth said is the implied run rate at that point. That's part of the reserve requirements process this year with the new business. There is a little bit of that happening. On your second question, yeah, we are seeing sort of very stable trend on the oncology side, on both, really across the board. We have looked at 2026 in a very similar trend level as 2025.

Speaker #3: So that's part of the reserve requirement process this year with the new business. So there is a little bit of that happening. On your second question, yeah.

Speaker #3: So we are seeing sort of very stable trend on the oncology side, on both really across the board. And we have looked at 2026 in a very similar trend level as 2025.

Mario Ramos: I will say, given one of the things that Seth talked about and we have in the earnings deck, our contracts now work in such a way that not every point of trend is the same. We have a number of different mechanisms to adjust trend for things out of our control. A 15% trend, as long as it's being caused by the change event metrics that we have in our contracts, may not be a big headwind for us. We will continue to provide flavor with trend because that will impact MER, but we just want you guys to keep that in mind, the way our contracts work now, there's some very specific things that accrue to us on the trend side, and it really depends where the change is coming from.

Speaker #3: I will say, given one of the things that we that Seth talked about and we have in the earnings deck, our contract's now work in such a way that not every point of trend is the same.

Speaker #3: We have a number of different mechanisms to adjust trend for things out of our control. So a 15% trend, as long as it's being caused by the change event metrics that we have in our contracts, may not be a big headwind for us.

Speaker #3: So we will continue to provide flavor with trend because that will impact MER. But we just want you guys to keep that in mind, the way our contracts work now.

Speaker #3: There are some very specific things that accrue to us on the trend side, and it really depends where the change is coming from.

Seth Blackley: Jalendra, the last thing I'd add on the oncology trend side, I think the baseline that we saw across 25 and what we're expecting for 26, again, is consistent, not up or down in 26 relative to 25. We, again, 25 came in, roughly where we thought.

Speaker #5: Yeah. And Jalendra, the last thing I'd add on the oncology trend side, I think the baseline that we saw across '25 and what we're expecting for '26, again, is consistent—not up or down in '26 relative to '25.

Speaker #5: And we again, 25 came in roughly where we thought.

Speaker #1: The next question will come from Jared Haas with William Blair. Please go ahead.

Operator: The next question will come from Jared Haase with William Blair. Please go ahead.

Speaker #7: Hey, good evening. Thanks for taking the questions. I appreciate all the details. As it relates to the EBITDA outlook, maybe I'll ask one on the pipeline.

Jared Haase: Hey, good evening. Thanks for taking the questions. Appreciate all the details as it relates to the EBITDA outlook. Maybe I'll ask one on the pipeline, and I think there was a bullet point in the earnings deck you mentioned, the late-stage contract opportunities that could provide additional upside here in 2026. I just wanted to sort of flesh that pipeline opportunity out a bit more, kind of understand how that's weighted to Performance Suite versus TNS. I guess, you know, a specific part of the question here would be if that is weighted, excuse me, to larger Performance Suite deals, could that potentially lead to, you know, an additional drag in the back half of the year if those do come to fruition?

Speaker #7: And I think there was a bullet point in the earnings deck you mentioned the late-stage contract opportunities that could provide additional upside here in 2026.

Speaker #7: And so I just wanted to sort of flesh that pipeline opportunity out a bit more, kind of understand how that's weighted to performance suite versus TNS.

Speaker #7: And then I guess a specific part of the question here would be if that is weighted, excuse me, to larger performance suite deals, could that potentially lead to an additional drag in the back half of the year if those do come to fruition?

Speaker #5: Yeah. Thanks for the question, Jared. So a couple of things on the pipeline. I'd say I think I've been saying this for maybe a year, year and a half about the challenges that managed care companies have due to translate into pipeline activity for us.

Seth Blackley: Yeah, thanks for the question, Jared. A couple things on the pipeline. I'd say, you know, I think I've been saying this for maybe a year and a half, about the challenges that managed care companies have do translate into pipeline activity for us. That's definitely bearing out, growth rate this year, the size of the pipeline. It continues to be really balanced, Jared, to be honest, between Performance Suite and Tech and Services. We have some very significant Tech and Services opportunities. We're happy to announce, you know, talk about two big Performance Suite opportunities today, but there are a number of both.

Speaker #5: And that's definitely bearing out. Growth rate this year, the size of the pipeline, it continues to be really balanced, Jared, to be honest, between performance suite and tech and services.

Speaker #5: We have some very significant tech and services opportunities. We happened to announce and talk about two big performance suite opportunities today, but there are a number of both that could affect the growth rates over time.

Seth Blackley: that could affect, you know, the growth rates over time, I think we feel really good about the growth rates over time. I would not worry about announcing a new Performance Suite deal that creates a new drag on 2026. That is not something that we're gonna be doing this year, with the new Performance Suite contract. I think there are some go lives on the Tech and Services side that, you know, could provide some modest upside, but I think the thing you should take away is that the 2026 framework is pretty well locked down at this point. We don't have a, you know, go gets that really, that we need to go figure out on the revenue side.

Speaker #5: I think we feel really good about the growth rates over time. I would not worry about announcing a new performance suite deal that creates a new drag on 26.

Speaker #5: That is not something that we're going to be doing this year. With the new performance suite contract, I think there are some go-lives on the tech and services side that could provide some modest upside.

Speaker #5: But I think the thing you should take away is that the '26 framework is pretty well locked down at this point. We don't have go-gets, really, that we need to go figure out on the revenue side.

Speaker #5: And so really, all of this that I'm talking about is for 27. And it's a nice blend of tech services and performance suite.

Seth Blackley: Really, all of this I'm talking about is for 27, and it's a nice blend of, you know, Tech and Services and Performance Suite.

Speaker #1: The next question will come from Jessica Tassan with Piper Sandler. Please go ahead.

Operator: The next question will come from Jessica Tassan with Piper Sandler. Please go ahead.

Speaker #8: Hi, guys. Thank you for taking the questions. And I'm Mario congrats on the first official earnings call. So we appreciate all the new disclosure, but obviously, we've been kind of burned by the performance suite business before.

Jessica Tassan: Hi, guys. Thank you for taking the questions, Mario, congrats on the first official earnings call. We appreciate all the new disclosure, but obviously, we've been kind of burned by the Performance Suite business before. Just why should we be confident that the 103% MLR on new contracts in 2026 reflects conservatism versus inadequate pricing on new business? I think your 2025 results kind of imply about a 9% OpEx burden on Performance Suite revenue to get to, you know, approximately a 2% Performance Suite EBITDA margin. What is the MLR and OpEx combo to get us to those 7% to 10% long-term target margins in the Performance Suite? Thank you.

Speaker #8: So just why should we be confident that the 103% MLR on new contracts in 26 reflects conservatism versus inadequate pricing on new business? And then just I think your 2025 results kind of imply about a 9% OPEX burden on performance suite revenue to get to approximately a 2% performance suite EBITDA margin.

Speaker #8: Just what is the MLR and OPEX combo to get us to those 7 to 10 percent long-term target margins in the performance suite? Thank you.

Speaker #5: Hey, Jess. I'll take the first one. So look, I think the main thing that I would focus on with respect to the new business is the structure of the contract.

Seth Blackley: Hey, Jess. I'll take the first one. Look, I think the main thing that I would focus on with respect to the new business is the structure of the contract. Yeah, we have a slide in the pack that shows you the asymmetry of how that works, number 1. Number 2, you know, at 103, we're definitely underwriting out of the gates, we think, at a very conservative place. You know, you being able to apply the combo of conservative underwriting and a good contract does create that asymmetry that we talked about in the third to last factor that Mario commented on his run, is I think we've taken all that and also applied it to how we guide it for the year.

Speaker #5: And we have a slide in the pack that shows you the asymmetry of how that works, number one. Number two, at 103, we're definitely underwriting out of the gates.

Speaker #5: We think at a very conservative place. And being able to apply the combo of conservative underwriting and a good contract does create that asymmetry that we talked about in the last third, last factor that Mario commented on his run is I think we've taken all that and also applied it to how we guide it for the year.

Speaker #5: Meaning you got accounting policies and reserving and 103 does a certain set of things and then just generally how we land on the guide across all the factors of the business.

Seth Blackley: Meaning, you got accounting policies and reserving, and 103 does a certain set of things, and then just generally how we land on the guide across all the factors of the business. We tried to, you know, orient towards conservatism and new CFO part of that, I think, is a good and healthy dynamic in terms of being conservative. That's how it started. On the OpEx thing, I think the thing you got to think about is flow-through economics, that 2%. I didn't totally track all the math, but each incremental dollar of care margin in the Performance Suite is disproportionately gonna fall to EBITDA, Jess, because there is some variable OpEx, but it's not, you know, it's a more of a fixed cost investment on a lot of that.

Speaker #5: We tried to orient towards conservatism, and the new CFO, part of that, I think, is a good and healthy dynamic in terms of being conservative.

Speaker #5: So that's how it started. And then on the OPEX thing, I think the thing you got to think about is flow-through economics, that 2%.

Speaker #5: I didn’t totally track all the math, but each incremental dollar of care margin in the performance suite is disproportionately going to fall to EBITDA, Jess, because there is some variable OPEX, but it’s not—it’s more of a fixed cost investment on a lot of that.

Speaker #5: And so I think the 7 to 10 percent we feel really good about. I think we're achieving that today on the legacy cohort, as a for instance.

Seth Blackley: you know, I think the 7% to 10%, we feel really good about. I think we're, you know, achieving that today on the legacy cohort as a for instance, and feel really good about being able to get there with the whole book over time.

Speaker #5: And I feel really good about being able to get there with the whole book over time.

Speaker #1: The next question will come from Jeff Gara with Stevens. Please go ahead.

Operator: The next question will come from Jeff Garro with Stephens. Please go ahead.

Speaker #9: Yeah. Good afternoon, guys. And thanks for taking the question. I'll stick on the MER front. And trying to think about that 89% actual performance for 2025 and then the 93% expectation for the full book of business for 2026 that has the drag of 900 million at that 103%.

Jeff Garro: Yeah, good afternoon, guys, and thanks for taking the question. I'll stick on the MER front and, you know, trying to think about that 89% actual performance for 2025, and then the 93% expectation for the full book of business for 2026, that has the drag of $900 million at that 103%. My implied math is there's on the remaining Performance Suite business from 25 to 26, there's some improvement, pretty modest, but would love to hear you explain more about the specific drivers of improvement and opportunity, even beyond what's, you know, kind of underwritten in that 93% full year 26 expectation for the kind of remaining Performance Suite business, and, you know, much of which is already on those new contract structures. Thanks.

Speaker #9: And my implied math is there's on the remaining performance suite business from 25 to 26, there's some improvement pretty modest, but would love to hear you explain more about the specific drivers of improvement and opportunity even beyond what's kind of underwritten in that 93% full year 26 expectation for the kind of remaining performance suite business and much of which is already on those new contract structures.

Speaker #9: Thanks.

Speaker #10: Sure. I think it's just along the same things we've talked about. It's because we have so much new business—upwards of $900 million, we expect this year in new Performance Suite business.

Mario Ramos: Sure. I think it's just along the same things we've talked about. It's because we have so much new business, upwards of $900 million, we expect this year in new Performance Suite business. As typical, we're not unusual. We are reserving. We have to build up reserves. We have to build up IBNR over the first few months. Because, as I said, the new relationships, new data flow, just the teams working together, we do have a framework that tends to be more conservative on the reserving side. That doesn't last all that long before, especially contracts that start in the middle of the year. Once you get over that initial reserving, you actually start looking at some benefits.

Speaker #10: And as typical, we're not unusual. We are reserving. We have to build up reserves. We have to build up IBNR over the first few months.

Speaker #10: And because as I said, the new relationships, new data flow, just the team's working together, we do have a framework that tends to be more conservative on the reserving side.

Speaker #10: That doesn't last all that long before, especially contracts that start in the middle of the year. Once you get over that initial reserving, you actually start looking at some benefits.

Speaker #10: And so part of what you're seeing in the fourth quarter is reversal of some of that. And the base business is continuing to perform well.

Mario Ramos: Part of what you're seeing in Q4 is reversal of some of that. The base business is continuing to perform well. That's why the blend is at 93%, which is worse than last year. It's primarily the new business driving up MER, offset by continued good performance on our existing cohort.

Speaker #10: That's why the blend is at 93%, which is worse than last year. It's primarily the new business driving up MER, offset by continued good performance on our existing cohort.

Speaker #5: Yeah. And Jeff, I think part of the question too was, okay, how does the existing cohort get a little bit better? And there are some ongoing clinical initiatives, but there are also some contractual things.

Seth Blackley: Yeah, Jeff, I think part of the question, too, was, okay, how does the existing cohort get a little bit better? There, there's some ongoing clinical initiative, but there's also some contractual things. I'd say the majority of the improvement is what I would call contractual in nature, which gives us a lot of confidence in it, as opposed to, you know, go get on the clinical side.

Speaker #5: I'd say the majority of the improvement is what I would call contractual in nature, which gives us a lot of confidence in it as opposed to, you know, going to get on the clinical side.

Speaker #1: The next question will come from Matthew Gilmore with KeyBank. Please go ahead.

Operator: The next question will come from Matthew Gillmor with KeyBank. Please go ahead.

Speaker #11: Hey, good afternoon. Just following up on some earlier questions. I'd be curious if you could just orient us around some of the swing factors in terms of the high end of the EBITDA guide versus the low end as well.

Matthew Gillmor: Hey, good afternoon. Just following up on some earlier questions. I'd be curious if you could just orient us around some of the swing factors in terms of the high end?

Seth Blackley: ... of the EBITDA guide versus the low end, is trend on oncology costs sort of the main one to think about, or are there other sort of factors that you'd orient us around?

Matthew Gillmor: ... of the EBITDA guide versus the low end, is trend on oncology costs sort of the main one to think about, or are there other sort of factors that you'd orient us around?

Speaker #11: Is the main trend on oncology costs, or is there another factor we should be thinking about? Or are there other factors that you'd orient us around?

Mario Ramos: You know, I think it's MER to start with, which is why we've started talking more about it, why we're disclosing it in a different way in our financials. Really is about MER, especially as we sit here, we think we have a good view of membership. Aside from any other exchange issues, we feel very good about where we are. Then it's the evolution of, can we accelerate the savings that we're projecting? Again, as I said, trend can be a factor. We feel like we're being, you know, appropriately conservative on those metrics, especially given the new contract provisions, where not every 1% of trend is the same.

Speaker #10: I think it's MER to start with, which is why we've started talking more about it, why we're disclosing it in a different way. In our financials, really is about MER.

Speaker #10: Especially as we sit here, we have a we think we have a good view of membership aside from any other exchange issues. We feel very good about where we are.

Speaker #10: And then it's the evolution of can we accelerate the savings that we're projecting? Again, as I said, trend can be a factor. We feel like we're being appropriately conservative on those metrics.

Speaker #10: Especially given the new contract provisions, where not every 1 percentage point of trend is the same. We have a lot of levers to protect us in case trend is heading the wrong way for things that we don't control.

Mario Ramos: We have a lot of levers to protect us, in case trend is heading the wrong way for things that we don't control. That is the biggest swing factor by far.

Speaker #10: So that is the biggest swing factor by far.

Speaker #1: The next question will come from Richard Close with Canaccord Genuity. Please go ahead.

Operator: The next question will come from Richard Close with Canaccord Genuity. Please go ahead.

Speaker #12: Yeah, a couple of questions. Seth, earlier on when you talked about exchanges, you said something about return to growth over time, and I'm just curious what goes into that comment.

Richard Close: Yeah, a couple questions. Seth, earlier on, when you talked about exchanges, you said something about return to growth over time, and I'm just curious, you know, what goes into that comment? A follow-up with Mario, just, you know, your thoughts. You've been here 90 days, I guess, on the ground. Sounds like your fingerprints are on the guidance and some of the new disclosures. Just curious, you know, maybe your thoughts in terms of any changes you're thinking about going forward that would be helpful. Thanks.

Speaker #12: And then a follow-up with Mario, just your thoughts. You've been here 90 days, I guess, on the ground. Sounds like your fingerprints are on the guidance and some of the new disclosures.

Speaker #12: Just curious—maybe your thoughts in terms of any changes you're thinking about going forward. That would be helpful. Thanks.

Speaker #13: Yeah. I'll start on the exchange and then pass it to Mario. So Richard, what I'd say there's two things on exchange. One is if you go just look at how consumers have bought that product, in the marketplace, it has had growth to it that go outside of subsidy swings.

Seth Blackley: Yeah, I'll start on the exchange and then pass it to Mario. Richard, what I'd say is there's two things on exchange. One is, if you go just look at how consumers have bought that product in the marketplace, it has had growth to it that go outside of subsidy swings, and there is interest in the product generally. We have this dislocation from subsidies being pulled back and risk pools are getting shifted. I think over time, the idea of consumers, using it to buy product probably will come back over some time period, and whatever the growth rate that'll be, that'll be.

Speaker #13: And there is interest in the product generally. So we have this dislocation from subsidies being pulled back and risk pools getting shifted. I think, over time, the idea of consumers using it to buy product probably will come back over some time period.

Speaker #13: And whatever that growth rate that'll be, that'll be. Second factor is more of a wild card, but should there be a change in the midterms or legislation or anything like that to adjust how subsidies work, that could be more of a step up in membership, which we're obviously not counting on either of those two things in the 26 number.

Seth Blackley: Second factor is, you know, more of a wild card, you know, should there be a change in the midterms or legislation or anything like that to adjust how subsidies work, that could be, you know, more of a step up in membership, which we're obviously not counting on either of those two things in the 26 number. You know, could be something in the out years.

Speaker #13: But it could be something in the out years.

Speaker #10: Yeah. And it's been a great 90 days, or a long 90 days. If anything, I'm just more excited to be here than I thought I'd be.

Mario Ramos: Yeah, it's been a great 90 days or a long 90 days. I'm, I'm just... If anything, I'm more excited to be here than I thought I'd be. Team is amazing. You know, I think what we do is at the heart of what we need more of to fix what's wrong in healthcare. All that feels really great. I've tried to partner with Seth and figure out a way in how we communicate with all of you and our other investors with more clarity, transparency, and how it directly correlates to what you're seeing in the financial statement. I think if anything, I will try to continue to do that.

Speaker #10: The team is amazing. I think what we do is at the heart of what we need more of to fix what's wrong in healthcare.

Speaker #10: So all that feels really great. I've tried to partner with Seth and figure out a way in how we communicate with all of you and our other investors with more clarity, transparency, and how it directly correlates to what you're seeing in the financial statement.

Speaker #10: So I think, if anything, I will try to continue to do that. The MER, in my mind, gets us quite a bit of the way to a place where we're doing that.

Mario Ramos: The MER, in my mind, gets us quite a bit of the way to a place where we're doing that. We will continue to look at new and improved ways to try to communicate with you guys so you can understand how our business is performing and hold us accountable.

Speaker #10: But we will continue to look at new and improved ways to try to communicate with you guys, so you can understand how our business is performing and hold us accountable.

Speaker #1: The next question will come from David Larson with BTIG. Please go ahead.

Operator: The next question will come from David Larsen with BTIG. Please go ahead.

Speaker #14: Hi. Can you talk about what your mature performance suite EBITDA margins look like? What does that percentage how long does it take to get there?

David Larsen: Hi, can you talk about what your mature Performance Suite, EBITDA margins look like? What is that percentage? How long does it take to get there? Then just over time, like in 2027, 2028, 30% revenue growth, that's high, that's great, but it seems like it's coming at the cost of margin degradation and free cash flow. Like, why not grow revenue, let's call it, like, 10% or 15% year-over-year, and focus on more EBITDA growth, EBITDA margin growth, and free cash flow and debt paydown? Thank you.

Speaker #14: And then just over time, like in 2027, 2028, 30% revenue growth—that's high, that's great. But it seems like it's coming at the cost of margin degradation and free cash flow.

Speaker #14: So why not grow revenue? Let's call it like 10% or 15% year over year and focus on more EBITDA growth, EBITDA margin growth, and free cash flow and debt pay down.

Speaker #14: Thank you.

Speaker #10: But I think on the we're not going to talk we don't talk about EBITDA margin, but we can talk generally about our sort of existing book of business.

Mario Ramos: I think we don't talk about EBITDA margin, but we can talk generally about our sort of existing book of business. When you look at the MERs that we're disclosing today around the new cohort and what we had at the end of 2025, you're getting to a pretty good care margin. We've talked around 7% to 10%. The existing book is doing a little bit better than that, partly because of what Seth said, we're getting some contractual adjustments that improve our base rate, which aren't temporary, but they won't happen every year. They'll stay there, they just won't happen every year. You know, for the whole book of business, I think we're feeling very good about how it's performing.

Speaker #10: And when you look at the MERs, that we're disclosing today around the new cohort and what we had at the end of 2025, you're getting to a pretty good care margin.

Speaker #10: We've talked around 7% to 10%. The existing book is doing a little bit better than that, partly because of what Seth said. We're getting some contractual adjustments that improve our base rate, which aren't temporary, but they won't happen every year.

Speaker #10: They'll stay there. They just won't happen every year. So for the whole book of business, I think we're feeling very good about how it's performing.

Speaker #10: And I think I'll let Seth comment on the focus profitability versus growth. I just to me, coming in, understanding the high mark relationship, some things are just they're great for the business, and it may create short-term pressure.

Mario Ramos: I think I'll let Seth comment on the focus, profitability versus growth. I just, you know, to me, coming in, understanding the Highmark relationship, some things are just, they're great for the business, and it may create short-term pressure. The long term, we wanna create value. You know, we know that we can lay this out for you guys so you see the huge opportunity we have in front of us with that partnership, with the current revenue this year, even though from a profitability standpoint, we will have to execute to get it to the point that we know we can, like the rest of the business that we have.

Speaker #10: The long-term, we want to create value. We know that we can lay this out for you guys so you see the huge opportunity we have in front of us with that partnership with the current revenue this year, even though from a profitability standpoint, we will have to execute to get it to the point that we know we can like the rest of the business that we have.

Speaker #14: Yeah. And David, I'd add just one other thing, which is the performance suite we think is the best way to create value for our partners, which we got to start with them.

Seth Blackley: Yeah, David, I'd add just one other thing, which is, you know, the Performance Suite, we think is the best way to create value for our partners, which we got to start with them, and we think it's more economically attractive on a per life basis for us as well. You know, I think particularly when you have the enhanced model, more predictability and the like, you're willing to go through a period of investment to get there. It's kind of what Mario just said, but I do think it's important that the pie of value is bigger under the Performance Suite than Tech and Services. When you choose between those two products, you know, we've, the enhanced Tech and Services, we think is the better of the two products. If the client wants Tech and Services, we'll obviously do that.

Speaker #14: And we think it's more economically attractive on a per-life basis for us as well. And so, I think, particularly when you have the enhanced model, more predictability, and the like, you're willing to go through a period of investment to get there.

Speaker #14: It's kind of what Mario just said. But I do think it's important that the pie of value is bigger under the performance suite than tech and services.

Speaker #14: And so when you choose between those two products, we've the enhanced tech and services, we think, is the better of the two products. If the client wants tech and services, we'll obviously do that.

Speaker #14: We'll do whatever they are interested in doing. And then in terms of the investment ramps and the like, again, I think to Mario's point, you find a partner who's a great partner and they're interested in creating a partnership together, you do that because it's going to create value over time.

Seth Blackley: We'll do whatever they are interested in doing. You know, in terms of the investment ramps and the like, again, I think to Mario's point, you find a partner who's a great partner, and they're interested in creating a partnership together, you do that because it's gonna create value over time. I think we're making the right decisions to maximize the value of the company.

Speaker #14: And so, I think we're making the right decisions to maximize the value of the company.

Speaker #1: The next question will come from Matthew Shea with Needham. Please go ahead.

Operator: The next question will come from Matthew Shea with Needham. Please go ahead.

Speaker #15: Hey, thanks for taking the question. Appreciate the update that 90% of the performance suite contracts now have the enhanced protections and MER corridors. But of the 10% that have not migrated, you noted the scope is limited and protections are not economically warranted.

Matthew Shea: Hey, thanks for taking the question. Appreciate the update that 90% of the Performance Suite contracts now have the enhanced protections and MER corridors. Of the 10% that have not migrated, you know, to the scope is limited and protections are not economically warranted, could you just update us on what is in that 10%? It sounds like that will stay without protection. How are you thinking about those contracts longer term? Would you eventually look to migrate or sunset those, or do you have confidence in them, even without the protections? Thanks.

Speaker #15: Could you just update us on what is in that 10%? And it sounds like that will stay without protection. So how are you thinking about those contract longer term?

Speaker #15: Would you eventually look to migrate or sunset those? Or do you have confidence in that confidence in them even without the protection even without the protections?

Speaker #15: Thanks.

Speaker #16: Matthew, I would expect almost all of those to move to the enhanced as well. And maybe there's a couple percent of the 100 that are never migrate, but I think it's going to be high 90s at some point would be my guess.

Seth Blackley: Matthew, I would expect almost all of those to move to the enhanced as well. Maybe there's a couple % of the 100 that are, you know, never migrate, but I think it's gonna be high 90s at some point, would be my guess. I can't guarantee that, but I think that's where it's headed. I think it's the right call for our partners and the right call for us. It kind of gets everything into a standard structure. That's how I think about it.

Speaker #16: I can't guarantee that, but I think that's where it's headed. And I think it's the right call for our partners and the right call for us to kind of get everything into a standard structure.

Speaker #16: So, that's how I think about it.

Speaker #1: The next question will come from Sean Dodge with BMO Capital Markets. Please go ahead.

Operator: The next question will come from Sean Dodge with BMO Capital Markets. Please go ahead.

Speaker #17: Yeah. Thanks. Maybe just on the cost efforts, you mentioned Mario for 2026. You said you expect $50 million of that to be captured within the year.

Sean Dodge: Yeah, thanks. Maybe just on the cost efforts, you mentioned, Mario, for 2026, you said you expect $50 million of that to be captured within the year. Just the timeline on those, are those going to unfold pretty randomly across the year? Are they more kind of early year or later year, kind of more heavily weighted? I guess, just how should we think about the run rate benefit of those, going into 2027?

Speaker #17: Just the timeline on those. Are those going to unfold pretty randomly across the year? Are they more kind of early-year or later-year, kind of more heavily weighted?

Speaker #17: And then I guess, just how should we think about the run-rate benefit of those going into 2027?

Speaker #10: Yeah. And those are baked, obviously, in the adjusted EBITDA guidance—into the cost base that is implied by the guidance. I would say Seth talked a lot about getting $20 million last year in AI and automation initiatives.

Mario Ramos: And those are baked obviously, in the adjusted EBITDA guidance, you know, into the cost base that is implied by the guidance. I would say, Seth talked a lot about, you know, getting $20 million last year in AI and automation initiatives. Those already happened at the end of 2025. Of the 50, 20 were done then. We did another big portion of the remaining 30 in early this year, and there will be a piece that we will continue to get throughout the year. It's largely running through. As I said, when you look at what we've guided to and the cost base implied by that, the $50 million is in there.

Speaker #10: Those already happen at the end of 2025. So of the 50, 20 were done then. We did another big portion of the remaining 30 in early this year.

Speaker #10: And there will be a piece that we will continue to get throughout the year. So it's largely running through. And as I said, when you look at what we've guided to and the cost base implied by that, the $50 million is in there.

Speaker #10: There isn't a ton of wrap or additional run rate because they were mostly—they were almost be done earlier in the year.

Mario Ramos: There isn't a ton of wrap or additional run rate because they will mostly be done early in the year.

Speaker #1: The next question will come from Kevin Caliendo with UBS. Please go ahead.

Operator: The next question will come from Kevin Caliendo with UBS. Please go ahead.

Speaker #18: Hey, guys. Thanks for getting me in after I dropped out of queue. I appreciate the downside protection of your new contracts, but I really want to understand when you are signing new business, what kind of IRR or ROIC are you modeling out or shooting for?

Kevin Caliendo: Hey, guys, thanks. Thanks for getting me in after I dropped out of queue. I appreciate the downside protection of your new contracts, but I really want to understand, when you are signing new business, what kind of IRR or ROIC are you modeling out or shooting for? I get maybe it's not as high as it used to be because you have, you know, lower downside. Obviously, there's risk-reward here. When you're modeling this out, what are you, what are you aiming to achieve? Like, what's the target return, and how do you think about when that return is gonna come about, year one, year two, year three, et cetera? Just trying to understand from a modeling perspective, how to think about it, how you guys think about it, how we should think about it in terms of total returns.

Speaker #18: And I get maybe it's not as high as it used to be because you have lower downside. Obviously, there's risk-reward here. But when you're modeling this out, what are you aiming to achieve?

Speaker #18: What's the target return? And how do you think about when that return is going to come about, year one, year two, year three, etc.?

Speaker #18: Just trying to understand from a modeling perspective how to think about it, how you guys think about it, and how we should think about it in terms of total returns.

Seth Blackley: Yeah, let me add a little bit more color to how we think about these contracts, which I think will partly answer your question. There's a spectrum from Tech and Services, right? Where there's no investment and no downside, all the way to the Performance Suite enhanced model, where you might have 10% margin, but you have some downside. There are things in between. You know, we are underwriting around our cost of capital at Avalon. You don't want to be over 20%, you know, cost of capital return, which gives you space in between our cost of capital and a good return. Again, you have to look at how much downside exposure is there in the opportunity versus how much upside is.

Speaker #19: Yeah. And let me add a little bit more color to how we think about these contracts, which I think will partly answer your question.

Speaker #19: There's a spectrum from tech and services, right, where it's there's no investment and no downside, all the way to the performance suite enhanced model where you might have 10% margin, but you have some downside.

Speaker #19: There are things in between. And we are underwriting around our cost of capital. At Evelyn, you don't want to be over 20% cost of capital.

Speaker #19: Return, which gives you space in between our cost of capital and a good return. And again, you have to look at how much downside exposure is there in the opportunity versus how much upside is.

Speaker #19: But that's how we would think about it—it's clear, at a 20% hurdle rate at least.

Seth Blackley: That's how we would think about it, is, you know, clear at a 20% hurdle rate, at least.

Speaker #1: The next question will come from Ryan Halstead with RBC. Please go ahead.

Operator: The next question will come from Ryan Halsted with RBC. Please go ahead.

Speaker #20: Thanks for squeezing me in. Just my question is, again, focusing on the MER, obviously, a key KPI and oncology cost trends is also clearly a big contributor to that.

Ryan Halsted: Thanks for squeezing me in. Just my question is, again, focusing on the MER, obviously a key KPI and oncology cost trends is also clearly a big contributor to that. I mean, is there for the portion of the risk that you are controlling or at risk for, is there a good way of looking ahead at kind of what would be, you know, the swing factors into that portion, whether it be, you know, is it prescribing patterns of higher costs therapeutics? Is that sort of the piece of the oncology cost trends that you're still most exposed to, I guess, or in control of?

Speaker #20: I mean, is there—for the portion of the risk that you are controlling or at risk for—is there a good way of looking ahead at what would be the swing factors into that portion, whether it be, is it prescribing patterns of higher costs?

Speaker #20: Therapeutics—is that sort of the piece of the oncology cost trends that you're still most exposed to, I guess, or in control of?

Speaker #19: Yeah. Yep. Great question. So, yeah, I would think about it as follows. Probably 80% of what we're exposed to or in charge of managing would be the therapeutic.

Seth Blackley: Yeah. Yep, great question. Yeah, we think about it as follows. Probably 80% of what we're exposed to or in charge of managing would be the therapeutic, and 20% would be other costs, which might be radiation therapy or things like that. Within the therapeutic exposure that we have, we carve out new drugs and indications or things that are, you know, not in our control. Things that would be in our control would be, you know, for a given cohort of patients that are receiving similar types of treatment, what is the average cost of the therapeutic for that case, plus the 20% of other? That's really how we think about it.

Speaker #19: And 20% would be other costs, which might be radiation therapy or things like that. Within the therapeutic exposure that we have, we carve out new drugs and indications or things that are not in our control.

Speaker #19: So, things that would be in our control would be, for a given cohort of patients that are receiving similar types of treatment—what is the average cost of the therapeutic for that case, plus the 20% of other?

Speaker #19: And that's really how we think about it. I think that's our unique value proposition, is being able to manage the therapeutic dosing, selection, timing, etc.

Seth Blackley: I think that's our unique value proposition, is being able to manage the therapeutic, you know, dosing, selection, timing, et cetera. You guys know, I'll use checkpoint inhibitors as an example that everybody understands. They've been very high-cost drugs like Keytruda or Opdivo or others. The duration of that is the patient on it for 90 days, 120 days, 150 days? If it's not working, are you able to get onto a new therapy quicker? What's the number of vials, you know, or dosage that are open, et cetera? It's all of those decisions, which again, are very tied to the patient profile and the genome and deeply clinical decision-making, which is really the core of, you know, the clinical work we do.

Speaker #19: You guys know I'll use Checkpoint inhibitors as an example to everybody. Understands? I've been very high cost, drugs like Keytruda or Opdivo or others.

Speaker #19: The duration of that—is the patient on it for 90 days, or 120 days, 150 days? If it's not working, are you able to get onto a new therapy quicker?

Speaker #19: What's the number of vials or dosage that are opened, etc.? It's all of those decisions which, again, are very tied to the patient profile and the genome and deeply clinical decision-making, which is really the core of the clinical work we do.

Speaker #1: This concludes our question and answer session. I would like to turn the conference back over to Seth Blackley for any closing remarks.

Operator: This concludes our question-and-answer session. I would like to turn the conference back over to Seth Blackley for any closing remarks.

Speaker #21: All right. Thank you for joining tonight. It's great to have Mario on the team, and I just want to say a big thank you to the entire Evelyn team.

Seth Blackley: I thank you for joining tonight. It's great to have Mario on the team, and I just wanna say a big thank you to the entire Evolent team. It's been, you know, a lot going on over the last year and a half. Our team is highly committed to the mission of this company. I'm really proud of them, and I'm very confident that the team and I and the board are gonna deliver for our shareholders, and I'm excited about that.

Speaker #21: It's been a lot going on over the last year and a half. Our team is highly committed to the mission of this company. I'm really proud of them, and I'm very confident that the team and I, and the board, are going to deliver for our shareholders, and I'm excited about that.

Operator: The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.

Q4 2025 Evolent Health Inc Earnings Call

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