Okay, I think we are at 2:00 P.M. Good afternoon, everyone. Welcome. Thanks for joining us for the management presentation with Amedisys. My name is Matt Larew. I cover Amedisys here at William Blair. Pleased to be joined by President and CEO Chris Gerard, as well as the CFO Scott Ginn. Nick Muscato, who is Chief Strategy Officer, is in the back. Before we begin the presentation, I just wanna mention two things. The breakout session is in Richardson, which is on the second floor right after this presentation. For a complete list of disclosures or any conflicts of interest, please visit williamblair.com. Again, very pleased to have Amedisys here for another year with us. With that, I'm gonna turn it over to Chris and Scott. Great. Thank you. Thanks, Matt. Good afternoon, everybody. My name's Chris Gerard, I'm the President and Chief Executive Officer here at Amedisys. I'll give a little bit of my background. Let Scott give a little bit about his background, then we'll go through a little history of the company and walk through a little bit of our strategy, you know, for the near and long term. For myself, this is my 30th year to be in the post-acute space, specifically the home health and hospice space. I got in the business in 1993. I started my first home health agency in 1998. Started my first hospice agency de novo in 2001. Grew to several facilities, recap private equity group out of Chicago, out of here in Chicago in 2007. Then further grew that business to 53 locations. In 2012 sold that to Kindred Healthcare, which was their largest here at the time, kind of entry into the home health space as they were trying to transition the organization to the home health and hospice business along with their LTCHs and their SNFs and their rehab. Joined Amedisys, 2017, January, as the Chief Operating Officer. Just finished 5 years here, under that title, as well as I was promoted to President, last February, and then I moved into the CEO role just in April of this year. It was announced in January. Thrilled to be here. Thrilled to tell you a lot about the company, and I'll let Scott give a quick introduction of himself too, as well. Sure. Scott Ginn, Chief Financial Officer. Been at Amedisys since what? 2007, so about 15 years. Had all different roles within the accounting and finance team. Started off as Senior Vice President of Accounting and Controller. Became Chief Accounting Officer and was about 5 years now I've been CFO. So, so most of my early career is in public accounting, but have, you know, been at Amedisys through a lot of the past 15. So 15 and 15 seems to be my magic number so far. So, you know, it's been a great run and, you know, we were $500 million in revenue when I started and, you know, here we are today. I think we doubled within 6 months. Quite an interesting run and so really excited to be here and glad to talk to you guys. Great. A little bit about Amedisys. This is our 4 year in existence. It was founded in Baton Rouge, Louisiana, by the founder Bill Borne was the CEO here all the way up until 2015. The organization was initially a home health business that started to branch out into Hospital at Home a little bit early on. Also did some hospice business, and spent a lot of time also in the technology and the information systems business as well, which it built out its own EMR, built around its own kind of patient base, which was one of the, you know, early companies to be able to do that in our space. Company went through a little bit of challenges in 2012 through 2015. We were having some challenges regulatory-wise. There's also the burden of kinda the EMR that we had in development we were managing was a financial burden on the organization, as well as the company had gone through some investigatory stuff in 2007 through 2012 and settled with the government with a CIA in 2012. It actually settled in 2014. As the organization went through the changes and turnaround, Paul Kusserow came in as the Chief Executive Officer in 2015 to really kinda reshape this organization. The company had been through some great times and some tough times, but now coming out of this, Paul Kusserow came in with a kind of a vision to be able to really kinda reshape and really refocus the company on what it does best, and that's taking care of the patients in the home. To really step away from, you know, kind of its own EMR and managing the information system side and let other companies do that, so that we could just focus on squarely taking care of our patients. Over the last seven years since Paul's been here, we've been able to to grow, you know, tremendously through organic growth as well as inorganic growth, and actually, you know, kind of establish ourselves at the top in the industry in pretty much almost any metric that you measure out there in the home health and hospice space. Quality, growth, operational excellence and efficiency, margin profile. The organization has really kind of established itself very well, which is exciting for us 'cause when we talk about some of the secular tailwinds that I'll go through here in a little bit, we're really kind of, you know, positioned to be able to capitalize on what's gonna be coming our way over the next couple of decades. One thing that's interesting, though, so you see here, we're, you know, almost 549 sites that we have today. We have the home health business, which is providing skilled care in the home for people that are recovering at home back into independent living. We provide hospice care for end of life care for patients that basically are seeking end of life care. We help them to pass away safely with dignity in their home. We also provide personal care, unskilled caregivers in a couple of states where we're actually helping with activities of daily living on a day in and day out basis. We recently added the high acuity line of business, which is Hospital at Home and SNF at home, providing higher level post-acute care, which would normally be lower level hospital care, but it's being provided in the home. We added a business I'll talk about in a second last year that really kinda gave us this capability. When you think about our full capabilities now, it goes from high acuity in the home, Hospital at Home to rehab type business, SNF at home health, hospice, personal care, and palliative care that we're able to provide, and we serve about 500,000 patients on an annual basis. Now, when we added Contessa, which is the hospital at home company that we acquired last August, it gave us this high acuity capabilities in the home to be able to really be a safe place for patients to divert away from a hospital setting. They go into the emergency department, you know, they actually qualify to be able to be served in the home versus in a hospital bed. If you think about during the pandemic, there was a real, you know, shortage of beds and opportunities for these patients to actually land in beds because of the hospitals being overwhelmed. It gave this diversion to the home, and it allowed us to actually send clinicians in and provide this higher level of care for about the first five days of service, and then transition those patients on to more stable care for home health and then back into independent living. Also, CMS actually put a waiver in place that still exists today for reimbursement around this. When we acquired Contessa, it was built more on Medicare Advantage penetration and our ability to partner with hospital systems to provide this higher acuity care in the home, save the plans money, but also be able to provide at a lower cost point and actually, you know, share profits with the hospital in the joint venture arrangement so that we can actually be able to you know kind of you know loosen up the system, if you will, allow the plans to actually have a better attractiveness for us and what we're doing in the home and pay us fairly for it, as well as keep the beds free in the hospitals for the higher acute patients. Also what this has done is it's unlocked some joint venture kinda models for us. Prior to Contessa, we had a handful of joint ventures in our home health and hospice space, where basically we partnered with a hospital. We would run the home health or the hospice business or both, depending on the arrangement of that relationship. We would basically manage those patients and had some pretty good success in doing that. With Contessa, they came with a joint venture model to where they would joint venture with the hospital to provide hospital-level services in the home. What we're seeing now, as you can see now, we have about 46 sites across both lines of business, home health, hospice, and then in the Contessa high acuity care. 17 joint ventures that generate about $80 million a year. We think this is just the beginning. What's kinda been interesting since the acquisition is larger hospital systems, even though Contessa came with a very significant pipeline of joint ventures that they were working on and we're gonna be able to close over the coming years, and we've already had a couple close since the acquisition. Hospital systems also started coming to us with larger kind of arrangements or relationships in mind, wanting to put in their home health and their hospice assets, along with the joint venture for Contessa, and possibly even us putting in our home health and hospice assets in large markets to where we're actually providing on a very broad scale Hospital at Home all the way to end-of-life care in a joint venture environment. I think it's safe to say that, you know, Contessa going alone was gonna have a good run on hospital joint ventures, particularly around more regional and smaller market hospitals. Amedisys was gonna probably have, you know, a handful of joint ventures that we add on a day in and day out basis, but not really be that part of our core business. Today we have such an offering out there that the hospital systems are really wanting to form a deep relationship for us so that they can actually optimize their beds, they can participate in the economics of patients that never land in their beds, as well as they can optimize their home health and hospice business because hospitals historically are not good operators of home health and hospice, which is our core business. This is what we do every day. Allows them to unload part of that onto us. We manage the day-to-day, we drive the economics, we drive the efficiencies and the quality. From that, we get, you know, to where basically it's a solid relationship. We think we'll be announcing some broader-based joint ventures in the very near future that I would say were not part of our roadmap prior to the acquisition of Contessa. Back to Paul when he came here, the first thing he did is he said, "I'm gonna really work on, you know, what is the strategic pillars of this organization." Spent a lot of time in the field understanding what we do day in and day out and understanding what's gonna drive success in this organization. These strategic pillars were established seven years ago, and we haven't you know wavered from them at all, haven't changed from them because it's really been driving our success, and we think when we're looking into the future, it's gonna be key for our success as well. Clinical distinction, be the best at what we do, provide the best quality care that we can in the home. What we have been able to do is really rise to the top in terms of our star ratings, which is publicly reported quality ratings for home health to the nation's highest star-rated large scale organization out there. Took us a while to get there. We initially were really kind of, you know, very, very far behind the pack, but we stayed focused on the things that matter in the patient's home, in making a difference with the patients' lives, and we were able to basically raise our agency to the level it is right now. 99% of our care centers that we have today are four stars or greater, which we're very proud of. Also, employer of choice. Be able to actually amass the clinical capacity to be able to take care of the demand which we see every day has always been a focus for us. You know, when Paul got here several years ago, our turnover was probably in the high 20s to low 30s, sometimes even worse than that, depending on kinda what the environment is. We focused very, very intently on being able to drive that down over the years to where we even got to a low of 16.7% in 2019 prior to the pandemic, which took a tremendous amount of focus for us to be on our people. As you step back and you think about our organization, every dollar of revenue of this $2.5 billion organization has to do with a clinician taking care of a patient in their home. If we don't have the caregivers and the clinical capacity to take care of the patients, we know the demand is out there. Focusing on our people has been just paramount for us to be able to be successful. I'll even say today, with the 19.4% Q1 turnover rate that we had this year, my 30 years of being in this space, this is probably some of the most challenging kind of labor environments out there. There's just a lot of dynamics to work through. Companies that are really focused on their people are gonna be the ones that are gonna be successful. Those that actually have the clinical capacity at the end of the day are gonna be the ones that are gonna be successful. That's where I'm really proud of where we are, and I'm real optimistic in our ability to be able to have a long-term, you know, kind of track record of success. Operational excellence and efficiency, which is kinda, you know, when I came to the organization, that was kind of my sweet spot. It's really kind of being able to run the operating metrics of an organization to be able to really see what leverage you can pull day in and day out to be able to just optimize a business. I spent a good deal of my time, the five years that I've been here, just really focusing on org design, getting scalability with our business practices out there, setting the right metrics for us to manage to, and setting the parameters for the staff and leaders to work within so that we could drive excellent results. As you can see, we went from a single-digit margin business just a few years ago, to we're at 12.2% EBITDA margin today. We still think there's opportunity for us to continue to even be more operationally excellent and efficient over the coming years. Then lastly, driving growth. With 549 care centers, 38 states, you know, our ability to be able to take care of the demand that's out there is our challenge every day. To be able to establish yourself as the best employer, to drive great metrics and attract great talent, then we have the volume that we should be able to, you know, to be able to depend on, to be able to grow this organization organically. you know, when you put all that together, that's kind of where we feel like we're set up, you know, today to really think about what the next decade to two decades look like, and we'll talk about that here in a second. Scott, give you a little bit on the breakdown. Yeah, no. This slide just kind of breaks down our revenue sources, and, you know, right now roughly 35% hospice, still the bulk of our business in the home health side is 62% of that revenue. We would expect hospice probably be a little higher than this at this point, but, you know, they've been the hardest hit on the top line from a revenue perspective with the length of stay disruption. So that's kind of brought that down. We do a lot of activity around M&A, which I'll talk about in a little bit. You know, on the home health side of the revenue, you can see our breakdown. A lot of questions around this. Roughly 67% is Medicare fee-for-service, which means we're paid episodically on that business. That's over a 60-day episode of care. We also have a private episodic, which is paid just like Medicare, but they probably have a discount to it, somewhere around 90%-95% of the Medicare, the remainder is a per visit business. So that's just as on a visit basis, we get reimbursed on that. Really the lowest margin on business, one that we've talked a lot about and how to deal with Medicare Advantage plans. Then hospice still always gonna majority of that's gonna be a Medicare payer at 95%, with most of that being routine care. You know, when you talk about the secular tailwinds that we have in this industry, you know, you look at the aging demographic, and that's really kind of the primary driver of demand for what we're gonna have over the next couple of decades. You see, you know, the CAGR of growth for those 75 or older is 4%. You see that with also when we get into the out years, 2030 beyond, the CAGR for those 85 and over gets up to 5%. You know, our average patient age is about 78 years old. You know, this is really starting to come in. The oldest baby boomers right now are around 76, 77. It's really starting to come in toward the demand for the services we provide is going to grow almost exponentially over the next few years. You know, also think about the pandemic and how it actually put a new focus on the capabilities of care in the home with regards to, you know, SNFs and other post-acute settings. During the pandemic, a lot of patients that would normally have landed into a SNF downstream from a hospital bypassed the SNF and went straight to the home, and we were able to take care of those patients safely in the home. We captured a good piece of that market that we still have today because it created this kind of understanding that these capabilities were always there. The discharge planners of the hospitals had not traditionally used it as much. They would send the patients directly to the SNF. As the discharge planners of the hospitals and the consumers, the patients, saw the value of the care in the home, it was able to really kind of drive additional growth to our industry that we think will continue, you know, from here on out. If you back up and you think about our high acuity care that we're talking about with Hospital at Home and SNF at home, those capabilities are even broader for Amedisys than I would say our competitors out there. Yeah. In this slide, just a little bit of breakdown of where the industry is. We get a lot of questions about, you know, consolidation and what's out there. You can see, from a market share perspective, I mean, we're only about 4.8% on home health, right around 3.5% on hospice, and that's after a fairly, acquisitive period over, the last three years for us. Still, as you put the top ten together, they're both kind of hovering around that 25% range. A lot of opportunity out there to consolidate the industry. We get a lot of questions about when that's gonna happen. As we've talked a lot about COVID dollars coming in the system, sequestration relief, we think, has helped support a lot of the home healthcare centers kind of post the PDGM reimbursement model for us, which was a changer for the industry in 2020. It really put a lot of pressure on organizations and, you know, we think it will pick up. It's been a little slower than we thought, but I think this is probably one of the untold stories and the things we don't stress enough from us, I mean, in the past three years, we've deployed a little less than $800 million on acquisitions and mainly on the hospice side of the business. As of late, we've probably spent another $100 million on stock buybacks, and we've deployed, I would say, the capabilities around $30 million. Really, you know, sort of around $920 million that we put into different types from a capital use perspective, which just speaks to the strength of our balance sheet. We're still only 1.3 levered. None of those numbers include the Contessa acquisition, which we did put that on a term. We spent about $250 million on that. Really, the cash flow generation of this company, the ability to do acquisitions, integrate them successfully, and pay them off from a spend perspective really quickly, is something and a story as we approach this more market consolidation in the future. Yeah. Along those lines, and as Scott just mentioned, how fragmented the business is, and you think about all the care settings that are out there for patients to receive care. Now obviously, inpatient hospitals are a must, and patients are our patients that are not gonna be able to avoid the hospital. You know, you can see kind of what the market looks like, over 4,900 locations that are out there in existence today. It's, you know, 36.5 million cases, $500 billion market. The average spend is about $13,500 on a hospital stay. Once you go beyond the hospital and you get into the long-term acute care hospitals or the inpatient rehab facilities or skilled nursing facilities or home health, you can see the economics around care delivery is much more skewed towards home health. The average episode is $3,000 per patient or per episode. You know, we feel like it's a $26 billion industry that we're part of today, and we see that the 3 that are just to the left of us, and actually you can go into the hospitals, there's opportunity for us to pull volume out of all of those other settings into home health as we scale our capabilities around Hospital at Home all the way to our end-of-life care that we provide. As Scott mentioned, you know, on the fragmentation, you know, this industry at some point will need to consolidate, and really kind of get to where there is, you know, fewer players out there, more with scale that are able to really handle the volumes that are coming our way. It creates a better regulatory environment for us as well, managing a fewer number of agencies. We feel like, as the pressure is on the system, the healthcare system from a cost perspective and Medicare solvency and Medicare Advantage penetration being what it is and looking to drive the best economics, we feel like all of those are factors that are gonna push more into the home and away from any of the other high-cost settings over time. This is kind of unique. This is kind of where we are as Amedisys. As we look at our strategic plan, we put together a five-year plan, over the last year and a half, and we really think about what we got to focus on. We have some near-term initiatives that we think will actually be big time winners for us, but we have some other things that position us for the long-term kind of trends that are happening out there. The Amedisys initiatives, you know, starts again with quality. The top two things on here is value-based purchasing, and that is actually gonna be CMS bonus payments that'll be starting to be earned in 2023, and the first year payout will be 2025. It's a plus or minus 5% opportunity based on our quality performance relative to our peers and the standards that are set. You know, our goal is to leverage ourselves as the highest quality provider out there to be able to capitalize on these bonus payments as we go into the out years. Hospice Care Index is gonna be the first publicly reported hospice in kind of quality ratings out there that are coming out this year. It's our intention to be also at the top of the list amongst our competitors in terms of the quality of hospice services we provide. We expect to leverage that for more volume as well as leverage that for future reimbursement upside in the event that there is some. Workforce transformation. I mean, you can't go into any industry right now that's not fighting through some sort of different environment and dynamic around labor management and human capital management. For us, it's, you know, it's no different. The good news is that we're in an industry that really hasn't evolved very much. A lot of functions are still decentralized. You saw that 549 locations that we have. We have a lot of functions that happen at those local locations that require FTEs that are not clinicians to be able to do those functions that can be centralized. We're spending the next probably year and a half of really kind of finding some opportunities on the G&A side to take some major functions that we spend maybe $150 million a year on and get those into centralized functions that may even be virtual so that we actually have it seamless at the care center level, but we get the upside in terms of the G&A savings, and we're able to actually focus more on the clinical capacity so that we can have the caregivers taking care of our patients. That's something we're super excited about. We've also done some investments out there that have actually helped us, you know, kind of succeed in the near term. We went through a major reimbursement change in 2020 that was the biggest change in 20 years for our industry. It required a seismic shift in how we took care of our patients. We invested in a company called Medalogix, which is a technology company that helped us really kind of fine-tune our care delivery model for our patients and navigate into PDGM in a way that we actually exceeded our expectations in the first year. We're still key investors in that business. That business has expanded since we've invested in it. It's also recapped and added some other lines of business within itself, so we're excited about that. Medicare Advantage. You know, Medicare Advantage penetration, 43% of the senior population is Medicare Advantage today. It's continuing to grow. We have some things that we're doing that are pretty unique out there in terms of trying to leverage our scaling capacity and some of the things that we are capable of doing in the home and our capabilities to be able to drive better economic relationships with Medicare Advantage. It is a headwind for us in the industry, but we feel like, you know, having the assets that we have and scaling those assets to be able to provide a more comprehensive care plan in the home over time is gonna put us in a place to where we're gonna be able to get better economic relationships with the plans and save the plans money at the same time. You know, optimization around just utilizing our clinicians at the top of their license is important for us. That's a margin opportunity for us. Hospital at Home and SNF at Home, scaling that business is absolutely critical for our success. We feel very comfortable that we're gonna be able to do that and excited about the prospects around that. Eventually, totally integrating Amedisys and Contessa so that there is a seamless continuum of care that we're providing from Hospital at Home all the way to end of life. Lastly, you know, further expansion and looking at other offerings that we may be able to provide in the home that actually create a broader, you know, kind of care delivery model. If you look at kind of the whole ecosystem of care, you know, we're established. We're ready to be, you know, position ourselves to be a risk-bearing tech-enabled home care company. With our referral relationships out there, once the patients are either out of the hospital or on their way out of the hospital into the home, we should be able to provide almost every comprehensive level of care that the patient needs in their home to be able to help them achieve their ultimate outcome. Be it, you know, recovery back into independent living, or if they have a terminal diagnosis, helping them to pass away safely in their home with total dignity. You know, as we put these pieces together, we feel like this has kind of got us in a position to where we can really kind of, you know, influence where patients go, the care that they receive, and the outcomes that they actually achieve. Quickly on financials, real quick, Scott. Sure. If you kind of look at the first quarter, a little stale now, but you know, a lot of the noise coming out of there was we were down about $12 million year-over-year. About $6 million of that was the add of Contessa. They were, as we've talked about that, we're building losses right there on them at this point. That's gonna be probably about 60% of those negative EBITDA will be in the first half, about 40% in the second half. That had a lot to do with the story here. First quarter was hit pretty badly from an Omicron perspective. Highest level of quarantines. We had about 7% of our clinical staff on quarantine during that period. Really hit us on the top line from that. We know we lost admits, impacted length of stay as well. That was an area we felt would come back down, kind of modeled that into our numbers to be on par with 2021. Actually it was higher, which was somewhat surprising to us. Fortunately, those numbers are moving back down. Really it's kind of a tale of two segments as you think about what's going on in home health and hospice. Both of them have labor pressures. The good news on hospice side is we get length of stay normalization, build ADC, we believe there is capacity. We had talked in previous calls. I think around Q3, we talked about $12 million of capacity. It's a fixed cost model, so as you build ADC, our margins should improve there. If you look at home health margin, actually, fairly on a gross margin line, pretty comparable to prior year. We had a lot of labor pressures. If you look at our cost per visit line, it was up roughly 9% year-over-year. As we talked, as we came into the year, and a lot of people talked about how you're gonna overcome these issues around labor, you know, we felt we had some work we could do around our visits per episode from a utilization perspective. That's down about 0.9 year-over-year. If you look at a cost per episode, if I take that cost per visit times the number of visits we're doing, that actually was only up about 2.5% year-over-year. We were able to offset a fair amount of that labor pressure, plus we had a rate increase and therefore our margins held up. Just little delay from a volume perspective, mainly because of the lost admits around Omicron. I think that's. That's it. Matt, I told you we'd give you a little bit of time. I only gave you a minute and 42 seconds, so sorry about that. I think there is a breakout, though, after this, right? There is a breakout again in Richardson. I guess let me also ask one question. It's from the second or third slide, which was interesting because you talked about your joint venture strategy. You know, four or five years ago, you know, obviously, LHC has long had sort of their joint venture strategy. I think intentionally almost, you were aligned with payers or at least not pursuing joint ventures. I'm curious, do you see a void or an opportunity there because they're now gonna be under the guise of Optum to go out and pursue new opportunities that maybe they won't go after? Is it strictly because of Contessa? I'm curious if that's a truly a strategy shift or if that's more of just a aesthetic shift on the slide. Yeah. I'd say it's three things. You know, I think it is meaningful that LHC Group is gonna be acquired by a payer, and that may change their joint venture strategy in the future. Historically, LHC Group has been kinda more the rural, smaller hospital systems, you know, kind of joint venture plans. That was kind of the nature of the joint ventures that we had in place prior to Contessa. What we've seen happen now is if you think about some super large urban cities with large systems in place that want to provide the full continuum of care, and they wanna leverage capabilities from Hospital at Home to end of life care in the home, and they may have some, you know, undermanaged assets of their own, I think it creates an opportunity for us to step into. It may look a little bit different than what LHC has done in the past and what we've done in the past because, you know, these may be some very sizable systems that we're talking about doing business with in very large areas. Okay. We'll maybe take the rest of it to the breakout because we just ran out of time. Thanks to everyone for joining us, and we'll see you over the next few days. Thank you.