Good morning, everyone. I'm Steve Baxter, the Healthcare Services Analyst here at Wells Fargo. We are pleased to be joined by agilon health, a leading player in the physician enablement and value-based care space. From the company, we are joined by Tim Bensley, CFO, Ben Kornitzer, Chief Medical Officer, and Matthew Gillmor from Investor Relations. Thank you very much for being here today. Thanks, Steve. Yeah. So just to start, you know, on the top, obviously, utilization's been a huge area of focus. You know, on the second quarter call, you guys called out, you know, some really strong performance in terms of, you know, the clinical model driving, you know, like, lower inpatient-type utilization, compensating for- You know, some of the things you're seeing on the, you know, the outpatient and ER side, and that's, like, the kind of trend the company drives to over time. I guess, what's the latest update you can provide on, on what you're seeing on the utilization front? And then, we can talk more about the, the clinical model. Yeah. No, I think you nailed it, though, by the way. The... You know, obviously, there has been a lot of focus on utilization coming through the first half of the year. And, you know, I think this current environment really gives us the opportunity to demonstrate, you know, the power of the agilon model. I know that sounds like, you know, like, simple, but our model is essentially designed to have a more efficient and, you know, really more consistent impact on utilization than probably just, you know, any other model out there, just certainly the normal, you know, fee-for-service environment. You know, if you think about it, we're coming in with this, you know, overall partnership model that drives this tremendous alignment with the, with the primary care physicians that we partner with, you know, to really work on driving outcome over time. But the second thing is, you know, we're bringing this platform that allows the, or, you know, helps the, the primary care physician both, you know, both identify and bring the right care to their, to their patients that, you know, then essentially, over time, does have that kind of leveling impact on utilization. Also helps us, you know, drive utilization down below what the overall, you know, I think, Fee-for-Service environment would be. I mean, essentially, at the end of the day, I think an attributed, you know, a PCP that's operating with an attributed patient in that, you know, full kind of risk model is approaching that patient in a much different way. You know, our physicians are essentially providing tremendously improved continuity of care versus what you would get in Fee-for-Service. In a Fee-for-Service model, you know, utilization is managed by somebody gets sick, and, you know, it's very ad hoc. They have to go into an emergency room or, you know, potentially get hospitalized, but it's all done on a very ad hoc basis. Where we have, you know, much better continuity of care, we're handling, you know, the conditions of our patients on a more, you know, ongoing basis, and basically managing them on a proactive basis as they happen. I think that has the impact of, you know, both lowering utilization, as well as having more consistent utilization over time. It may even have a positive impact on, you know, avoiding some of the pent-up demand issues that came out of post-COVID. Having said that, you can see the results in our numbers. So when we, you know, came out and talked about Q2, we said that, you know, we're not only seeing, you know, that we're beating kind of the average utilization on the inpatient side. And by the way, of course, inpatient is by far the largest, you know, part of our cost basis. We're actually seeing an actual single-digit decrease- in inpatient utilization against our population that we reported in Q2. And now, at the same time, of course, we have been seeing, you know, pretty large increases in outpatient. That's a smaller portion of the overall cost pie, and so the inpatient, you know, decrease is more than offsetting that. But we've been seeing that, you know, we've been seeing that phenomena. We've been talking about it over the last, you know, year, not over the last couple of months. You know, having said that, of course, you know, the big payers get information more current than us, and- Sure ... and so, you know, we want to make sure that we're being, you know, kind of thoughtful about what they're saying. And so we did, of course, kind of strengthen our reserves both in Q2 and for our outlook for the balance of the year, to make sure that we're, you know, we're covering any potential increase in utilization and, you know, can avoid you know, make sure we're properly reserved as we end the year. You know, Ben, I don't know if you want to talk any more about the impact of the model on that kind of leveling of utilization and improvement or? Yeah. By the way, Tim has been doing such a good job at our meetings, covering the clinical components. I said, "I'll take all the financial questions. He'll take all the clinical questions." No, if you think about it, I mean, the vast majority of admissions to a hospital are ambulatory-sensitive. So those are patients with heart failure. Can you do a better job managing their heart failure so that they're on the right medications, they're taking daily weights, their blood pressure is controlled? We published a white paper showing the impact of better diabetes control. Those patients were 50% less likely to get readmitted if their blood sugars were well controlled. We have a program that really focuses on our most seriously ill patients. We're seeing statistically significant decreases in terms of admissions when we're focusing on those patients, ICU stays, ER visits, total cost of care, and then also more days at home, which, for our most seriously ill patients, is really w hat they want to be doing. And if you think about it, it's all about having that longitudinal, continuous relationship with the patient to avoid those exacerbations. But what it also does, if you think about it, if a patient has lower back pain, right? Instead of taking a look at a billboard that says, you know, "Call the Laser Spine Institute," they're gonna go see their PCP. Yeah. The PCP is more likely to say, "Listen, let's see how you do with physical therapy. Let's see how you do with some conservative management." And so our ability to do that over time really mitigates against a lot of those spikes that you would see, but also gives the opportunity to lower the cost of care. Yeah, I mean, it just makes sense if you're seeing, especially your most critical patients with the most conditions, on a more regular basis, you're just proactively managing their condition, which is gonna avoid a lot of utilization. Yeah. Because you're seeing them more consistently, and have this, you know, more, this better continuity of care, you're able to actually get them enrolled and take advantage of these programs that we've—these clinical programs we've put in place. So, I mean, our entire model, the power of our model, is really built around that concept, and I think it's having a positive impact, and it's one of the reasons why we can have—you know, differential utilization performance and differential financial performance, than probably the broader Fee-for-Service environment. And then, Ben, you know, there are programs that are more centrally driven by agilon, whether it's things like renal, palliative, like high-risk patients, versus things that are managed more kind of in like the local markets. Can you talk a little bit about, like, why these programs are managed more at the, the agilon level, and then how you cascade that down into the markets? Yeah. So, so historically, if you think about the way a PCP practices, PCPs tend to be very, very good at taking care of patients that they're seeing at the moment. Where they have blind spots is all those patients who aren't coming to that office that day. And so if you see 20 or 30 patients a day, you may have 2,000 patients on your panel that you're not seeing. Knowing which one of those patients are at risk for heart failure, knowing which one of those patients may crash in dialysis, knowing which ones of those patients may have anxiety, or behavioral health issues, or social determinant issues that are preventing them to come in to see you in the first place. So our ability to aggregate really large amounts of data from all of these different payer plans, from traditional Medicare through our ACO REACH relationships, allows us to basically create benchmarks and algorithms to identify who's at risk. No individual PCP would be able to do that. In fact, even our most sophisticated practices wouldn't be able to do that. So what we're able to do is bring them this information on which patients are at risk, actually embed resources in those practices that can get those patients on that physician's schedule, and then, rather than having a sort of disconnected, siloed approach, this is a Humana patient, this is a United patient- This is a fee-for-service patient, we can present them with a singular view of their patients at the point of care. And if you're seeing Betty Smith, all of a sudden you realize, well, Betty Smith needs to have her medications adjusted for her heart failure, so double her dose of Lasix. She has gaps that need to be closed. She hasn't had a mammography done, this year. Yeah. And she's seeing four specialists. You should coordinate care better with those. So the fact that we can bring that information to the physician at the point of care, measure what that physician is doing so that we're able to give them feedback, and then help them understand proactively, well, based on Betty's risk factors, this is someone that you've only been seeing twice a year. You probably want to see her four times a year or six times a year. And so the structured, standardized way to do that, that's very, very intentional that's actionable, that can be measured and tracked over time, that's a capability that we bring that's, that's delightful for the PCPs, but also makes sure that you have really high levels of performance consistently across our partnerships. A segue to that would, I guess, be like, you know, you guys obviously have great capabilities and access to data here, like payers have some of these capabilities as well. I guess, how different are the solutions you're putting out and how it flows through to the PCP and ultimately the patient, versus what payers are enabled to do on their own? Yeah, I mean, first of all, we work very closely with our payer partners. I think what's distinctive is our relationship with those PCPs, where we have immediate proximity. So if you think about the example I gave, we're not just identifying those patients, and there's a benefit to being able to identify them across multiple- Yeah. Payers, right? So that, you know, we have visibility. I would think the average market may have 5-7 different MA contracts, as well as, you know, a traditional Fee-For-Service through, through ACO REACH. So that multi-payer data gives us sort of granularity, 'cause each one is slightly different. But then the fact that we actually have resources in that practice, whether they're nurses, whether they're operators, whether they're social workers or pharmacists, is a major differentiator. And then we can work directly at the point of care, whether it's through the EMR or through other point of care tools, so that when that PCP is seeing that patient, we're actually able to port information. It's a... You know, one of the frustrations as a physician has always been, you get different information from different payers. There is no way to keep track of all the different contracts and permutations of those contracts. But when you have a singular view for every single patient over the age of 65, and there's commonality, 'cause we know as you get older, your kidneys slow down- Your heart doesn't pump as well as it used to. Unfortunately, your brain doesn't function as well as it used to when you were younger. And so that commonality allows us to deploy solutions across that population. I think the comment you made about proximity is important as well, because the other differences... And you know, I think obviously, you know, the payers have been out there doing this a long time, and obviously, they're you know, they can be successful to the extent that they can with the programs that are in place. But the difference between that and a program that you're putting in place that is being delivered to the patient through their PCP versus, you know, getting a call that, "Hey, this is your, your health you know, your health insurer is, I think, a big difference as well. And so I think that the opportunity or the probability of success of getting somebody into one of these clinical programs and staying in it and working through it when their PCP is leading them through it is a big difference. We see for our highest risk programs, when we had external groups making phone calls to talk to patients about enrolling, we had about a 20% opt-in from the patients. When we had the physicians having those same conversations, it was 80%-90%. So that credibility is extremely high. I also think that it's just, there's something very satisfying to the PCPs about being in the driver's seat and seeing that singular view. And so, you know, with one of our early partners that had worked with a bunch of different payers, those payers had given, you know, fax recommendations on what to do as patients came in, and there were two physicians we spoke to at a competition who could take those faxes, stack them on their desk to get the highest level, without actually responding to a single one, because they thought they were so low value. Now that it's embedded in their EMR and this becomes- Yeah Part of how they actually operate, they're delighted, and the recommendations that they're getting don't feel like they're coming from a disconnected third party, but they say, "These are actually our peers. These are the people that we work with. These are people who are core to our team." And so those recommendations that they're seeing actually make sense to them and work with their workflows. Yeah. So when you think about, like, a new partner coming into that environment and having this new access to information and then some reengineering of how they actually provide care, I mean, take us through how that works. Like, how do you implement that, and how does it progress over, you know, the next couple of years as you work to drive, I guess, greater adoption of the tools that you make available to them and greater standardization, maybe across the various physicians in a practice? So I think that, you know, the folks have the greatest credibility in our model are the physicians themselves. So we bring colleagues from other markets who have done this before. It's almost like saying, "Here are the answers to the test." Right? We're going to tell it to you on day one. And then working with what are really already highly effective organizations, and the groups that partner with us are successful practices within a Fee-For-Service construct. So they have governance, they have good leadership. Our ability to sort of reorganize in a way that supports them to value-based care is very transformational. So one of the things that we often do is help them create pods. So rather than working across 50 or 100 or 200 PCPs, basically shrinking down levels of accountability to 5 to 10 physicians. There's often a pod leader, so that's one physician who's within that practice, knows the doctors, they admit to the same hospitals, they refer to the same specialists, and so that person becomes the champion for these programs. You know, we had a retreat last year, and we had one of the physicians who was essentially the pod leader for all of the pod leaders. What was so interesting for him is that information that we brought at the point of care, he got it, and he disagreed with us. Then he took a look at his own chart, and he realized that one of his patients had a pulmonary condition that he had missed. Hmm, okay. He said that to the whole group, and it changed the whole way that they looked at the process, because all of a sudden, rather than this just being another box to check, they realized that this resulted in better patient outcomes. Yeah. When they heard that from one of their peers who was respected within that practice, the amount of influence, the amount of credibility that brings is very, very powerful. And then I guess it'd be interesting to get some perspective on how much the implementation process has changed over the past few years. Have we started to become more familiar with the company? The company's obviously deployed some capital into areas that are helped with that, like your sales cycle is getting pulled greater forwards. You have even more time on the platform before you go live. I guess, how would you contrast how the implementation process works now versus maybe how it worked a couple of years ago, even? One of them is clearly the fact that our business development process has been accelerated, and we are definitely getting longer implementation. The longer you can get, the better, even for things like, you know, just getting the good BOI process in place, getting the good, you know, getting risk-adjusted properly in the first year, doesn't just get you to the right, you know, revenue rate in the, in the in the first year when you go live, but it also just allows you to get that course of care kind of in place and ready to go for the first year. The second thing is we are now actually, and you can probably talk a little about this, Ben, we are starting to now, already implement some of the clinical... this is allowing us to start to implement some of the clinical programs and get them, you know, ready to go in year zero. So we have partners in year one that are already implementing some of these more sophisticated clinical programs that probably in the past, they wouldn't be entering into in year two or year three. And so that's, you know, tremendously helpful in getting kind of people up the curve faster. And the last thing that we're just now getting going on that's gonna be really helpful is, you know, we just invested, and there may be more. You can add more if you want, but I was gonna throw in, you know, we just acquired this company, mphrX, which has this Minerva Pro product that allows us to get much quicker integration with the EMRs which just gets more information back to us, which allows us to drive those programs even more efficiently and in a better way. That is so important because, you know, we're entering into so many more partnerships that are multiple TIN, multiple EMR, you know, kind of these distributed networks. So if you look at a place like very, very large group we brought in Detroit, United Physicians, the number of EMR combinations and instances there is many more than there are actually EMR providers because they're all on different instances of these different EMRs, and it's just really allowed us to, you know, getting that ability to do that really quickly and get that information up and running gives us, gives us the ability to, to, you know, drive the market forward quicker as well. And then when you look at, you know, obviously, there's a lot of focus in the past couple of years on MaineHealth. This is your first hospital partnership. You know, give us an update there on how that's going and I guess, how we're thinking about the broader population of opportunities to stay within health systems. Yeah, absolutely. I mean, first of all, the overall, you know, performance of. You know, we have a very big, very diverse Class of 2023 that came on. It's over 100,000 members. The good news about the Class of 2023, which includes MaineHealth, is that it is actually bigger than we thought it was gonna be. So you know, we were a little conservative with people like MaineHealth coming in, of how well we're gonna be able to pull through all the attributed members, get all the, payer contracts in place the way that we wanted to. That has worked out, you know, better than we expected, and in fact, our membership in MaineHealth by itself is quite a bit larger than we expected it to be, which is great. It's a little bit of a different model, obviously, in that, you know, primarily it's employed physicians. Yeah. There are some affiliated physician groups as well, but it's primarily employed physicians. So the way that you approach that is something that we had to learn and, you know, how you actually go in and work with the medical group to incent the physicians to do the things that in our other partnerships, you know, they're getting incented by the fact that they're getting 50% of the surplus back to them. But it's really a MaineHealth, it turns out, and particularly the medical group at MaineHealth, is a group that has historically been kind of pretty committed to high performance. I think they see this as, you know, many opportunities. One is to just provide better care for their patients, which is a big motivator by itself. It's an opportunity for them to really economically sustain that primary care physician medical group, which is, you know, continues to be a big motivator for them. And it, it's a way for them basically to also avoid unnecessary utilization of the rest of their system. That allows them to kinda get the right patients in the right environment in the rest of their system without having to invest, you know, incremental capital to do that. So all that, I think, has been aligning that group to really perform very well for us. And, you know, so far this year, you know, the group is performing in terms of a Medical Margin, PMPM basis, you know, right at or actually slightly better than we expected when we entered the year, so we're pretty encouraged by it. We're taking, of course, those learnings and can immediately apply them to the two big regional health systems that we're implementing in Dayton and Grand Rapids, so that's been helpful. Now, those groups interestingly get double benefit, 'cause they're getting the benefit of learning from what we're doing with MaineHealth, but they're also getting the benefit of they're both entering markets where we already had PCP group, partners. And so there's already infrastructure, contracts, everything was already set up there. So they kind of got a jump start to begin with. Plus the fact that they're getting the learning. So I think the implementation process for both Premier and Holland is actually going really well, and, you know, it's really encouraging that that's gonna give us, you know, the... I guess if you think about the way that we built, you know, the original network was, you know, we started with one partner group in Ohio, and as we built success, we built more and more on, and had success. You know, our success became evident. That became a big recruiting tool for bringing more groups in. You know, we're just at the very early stage of that for health systems, but so far, so good. Maine, performing well, implementation going well in these two new markets, so we're, you know, we're pretty optimistic and, you know, certainly expect that health systems will be, you know, a part of every one of our classes going forward. I mean, we don't have anything specific to announce for 2025, but I would expect that health systems will be part of the mix going forward. Okay. Then, you know, it's good to hear on the second quarter call that you're already signing partners for 2025, and you made some comments- We are. about the pull forward, a little bit of the sales cycle. Yeah. I guess as we think about it, I'm guessing you're not gonna tell me the size of the 2025 class today, but when we think about it conceptually, I guess, how should we think about whether there are or are not any kind of rate-limiting factors around, like, what the size of a class could be, your comfort level onboarding, a certain level of membership, things like that? Yeah, there really is nothing limiting it other than, you know, our understanding with the partner that they're kind of ready to go. So, you know, it's worked out pretty naturally that we've grown up now, that for a couple of years in a row, we're gonna have classes that are, you know, in excess of 100,000. So, you know, we don't quite need to be quite that high to get to the numbers that we put out there for, for 2026. So hopefully, we've been a little bit conservative in that. But, you know, certainly there's, you know, there's nothing that's gonna keep us in the Class of 2025 and 2026, you know, on top of these very big classes in 2023 and 2024 to get to that, you know, 850,000 MA members- or something like... I mean, there's nothing there. If we have a couple of big groups that are available to come in and, you know, for whatever reason, one of those classes could be bigger than what we've done, there's nothing keeping us from doing that. And particularly if, you know, it's bigger because we're bringing in, you know, a couple of very large players. Like this year, we brought in two pretty big groups with MaineHealth and United Physicians, you know, one health system, one kind of distributed, PO kind of network. You know, if we're bringing in, if for some reason there was a couple of very large ones to bring in and that pushes the number higher, there's no, there's no, like, membership limit on what we can bring in each year. Okay. And can you guys talk a little about your success, you know, recruiting physicians into the existing practices? That's been another lever of growth, like participating in success that your, your physicians are having in a market. I guess, how have those trends worked over the past couple of years? And, you know, it's been a pretty tight labor environment. Has that impacted the ability to recruit physicians at all in the practices? Well, and maybe there's two different ways to talk about this. One is the role that we have when we go in and establish an anchor partner in the market as sort of a consolidator within that market. So that's a little bit different than what you're asking, I think, and we've been obviously pretty successful there. So about, you know, a third of our, what we call same geography growth, which has been, you know, kind of low- to mid-single-digit in our partner groups, you know, over the last few years, about a third of that is really coming from that, you know, just consolidating other physician groups essentially into that existing group. Supporting the rest of the growth, which could, you know, require obviously, the ability to recruit physicians into the existing partner, It's obviously, you know, it's a challenging environment to do that, but I think we've been pretty successful there too. But two things are helping us out. I'll let Ben talk about this, but one is, to begin with, we have very low physician turnover in our group, so that's helpful, so you don't have as many h oles to fill. And then, you know, we've had a number of programs that we partner with our physician groups with to, you know, help them recruit new physicians in. I don't know if you wanna talk about, you know, our ability to kind of do that side of it, separate from the kind of consolidator function that we have. Yeah, no. I mean, we work very closely with our partners. As Tim mentioned, you know, our physician retention is in the, you know, I think 95% range, which is very, very high you know, nationally. And then, you know, we offer the ability to help them go and, you know, post, you know, primary care physicians, either getting net new grads, whether they're right out of residency or they're moving into the geography, as well as physicians who have their own practices and want to transition and join an existing agilon practice. It may be a one or two-physician practice. You want to join one of the, the larger aggregating practices that we have. We've helped facilitate, identify that, create the economics to do that. And as I talk to a lot of these physician groups, you know, one of the concerns nationally is the sustainability of primary care. You know, I speak to more physicians. You know, one of them is a third-generation doc, who said that he was pretty pessimistic a few years ago about the future of primary care and would have told his kids, "Don't go into medicine, definitely don't go into primary care." He's now recruiting actively into his practice. That hadn't happened bafore. There's a level of optimism that just didn't exist before. I think it's a combination of, you know, one, the economics have really flipped, right? You know, going to primary care now can be a very, very attractive economic opportunity, but they're also enjoying the practice more. They're feeling a greater s ense of ownership. Their patients are having, you know, better outcomes. And actually, some of our most successful physicians are doing it, not by running faster on that hamster wheel, but by seeing less visits per day, but longer visits- Sicker patients Focusing on those sicker patients. And so they're really enjoying that, and when they speak to colleagues, that's very attractive. Then pivot a little bit to the ACO REACH side. I think that was, you know, like a, a positive surprise in the second quarter's results that, you know, that was running so well, and then also that you were increasing your, your outlook for the year there. Could you just help us understand a little bit the, the kind of the moving parts? Like, what gave you the visibility that your performance was better than maybe you initially expected, and how you expect that plays out, both, you know, the balance of this year, and then as we think about the sustainability of that performance, as we think about the next couple of years and getting out to your guidance? Yeah. No, absolutely. So, yeah, we're really... We're in kind of a watershed year for ACO REACH for us- After, you know, it's been a pretty volatile program for the first couple of years. So as you mentioned, it's really interesting when we came out in Q2 and said, "Hey, hey, look, based on everything that's going on in the current environment, we're gonna be a little bit more conservative with the MA side of it." And we actually lowered our MA Medical Margin net by about $30 million, and really offset that by taking our ACO REACH up. You know, the combination of those two changes, the sort of more conservative viewpoint on MA and a really increased confidence, which I'll answer your question here in a second around ACO REACH really gives us a huge amount of confidence in the guidance that we put out there. So we're pretty confident with that kind of new mix that- We're confident in the guidance that we put out for at Q2 for 2023. So as you said, a big part of that is ACO REACH, so why are we confident in that? Well, a couple of things. First of all, the big volatility in ACO REACH over the last couple of years has been around what's your revenue number gonna be? So we get really good visibility from CMS on our own numbers in terms of what our RAF performance is gonna be and what our cost performance is. But this, you know, what the overall, at the end of the day, benchmark revenue rate's gonna be, which just moves with cost during the year. Or in other words, predicting what the retroactive trend adjustment is gonna be, has really been a big problem. So the first thing that happened to us was, you know, around the end of the third quarter, beginning of the fourth quarter last year, CMS really did start providing significantly better information- to all of the participants around what the overall Medicare Fee-for-Service reference population looks like, which allows us to calculate what we think the RTA is gonna be. And so that gave us a more complete view of revenue. So right now, you know, well into the year, you know, we feel like we have a really good viewpoint on what that RTA is gonna be. We obviously have a good viewpoint on what our risk adjustment numbers are gonna be. So we have, you know, good confidence in our revenue number. But the more important thing that's happening is, and maybe we didn't quite get this, is, when we started the year, was when you're in a year of, sort of, a little bit higher utilization, our model is, of course, as we talked about in the very opening question, designed to outperform that utilization trend. We are seeing that significantly more clearly in ACO REACH because we have the ability to compare our performance back to that Medicare Fee-for-Service population data that they give us. Our costs are actually... Our utilization is actually outperforming that reference population by, like, over 300 basis points. And now, that's not surprising because you're comparing it to a much more, you know, unmanaged Fee-For-Service population. But, you know, it's really encouraging for us to see that the impact of our platform and our, our processes, our programs, our clinical programs on that, ACO REACH population, you know, is really having a dramatic impact on cost. So, you know, now, for this year, we're seeing much more confidence around the visibility of revenue. Really, really good spread between our performance- the Fee-For-Service population. That's driving, you know, outsized performance overall. As you go into the future years, the interesting about ACO REACH is, the revenue number will just move with whatever the cost trend is. So as long as, as you go forward into the future, you can perform on a cost basis, at least as well as the reference population, you kind of will maintain that kind of $30 million you know, buildup that we've gotten in profitability. And of course, that's not gonna happen. So as we go forward, we will... Clearly, our model is, you know set to outperform the reference population, so we would expect that as we move forward through 2024, 2025, and 2026, that our, you know, our profitability in ACO REACH will actually expand below the 30 million-35 million we're forecasting this year. Then the second thing is, we took kind of a, you know, one-year hiatus on adding new members. Yeah. And a lot of that was because there was a lot of uncertainty and volatility in the program.. You know, it wasn't, you know, it wasn't something that people wanted to jump into. We're now jumping back in next year with a couple of new partners, and we'll be, you know, adding about 25,000 new members as well. Yeah. So, you know, we get the benefit next year through 2026 of both actually able to now grow the membership again and really feel much more comfortable to how our model works in the context of ACO REACH. So, you know, that in context with, you know, what we've said about how we're gonna now end the year on MA, we, you know, we've got a lot of confidence in delivering this year's guidance. And, and all that actually helped us out going into 2024 as well. Yeah. So you think about, like, what the size of the business could evolve to beyond 2024. Like, I imagine that you have as many Medicare fee-for-service patients as you do as MA patients in your panels, or something about that, if national penetration is 50%? Yeah, that's probably about right. Yeah. In theory, you could have an ACO REACH book that's as large as your MA book over time. How do you guys think about that, given that it still is a newer program? Like, what's the right size for that? I think the answer to that question will come more when we understand what the next generation of ACO REACH is. So right now, the program is, you know, a CMMI innovation program and it's scheduled to sunset at the end of 2026. CMS has obviously come out and been very vocal about that they want, you know, all of Medicare patients in some kind of a value relationship going forward. So, you know, the expectation. And by the way, I think it's also been clear that, when you put patients into a value scenario, the ones that perform best are the ones that are in a full risk scenario. So we would, as ACO REACH, so we would expect that, you know, there would be some kind of a, you know, next generation of full risk opportunity for fee-for-service patients that's going to, you know, move on beyond the end of ACO REACH. I think when that gets announced, that'll be that'll be the key input to the answer to your question of, "How many more of our current partners have Fee-For-Service members that they're, you know, perhaps are participating in some other ACO program or something, that would then basically be, you know, brought under the agilon umbrella under a full risk scenario?" So I mean, ultimately, yeah, at the end of the day, I mean, it would be nice to have, you know, 100% of our Medicare members in our, 100% of the Medicare panels in our partners being on a program. But I think we're gonna have to see... You know, obviously, ACO REACH got off to an interesting, volatile start. Sure. We're gonna have to see what the next generation is to see how that, how that really plays out. Okay. And then a big focus, obviously, for the next couple of years is gonna be the transition to the new risk model. Just give us a sense of, you know, as you guys have analyzed the risk model transition, I guess what you see is, you know, the impact to the company initially, and then what you're working towards to, you know, to offset whatever those impacts are. Yeah. So let me give you about a minute-and-a-half answer, and then maybe- Sure ... you have a couple of interesting thoughts on this to make sure we don't run out of time. No. But, you know, overall, when we've looked at the impact of it, you know, we're in a little bit different environment than people that are in, like, you know, super high, you know, risk adjustment level. You know, our risk adjustment, average risk adjustment is much lower than most. We have a pretty broad population out there. Our average risk adjustment, our average RAF scores are like, you know, just a little bit over 1. When we've looked at the impact of it... And now we get a pretty good view, right? Because all of the, the impact of the model on our risk scores is, you know, we're two-thirds of the year doing the really good work that's gonna get us to how we get paid next year. You know, we believe that the impact of the transition to V28 by itself, the really good work that we continue to do on risk adjustment with our members, and when you put that, in fact, you know, in combination with the actual benchmark increases coming in next year, you know, the mix of members that will be coming in, all that combined, we feel like, you know, our overall revenue number next year, with all this in, should be, you know, with somewhere in the flat to slightly up on a PMPM. Yeah. So that's good news for us. You put in combination with that, you know, all the great work that we're doing around clinical programs and, you know, actually getting more confident in our ability to beat that fee-for-service population in terms of utilization and drive costs out, you know, it gives us a lot of conf- And that, and the third thing is, we have a really strong class coming in. Yes. It's gonna start at a higher than average medical margin. We feel really, really good that, you know, we're in a good shape rolling into 2024. It lets you have minute 23- Yeah, that's, that's perfect. because I think you had some comments earlier. Yeah. You know, what I would say is, when you take a look at the changes in V28, a lot of them are really directed on what I would call very aggressive practices. Our physicians tend to practice in a traditional, you know, primary care model. They're seeing commercial patients, they're seeing Medicare patients. It's not a purpose-built clinic, so we're not screening every single patient with an echo to see if they have signs of heart failure. We're not doing CT scans to see if there's any, you know, atherosclerosis of the aorta. We're not regularly diagnosing, you know, protein-calorie malnutrition, all these diagnoses, which aren't sort of bread-and-butter medicine. We practice traditional bread-and-butter medicine. We do a really good job identifying the appropriate diagnoses, largely to connect them with the right programs, to make sure that if we have a renal patient, that patient is being hooked up with a team that can monitor their medications, that can control their blood pressure, that can give them treatment options. So when you take a look at the fact that some diagnoses are disappearing in V28, some are having their risk adjustment factor lowered, some are actually increasin those diagnoses that tend to be bread and butter through the PCP, not sort of an army of nurses going on a fishing expedition. Those ones tend to do very, very well in this new model, which I think is sort of confirmatory of our approach, which is to invest in primary care and primary care relationships, which is why I think we feel pretty good about, you know, what the next couple of years look like. Okay. Well, fantastic. I think that's a great place to leave it. Thanks for your time. Thank you very much for your time. Great. Thanks for coming. Thanks, Steve. Thanks so much.