Greetings and welcome to the Amedisys investor call to discuss the signing of the Contessa acquisition. At this time, all participants are in a listen-only mode. A brief question -and- answer session will follow the formal presentation. If anyone should require operator assistance during the conference, please press star zero on your telephone keypad. As a reminder, this conference is being recorded. It is now my pleasure to introduce your host, Nick Muscato. Thank you, Nick. You may begin. Thank you, operator, and welcome to the Amedisys investor conference call to discuss our signing of the definitive agreement to acquire Contessa Health. A copy of our press release, supplemental slides, and related Form 8K filing with the SEC are available on the investor relations page of our website. Speaking on today's call from Amedisys will be Paul Kusserow, Chairman and Chief Executive Officer, and from Contessa, Founder and Chief Executive Officer, Travis Messina. Also joining us is Chris Gerard, President and Chief Operating Officer, Scott Ginn, Executive Vice President and Chief Financial Officer, and Dave Kemmerly, Chief Legal and Government Affairs Officer. Before we get started with our call, I would like to remind everyone that statements made on this conference call today may constitute forward-looking statements and are protected under the safe harbors of the Private Securities Litigation Reform Act. These forward-looking statements are based on information available to Amedisys today. The company assumes no obligations to update information provided on the call to reflect subsequent events other than as required under applicable securities laws. These forward-looking statements may involve a number of risks and uncertainties, which may cause the company's results or actual outcomes to differ materially from such statements. These risks and uncertainties include factors detailed in our SEC filings, including our Forms 10-K, 10-Q, and 8-K. In addition, as required by SEC Regulation G, a reconciliation of any non-GAAP measure mentioned during our call today, the most comparable GAAP measure will also be available in our Forms 10-K, 10-Q, and 8-K. Thank you. Now I'll turn the call over to Amedisys Chairman and CEO, Paul Kusserow. Thanks, Nick. Thanks to everyone for joining our call on such short notice. We're excited to take this opportunity to discuss a true strategic milestone for Amedisys, the acquisition of Contessa Health. When I first started with Amedisys in late 2014, we made a commitment to our patients, our employees, and our shareholders that we would strive to have best-in-class clinical quality, become the employer of choice within the Home Health and Hospice industries, implement operationally efficient practices, grow at above industry rates, and innovate around our core businesses to drive more and high-a cuity care into the home. With the signing of this deal, we are taking a material step in realizing our innovation strategy to provide more and better care in the home to all who want it. Further differentiating ourselves from the traditional Home Health and Hospice industry. Let's talk about the deal. The leader in its space, Contessa, is a tech-enabled hospital at home, SNF at home platform acquisition, one that Amedisys will continue to invest into for future growth in Contessa's current lines of business, but also for expansion into new areas of care in the home, such as palliative care and primary care. The acquisition also adds significant capacities and capabilities to Amedisys, which include a new Medicare Advantage-focused claims payment and analytics platform, underwriting and actuarial capabilities, and additional experience in bundled payment arrangements and risk-taking relationships. Other strategic benefits from this acquisition include. It adds high-a cuity to home-based care to our current service offering, allowing Amedisys to create a premier home-based health system. It adds significantly to Amedisys' total addressable market, the TAM, of the in-home care services market for Amedisys from $44 billion - $73 billion. It differentiates Amedisys as the first national home health provider to move into the tech-enabled hospital at home and SNF at home space in a meaningful way with the ability to scale across a large geographic footprint. It provides an innovation platform for future investment and growth into additional in-home care services. It expands the Amedisys Home Health and Hospice M&A pipeline to include new or enhanced joint ventures with health systems. It accelerates admissions growth opportunities for Amedisys Home Health and Hospice to seek care coordination and preferred provider arrangements with current and future hospital at home and SNF at home hospital partners. It leverages Amedisys' nationwide home health footprint, industry-leading quality home health clinicians, and home health business development staff to accelerate Contessa's revenue growth opportunity. It enhances the ability of Amedisys to provide quality care and outcomes across a continuum of care, and it lowers costs for commercial, Medicare, and Medicaid Advantage payers. It also creates an attractive platform to recruit and retain highly trained and skilled clinicians interested in providing high-a cuity c are in the home. Now, for a better understanding of the company, their history, and development, I'd like to turn the call over to Travis Messina, the Founder and CEO of Contessa. Travis has been at the helm of Contessa since he founded the company in 2015. Prior to that, he was Chief Investment Officer at Martin Ventures and Vice President of Development for Vanguard Health Systems, and an Investment Banker for Signal Hill Capital and SunTrust Robinson Humphrey. He has built a talented management team and developed a culture of quality and service that mirror our culture at Amedisys. I'm extremely proud and excited to welcome Travis and all of the Contessa employees to the Amedisys family. Travis, welcome, and thank you for joining us. Paul, I truly appreciate the kind words and ability to join you and the team today for this exciting announcement. I would also like to thank Chris, Scott, Nick, Dave, and the entire Amedisys team that made it possible to get to this important milestone. I speak on behalf of the entire Contessa team when I say we are excited to reach this point and thrilled for what we will accomplish together in the future. Having an M&A background myself, I know that to maximize the success of a transaction, there must be a solid alignment between cultures. After spending a great deal of time with the team throughout the diligence period, I am confident saying that alignment clearly exists. Before we talk about our future as one team, I think it would be helpful to give an overview of Contessa and what brought us to this point. We started Contessa with the ambitious goal of creating a virtual integrated home care platform so that any patient could receive whatever level of care they desired. Our initial focus was on providing hospital-level care in the home. There has been a lot of talk about hospital at home programs since the onset of the pandemic, I want to clarify what we mean when we talk about hospital-level care in the home. When Contessa team members discuss the programs we operate, we are talking about patients that have failed ambulatory treatment and meet the requirement to be admitted to an inpatient facility. We target patients that are having complications of general medical conditions for things such as congestive heart failure, COPD, pneumonia, et cetera. These conditions account for a substantial portion of inpatient admissions and rarely necessitate the level of monitoring that would require a patient be admitted to an institutional facility. Given the way the health system currently operates, when patients need hospital-level care, they have two options. They either get admitted, or they leave against medical advice. Contessa creates a third option. With the context of the patients, we initially target in mind, I think it is also important to note why we started with this population. These patients have the highest acuity and the most emergent events. Given these two characteristics, we knew that if we could generate high-quality outcomes with attractive unit economics, we would be able to expand clinical models to cover the entire continuum of the healthcare spectrum, and we are starting to do just that. In order to generate high-quality outcomes at attractive unit economics for this level of care in a home setting, Contessa had to establish three core business capabilities. First, we established the clinical infrastructure that consists of care protocols, policies, and procedures for rendering institutional-level care in the home. Secondly, we established MSO-like services to contract for our care models and risk arrangements. Virtually all of our managed care contracts are structured as episodic risk arrangements, that required building out meaningful infrastructure to take risk: capabilities such as claims analytics, medical economics pricing, actuarial underwriting, and ancillary network contracting. Lastly, we established our proprietary informatics platform, Care Convergence, which has three main products. First product, Tracker, enables us to manage the logistics associated with high-a cuity c are in the home. This ensures that people get the equipment to the homes of our patients and turnaround times that mirror those experienced on the floor of a hospital. The second product is Knowledge. This is the analytics portal that leverages proprietary algorithms that enable us to underwrite our risk arrangements with managed care organizations, predict the likelihood of death for our complex patient populations, and manage our business with real-time insight into clinical outcomes and financial performance. The last product, Exchange, is the claims platform that enables us to adjudicate claims for providers participating in our care models. Historically, Contessa has utilized equity joint ventures to partner with leading health systems to operate these care models. We started with the Marshfield Clinic Health System in Wisconsin and have gone on to add numerous high-quality partners, including Mount Sinai in New York, CommonSpirit Health, Ascension Saint Thomas, Prisma Health in South Carolina, Highmark Health, and Gundersen Health. With these provider partnerships in place, we began securing reimbursement from health plans across the country, and thus the ability to apply the model to patients beyond those in pilot programs. We have generated excellent outcomes, including patient enrollment of approximately 85% for those that qualified and are offered the program, reductions of readmissions by nearly 40%, and patient satisfaction scores in excess of 90%. While we are extremely proud of these outcomes, we are especially proud that these outcomes have been achieved while operating under value-based arrangement. Our managed care risk arrangements are episodic risk arrangements and make us financially responsible for all related to care during the applicable episode, typically 30-60 days. These episodic rates provide the payer a prospective discount to the 30-day historical baseline while capping the spend at the agreed-upon episodic rate. With a solid foundation of partners, a demonstrated ability to execute on the program, and a rapidly increasing market demand, we knew we needed a partner to help solidify Contessa as the leader in this space. We knew we needed a partner that possessed a strong reputation amongst payers for innovation and value and had the scale and quality needed to meet the demands of the significant addressable market. Not surprisingly, Amedisys checked all those boxes, and the rest, as they say, is history. Thanks for the overview, Travis. Again, a heartfelt welcome to you and your team. The signing of this deal marks a major step in our innovation strategy and sets the stage for Amedisys to continue to meaningfully differentiate ourselves from other providers and most importantly, bring the gift of care in the home to more people. As you can see, there is much to be excited about as we embark on this journey of innovation with Contessa. With that, we will conclude our prepared remarks. Operator, can you please open the call for questions? Thank you. We'll now be conducting a question- and- answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate that your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. One moment please while we pull for questions. Thank you. Our first question comes from Brian Tanquilut with Jefferies. Please proceed with your question. Hey, Brian. Hey, good afternoon or good evening, guys, and congrats first to Travis and congrats to Paul as well. Very happy to see this merger or this acquisition. Paul, I guess my first question for you, how are you thinking about this deal being accretive to your growth? I mean, is this growth accretive to Amedisys? How do you view it as it relates to your growth runway? You obviously laid out the TAM expansion. If you can give us some color on where that will come from, also, just the JV discussion, something that in the past you haven't really done much of. Just trying to see what it does for your growth rate, and also just all the capabilities that it adds to Amedisys. Well, as you see, when we talk about the financials, Contessa is still in its early stages, we're going to continue to invest in the expansion. What we like here is very strong top-line growth. What we liked is we were going through and talking with its existing clients. We think there's tremendous capability and capacity to expand within its client footprint. We also have tremendous amounts of folks who are interested in expanding on this. I think COVID and the waiver drove that. In terms of what it's going to do for earnings, clearly, we're going to report this separately. There will be some losses. There will be some investment. Again, I think what we've proven is that we think with a lot of cross-pollination, we can probably improve on getting to breakeven. We will be definitely investing. We plan on investing. This will be, in a lot of ways, our innovation arm, and this will be an opportunity for us to continue to expand, particularly continuing to drive more hospital at home, more SNF at home in a different way than what we're doing with Sound Physicians, continuing to expand on our palliative work, and then we'll be moving into primary care. We're anticipating dipping our toe in the water on the primary care level. I don't know, Scott, from a financial perspective, is there anything you want to add? Just coming back and looping around on just what does this mean for us as Amedisys. I think, just the JV opportunity that's out there, I think the growth for us at Home Health and Hospice admissions, I think we have both an organic and inorganic opportunity from enhanced relationships or hospital relationships with what they already have from those JV partners and any future JV partners that come up. I think our ability to work with those partners and offer really some tremendous services, I think there's a lot of upside potential in this deal outside of what it means just strictly from Contessa. Got it. Paul- Go ahead, sorry. No, Travis, I don't know, Travis, any comments? I think that you and Scott hit it well, Brian. The thing that I would just echo is that there's a lot of opportunity for top-line growth within the existing partner base, as well as the additional cross-pollination opportunities that Scott had just referenced. Got you. I guess, follow-up, just on the financial aspect of this deal, right? Paul, you're calling investments, and I think there's roughly $6 million-$9 million of EBITDA drag this year. Taking out the corporate overhead of Contessa, as we look at the contract and the core operations of Contessa at the hospital level, what does that look like? Is Contessa profitable at that level as you think about MLRs and just the true operational financials? Yeah. Travis, you want to take that one? Sorry to cut you off, Brian, great question. The answer is yes. If you look at the JV economics, it's actually, from a gross margin perspective, a very strong business. These JVs typically run in the low to mid 30% margin range from a gross margin perspective. What you're seeing is each individual JV performs very well and the company has built an infrastructure to support growth. That's where the drag comes. If you look at each of these individual JVs, it gives a lot of confidence and ability as we scale this thing to start seeing economies of scale. The JV performance is something that really was attractive to us when we were looking at this company diligence. Yeah, if you talk about capital light spend on this company is quite impressive. That was one of the things, and we're going to build into the overhead. Its elements and capabilities that we believe as we continue to expand that we'll need. That's going to be the initial drag over year one and two. I know, Scott, you want to comment on some of the economics and how the capital light process works? Yeah, no, I think you hit those well, but I'll just add that it is the cost to entry of the new JV partners roll out is pretty low. The breakeven point is low. When you look at what we're seeing from an operating impact, adding JVs isn't as much as a pull- down. It's just ability to go scale this and to your point around the core structure is built. Travis has done a great job building that team and really getting this ready to scale. Feel good about that ability, as we move forward and look to do other things. I think you'll see us continue to invest in the IT platform as we think about increasing scalability around that. The rest of any kind of other spend you'll see us look towards is any kind of M&A activity, as Paul alluded to, primary care, other things that make sense from innovation perspective to build this platform out. Gotcha. Last question for you, Paul, sorry for the third one. What does this do for MA for you? I know in the past you've given guidance on where you want MA to be as a percentage of your business and value based as a whole. Just curious, where does this take you in terms of your MA penetration and your view on what it does for your tool belt as it relates to risk-based contracting? Yeah, fee for service is still the coin of the realm in terms of the traditional business. What this does is it allows us, particularly in an era of conveners, that are trying to commoditize things out there, this allows us to show up with a much richer toolkit. It allows us to extend the addressable audience of the health plans and provide care in the home. That, therefore, I think increases at least the conversations that we've had since it's been out. They're very brief, of course, people have been calling in, but is that this expands our capabilities to such a level that, again, we aren't going to be commoditized on this and with the conveners, that's a concern. Again, it allows us to move up the acuity chain, and it gives us more leeway or more cushion by our ability to take these people out of institutions, and therefore the margins there are much better due to the level of complexity of care that's desired. These folks are particularly post-COVID, they are electing overwhelmingly to try to be taken care of in the home. We see this as a very high top line, fast growth opportunity. Again, we think it somewhat displaces some of the traditional ways people look at us. At least we're hopeful it will. Awesome. Thank you. Congrats- Thanks. Thank you. Our next question comes from Matt Larew with William Blair. Please proceed with your question. Hey, Matt. Yeah. Hey, Paul. Congrats on what's a very interesting deal for the company moving forward. Just quickly on the revenue growth here. I think just based on the deck, it looks like around $25 million or so of revenue this year going to something like $64 million, $65 million next year. How much of that is coming from existing? Travis alluded to both growth with existing partners as well as new opportunities. How much of that is coming from each? Is that the kind of growth profile we should be thinking about, making this business double every year for the foreseeable future, given the market opportunity? Travis, you want to take that one? Yeah. Paul, I can take that one. Matt, we'll give a lot more color around what the revenue profile of the company looks like, at the end of the quarter when we release earnings. You're right, and we gave those pieces specifically so you could see that. It's coming from both. It's coming from penetration within existing JVs, as well as new JVs, coming from expansion of hospital at home, SNF at home and potentially, some new services as we work with our JV partners to roll out new services. We'll give you a lot more clarity around that, at the end of the quarter. Matt, this is Travis here. The category is pretty strong, Matt. We've looked at this, we've reviewed this with Travis. Again, there's a lot of virgin territory ahead, we're excited. Due to COVID again, and the waiver that's out there for hospital at home, there's a lot of people who are trying to figure out how to do it, realizing when they get into it's quite complicated. It's a risk entity. I'll let Travis put forth both rosy elements of expansion within our existing core and then what we've got in the pipe. Yeah, absolutely, Paul. Matt, to add a little additional context to how we're able to achieve these types of growth rates, there are multiple levers that we pull to produce those types of growth statistics. First and foremost, the model that we've created and that we're implementing in markets was never reimbursed by health plans, and to a great extent, prior to our founding. We are literally going one by one with those payers. Every time you bring a new payer into the market, you increase the addressable market and the number of addressable lives. Secondly, with our health system partners, it's always a rollout plan that is well-defined amongst the facilities. All of our partners have been multi-site health systems. We're starting at one, two, three locations and expanding throughout their footprint as we go. You have this dual lever, if you will, that enables you to achieve growth by bringing on more health plans as well as bringing on more admitting sites. Okay, that's great. Then I'll try to get a two- for- one here, and it's about expansion beyond the core hospital at home market. Part one is probably more for Travis, which is the Care Convergence platform. How much is that purpose-built for a product like hospital at home versus something being leveraged into other high-a cuity home markets? Piece two about that is just maybe an update, maybe more for Paul, I guess, on legislatively how you're feeling about the momentum for some of these models that would really maybe add some potential market for the Contessa platform. Sure. Okay, Travis, you first, I'm going to punt to Kemmerly. Absolutely. Matt, as it relates to the platform, initially, we built it with a lot of flexibility because we knew we were purposefully going to expand into additional care models. We started, as I mentioned, with hospital-level care at home. We have now launched a SNF- at- home program exclusively within Medicare Advantage plans, and so it had the ability to incorporate intensive therapy services and cover that type of care. Now, as Paul mentioned, we're moving into palliative services. It is structured in a manner such that enables us to bring different care models onto the platform to handle things such as the logistics, the performance, et cetera. DK? Yeah. What'd you want me to address, Paul? I'm sorry. I think Travis covered it. I'd like you to talk about, I think what Matt was asking is incrementally, one, Matt, just to be clear, we did not model this. We modeled that at the end of the public emergency that the waiver would go away. I think we are going to clearly go to Washington, and Dave will lead this effort to lobby to extend the hospital at home waiver. Our models don't reflect that. Dave and Scott Levy have done a really nice job of getting stuff done when we haven't anticipated. Dave, what are our efforts going to Washington to try to push this through? They'll start immediately. We'll work with CMS and CMMI and others up there to see about extending the waiver. If it looks like it requires any statutory authority to extend the waiver beyond the public health emergency, we'll certainly go to Congress and work that angle as well. We'll also immediately look for partners in this space. We may find some willing partners in, obviously, in our JV partners and in the hospital space. We'll look for anybody and everybody that has interest in SNF at home, hospital at home, but specifically in this case, hospital at home waiver. We're looking for friends, and we think we'll find them. If not, we'll push this rock. We're confident in our ability to push it. It just makes a whole lot of sense because it's good for patients, it's good for taxpayers. It's good for all payers, public and private. This is a home run for everybody. There's no downside. Last but not least, it's what we all know and found out more during COVID, during the pandemic, is people want to be in the home. We've been saying that for a long time, and this just makes our case even stronger. I'm very confident that we have a compelling story to extend the waiver, and it's not just about the Amedisys Contessa offering. It's good for patients out there and for the industry. We'll find out as we press this, are there those that disagree with us? I don't suspect there are. I suspect it'd be a lot tougher argument to oppose the extension of the waiver. Probably more than you wanted to know, giving you some of my strategy, but we're on it immediately. Yeah, I'd say, Matt. Okay. Thanks, Paul. In addition to that is I'd say that the high-quality prestige health systems, not-for-profits, are the ones who this resonates the best with, as you've seen from the client list. This is where we probably will get our most willing folks initially who want to do this. We think it's going to be those entities and those people within those organizations we think will be the most helpful. Thank you, Matt. This is Travis. I'll add a little additional context to Dave's comments, specifically as it relates to finding friends to create that alliance, if you will. There have been over 130 hospitals in about 32 states that have been approved for the waiver, more are signing up each day despite the waning of the public health emergency. Clearly there is that interest and demand from the market, and we are already part of those efforts and look forward to being a part of the Amedisys team to leverage that bigger scale to support that initiative. That's a great base to start with, and it won't take a lot of convincing with that crowd. Good place to start. Matt? Yep. Thanks all. Thanks, Matt. Thank you. Our next question comes from Justin Bowers with Deutsche Bank. Please proceed with your question. Hey, good evening, everyone, and congratulations on a very innovative step in the space. Some good questions thus far. I guess I kind of wanted to ask Matt's last question a little differently, and that is, on the policy front, how much has D.C. and where the puck has been going over the last couple of years and what you see happening at CMMI, et cetera, how much of that has played a role in the strategy for what you guys are doing? This is for Paul and Travis. Then how do you see this playing out over the next three to five years? I'll pause there. Yeah, I would say, first, thanks, Justin. Good question. I would say that the attitude in Washington has shifted tremendously. I think it's been influenced by, again, COVID. I also think when they're looking at the baby boomer tsunami that's starting to hit with the leading baby boomers now at 76 and needing Home Health and Hospice, that the economics of this and the preferences of these folks are demanding customized in-home services. When you add where this demographic wants to be, when you add the capabilities that Contessa can bring to this and the expansion of this market, with the consumer, the demographic forces at work, the psychographic forces at work, the cost structures that the payers are looking at as they try to push out of institutions, the fear of institutions due to what happened with COVID, it's really quite a perfect storm, that's why we think that things are moving in that direction. As you've seen AARP just, they've come out with this data that 95% of people want to live and die in their homes. I think that you're looking at what's going to be a huge demand, and for us, it expands the market in very different ways. What we're looking to do, I think in a lot of ways here, is to up our game and distance ourselves from the meat and potatoes players that are out there and show that aging in place is something that this company alone can get to. This is a first step in that, and we obviously have lots to prove, but this is a very important step for us. We believe we've earned it, as I talked about in my opening remarks. This is a strategically very important step for us to create differentiation with a wider and wider population that really needs us. Justin, this is Travis. I'll add a couple of comments to Paul's remarks. I think first and foremost, the initial hesitation from any administration was whether or not there was that desire from the health system. As I mentioned a second ago, clearly it's evidence that it's there. The second comment that I would make is that there was a similar pilot that actually was created or approved under the Obama administration that Mount Sinai in New York carried out. The typical trend has been that at the end of that demonstration project, you have about a five-year period while CMMI reviews the results before they create a formal plan. The end of that program was the end of fiscal year 2017 for CMS, and so you're kind of coming up on that timeframe. Again, now that there are so many health systems participating in the program, the anecdotal feedback is that the quality is there and that the desire is there. It absolutely is a part of that effort to continue pushing going forward so that it adds a decent amount of the payer base in addition to the MA plans with which we contract. Yeah. Justin, I'd just wrap this with, I think generally looking at it from the high level, I think you see CMS really is interested in value and outcomes. I think that has bridged the Obama to the Trump to the Biden administration. If you look at the most recent rule released this week on home health, you see the expansion of VBP nationwide, and that was something that began, that demo under the Trump administration. You see the Biden administration pushing it out, 50 states, and that's something we've been very interested in, as you know, and have pressed for. There are other examples. The power of a great idea and the power of this. This is about value, and this is about outcomes. Again, being in the home, to be repetitious and be on message here. I think we have a partner, if you will, or a promoter of these type programs in CMS. I'd be shocked if they went a different direction. I think that the training has started and the recognition by all payers, again, public and private, about value and outcomes, and this fits squarely in that. It's, again, what patients want, and it's a great deal for taxpayers, and CMS has to look out for that. I'm kind of repetitious here, but I just really think, I don't see regulatory hurdle. There's hurdles you got to get through to extend a waiver, but I don't think you see a willing agency on this front for the foreseeable future. Yeah. You answered one of my follow-ups in the process, Dave, so appreciate it. Travis, really appreciate your comments as well. I'll hop back with you. Thanks, Justin. Thanks, Justin. Our next question comes from AJ Rice with Credit Suisse. Please proceed with your question. Hey, AJ. Hi, everybody. How are you guys? Couple quick questions, if I could. Maybe just first of all, to put a fine point on the economic discussion. Makes sense that there's some startup losses this year. There's investment opportunities looking out. It's obviously growing the business quite rapidly on the top line. Do you have anything in mind in terms of when you think this business will be an EBITDA contributor to Amedisys overall? Sorry, go ahead, Scott. We'll come back around with a better view for you guys when we get this deal closed and show you what our projections look like on a go-forward basis to give you guys some more color. We know how important that is to show it. I think early on, we're going to be as aggressive as we can be to get the top-line piece in. As I said earlier, corporate structure really is built to scale fairly well, so that is going to support some high top-line, which will make us be able to get there. It's just going to be how aggressive we want to be going forward and what new things we add to this business line. We'll give you guys a better view when we come out with Q2 results and, as soon as this thing is closed out and what we expect, we'll certainly be able to give you guys some more details. Okay. Just a second question. On the idea of taking the risk on the 30-day episodes, the 60-day episodes, I guess I'd love to flesh that out a little more. Is Contessa at risk if that patient ends up going back into the hospital? Is there any particular ways you're managing risk? Do you use reinsurance? Give us a little flavor for your risk management strategies if you're taking on that risk. Yeah, AJ, this is Travis here. Appreciate the question. I'll give a little bit of context both to the rate setting, the risk structure, and how we hedge that risk. First and foremost, we get claims data extracts from the health plans for extended periods of time, typically at least three years, for whatever lines of business for which we may be contracting. We run those claims through our analytics platform so that we can come up with these episodes based on definitions that are agreed upon with the health plan. Once there is the agreement on the baseline, we then prospectively discount that historical spend to come up with a 30-day rate, and we do so on a DRG equivalent basis. At that point, that's the capitated payment for the 30 or 60-day time period for which we are at risk for related complications. The definitions are inclusive of HCPCS, CPT codes, DRGs, et cetera. Typically, it covers a pretty substantial portion of the total spend within that episode of care, that 30-60 days. We do reinsure. We have effectively stop loss, which we pay. We have a self-insured retention limit, where we fund up to that point. Beyond that, we have a co-insurance amount that we have to pay up to the cap to protect us in the event that there are significant complications and excessive spends. Okay. All right. Just my last thing is, obviously, the growth runway here is substantial. There's a lot of opportunity for investment. I guess conceptually from the Amedisys perspective, does this change your thinking on where you're going to spend capital, the acquisition dynamics that you look at for home health, traditional home health, I guess I should say, and Hospice? Should we think about your acquisition spend and investment spending being directed in a different area, or is this sort of completely additive to what you would otherwise hope to do in Home Health and Hospice? I would say this is additive. I think in no way, we're going to leave enough, and we're in the process of looking at our credit facility right now, and we'll try to get that done in parallel with the closing of this. We'll leave enough room to continue to do our ambitious plans around home health acquisitions in the near term. I think there'll be enough capital through what we're able to generate from our cash flows, which have remained strong in order to do what we need to do, and also add to the business. It really won't derail that. Okay. All right. Thanks. We're anticipating, AJ, that we have some good deals in the pipeline. We're hoping to, if we get lucky, get a couple done. If we hope to get a deal done before the end of the year that we're getting closer on. We're building out de novos. We're still doing that. I think the idea is we're still expanding, we're still employing capital to do that. There's places on the map we need to continue to expand. The other thing is, frankly, there's going to be places where we're going to need to provide coverage for Contessa. We're going to be doing de novos around some of the Contessa clients where currently there's no overlap. It provides us some really good opportunities, and we still expect the shakeout to occur, when the CARES Act money goes away. We're feeling like, this is something that's additional, and we'll still continue to have the powder to go off and do what we would've done normally. Okay, great. Thanks so much. Yeah. Thanks, AJ. Thank you. Our next question comes from Joanna Gajuk with Bank of America. Please proceed with your question. Hey, Joanna. Hi. How are you? Thanks for squeezing me in. I didn't expect it's going to be that long, but I guess I'll take that. Thanks for taking the question. Just to clarify some, I guess, basic concepts here, because it seems Contessa does not employ any providers, right? Is this the situation where that's why, I guess, you guys do these in JVs with hospital systems because the hospital partners actually staff these models. Is that how it works? Joanna, this is Travis here. I appreciate the question. I'll provide a couple of clarifying comments. Typically we try to leverage the providers of our health system partners. It's not the driving reason behind the partnership. If I look at the care team, the way to best think about it, the admitting hospitalists are typically employed by the partner health system. The nurses that are providing the care in the home are a mix between nurses that Contessa employs in certain states, and in other instances, we do partner with the local agency. In some instances, that's an agency that is run by our partner health systems, and in other instances, it was run by a third-party agency. This is where it became absolutely critical in a lot of the sense, behind the strategy with the partnership with Amedisys came to fruition because this is not traditional home health, and making sure that you have someone who's willing to invest in high-quality nurses, which they obviously have a track record of doing so, was absolutely critical to the success. The last reason for the partnership is not necessarily, again, for their providers. When you look at members of health plans that need hospital-equivalent care, typically 80% of the time, they first present at a hospital. If you want to provide that level of care in the home, you have to have a partnership whereby you have access to that admitting site and you have the involvement of the health system, so you can treat a patient of that acuity. Right. I guess especially the last point of who would refer patients to you, that has to be essentially a hospital partner of yours. Usually these JVs, what's the stake that the hospital takes? I assume it's minority, but how small or how big, I guess? Yeah. Typically, our partnerships are either as close to 50/50 as possible, but in six of the eight partnerships, Contessa has 51% ownership. Okay. Also what I was getting at with this is that, with this rapid growth that is expected, right, for the Contessa platform, we're talking about more than doubling revenues. How can you ensure there's enough labor, I guess, to be able to staff these programs? It seems like you have your own employees, and I guess, the hospital partners obviously are vested in it, they would be able to, I guess, staff some of these models too. I guess outside of that, kind of any color on the labor and ability, I guess, to staff these models and, with the growing demand and competition, I guess, from different settings, what gives you confidence that you can staff these models? Yeah, Joanna, I'll take a first stab at that, and I'll let some of the team members from Amedisys chime in. We look at staffing according to the care team members. First and foremost, the admitting hospitalists, their staffing ratios are pretty comparable to what they are on a traditional unit. They're in the mid-teens range from a panel size. Having appropriate hospitalists is well within the realm because of the fact that they have the ability to see just as many as they would see on the floor because they are leveraging virtual visit capabilities. They are not making visits into the home on a daily basis. We employ through our joint ventures another care team member that's a nurse, but we call them a recovery care coordinator, and they are, in essence, a care management function. They are overseeing the care, but they don't render the care. They typically have about a 30:1 ratio for 30-day a month episode of care. They, again, can take on quite a load, and they are backed up by a virtual care unit team that we have here in Nashville, that is staffed with various licensed professionals. Lastly, for the nurses in the home, given the amount of time that is required for our visits, this is very comparable to the amount of cases that a nurse would have to see for a typical visit for a typical Amedisys patient. The staffing is not too terribly different, or the ratio, I should say, in terms of the number of patients a nurse can see at any given point from their core business. Hey, I'm going to Chris Gerard. Yeah who's been leading our labor efforts. I just would say, Joanna, that our retention has never been better. Our recruitment function is operating extremely well above any of the staffing agencies that we see out there. I feel very confident and Chris has been driving a lot of these initiatives, I'll turn it over to Chris. Yeah. Hey, Joanna. As we've been talking for a bit, capacity's been a big focus of our organization for a while now, and particularly on the nursing side. When we look at Contessa model, the demand will be on the nursing side, particularly RN, which is where we're really focused on driving down our turnover and increasing our capacity. I am super excited about our performance so far, I expect that we're going to continue to see better capacity unlock in the organization as our retention continues to improve. Now we're starting to see really good kind of recruiting efforts in the markets where we need our clinicians. The last thing I'd say is I think this actually can attract more nurses. This is a highly specialized piece of business that some nurses that are really looking for something just a little more special to do and to impact the cost to the health system. I think this is something that we're going to have a number of nurses raise their hand and say they would love to do this and be trained up to do this, and be part of the care team, and I think it'll also help us in attracting clinicians. Yeah. I think Chris's point, Joanna, is really important. I think that Travis will probably add to this, but I think one of the reasons why we were able to get this deal, it was a very competitive deal. I think that one of the reasons is, I think as Travis was looking into the future, and we've had these discussions with him all along over the years, is in order for Contessa to scale, they're going to need an entity like ours that can hire and build and nursing capabilities where he builds his business. Without that type of scale, he could've easily gone to a strategic investor, but I think we provide that level of scale and overlap in the scale where I think he can grow much faster. I'm speaking for you, Travis, but you might want to call me out on me. Paul, I think that you're spot on in that regard, Joanna. I mean, a critical component of this level of care in the home is having the right nursing services so the physicians that are referring patients into the program are comfortable with the level of care that they receive. If you don't have that critical component, which obviously we'll get through this partnership, it makes it tough to drive adoption. Right. Thank you. Detailed answer. Appreciate everybody chiming in. I guess if I can, just last thing, I guess very big picture question, talking about the Medicare waiver being extended. I guess any way to size it up in terms of how you guys think about percent of patients that would qualify for hospital at home of the Medicare population or any kind of way to think about it? Thank you. DK, you want to take that one? Or Travis? Joanna, this is Travis Messina. As we think about it, the overwhelming majority of our patients are of a Medicare age population, obviously. North of 70% of our enrollment has been through Medicare Advantage. I think that we're well-insulated in that regard. You think that, yeah, extending this waiver, that would be quite additional. Yeah. Expansion. Yeah, Joanna, like you mentioned a couple of times, the Medicare fee-for-service component is not built into this model, nor was this acquisition predicated upon that actually sticking in place. I think the strategic nature of this model works in just the Medicare Advantage world. If that sticks around, the TAM opportunity becomes substantially bigger. Right. Yeah, appreciate it and good luck on August 22nd. Thank you, Joanna. Thanks. Thanks, Joanna. Thanks. Thank you. Our last question comes from John Ransom with Raymond James. Please proceed with your question. Hey, John. Hey, guys. Travis, how much investment has it taken to get the company to this point? John, we're not going to disclose that number since the deal has not closed yet, but we're happy to talk about that once we get through Q2 and get the deal closed. Yeah, you don't sound like Travis. That was not Travis. I'm recognizing that Cajun inflection. That was not Travis. Second question is, if we just look at the kind of like Encompass did the whole collaboration referral kind of old school to the legacy Triple H business, is that going to be noticeable? Should we think about this as a standalone investment and any sort of spillover into the legacy Triple H business as a happy accident? I think there's going to be spillover, John, and I think that's a really good question. We haven't modeled it, but there's a lot of excitement about this idea. There's a lot of demand for this. There's going to be opportunities where already, in diligence and other things, there's going to be tremendous opportunities for us to expand our capabilities where we're already quite active. The overlap is pretty good. As you see in the document, it's 40% in Home Health and almost 50% in Hospice. There's going to be a lot of cross-pollenization, which we haven't put in the model. There's also going to be places where we're going to go, and we've already experienced this, where they say, "Let's look at the whole ball of wax." We have some opportunities there. I think there's going to be a lot of opportunity, but we haven't put that in the model. As we talk to our BD folks, our 1,300 BD folks out there, they're getting very excited about it. They think there's lots of places where this is going to be of interest. Yeah. Hey, John, it's Chris. I'm just saying, when you look at, as Paul mentioned a little bit, the overlap, where we're in those markets with our lines of service today, and we may not be getting or having relationships with the systems that Contessa's JV'd with, that's opportunity for us. As we enter into new JVs for the hospital at home model, it will also lead to deeper relationships that can also feed the other lines of business. We didn't count on that. We're not modeling that, but we see that as significant opportunity that we're going to go after. I guess my other, what's not clear to me is, let's say that prior to Contessa, Mrs. Smith would be in the hospital for X number of days with congestive heart failure. Who's making the call that says, "Hey, let's send her home to this new model that has only been around for five years, and we're going to quote, unquote, 'roll the dice' and do a hospital care at home, and we've got enough confidence in the outcomes." Is that the physician? Is this the discharge planner at the hospital? Is this the health plan? Who's making the call to say, let's move this patient sooner than we would have before this model existed? Yeah, John, this is Travis. The admitting physician ultimately has the determination as to whether or not a patient can go into the program. No differently than when a physician admits a patient to the floor, they make the decision as to whether or not hospital at home is an eligible avenue for that patient. Secondly, because of EMTALA, you can't force the patient into the program, so they have to provide informed consent. Anytime when we offer a program to a patient, they have to sign that informed consent to enroll in the program. Yeah. That kind of leads me to my last question. How much missionary work do you have to do to break physician historical practice patterns around sending patients to your site of care versus just keeping them in the hospital? This does require quite a bit of behavior change, if you will. What we have found, and especially as a result of the pandemic, once physicians realize the level of care that you can render in the home, specifically for these conditions, if you think about their treatment plans in the hospital, they're getting nursing visits perhaps every four hours at best, and they're getting infusion services, and then perhaps the administration of oxygen. Those are the three most typical services that are provided, and it's not necessary to be in that institutional setting. Once they realize that they have a nurse at the patient's bedside, they have the ability to hear the auscultations of the heart, lungs, and other organs through virtual stethoscopes. They actually become quite comfortable knowing that they do have a caregiver in the home at the patient's bedside. Thanks. That's it for me. Thanks, John. Appreciate it. I'm going to thank everyone. I want to thank the operator for coordinating this, want to thank everyone who joined us tonight. Appreciate your time, look forward to catching up with you during our second quarter 2021 earnings call. Till then, stay well. We'll be talking to you. We're really excited about this. Thanks so much for spending your Wednesday night with us. We appreciate it. Take care. See you. This concludes today's conference. You may disconnect your lines at this time. Thank you for your participation. Have a wonderful evening.