All right, so we're here at the top of the hour, so we're just going to get started. Welcome to Day One of the Stephens 2025 Annual Investment Conference, live and in person in Nashville. I'm Raj Kumar, Healthcare Services Analyst with Stephens. For our next panel, we have Ardent Health. Ardent Health is an acute care operator in the U.S. with a portfolio of 30 inpatient hospitals across eight unique markets and a growing ambulatory and outpatient footprint. The company implements a JV strategy to drive effective scale in its faster growth mid-size urban markets with established health systems to achieve market-leading positions in their respective markets. Today, from Ardent, we have Marty Bonick, President and CEO; Alfred Lumsdaine, CFO; and then in the audience, we have Dave Styblo, Head of IR as well. I want to thank the Ardent team for joining us here today. I know the company broke some news this morning around a $50 million share repurchase authorization, so maybe start off with that. I know the company wanted to speak a little bit on that. Sure, happy to announce the share repurchase program. We view this from a capital deployment perspective as not inconsistent with where you continue to have a growth focus, both expanding our ambulatory footprint and focused on expanding into other markets. We view this from a $50 million, given the strength of the balance sheet, very modest leverage, two and a half times on a lease suggested basis, and over $800 million in available liquidity. We view a $50 million commitment to the equity from a board perspective to be a prudent deployment of capital, candidly, given current valuation, and view it as an opportunistic opportunity to buy back shares. Great. Maybe just starting off with the year in review and kind of Ardent's stance, it's been a year and a half since the company went public. Maybe we want to start off with some comments on kind of how the Ardent story has progressed and maybe bucketing it between what remains consistent with kind of when you came out into the public market and what has kind of evolved relative to the pre-IPO expectations and kind of where you see the Ardent story going ahead. Yeah, great question. As we look at it, I think things are very much on track from a business perspective and where we expected things to be. We went public with a thesis around growth, and it was a tri-part growth thesis. The first is that we were going to continue to grow inside of the markets. As you referenced, we've got eight growing mid-size urban markets that we participate in. We've had strong inpatient share in those markets. However, we all know healthcare is growing beyond the inpatient environment and the outpatient environment. We said our first and foremost goal was to continue to expand our outpatient footprint. Over the last year and a half, we've added over 27 urgent cares, which is a front door into the health system. It builds our clinic practices. It spills into the hospital environment and our outpatient services. We know that there's still ample room to grow because, again, our markets are growing about two to three times faster than the U.S. average. We see this outpatient expansion is very much the first step in our tri-part growth strategy. The second is opportunistic M&A, either tuck-in acquisitions inside of our core markets or ancillary to our core markets or new markets. Now, with the regulatory environment, we're going to be very picky and choosy about where we enter into. We want to enter into markets that have similar demographics, that mid-size urban market that has positive growth rates in an area where we can land and expand our services, start off with an anchoring system of hospitals and the ability to grow into that outpatient core and continue to expand healthcare in that new region. Third is around margin expansion. We have had what we call our impact initiatives that are gaining traction in our results. Last week, we quantified $40 million of activity that has already been baked into or already implemented and will be baked into our run rate into next year. That is only a part of the impact initiatives we see. As we look back in terms of the strategic fundamentals of the business, we think that we are on very solid footing, growing urban markets, growing our fair share of the market and then some as we grow into the outpatient areas and selectively looking for growth, particularly with our joint venture partnership model that we have. We very much feel like the business is on track despite some of the industry headwinds that everybody is grappling with. Got it. I think maybe focusing on the third quarter, there was a dichotomy between volumes and demands were structurally strong. Like you said, you're seeing market share gains as well. On the cost pressure front, which has kind of been a dominant point for the industry, is on pro fees. Would it be kind of helpful to recap the messaging for the quarter and overall guidance revision? What that kind of entails for the preliminary 2026 framework, I appreciate that you're kind of undergoing that process and budgeting for 2026, but maybe kind of any tidbits that can kind of help us from an overview standpoint or a modeling perspective. Yeah, I'll start and then let Alfred chime in here. As we think about a couple of those headwinds, they are not unique to us. If we look across the industry and you read any trade publication, you can see the impact that payers have had on the business to providers, particularly in the managed products. Managed Medicare, managed Medicaid, some of the health exchange programs. With the markets they were in, particularly in the health exchange, we've seen some significant growth this year on the health exchange side, and we are under-indexed compared to our other peers. The depth and breadth of these plans inside these mid-size urban markets is perhaps not as wide or as beneficial as it may be in some of your larger major metros. We have taken action, and we have recently terminated and now renegotiated an agreement that was a significant agreement for us because we were essentially yielding less than Medicare rates, which in a commercial environment is just untenable. More of those types of actions to come. The other part of it is with our partnership with Ensemble. We are feeling the impacts of the industry headwind around denials and underpayments, and we're still doing better than the national average, but we did see a tick up as we went into Q3 after elevated trends that started roughly late Q2 of last year. All of these things are things that are part of our impact program in terms of how do we overcome those. On the professional fee side, the big headline this year, 2023 was the peak, and I think in the way the industry saw a major reset in professional fees. Anesthesiology was the first specialty that came through. Anesthesiology became last year's big focus, and this year it's been radiology. Historically, we've not had a lot of subsidization in the radiology space, but as the shortage has picked up across the country, we're seeing this as a headwind, and our peers are calling this out as well. It is not something that's unique to us, but we do believe it will moderate. We hit a peak in 2023. Things are coming down in 2024. We expected them to moderate into the high single digits in 2025, and we'll end up probably in the low double digits, I should say. Part of that was subsidies that did not exist and now are. We've substantially renegotiated all of our anesthesia, and now majority of our radiology. As we left this year, we do expect pressures to stay north of inflation, and some of these programs are volume-driven and our volumes are growing. The rate increase by having programs that did not have a subsidy and now do, we expect to lap that and see continued moderation as we go into next year. As we think about, I mean, to your point on 2026, too early to talk about our overall perspectives as we sit here today. What remains unchanged is our perspective that Ardent Health is well positioned. You've seen it in our growth markets with a very strong balance sheet, very modest leverage and liquidity, both to support internal and M&A growth. From that perspective, we think we're very well positioned. We continue to believe that margins will expand over time and that our margins will move to mid-teens over time. We also acknowledge those twin headwinds of elevated pro fees and denials that have persisted longer and with a greater intensity than we expected. What we can do to offset that by accelerating those margin improvement activities focused on increasing the volume and the speed at which we implement those into 2026. We look forward to, as we come to guidance in early 2026, to talk about just how we've been able to implement those programs faster to offset those headwinds, which we, again, as we sit here today, we're preparing for a world where these are pervasive and what are the things that we can do to offset that and continue on that growth trajectory. Yep. Maybe just. Yeah, yeah. Just on the payer denials and just the difficulty of addressing that because it has been going on a while, can you help us just understand what's being done and if it's complexity or games being played with contracts or changes or something that's just difficult for Ensemble to stay on top of? What exactly is going on and how we can take to resolve? Yeah, it's not an Ensemble issue so much. It really is across the industry. If you just think about how the insurance system works, they're setting rates and they've got a baseline assumption of both utilization and acuity of payment. This year, seemingly the insurance companies got that algorithm wrong. Again, we're in durable demand growth. The population has gotten older, it's gotten sicker, and we're seeing the benefits of that, but they have no levers to reset pricing mid-year. Their lever has been to pull back in terms of the payment or slow down the payment or what have you, whether it's through payment policy adjustments, through request for information, which just turns into a delay in payment and/or a write-off over time, all of those things. As they're resetting rates going into next year and we're seeing some of the biggest inflationary sticker shock that we've seen in over a decade, hopefully that allows them to reset and take some pressure off the provider side because, again, they're getting pressured from legislature, states, providers in terms of some of their tactics. From our perspective, again, if we look at our denials compared to the national averages, we're actually below them, but they have increased inside of that footprint. We believe that our partnership and collections with Ensemble, they allow us to punch above our weight class, so to speak, because they're managing revenues under management, significant multiple bigger than we are. They're putting a ton into their systems in terms of AI, machine learning, and the ability to send out clean claims and receive them. When you see some of the things like Aetna or United, Aetna, I believe, that was talking about just automatically downcoding claims, that's had a lot of pushback, and they've started to retreat from that stance. This is the natural tug of war that's existed inside this industry forever. To the point of your question, what are we doing about it? Internally, we have established, rather than historically, many of these functions work in their own, I would say, silos, managed care operations, revenue cycle, legal. We have developed a revenue integrity team combining those functions. Some of the near-term impacts from that have been a significant increase in demand letters. We wrote 60 in the last 90 days and have seen full acceleration of recoveries from that effort. This contract, Marty mentioned in Texas where we were yielding less than Medicare, one of the things that we did in that renegotiation, we terminated the contract fully intending to terminate it. Payer came back to the table. We improved the rate. Actually, more importantly, inside of that contract, we changed the cash flow mechanism to where we're going to be funded money for our claims, and they'll have to recover it from us through the denial process. That just, will it change the denial? I don't know. Does it change the dynamic in terms of we're holding the cash instead of the payer holding the cash? Hopefully. Those are just some examples of what we're doing. Maybe just following up on that topic on the payer deny activity, volumes are still strong. Maybe just figuring out if these are kind of pre-auth type of denials, prominence, or just kind of prominence around pre-claims or final claims and any color around kind of how or if there was any impact on the volume front from the payer denial activities in 3Q and if there's kind of any way of sizing that. Yeah, I mean, the challenges with the denials have been pretty universal, and it's been much more acute in the managed products and exchange products than it has been in the traditional commercial or traditional Medicare, Medicaid environment. We'll just start from that perspective. What we're seeing in those lines is denials that are almost 2x what they are in the traditional realm. From our internal initiatives, we've done a lot of things that are working from our perspective with the unintended consequence of some of these payer headwinds that we've seen. We've opened up our front doors into the hospital. We've improved our length of stay, which has improved our ability to take more patients in. We've focused on our transfer centers, which has allowed more volume to come in. We're going to have to look at making sure we're maximizing the contracts and the yield from those contracts for the services we're providing and getting rewarded for the services that we're paying for. There's some additional optimization work that's going to have to be done in terms of that. That's a little bit off of your question, but as you think about premium tax credits, and it's at this point looking less likely that something's going to be done there. Could there be a shift out of those programs? Would that have an impact on volumes? We believe, again, because of the strength of our positions and the strength of the growth in our markets, that we're going to be able to offset those. Maybe volumes come down slightly, but that's okay if the quality of that yield improves. Anybody that moves from a traditional exchange product back into an employer-sponsored insurance plan is going to ultimately be a tailwind to us, just given the low yield on some of these exchange rates. It is a dynamic and fluid environment. We believe that, again, the initiatives we put in place to open up volume and to capture more market share have been working, and now we can become a little bit more selective as we optimize for the right patients coming into the right locations. Yeah, and maybe touching on payer mix trends, you're seeing kind of double digits exchange volume growth. You're relatively slow equipped in the third quarter relative to the first half of this year. Kind of on that backdrop of just kind of thinking about your exchange membership may not be as profitable as we're seeing amongst your acute care peers, what's the mix of that in terms of how many of your exchange members are essentially being reimbursed at less than Medicare or even closer to Medicaid types of rates? We can kind of frame that opportunity against this 2026 enhanced subsidy headwind. Maybe just on following up on that on the payer denial activity side, how did kind of volume trend on managed Medicaid and then Medicare Advantage in the quarter relative to fee for service? Yeah, I think one of the dynamics at play has been significant growth overall in the proportion of our volume that is attributable to managed products that increased year over year over 300 basis points. When we think about denials, when we think about those dynamics, that certainly has played into the overall denial overview. From a reimbursement perspective, I do think because of the markets we're in, which have relatively less competition from even an exchange standpoint, I do think that has yielded a less favorable pricing from a provider perspective inside of our markets, and that has yielded. I mean, overall, we still yield above Medicare on average, but much closer to Medicare than traditional commercial. I do think that's a different dynamic when you look at urban environments where the competitive landscape for exchange products is much deeper. Then maybe going back to the pro fees, I think the company had a fireside chat in a different setting kind of intra quarter. It seems like the pro fee dynamic may have creeped up at the kind of latter end of the quarter. Maybe just any commentary on that. Maybe if we can go back a month by month framework in terms of how that line item grew and trying to get a better sense of kind of what that spike was, say, in September. Yeah, so these contract negotiations do not work like the payers per se, where you have got kind of set dates in place. As I have referenced before, particularly in the radiology subsidy, where we have seen the largest growth this year in terms of that, we went from having no subsidies to people essentially coming to the table and saying, "In order for us to continue to provide services, we are going to have to have a different financial arrangement." Yes, those things did sort of creep up as the quarter was going and without really having the visibility because with the majority of our contracts now, as we contract with people, we are getting forward visibility or current visibility into the economics of how that contract is working. We can try to model and forecast that out with better specificity than we have had in the past. For these that we did not have that, we just did not have the ability to see that there was an underlying problem. In order to continue to provide the services and keep the hospitals flowing, these became things that sort of popped up that were off of our radar, so to speak. As we get through, again, working through each of our markets and sort of lapping this year, that step-up function, say, if we were paying $1,000 a month and went up to $1,050 a month, that is an inflation and there is some volume component. If we went from $0 a month to $1,000, that is a big step up. As we sort of lap each of these specialties, we think that next year we get into a more moderate pace of inflation plus volume growth versus new contract growth that we did not have visibility into before. Radiology, to your point, was certainly the pain point within the quarter. Anesthesiology second, but radiology really prominent. To Marty's point, historically, you did not provide any subsidies on those radiology agreements. Yeah, we are saying we think we are to a point at least every contract has gone through what we will call a reset. I personally do not expect those to go back to inflation anytime soon on average, but we do think that the rate of growth naturally abates following kind of everything resetting. Yeah, I appreciate the dynamic in terms of going from no subsidies to subsidizing kind of the cost for these kind of specialties. Maybe just breaking down that dynamic against kind of volume growth, right? What was the pressure? How would you kind of weigh the pressures between those two kind of buckets? Yeah, each specialty is a little bit different. For anesthesia, there very much is a correlation, more volume equals more providers equals more subsidy. In, for example, more volume does not necessitate more providers, but to a certain percentage, and you cross volume thresholds, and then you are going to add providers. We have actually seen a slight backwards retreating on, but our surgical growth based upon the rationalization efforts that we have had, and it is working. Growth is happening on our surgical side, and that has an increased cost on the anesthesia. Radiology is somewhere in between, depending upon the mix of inpatient and outpatient that they have and other alternative sources. There is definitely a volume component to it, but it works in different mechanics with each specialty. The impact initiatives are kind of important to this aspect and why you're kind of recontracting. Are there any other specialties that haven't really creeped up in kind of recent history that you kind of foresee? Is there like a proactive stance on that front from a contract perspective? We're just kind of going across the board, across all the specialties, so there's not a really surprise factor. Yeah, hospitalist is another one that is embedded inside of there, and we've dealt with that. Those are the core specialties that we see. In some of our higher volume hospitals and larger programs around OB, you sometimes see a little bit in the NICU side, which has been fairly stable. OB laborist, which only are in our largest facilities. Those we don't see sort of mass spread because of the relative concentration of those services across our footprint. I think we have pretty good visibility at this point in terms of what they are, what they're going to look like going forward. To Alfred's point, we do expect that they're going to continue to grow north of inflation and grow with our growth. Hopefully, we've been through, again, that resetting that Alfred talked about. Service line optimization, a key initiative kind of from driving more throughput and kind of more yield on that front and driving more surgical volume. Is that kind of like what's the kind of give and take from that dynamic as you kind of throw in more specialties to kind of contend with and deal with on that front versus the relative cost? Yeah, we're going to continue to focus on, again, those high acuity services inside the hospital while we build outpatient capacity to move the lower acuity out. That's an and strategy. On the inpatient side, that's embedded inside of our provider fees, which is part of our SWB line. We've been managing that growth consistently. As we're growing those specialties, we're seeing the growth in our services, and those are relatively staying in sync with each other. There's just a dislocation between some of the hospital-based. Part of that is also due to the surprise billing and IDR processes that they're going through, and they're feeling some of the same pressures from payers that we are. Even though you look at the trends and statistics, the hospital-based groups are winning the large, large super majority of claims that they're putting up against that, but they're still not getting reimbursed even after they're awarded by the judge that they're deemed to be the winner. They're still slow paying or still not getting paid to the extent that they should be. We become the deep pockets because we have to keep the ERs open and the ORs open. There's a duplicative effect there. Now going into next year, there's this $40 million run rate kind of annualized savings that the company's called out. Clearly, a lot of that you've called out as being much more near-term in terms of that progress. Maybe just kind of any update. I know we're only a week post out the earnings call, but maybe just any color on the details on what some of those kind of near-term levers are to kind of drive that $40 million of annualized savings. Sure. As Marty noted earlier, the $40 million is complete. The vast majority of that was labor-related, both through workforce optimization as well as contract labor contract renegotiation. That will be both a small piece of our Q4 impact and then a full year impact of $40 million next year. While I'm not going to call that the tip of the iceberg, there still is an iceberg of opportunity up underneath of that that we split into really three categories. We'll call it revenue integrity, which I touched on, initiatives to drive better yield. There are supply chain and procurement initiatives, and there are labor and productivity initiatives split. We'll call it roughly equal in terms of those three categories. We've been working on these for some amount of time, but we continue to broaden the aperture in terms of expanding the opportunity set and accelerating. Last year, we brought in a new Chief Operating Officer who has both a health system and a large retail background and has operated at a level of, we'll say, both scale and efficiency that I would say the health system world is not accustomed to operating in terms of standardization. That is bringing, I'd say, an expansion of the opportunity set really across all of those categories. Is there kind of any embedded assumption around kind of the rural health front? That was a kind of tailwind that the company had called out in that $40 million figure. We haven't yet quantified that. I think as states continue, there's really no way to efficiently do that. We've seen numbers published by analysts for us somewhere in a broad range of, call it $15 million-$40 million. I think it's all speculation at this point. The states haven't even made it clear it's going to be done individually in terms of who defines what is eligible and how the monies are distributed. Again, until we get down the road with state rulemaking, it's not an efficient use of time to try to quantify. There clearly will be a benefit coming. We would have no way to quantify that today. Specific to your question, Raj, no. None of the $40 million we've quantified contemplates anything at rural. That would be additional upside. Got it. Maybe just kind of pulling back and focusing on the long-term growth targets that the company has, organic growth, mid-single digits, get to high single digits with capital deployment, focusing on the volume portion of that growth and kind of thinking about that 2026 headwind around the hand subsidies. Kind of how would you balance that against increased growth and expansion on the outpatient and ASC footprint and then additional kind of inpatient service line optimization? Is that kind of enough to kind of from a rev growth standpoint to still achieve that organic growth framework of mid-single digits? Yeah. I mean, I think we still feel very confident in that long-term growth algorithm. And again, it just goes back, and it's worth reiterating just the strength of our positions and the strength of our markets. If you've got population growth of 2%-3%, that's just a built-in tailwind. People need healthcare services. As we grow into the outpatient, we'll capture more of those and presumably some of that higher margin business that doesn't always flow through the inpatient side. So we feel very confident in that. If you look at our admissions this year, growing over 6% year to date, the outpatient side through 2.9% in Q3 from an adjusted or equivalent admissions perspective. And so our growth is very much in line with where we stand in our markets. We still know that there's more to come on that outpatient side for us to continue that catalyst. We feel very good on that. On the rate side, we've said 2%-3% blended rate plus 2%-3% volume growth yields that mid-single digit. As you said, as we expand outpatient, there's upside to that, and then there's other M&A. We feel very confident again in the demand for services. Again, we've got an aging, sicker population and good positions and strong growing markets. We think that that top line is very much in stride. With the impact initiatives that Alfred just outlined, we know that there's additional cost to go after that will improve margins. We feel very good about the durability and the fundamentals of the business. Maybe touching on the pricing, really nothing out of period in kind of when we think about pricing overall, other than just kind of the one Q delay in the New Mexico DPP that was recognized in the second quarter, but nothing from 2024, any retro perspective. How should we think about pricing growth next year? Still comfortable with that 2%-3%. Maybe just kind of commercial employer-sponsored is the vast majority of your book and kind of where this growth is stemming from X Hicks. Is that kind of still holding course over the last couple of years, 3%-5% in that framework? As you kind of look at your 2026 negotiated book, is that kind of like a good proxy? Yeah, I think there's no question that the rate negotiations have become more challenging going into 2025 and that we are moving, I would say, back towards, I'd say, a more normalized kind of, call it 3.5%-4% kind of range. Important to really focus on what is the underlying yield. It's well and good to negotiate a 5% rate increase, but if I'm yielding 2% out of that because of the denial activities underneath of it, I haven't accomplished much. Equally important to actually those top line rate negotiations is the terms and conditions and how are we actually how can we embed contractually mechanisms so that we actually stem the flow of denials. Got it. If we look again at our markets, I like to say that with almost all of them, we are the value-based system. To Alfred's point earlier about the focus around revenue yield, we're going to be more aggressive on that as well because we do have good positions in these markets, strong positions. As we saw with the contract we renegotiated, without us, they wouldn't have a network. That, I think, emboldens us to continue to put pressure and lean on the fact that we've got strong clinical services, strong clinical outcomes, and a demand for services that people want in our communities. We've got to fight to make sure we're getting that and getting the yield that Alfred talked about. Maybe just on the big kind of thing that can drive timing of funds is the renewal process for New Mexico and the 2026 DPP. I guess, is that a similar timeline to how we saw it in 2025 where they submitted the renewal end of year and then funds came into 2Q? Or do you think there's kind of since it's renewal versus a new program, is it more kind of expedited? Yeah. Every state has to renew every year. Yes, New Mexico got approved late in 2024 and then had to immediately turn around and reapply for 2025. There was that delay, particularly couple that with the change in administration and CMS. Going into next year, all things being equal, we assume that every state's on a renewal plan now that we're inside of. This just should become steady state operations. Not foreseeing any lapse or change in that. We should get back into a regular cycle. Yeah, not I don't want to get too wonky even from an accounting revenue recognition standpoint. But now that we have two years of approval, there are even precedents for accruing ahead of approvals once a program is up and running for a number of years. So I think we're into a world that it's much more ratable and predictable from a timing perspective. Okay. Maybe just now moving on to the capital deployment aspect, $50 million share repo authorized today by the board. Still plenty of liquidity and healthy leverage profile kind of as we think about ongoing development of the ASC and outpatient pipeline. Kind of as we think about what's coming online in 2026, you've called out a handful of assets, two ASCs, a number of UCCs and freestanding emergency rooms. How should we think about the prioritization of the markets and then the asset types themselves, right? Kind of seeing more UCCs in recent, but kind of more do we see more of kind of the ASCs coming into the mix since you kind of have figured out a more streamlined development process around that? That's exactly right. When we went public last summer, we said, again, we were going to start with outpatient development in our core markets while we look into new markets to expand into and more hospitals. We did exactly that. We added 27 urgent cares over the last year and a half, and that was the front door. We can see the pull-through of new patients coming into our system as a result of those investments. We were able to largely make some favorable acquisitions for us that accelerated the pace of not having to build these, open them, and fund the working capital and build the patient base. We took on established businesses that were positive and accelerated that expansion, which has opened up the front door to our health system. As we move forward, the ASCs, we've got a couple that are already in development that will open up mid-next year. We expect to put more shovels in the ground now that the ASC market is a much different multiple profile than the core business. We expect to do more de novo builds versus acquisitions. Not to say we won't do any acquisitions, but again, we want to make sure these are creative acquisitions that we can support and rationalize over time. These have a longer tail, call it a 12-24 month development cycle. We will be putting shovels in the ground and expect to deploy more capital as we go into next year on these projects in our core growth markets where we know we've got the physician support to drive these. The good news with the ASCs is if you're partnered with a physician and you have a joint venture equity with them, that you know that these centers are going to have the volume. You've got payers that are wanting things to shift to the outpatient. They're already shifting to the outpatient. This is a good bet on the future for us and a good use of that capital deployment because we can, if you're going to buy something at 10X with our multiple, that doesn't make a lot of sense right now. If you can build it for essentially 2X, that's going to be a much better growth algorithm for us for the long term. We expect to put more emphasis on those ASC builds now that we've got the pump running and with that outpatient story on the urgent care side. Thinking about the core margin expansion component, you acquired UCCs, and for the most part, you've called out that they're not profit generators. They're more kind of throughput generators from a volume perspective into the inpatient setting. As the client base and patient base kind of gets involved in this Ardent ecosystem, do those kind of on a standalone basis, as they gain more scale, kind of start to gain profitability or kind of more healthier profile to help that core margin expansion component? Yeah. I mean, if we look at them as an extension of our clinic operations, they are profitable. They're not generating substantial margins like an ASC might do. You look at some of our peers, and the margins that you can see against the ASC companies are much, much healthier than the traditional health system. They are creative assets from a profitability standpoint, both as a standalone as well as from the downstream. As we look at the assets that are most mature that we acquired a year and a half ago, seeing about a 45% increase in new patients to the system. Those patients, 15% of those end up having follow-up services, whether that's an outpatient diagnostic, a specialist visit, in a very small but meaningful way. There's some people that end up admitted to the hospital from that. It's a good strategy to opening up the front end of the health system to capture more patients. And then once we have you in that clinic, we're going to find out, do you have a primary care? Do you have a specialist that is needed to treat the condition you came in for and then build them into the ecosystem? So as you need that facility-based care over time, we've already got you in the network and can see that sort of progression across the system. Maybe thinking about the deal pipeline you spoke to, given where Ardent's trading at, does it kind of make sense to go after assets that are multiples above that? I think one of the core components is you have the SAM, the selector adjustable market, where there's midsize urban markets that you want to partner with from a JV standpoint with other health systems. You kind of talked to the pipeline, kind of the bell is kind of ringing on that standpoint. What should we think about kind of Ardent's ability to kind of execute on that front, given kind of the trading dynamics? Is that kind of on the back burner from an inpatient health system? Are there opportunities out there in the market that are kind of viable given kind of where we're at? No. I mean, that was, again, grow our current markets and the outpatient grow into new markets or hospitals adjacent to our core markets was phase two, and the third was optimization. It is very much still part of our strategy. We are going to be very disciplined in how we do that. We had an acquisition that we thought we were going to be able to transact on shortly after the IPO. As we got deeper into diligence, we found some things of concern and pushed back. We are not going to do a bad deal right out of the gates. We want the market to understand that we are not looking for growth for growth's sake. The company is growing quite nice just on its own with its core markets. We believe that there are opportunities out there. There's been a lot of things to come to market over the last year. We've looked at a lot, and we passed on most of that. Our new Chief Development Officer has done a great job. He's got 17 years of transaction advisory services working with nonprofits, a lot of connections, getting us into lots of conversations. I'd say that the interest in our joint venture model is as strong as we thought it was before. The opportunities are there, and we're going to be very selective. You add the regulatory backdrop on here that we're seeing. We're looking state by state in terms of not just how states are performing today, but where are they projected to be post-OBBA and making sure that if we get into a market, again, it fits our thesis, growth market, midsize urban, where we can land and expand. We can use our platform to really transform whatever acquisition we take on. Again, we are acquisitive, and we're going to be looking for the right types of partners to get into. Again, we're not chasing dots in the map, and we're not going to grow for growth's sake. Got it. Got it. I guess we're kind of coming up on the last five minutes here, but I appreciate all the uncertainties around 2026 and all the moving pieces, but maybe we can just walk through some key headwinds and tailwinds for next year. We've been kind of polling companies on kind of some aspects of the line items and businesses. Maybe first on kind of the labor aspect. That doesn't seem like it's been an area of pressure from nursing labor and just kind of given where volumes have trended. Maybe just kind of any update on the hiring retention trends and how we should think about kind of SWB growth relative to this year. Our focus around culture and providing the tools and resources for our staff to do their job is paramount. We see that play out in terms of our hiring practices and our retention. This year, we've seen a continuation. It has slowed, but we are still seeing a continued drop in contract labor as our recruitment efforts and retention efforts continue to improve. We have seen a reduction in turnover over the last couple of years, and that's playing out in the SWB line and most notably observed in that contract labor. We expect those trends to continue. Now, there's a nursing shortage, and there's been one throughout my entire almost 30-year career. It's just how acute at any given point. We are in a point where stable, I guess, is the word that I would use in a shortage market, respectively saying. We feel like we've got good, strong partnerships with our nursing schools and our key regions, developing those nurses inside of the training programs in our hospitals and matriculating into frontline staff for us as they continue their education. We feel good about that pipeline. We had a bolus of nurses leave during COVID, and I think the industry is still recovering from that. The initiatives we can see are paying off, and we can see the results trickle down through the. Maybe just kind of coming back to the impact initiatives. I know there's been technological investments kind of on the EMR side, but then if we think about kind of some of the uses of AI kind of around documentation, just increasing productivity and kind of getting rid of that administrative burden aspect, how should we think about kind of that impact from a volume standpoint? I think you've been making those investments for a long time. What's kind of been the incremental kind of volume push from that? Any areas kind of in the near term that you see opportunities for investments as we kind of think about the capital spend of the business? Yeah. I mean, certainly our investments and partnering with innovative technology is helping, one, on the recruitment and retention side. Some of the things that we're doing with virtual nursing and our Bio Button initiative and helping to improve length of stay and clinical outcomes and clinician burnout are all taking hold. We are going to be expanding those in the next year, which should have a part of that productivity component that Alfred talked about in our impact initiatives. In terms of ambient listening and documentation in our physician practices, we did a pilot with that. Overwhelmingly successful. We are rolling that out just as we speak across the platform. That will help with physician burnout. It will help with physician productivity and ultimately better documentation and coding. We partnered with a firm called Ambience, and we're also going to be helping to co-develop the inpatient nursing side of that. If you think about how do we change and really transform the way in which we deliver care across health systems, we've got to find a way of dealing with this labor dependence that we have. If we've got a nursing shortage, we can ask people to run faster and harder on the hamster wheel, or we could actually change the way in which the workflows work. If you look at a typical nurse, they'll spend upwards of a third of their day doing documentation. If you think about ambient listening and the benefits that that can have, whereas the nurse is conversing with the patient, it's documenting that and taking that burden off. I'm not saying we're going to see a third of productivity increase, but in the near term, if we can see a 5%-10% decrease, that's meaningful when you look at the footprint of nurses that we have across the entire company. I think technology is going to be part of that unlock that addresses the productivity challenge and addresses the workforce solutions that are the challenges that the industry has had. We're early adopters, and I think we're early inning. Yeah. Just some stats on the ambient listening pilot that we ran. Improvement at a four and a half hour reduction in documentation time per physician, increase in work RVUs, increase in HCC capture compared to pre-post. Maybe just to wrap it up here, and thinking about kind of supply expenses, it's been a key network from kind of all the industry peers, especially just drug expenses. Clearly, a factor into kind of day-to-day operations. You have a GPO that you've partnered with, but kind of relative to 2025, how do you see those cost trends or cost trending in 2026? What are some of the near-term levers or initiatives within kind of impact that kind of help address that maybe kind of longer term? Yeah. I think I'd say there's no rocket science involved in supply chain improvement and management. It's old-fashioned physician preference items, standardization, waste and obsolescence. It's just leveraging scale. Are there additional ways we can look to actually capture more scale and purchasing power in our negotiations? We're not expecting much impact from tariffs next year as we sit here today. Our expectations are for that to be pretty negligible. Great. I think that puts us right at time. Thank you very much for joining us today. Thank you, Raj. Appreciate it.