Ladies and gentlemen, the 2022 Investor Day for Cano Health will now begin. Today, healthcare is incredibly misaligned. The sicker the patient is, the more profitable he or she is to the institution, and that's just unacceptable. At Cano Health, our patients see us 3, 4 times more than the national average. Our job isn't just diagnosing your disease, our job is the management of that disease. The culture begins from the top and permeates through the clinicians to the call center, to the driver. That family service will reduce the cost of healthcare by keeping you healthy. We are more profitable the more healthy we make you. We don't make money on seeing you. We make money on making you healthy. We lower the cost of care, but most importantly, helping that member live healthy, happy and longer lives, and we can demonstrate that through the success we've had over the years. We do that through buy, build and manage. Those are our three growth avenues. That's really what Cano Health is all about. It's really taking the waste out of the system and improving it where everybody succeeds, but most importantly, the member, the payers, as well as us as an organization. It's about preventing illness. It's about preventing complications. It's about engaging with you and being proactive and having that continuity of care. Because if I do that, then I am truly treating you not like a number, I'm treating you like family. What we are doing for our patients, for entire communities, for state governments, and hopefully soon across the country, is incredibly important to solve a national necessity. What I'm saying here is that the model of care that we have developed over the years, it's about guaranteeing access, quality, and wellness to measurably improve outcomes while controlling costs. Good morning. I'm Marlow Hernandez, Chairman and CEO of Cano Health. Thank you so much for joining us today. I'm joined today by various members of our management team, and they're very much looking forward to taking you through their portion of our story. We will leave time at the end for Q&A. We have a lot to cover today. In the next three hours, we're gonna tell you about our mission and vision, the fundamentals of our business model, and the results of our enterprise. At Cano Health, we operate a dramatically evolved version of healthcare in America. I would like to start with an image. An image that I'm sure will be familiar to you, one that you have experienced yourself, that maybe you have accompanied a family member to, that represents the less evolved conventional state of healthcare in our country. Take a look at that picture. How many of you have rung that bell and waited until a voice on the other side of the glass said something like, "Name, date of birth, have a seat, and we'll call you"? On rare occasions, you may get eye contact, and if you're lucky, you might even get a hello. Well, what's worse is not just that aesthetic, is that the reason why you're in front of that window is because you are sick, other than for those relatively rare occasions of your annual checkup. That, my friends, is the transactional model of healthcare that permeates healthcare in America today. It could be compared. In many ways, it's similar to the experience of getting your car repaired at your local dealership, except perhaps less customer-oriented. If we put the concept of warranty aside, car companies are perfectly happy to have you get your vehicles checked up and repaired at their authorized dealerships. After all, those transactions create a margin for their ecosystem. In fact, the more services that are required, the more money is made, so long as reputations are not ruined. In that old car model, incentives are misaligned. The cons umer, you, is the only one hoping to not be left stranded in the middle of the road. Doesn't that sound a bit familiar? The healthcare system today, by and large, is similar to that model. It's transactional, it's volume-based, it's reactive, it's impersonal, it's inequitable. Show me a healthcare system that requires sicker and sicker patients to thrive and prosper, and I'll show you a business model that is unsustainable. In fact, it's already here. We spend twice more than comparable countries and don't get better results, according to the American Journal of Public Health. Medical issues are the leading cause of bankruptcies among American families, and if we look at it from the macro perspective, it may soon become a bankruptcy issue for our country. Now, let me be clear. I'm a practicing physician. I do not believe the problem lies with providers or healthcare staff or for that matter, hospitals, pharmaceutical companies, payers, or anyone else. The problem is structural. The problem is with the model. The problem is with the system itself. We can do better, much better. Imagine this. Imagine if the car maker had to pay you for lack of reliability. Imagine the benefit to society, the cost savings, not to mention the benefit to you, the driver. That alternative, in a nutshell, is the value-based model of care because it is aligned with the interest of the client. It focuses on the long-term result, not the short-term gain, which makes particular sense when it's quite literally life and death. In that more evolved model of healthcare, the model practiced today by the more than 4,000 professionals at Cano Health, interests are aligned so that healthcare outcomes are improved, the patient experience is enhanced, and the cost of care is reduced. At Cano, we put value before volume. We are paid a flat fee per member, per month. Rather than getting paid each time when we treat disease, we are paid to keep patients healthy. Makes sense, doesn't it? As a result, we invest. We have the incentive to invest 2 times more than the national average in primary care per member, and we earn a profit when those members are healthier, when we reduce unnecessary costs. Because we invest significantly more in primary care and prevention, we see our patients much more often than is typical. On average, 20 times per year for our Medicare Advantage patients at our medical centers. That allows us to engage more with our members, to get more actionable data, to identify illness earlier, improving outcomes while bending the cost curve. Cano Health's medical costs, which are, of course, primary care, the outpatient specialty care, inpatient hospital care for our MA, Medicare Advantage members, decline as a function of cohort maturity. In other words, the more time a patient spends with Cano Health, the less costly his or her care is because his or her health is improved. Take a look at that graph. That graph is truly transformational. For the 2019 Cano Health patient cohort, approximately 26,000 patients, whether at our medical centers or at those of our affiliates, medical costs should have increased by 10% per year. Yet, under our management, we actually decreased medical cost by 3% per year, even after factoring in the COVID-19 related utilization in 2021. This is updated data, December 31, 2021, and you've got the three years to look at. Premiums increased by 7%. Costs should have gone up by 10, yet the actual medical cost going down by 3%. This is what we mean by transforming healthcare. We believe America deserves the best healthcare system, and we believe that financial performance should be aligned with clinical outcomes. The beauty is that there is a market solution, a market solution that works for everyone, patients, providers, insurance companies, taxpayers. That solution, I believe, is key to preserving the American dream. See, the Cano model is not about a transaction. It's about nurturing a lifelong relationship. This is why our medical centers feel like a second home to our patients, an extension of their families. It is only when you truly know someone, when you know their medical and social needs, when you have the resources to invest in primary care and prevention, when you're getting the right data to be proactive in individualized care. It's only then that you're truly able to serve the patient's long-term needs. This is what we mean when we describe Cano's vision of high-quality care and lifelong bonds. This is what we mean by treating patients like family. As a doctor, my first two lessons were the following: No one cares how much you know until they know how much you care. What happens outside of the medical exam room is as important, or perhaps more so, than what I can do in the medical exam room. Therefore, we distilled what is truly common to all Americans, the healthcare needs that everyone has, into three pillars, access, quality, wellness. This is how we execute on our mission at scale. Let me take you through them very briefly. Access is simply what you think it means. It's about making it easier to connect with us. Quality is about ensuring that evidence-based protocols are followed, and wellness is about providing a safe environment and a programming for social support, for learning, for exercise, for hope in ways that complement the effectiveness of the primary care service. Said in a different way, wellness is about providing the setting and services that a PCP visit alone cannot, yet greatly enhances or even determines the effectiveness of that care. We grow our model through three distinct core competencies, building, buying, managing medical centers, which will be described later in the presentation by my colleague, Jason Conger. It is important to emphasize that while the healthcare needs of all Americans are universal, each community is unique. You have different cultures, income levels, premiums, costs, networks, disease burdens. Delivery of the right healthcare in the most compelling manner is a highly local process. Therefore, you need a flexible growth approach, matching the needs of the community with the growth avenue that allows us to effectively serve the greatest amount of patients in the least amount of time with the best clinical and financial results. The results speak for themselves. We're doing well by doing good. The more patients we serve, the more lives we save, the more communities we revitalize, the more resources we have to continue to fund our growth. We were founded in 2009. We have a proud history. This is now our twelfth year of operation. We have grown every year. Our performance demonstrates that a better service with the right strategy, scale, and density, results in uncommon performance. We have grown from scratch into the number one independent value-based care provider in Florida, and we're quickly expanding in key markets across the country, becoming leaders in those markets. As an example, my colleague, Maggie Arias-Petrel, will talk to you about our experience in Las Vegas. Since our March 2021 Investor Da y, you have heard me talk about build, buy, and manage. My colleagues and shareholders have been hearing about this since 2016 because this is what we have been doing since our first external capital raise, producing best-in-class performance, which is significantly ahead of our projections. While we continue to innovate in our space as a pure-play, value-based care pop health management company, our focus remains the same, growth through a balanced, profitable, and sustainable strategy. We currently operate 141 medical centers, employ 400+ providers, serve 1,000+ affiliates, and count on 4,000+ healthcare professionals who deliver industry-leading clinical quality and patient experience. Our journey has just begun. Our market is large and growing. In fact, our market is the largest in the United States and growing significantly as Medicare alone is projected to increase by $400 billion in the next five years. Healthcare, primary care specifically, is a necessary service. It's not a want, it's a basic need in any economic cycle. Because it is an essential need, an essential service, the payments are recurring and guaranteed mostly by governments and employers. Lastly, the future of healthcare is value-based because paying for outcomes rather than for volume of services is the only way we can ensure quality, equitable, and affordable healthcare. Cano Health is harnessing the societal tailwinds and providing a unique solution to the large and growing market demand. We specialize in senior healthcare, population health management, capitated models. We work with Medicare, Medicaid, ACA, employers, private payers, and we're the only proven solution at scale to measurably improve outcomes and decrease mortality while reducing costs. Our total addressable market today is $1.7 trillion and continues to grow with the aging population and the expansion of our services. In the future, the largest and most profitable healthcare companies will be those who meet the demand for healthcare with the highest quality and cost-effectiveness. The current status quo will not remain. Companies like Cano Health will supplant non-value-based companies to achieve significant market share akin to what the large national payers have today while generating attractive long-term margins. Now, let's talk about those margins and that market share. We estimate a 10%+ long-term market share, 15%+ long-term margins, and 20%+ long-term organic revenue growth per year. Currently, we're the only proven company at scale with a value-based platform, flexible growth model, and track record of profitable growth, particularly for the underserved populations. However, we don't need to wait 'til the future to establish our performance credentials. We already operate approximately 40 mature medical centers with run rate margins at or above our long-term targets. We expect adjusted EBITDA this year of $230 million-$240 million and have approximately an additional $300 million of EBITDA embedded in our business. Lastly, on a company-wide basis, we expect to be cash flow positive from operations this year and free cash flow positive in 2023. This will allow us to fund 30%+ organic revenue growth through 2025. Irrespective of economic ups and downs, we will continue to create value because we operate a necessary service for a large and growing market through a recurring revenue model that is adaptable to patient and community needs and is aligned with the needs of all stakeholders. Bottom line, I believe that you would want your parents to be patients of Cano Health, and that when you need comprehensive primary care yourself, that this is the healthcare model that you will select. With that, let me now turn it to Jason Conger, our Chief Growth Officer, to take you through our flexible growth model. Good morning. I'm Jason Conger, Chief Growth Officer of Cano Health, and I'm excited to have the opportunity to dive into our growth strategy and give you a sense of how we have and will continue to achieve rapid, sustainable, and profitable growth. Cano Health has proven its ability to grow throughout the company's history and continuously develops and refines its infrastructure and its methods of growth. We have developed core competencies in acquisitions, in integrations, and in center development. A key metric we use to measure growth is membership. As shown on this slide, you can see over the years we've notched membership increases every quarter. As you can see from the slide, our consistent organic growth has been supplemented by a highly accretive acquisition strategy. In the last nine months alone, we have added 47 medical centers, 113,000 members, 120 employed providers, and more than 200 affiliate providers. During that time, ending March 31st, nine months ending March 31st. During that time, we expanded into six new states via staff model centers or affiliate networks. Looking ahead to the rest of the year, we expect to end 2022 with between 184 and 189 medical centers, approximately 500 employed providers, and between 290,000 and 295,000 members. Our vision at Cano Health is to become America's leader in primary care while improving health, wellness, and quality of life in the communities that we serve and reducing healthcare costs. Our growth strategy supports the vision and is actually very simple. It's to serve the greatest number of patients in the shortest amount of time with the least amount of risk and the highest return on investment. The cornerstone of our growth strategy, as has already been mentioned, is our flexible buy, build and manage approach to land and expand in any particular market. Clinical capacity is a critical factor that we carefully manage. We currently have approximately 50% capacity overall in all our existing centers. As we fill that capacity through organic membership growth, we leverage center-level fixed costs and increase our margin. But as centers mature, capacity becomes a limiting factor for sustaining membership growth. We have a highly flexible multi-pronged approach to build capacity and drive growth through a mixture of three distinct but highly complementary channels. The first is to build de novo centers and add capacity to existing centers to leverage local density and create operational efficiencies. The second is to add tuck-ins to increase scale and density in existing markets and integrate those tuck-ins to improve their performance. The third is manage affiliate provider networks, including through the direct contract model, which in 2023 will become known as ACO REACH. We'll hear some from my colleague Bob Camerlinck later a little bit more about that program. As you would expect, each of those channels and each of our different kinds of centers have different kinds of characteristics. On this slide, you'll see incremental capacity, cash burn, and time to reach maturity follow a similar curve together. Tuck-ins being the lowest, and then our three models of de novo centers from smallest to largest. Each market, to varying degrees, is different than the rest, and so we have to customize our approach to each market. Our three growth channels give us the flexibility to enter new markets and to build scale and density faster and in the most effective and efficient way. In each case, we can tailor the approach to fit the characteristics of the specific market, which allows us to optimize deployment of capital and reduce risk. To give three examples of each of the channels, in New York City, which has a very high cost of entry, we entered the market initially through an affiliate network. In Tampa, we entered the Tampa market by acquiring an established practice with an experienced leadership team. In San Antonio, we entered that market initially through de novos. In each case, we aim to achieve our goals of speed, scale, density, and in time, deploy all three growth channels in each market. In addition, we constantly reevaluate the cost, risk, and benefit of utilizing each channel to enter a market. This flexibility that we employ allows us to change approach in response to changing circumstances. For example, in 2021, the average combined CapEx and OpEx cost for de novos began to increase due to macro factors like rising construction costs, supply constraints, and construction delays. In 2022, we shifted the mix of new centers that we plan to open more in favor of tuck-ins as compared to 2021. As you can see on the slide, the CapEx costs are similar but have risen for de novos. De novos have an OpEx cost as they're cash flow negative for about the first two years, roughly. Whereas tuck-ins provide cash flow positive performance within a year. We have a disciplined approach to entering new markets. We focus on serving mainly seniors and particularly low-income seniors. This naturally focuses our development efforts in areas of the country that fit our target member demographic. We target specific counties using weighted criteria such as the number of Medicare beneficiaries, the Medicare Advantage penetration rate, and the percentage of dual-eligible beneficiaries, meaning eligible for both Medicaid and Medicare. We look for underserved communities where our care delivery model is most needed and differentiated. We drill down within those broader markets that we've already identified to find catchment areas with high densities of dual-eligible Medicare beneficiaries. The heat map on this slide shows zip code by zip code density of dual-eligible Medicare members in San Antonio, Texas. The logos on the slide show our locations in San Antonio. As you can see, we follow a disciplined approach to market entry and then also follow it as we expand achieving scale and density in that market. As Dr. Hernandez mentioned, the total addressable market for Cano Health is somewhere around $1.7 trillion of healthcare dollars spent annually on Medicare, Medicaid, and subsidized Affordable Care Act care in the US. It is a core principle of Cano Health that we do not turn any patients away. As I mentioned, we are focused on seniors. Even with this focus, the growth opportunity is staggering. In Cano Health's top 25 markets alone, there are approximately 7.3 million Medicare beneficiaries. Of those beneficiaries, around 56% are Medicare Advantage beneficiaries, 25% are dual eligible, 25% are Hispanic, and 15% are African-American. That's just our top 25 markets. Again, we use a land and expand approach when entering new markets using the same three growth channels. We select the best growth channel to land in a market in a targeted location. Once we're there, we use all three growth channels opportunistically to expand. Expand meaning develop scale and density as rapidly as possible in the market. As scale and density increase, we're able to deploy additional services, improving outcomes, and reducing unnecessary utilization. We can expand existing centers to more efficiently increase capacity and greater access to care and increase the member engagement and enrollment rates. Speed, scale, and density are strategic imperatives for good reason. Speed because the opportunity is vast. We wanna serve the most patients in the shortest amount of time. As we achieve scale and density in the market, the benefits create a virtuous cycle that allows us to reduce risk and improve results through things like financial levers, such as better contracts, operational efficiencies, like lower operating costs, lower patient acquisition costs, and lower utilization or medical expense ratio. In addition to that, we achieve greater reputation and brand recognition, which improves member enrollment and our ability to recruit and retain quality staff and provider affiliates. To sum up, we are on track to deliver uncommon results through executing on our growth avenues, both organic and inorganic, to capture a significant share of the $1.7 trillion market opportunity. Now, let me introduce Pedro Cordero, our Chief Population Health Officer, to discuss Cano Health's population health platform. Thank you, Jason. Good morning, all. Thank you for being here today. My name is Pedro Cordero. I'm the Chief Population Health Officer at Cano Health. I have been with the company since 2017. Marlow provided a great overview of the industry and Cano Health competitive position, and Jason discussed how we are growing through multiple growth avenue. In my portion of the presentation, I will discuss how we use our technology platform, CanoPanorama, to help manage the care of our patient and deliver better outcomes at a lower cost. I'm gonna do a quick introduction what is CanoPanorama. CanoPanorama is a set of process, and with the technology together is the platform that we utilize in care management and population health. When we started Cano Health, we discovered that most systems in the market were designed based on reactive approach that responded to a patient event after the fact. In contrast, CanoPanorama is designed to be proactive, to anticipate patient needs based on our experience and clinical evidence. The traditional overview of the primary care physician is narrow and limited. A physician only see what happened within the four walls of the medical office. In larger systems and groups of physicians, maybe provide additional information to the providers. The use of proactive prevention is often limited or absent. Gaps and delays of information lead to missed opportunities to influence the care of a patient and the utilization of resources. Examples would be identifying the need of medication, making sure routine screens are accomplished, or focusing on resources on the higher risk. Our technology places our patient at the center of care, giving our providers a 360 view of all of the factors that can impact the patient outcomes. This is very important how we restratify our patient population and develop individual care plans. Approximately 3% of our population accounts for approximately one-third of the healthcare costs. The identification of a population risk, the development of care plans, and the monitoring of treatment can produce a significant impact on the costs and outcomes. CanoPanorama provides us with a single pane of glass into a patient healthcare. While building CanoPanorama, we focus on the challenges to achieve quality outcomes, and we have worked effectively to address them. I'm gonna address a few challenges that we have faced in the past and how we address them. One of them is data integration. We have integrated about 18 payers into our CanoPanorama. All of the payers provide data in different structure, view, and layout. We have standardized the data in a uniform way so it can be interpreted and utilized across the organization. This is especially important to our buying strategy since accelerated due diligence process and help us rapidly to integrate targets and larger acquisition. Another challenge that we face and we address is the credentialing and the billing backlog process. We cannot submit a claim to a payer without a provider being credentialed. Due to the process and workflow of the health plan, it could take up to 30-90 days for a provider to be credentialed. Until that time, you cannot submit a claim to the payer. Why is that an issue? Well, there are critical submission deadlines to CMS for funding. If the deadline is missed, cash collection could be delayed for months. We address this issue in the enrollment form. The unique algorithm built into the system only allows to enroll members under a provider that are already being credentialed with the health plan. Another one is utilization management. How can we provide to a clinical team information even before the patient actually reach the first PCP visit? We address that by creating, along with the clinical team, what we call the CMA tool, which is the Care Management Assessment tool. What is the Care Management Assessment tool? This is just pretty much a set of questions that based on the answer of the patient, the system stratify the patient as a high risk, medium risk, and low risk. This is one of the tools stratification algorithm built into a CanoPanorama. Another issue or another challenge that we face that we have addressed is how we can segregate the data and protect our patient information. We address that by creating a unique role system into a CanoPanorama. Meaning you only have access to patient information as long as you can have a direct impact on the outcome of the patient. For example, benefit coordinator would only have access to membership and eligibility portal. They will not have access to the medical data or financial data. These controls give us comfort that our data and processes are secure, and they're only available to those that can have a direct impact on the desired outcome. While there are many elements that go into our formula of success, CanoPanorama is an important part of secret sauce. A CanoPanorama is a differentiated and scalable platform. By using CanoPanorama, we have improved the member experience and helping to create life-long bonds while strengthening the Cano role at the center of the care. At the enterprise level, CanoPanorama allows to monitor the care interaction between patients and our providers. We analyze both trend and cost. Once claims hit our service fund, the system actually is implemented the second algorithm to stratify the patient. By utilizing technology, we allow our doctors to do what they do best, which is focus on the care of the patient. Data is not the innovation here. Everybody has access to the data. It's what do you do with the data. The innovation here is how we can actually translate that data into actionable item. Item that can deploy to be meaningful in the way that make a difference how we deliver care to our patient. By solving this major issue, it facilitates efficient allocation of resources and delivery of more effective medical care in real-time. Our care is comprehensive, standardized, and our algorithm helps us to reduce waste and provide better care to our patients. In this presentation, I'm gonna display multiple views and dashboards built within the CanoPanorama. This is one of them. This is the HIE real-time event, which is Health Information Exchange that covers most hospitals, for example, in the state of Florida. This alert allows our care managers to begin work on care plans immediately on discharge protocol, transition of care, and start working with our clinical team and hospital group in order to continue providing quality care to our patients. The visualization of the data is key to translating to the actionable data. For example, as we can see here in this view, we can drill down at any data given point in this view. You can actually segregate data based on organization, medical, service locations, payer, even a particular cohort of patients. One of the key algorithm built into this particular real-time event alert, which is refreshed every 15 minutes, is how we map the episodes and alerts. Over 200 hospital participate in the State of Florida providing events real time. Imagine 200 hospital providing events in different format, view, and layout. We have built an algorithm which help us to identify those alerts within admissions, discharge, ER visit, observation, and many others. Another important module that we are not displaying here that I wanna address is the pharmacy module, which allow us to actually identify and monitor key metrics or KPIs, which are GDR by patient, GDR by provider, RX per member per month, a medication to avoid in the elderly, which is key to RX quality metric. The second module that I would like to address that is not displaying in this presentation is the eligibility module. Why is the eligibility module important? We have already 18 payers integrated into our CanoPanorama. Imagine having to check multiple portals for eligibility, having the front desk, the benefit coordinator, support staff, having to check multiple portals to check eligibility. We address that by creating a universal eligibility module within CanoPanorama, that from one click, you can check the eligibility of that patient, which the system integrate most of the eligibility portal across the country. Another important module is this, what we're seeing, is the clinical performance dashboard. Here you can see that we actually track four critical metrics, admissions per 1,000, ER visits per 1,000, high-cost procedures per 1,000, which is critical, and the overall medical cost PMPM. On my right-hand side here, you can see that we can drill down. For many ways, we can actually drill down by organization, service location, payer group, et cetera. A gain, you can drill down in any given data point of this layout even at the patient level. The next slide is the admission dashboard, which is very standardized across the organization. Here we track multiple metrics: admissions, readmissions, readmission rate, length of stay, cost per admission. On my right-hand side, you can see the multifunctional filter capability of the system, which we have over 30 ways to segregate data. Again, by payer, organization, region, market, service location, and more importantly, particular cohort. If you wanna look for a particular cohort of patients, the system has the capability to drill down. In addition to that, we can track top 10 hospitals, for example, by admissions, readmissions. We also have total admissions, etc. The next one is what we call the transportation module, which interfaces directly with multiple modules within the CanoPanorama, in particular EMR system. Why is that critical? Because it allows us to be more effective in the workflow of patients at the clinic level. As I have been discussing, CanoPanorama is embedded across Cano Health. It aggregates, synthesize, and analyze data which guide us, provide us through workflow which improve clinical outcomes. I will close with this. At Cano Health, we have pioneered many aspects of the population healthcare delivery. However, this is just an ongoing evolution of CanoPanorama, as we continue to enhance our system, process by utilizing technology to deliver the best quality care for our patient. With that, I leave you with a video for Access and Wellness. Thank you. El servicio de transportación, por ejemplo, como yo misma, yo no manejo. Entonces, si no me ponen el transporte, no puedo venir. Aquí me siento bien, tengo muchas amistades y me tratan muy bien. I was in another health clinic, but it's never like this one. I was just seeing the doctor and then going home. A mí me llaman de otras clínicas. Yo digo, "No, no. Yo me siento muy bien en Cano. Una de las cosas fundamentales de Cano es el trato de todos los trabajadores, los médicos, que nos tratan como familia, nos llaman por los nombres y eso nos hace sentir importantes. Es una clínica que tiene todo lo que una persona mayor necesita. You really feel at home. I actually stop in at Cano Health sometimes just 'cause I'm driving by, and they always have time for you. They always have time for you. Yo como paciente de Cano invito a que vengan y sean parte de esta gran familia de Cano. Que sean tan felices como yo soy. Yo recomendaría que muchas de mis amistades y personas que no conozco que prueben a venir a Cano, que se van a sentir bien. Para mí, Cano Health es lo mejor que hay. I feel younger already. Good morning, good morning. I'm Dr. Merlin Osorio, Senior Vice President of Care Management. I met Dr. Marlow Hernandez and Gina Portilla January of 2017. While I was speaking with both of them, I realized that they wanted to create a patient-centric, quality-driven, cost-efficient primary care delivery system. Everything was surrounded around wellness. Before Cano Health, I was a medical director for two national payers. I am extremely excited to be here today and to share with you our superior results. Cano Health is a population health organization, and delivering these superior results happens having the right people, scalable processes, and the right technology. As Pedro Cordero mentioned earlier, our CanoPanorama produces actionable reports for our care managers and our clinicians. I would like to point your attention to the right side of the slide, where we have displayed our mortality rate. This slide compares 2020 fee-for-service Medicare patients to our Cano HMO patients. This data presented here shows that Cano Health has a 60% reduction in mortality rate. Let me say this one more time. Cano Health has a 60% reduction in mortality rate during 2020. This was during the pandemic, the COVID pandemic. Moving over to the center of the slide, Cano Health again shows a great reduction in emergency room visits per thousand. We see a 52% reduction in emergency room visits per thousand. Again, remarkable achievement. Moving over to your left side of the slide, we have our admissions per thousand. Again, Cano Health has a 23% reduction in admissions per thousand. When you take into account that one emergency room visit for our managed care population has a cost of approximately $2,500, a 52% reduction brings about great savings. When you also take into account that one hospital admission for our managed care population has a cost of approximately $14,000, you can imagine the financial impact that these numbers bring. Cano Health approach to care management drives improved outcomes and member experience. CM S realized early that primary care physicians and health care organizations are able to close care gaps with regards to preventive health screenings. CMS realized that we can close breast cancer screening gaps, we can close colorectal cancer screening gaps, we can address diabetic management in our patients. The one thing that CMS is paying close attention to is customer experience. In 2022, CMS has put a lot of weight in customer experience, and our HEDIS score for 2022 is gonna be 40% customer experience. No longer CMS is asking you, "Did you address your colorectal cancer screening," or, "Did you address your eye exams?" Now they're looking at customer experience. Our care management department is divided into four areas, four key areas. We have our care managers, we have our Cano at Home program, we have our quality management team, and our utilization management. Let me tell you about our care managers. Our care managers are actually embedded in Cano's DNA. These are the individuals that drive our high-touch approach to patient care. Our care managers are not only tasked with coordination of patient care, assessment of high-risk patients or transitions of care. Our care managers are embedded in our medical centers. Our care managers not only address patients' need at the center level, but they're also working with our interdisciplinary care team to ensure that we address all gaps in patient care. Having our care managers embedded in our medical center allows us to continue to work on our mission which is to form lifelong bonds with our patients and their families. Transitions of care begin upon hospital admission. Our care managers, working with our CanoPanorama platform that Pedro Cordero introduced, are able to obtain actionable reports. They have access to real-time hospital admission alerts. Our care managers have access to real-time emergency room visits alert. These allows our care managers to begin working on their transition of care the minute the patient walks into the ER. We also have real-time connections with Surescripts. These allow their care managers to have access, and our clinicians to have access to all medications that our patients have picked up from any pharmacy, medications that can be prescribed by a specialist or a primary care doctor or any other physician outside of Cano Health. Having this information allows our care managers to truly complete a medication reconciliation, which is key to help us prevent preventable hospital admissions. Our care management platform is also NCQA accredited, and it was customized to help us meet our patient needs. This platform is a tool that allows us to predict, prevent, and retain patients. Cano at Home. This is an innovative home-based approach for complex care management of our patients. We provide episodic care in the comfort of the patient's home. We also complete transitions of care following hospital discharges. We make available to all of our Cano patients a 24/7 medical urgency line. Imagine having one of your parents thousands of miles away from where you are, and your parent needs a doctor on a Saturday night because they woke up and they can't get up from bed. All the patient has to do is call our 24/7 medical urgency line, and one of our clinicians will come to the comfort of their home and actually treat their condition and address their pain and address their disease process. Quality management. Identifying care gaps to improve outcomes and drive quality of patient care. I'm extremely proud about our quality department and the things that we do in Cano Health because Cano Health has been ranked number one in the state of Florida for Humana Medicaid for six consecutive years. Those of you who have managed Medicaid patients, you can understand and appreciate the difficulty of being ranked number one six consecutive times. We also have five-star providers in our Medicare managed care population across multiple payers. As part of our transition of care, we have completed medication reconciliations on all patients leaving the hospital, whether it's an inpatient admission or an ER visit. Utilization management, we follow hospitalization trends, we follow generic dispensing. About generic dispensing, I would like to mention that 1% improvement in generic dispensing rate in our Medicare population is equal to a savings of $9 per member per month. We follow CMS clinical guidelines, local coverage determination guidelines, and national coverage determination guidelines to ensure the appropriateness of services being requested. More on utilization management. Medication-related adverse events are estimated to account for 20%, costing 20% of hospital admissions. For this reason, Cano Health implemented a medication management team within our quality department. This medication management team is tasked with ensuring that our patients receive their medications and their refills timely. Part D medication adherence is also heavily weighted for our five stars in HEDIS, and this team allows us to achieve great outcomes, meaning five stars. Readmissions are often avoidable, and through the appropriate transition of care, the average 30-day readmission rate for Medicare population is 16%. Implementing our Cano at Home program, working hand in hand with our care managers, has significantly reduced readmissions. Another important topic is addressing socioeconomic factors which have an emphasis in patients' well-being. We have social workers embedded in our centers, working with our benefit coordinators, working with our care managers, and also working with our behavioral health specialists to help us address social determinants of health. Last, we are committed for long-term care management and member experience. I want to say this, if you remember our presentation today, I want you to remember this. Cano Health has shown reduction in mortality, reduction in readmissions, reduction in admissions per 1,000, reduction in ER visits, and improvement in renal function. Dr. Aguilar, our Chief Clinical Officer, will present to us data on improvement in renal function. Thank you. Well, good morning, everyone. Thank you so much for being here and for joining us. I want to share with you Cano Health from the perspective of the Chief Clinical Officer. I am the Chief Clinical Officer for Cano Health, and my responsibilities are a variety. I am a primary care internist by training with over 35 years of clinical experience. Across the industry, I'm considered by my peers as a key opinion leader, a KOL, in part because I'm a peer-reviewed author in a number of leading journals, but also for the last two decades, I've trained thousands of clinicians across the United States, not only in a CME setting, but in conference setting, and not only in the United States, but across Europe, Canada, and south of the border. As a co-founder of Cano Health with Dr. Hernandez, my role as a Chief Clinical Officer is to lead the clinical team, to provide guidelines, to provide protocols and implement the protocols across our platform, and to provide clinical leadership. I want to share with you something very unique that Dr. Osorio was presenting. He was sharing data about our clinical outcomes, about the reductions of over 20% in hospital admissions, about the reductions in over 50% in ER visits, and 60% reduction in mortality. That's extraordinary. Why is it that we are so unique compared to fee-for-service across the United States in Medicare? What makes us so different? What is the secret sauce? I get asked that all the time. Well, you can see in this slide exactly why. We empower the physicians to focus on the patient to not only deliver care, but what differentiates us is we manage disease. It's disease management that results in these outcomes. Many of your family and your friends go to the doctors, and they're seen. You saw a video of a lady, "Well, I went to the doctor, and all they do is see me, and I go home." They get care, but are they getting management of their disease? We do this through a variety of ways. We have a smaller physician-patient panel, so allows them more time to work with the patient, and we have this clinical support that Dr. Osorio was talking about. When the patients are being seen by their primary care provider in the exam room where the magic happens, and they have hypertension and diabetes and kidney disease and heart failure, and they have all these diseases, and then they go home. While they're at home, they're not in front of the doctor, but their disease doesn't stop. They wake up ill in the morning, they're not feeling good in the middle of the day, over the weekends, and at night. Our additional supporting team bridges the gap so that our clinicians can focus on the patient when they're right there in the room with them. In addition, we have technology that supports our clinicians, not saddles them like a yoke around their neck. These support structures in the EHR are embedded with structured data which populates the last lab result, their target for diabetes, the medications that they use, the testing results that they have. These structured data are populated and are migrated from visit to visit. The doctor says, "Hey, Mary, I need a copy of that eye exam." "I'm sorry, Mr. Martinez. You know what? It's already in the notes. The doctor has the efficiency to work directly with the patient when they're in the room where the magic happens. We also have collegial competition, where we adhere to a very strict uniform monthly education of all our clinicians in the CME setting. Here in this table, you can see on the right side the Cano Health model compared to primary care physicians. The American Academy of Family Physicians published this data a few years ago that the average primary care provider sees 20+ patients a day. At Cano Health, they're seeing about 14. Think about that difference. You're there to see your provider seeing 20+ patients a day, and the Cano system is seeing 14. It allows you this additional time not just to provide care but to manage disease. We do this by reducing their panel. Instead of having 1,800-2,000 members assigned to you per clinician, it's 400. But what's extraordinary is what happens when you go to see the doctor. The average clinician is seeing the patient 2.2 times per year. That's about every six months. At Cano Health, we're seeing them 7 or 8 times a year. That's like every 45 days. Imagine an elderly patient, Medicare Advantage. It's been reported that the Medicare Advantage, 70% of them have two chronic diseases, hypertension, kidney disease, diabetes, lung disease, heart failure. These are very serious medical problems. The rest of the physicians are seeing 20+ patients, and they're having to manage their disease, their medication, their testing, their protocol, their follow-up. With 20+ patients a day, that's overwhelming. In Cano Health, we focus on the management of that disease, which results in reduced ER visits, which results in reduced hospitalization, which results in reduced mortality. Publishing our data that with diabetes, we can significantly reduce our sugar. We do this over and over again because what we do is so unique. In addition, we have this continued every month training of our clinicians on these chronic diseases. In fact, we meet once a month, and every clinician is required to provide their certificate of having completed the CME. We meet once a month across the United States, from Florida to California, from Chicago to the Rio Grande Valley, and we have a didactic presentation or a case presentation on that specific disease, whether it's prostate and prostate management, whether it's preoperative evaluation, so we can reduce the risk of operative complications, blood clots, pneumonia, because that costs money. Our job is to keep the patient well, and we train the clinicians on these chronic diseases, whether it's anticoagulation or abdominal pain, every month training our clinicians about the diseases they see from day to day. We have all this data, but in the exam room, and you see it on some of the slides, on the walls are the standard of care best practice guidelines, which are posted in every room, in every office, in every state. The clinicians can rely on these current guidelines, which have been published by the senior leadership of Cano Health at clinics like, the American Diabetes Association or the Cleveland Clinic Journal, so that our clinicians can resort to these best practice guidelines in the room. They pull the guidelines, they say, "Well, we're gonna do this because of this, and this we're gonna do because we standardize our care." These things is what drives excellence. If we have this published data on diabetes and hospitalizations in ER visits, what about evidence with credentialing our clinicians? Well, it turns out that in Washington, D.C., the National Committee of Quality Assurance, the NCQA, provides a standardization recommendations for those clinicians who provide excellent care. They recognize clinicians who have evidence-based measures to provide excellent care for diabetes, as well as NCQA certification for those who provide excellent care for peripheral vascular disease or for stroke prevention. In this last year, in December, we had submitted the data that 100% of our clinicians across three states who are eligible for this certification reached NCQA certification three-year recognition for diabetes recognition. That's amazing. What's even more amazing is that 100% of our clinicians who are eligible across the three states also received recognition for heart stroke prevention. That's extraordinary. 100%, not 50, 100%. What's really amazing is how many clinicians actually get this certification. Across the United States, there's about 200,000 primary care physicians, and when you add mid-levels, nurse practitioners, and physician assistants, that's about 300,000 primary care clinicians. Only 4,000 have received this recognition. At Cano, 100% of our providers have received this dual recognition. We're able to have these clinicians recognized. We're able to publish our data on hospitalizations, on diabetes. What about chronic disease, multiple chronic diseases? Let's pick a tough one. Patients who have diabetes and chronic kidney disease. That's a bad combination. You have t hose two, and you have a 6-fold, 600 times increased risk of having a bad outcome, heart attack, strokes, death, very costly outcomes, dialysis, heart failure. These patients are very sick. In fact, 20 years ago, there was a lot of data about what to do with those patients. A number of studies said, "Well, if you give these medication to these patients, you can slow down that relentless decline of kidney function, which eventually leads to dialysis and death." In fact, that is now the standard of care. There has been nothing in the literature for nearly 20 years in treating these patients. In June of 2019, a study was published that showed that if you look at the standard of care and you watch this decline of kidney function. Imagine in your home a water softener. Your water has a lot of calcium, and it clogs up the filter. Or it's under a lot of pressure, and it destroys the system. Instead of filtering 100 gallons per hour for the shower and the sinks and the dishwasher, it's now filtering 70 gallons per hour, 50 gallons per hour, 15 gallons per hour. Now it's not enough water for your filter, for your kidney, and now you need dialysis. This is a relentless decline in kidney function. On the slide I wanna show you, this is a standard relentless decline in kidney function over time, over 2 years. From a baseline, it just drops and drops and drops, and we know that. Stand ard of care using these kinds of medicines that we've known for 20 years. Then in June of 2019, a new product came to market and said, "If you use this new product, we can bend this curve. Instead of declining like this, we could raise it up a little bit so you don't have dialysis as often or kidney disease or heart failure." This data was very impressive. You can see the drop, and over the course of two years, there's a separation between normal decline and what this medication can do. In fact, this was so extraordinary that the FDA allowed this product to get an indication for diabetes-related kidney disease because it bent the curve. As the clinical leader for Cano, I said, "Well, what do we do? We have credentialed physicians. We have Cano at Home, a pharmacy to dispense medications. We see the patients on a regular basis. Let's look at our patients that match this population, chronic kidney disease and diabetes, who come new to Cano Health, and when they come into the Cano Health model, what happens to them? Are we able to bend that curve as well?" This is what happened. Two days ago, I returned back from New Orleans, where I presented this data at the International Sessions of the American Diabetes Association. Look what Cano Health did. Cano Health's had statistically significant improvements in kidney function for 15 months, and over the course of 2 years, stabilized the kidney at the same function that they were at baseline. When I was presenting this data in New Orleans, my colleagues were saying, "What were you using? What drug were you using?" I said, "The Cano model of care." The way we deliver care by treating disease, we can show reduced admissions to the hospital, reduced hospitalization ER visits, reduced mortality. In this chronic disease case, we have a relentless decline. Our model has shown that we could stabilize the kidney over the course of two years. We have subsequently submitted our data for three years. I can't show you that data 'cause it's not been accepted for publication, but when it is, I'll be able to tell you about our impact in slowing down dialysis, mortality, heart attacks, strokes, cost of care, ER visits, hospitalization. We'll have to wait to see. Our clinicians have been able to demonstrate this by publishing the data that we have this kind of outcome. Our focus is really to maintain the quality of health and to be the leading development of opportunities to improve the standard of care across America, and we do this by focusing on developing a lead, leading industry of clinician designed to manage disease, not just deliver care. We couldn't do this without the support of the clinic around us and all the factors that go in to developing the center where our clinicians deliver this magical care. We do this with the support of the clinical system. With that, I'm gonna present to you Gina Portilla, our President of Cano Medical Centers. Thank you so much. Well, good morning. Thank you, Dr. Aguilar. I am Gina Portilla, President of Cano Medical Centers. I oversee center operations and the National Member Engagement Department. I've had the privilege of being the first acquisition for Cano Health in December of 2016 with 4 medical centers. I have now a little bit over 20 years of experience just in managed care. Let me show you what's going on in Cano Health. I'm happy to announce that, as well as my colleagues, that Cano Health has reached 141 medical centers across the nation. We have over 400 primary care providers who service our fast-growing population. 66,000 of our members are Medicare Advantage, and because we cater to the low-income communities, Cano has a higher percentage of MA membership than most other provider groups. This is an opportunity for us because it allows us to enroll more patients all year long versus just depending on open enrollment. You can also see that we have a large Medicaid and ACA population, which is great because it's a natural pipeline that allows those who are aging in that have already chosen Cano Health as their primary care to just naturally continue their journey in the healthcare industry with Cano. Through the social workers that we have embedded in our medical centers, they're able to help patients apply for Medicaid, LIS, QMB, so all year long, we're growing steadily by helping patients reach their full benefits. In the Cano Health model, our focus is primary care, but we view primary care as a whole person self-care for the entire family. There are important components that our patients have come to expect from our patient experience in Cano. First, they will meet their center benefit coordinator. This is such a different experience because there's a dedicated person there to assist patients to navigate them through not just the services that Cano has but the health plan options, as sometimes it can be very complex. Our care management and care coordination actually begins as they choose their preferred provider. As you know, there's a provider shortage nationally, and patients are suffering long wait times just to see their provider, sometimes 2-3 months. In Cano, we offer a lot of options to make sure that our patients are able to see our providers. We have after-hour, weekends, nights, a lot of televisits. We're able to see patients same day because we offer walk-ins, and we assure that we do not turn patients away. Wellness is a critical service. This is important in our centers because, as mentioned, it's part of how we engage our patients. If our patients aren't coming into our centers as many times as they are, which is up to 20 times, they're not able to actually be proactive with their health. Wellness is very important, not just our classes, and our activities, but also the different services. Let's take a look at them. Although primary care is our focus, we have a variety of what we call our signature services. Part of well-being and preventative care model, we approach the expansion of these health services thinking through what do patients need. We have found that we start off even by transportation. Sounds easy, right? As we enter new markets, we realize that there's a huge gap. Patients aren't actually able to get into their provider's offices. In Cano, that isn't a problem. We're able to have them reach their health centers, whether they need it now or later in life. As they enroll in Cano, they feel more secure that they have some of these services. We have other services that are in addition, like social workers and benefit coordinators. They're just to assist the patients, sometimes with applications to food stamps, Medicaid, and other government-funded assistance. This is important because we're addressing critical needs for the social determinants of health. In Cano, we're not there only for when patients are sick. We're there to make sure that they have an improved quality of life, whether at the center or outside of our centers. We have our specialty services. These are, I think, some of the most important because patients like to receive these services in the same setting as their primary care. We have in-house dental, physiotherapy, preventive cardiovascular teams, and most recently, we've added behavioral health services. We have our great Cano at Home services that Dr. Osorio has mentioned, which provides care at the convenience of the patient's home. It's not only about convenience, it's about trust, and that's what we bring into our patients' lives. Let's take a moment to speak about behavioral health. Every market that we have entered and every health plan that we speak to immediately wanna know how are we tackling the need for behavioral health. Part of delivering high-quality care is understanding that there is no health without mental health. The initiative of integrating behavioral health service for a primary care model is something we're extremely excited to expand. Integration of primary care and behavioral health strongly emphasizes whole person care. We aim to improve the overall health of our members and facilitate their access to specialized healthcare services such as these. With our acquisition of Serenity in July 2021, we're now able to scale across all markets. Why is it important to have behavioral health? Our patients feel much more comfortable receiving, and any patient will receive this care in the same setting as their primary care. Our primary care doctors feel that it is much more engaging to work with a partner in the same setting as well, so they're more likely to refer to behavioral health. More importantly, when you realize that chronic health conditions cannot be tackled until we deal with the mental health conditions of our patients, that's what's truly important. You have to take care of mental health before really taking care of your physical health. Our centers, we've heard about them, we heard what we do. Here you can see them. We have access services to our different markets. Cano Health operating model is scalable and adaptable. You'll be able to walk into any of our centers and have the same look and feel. This is important because that's what patients come to expect. What you'll see that is truly the same in all of our markets is happy, engaged patients. That's what. It's incredible. You'll see it in some of our centers. Here you see Texas. San Antonio was our first market that we entered into nationally. Here we are now entering into Houston, and next week we'll be unveiling our first ground-up construction. Very excited to see all the growth in Texas. Here's our beautiful centers in Chicago, California, and New Mexico. They're always located with heavy foot traffic in highly dense dual-eligible populations. We are there for our patients. We are accessible and easy to find. How do we enter these markets? We have great marketing and brand awareness. We know how important it is to know what Cano is, but what is more important is to see what our services actually do. It's not the same to tell you that we offer primary care services. Yes, we do, but we also have physiotherapy. We have all of these services in-house, and we do it through thirty-minute infomercials, commercials, but more importantly, grassroots events. We make sure that we're facing our community, and we're telling them and engaging them and encouraging them to come in. We have found how important it is to add local experience and knowledge, so we focus on adding key leadership at these new markets, and their experience and patient feedback is what helps us expand on these services. Our goal is simple. We want to provide a better patient experience to the entire family, and we keep our brand promise as we expand through the community. With our high-quality care and introduction of our signature services, we bring back this very necessary lifelong bonds the patients need with their healthcare team. For low-income patients, this has never really been offered to them. In Cano Health, we have this, and we put our members first. In Cano, the patient voice, to me and to everyone who is in Cano, it's the most important thing we have. We survey all of our patients after their PCP visits. As you can see, our patients are happy. Not only do we see it through our survey results, but our center-driven enrollments are over 60%. Most of these enrollments come from word of mouth. Our patients are not only happy and healthier, but they want their family and friends to experience the same great level of service. This is not only why we review and take actions to improve services based on all patient feedback, but we also focus on these grassroots community events that allow us to have face-to-face communication with the community. Our organic growth is derived from this, these channels that lead to loyal customer and requires no direct marketing spend. As we expand nationally, what we see is so encouraging. Not only are our services being appreciated, but the need is so great that we can see our centers thriving in new markets. As the community accepts this concept of value-based preventative care, higher quality primary care plus services all in one patients. It's convenient. It's what is best for everyone who wants to receive health care. In Cano Health, we work towards offering so many options that we break the barrier of having access issues. We treat our patients like family from the moment they walk into our centers. We do this by bringing in associates that share the same values and are driven by the mission and vision of this company. Naturally, those who enter the healthcare field have a passion to help patients. All we're really doing is giving them the abilities and the tools to really treat patients like family and help them. Something as simple as a smile or even helping them when no one else could makes a difference. I wanna show you our next video, and then we'll take a brief break. The first step in medicine is preventive care, and that's what we're doing, and we're doing it in the way that we personalize that care. I feel like we're doing something that no one has done before. You know, taking care of not just the person's physical health, but also their mental health and also their social needs. No matter what Cano Health clinic that you visit, our approach is to standardize health care. We wanna make sure that all of our patients are getting the same level of high-quality care. It's exactly the same quality of care everywhere you go. We're a one-stop shop. You know, a lot of times the patients come here not specifically to meet with a doctor, but because they're here, if they have a question, we're happy to see them. It's not only a patient-healthcare relationship, it's a family relationship. It's not like coming to work. This is not a job. I just feel like it's just a place to come hang out with them, you know. Most personal trainers, they try to emphasize in the younger groups just 'cause they think it's easier for them to work with, but then they tend to neglect our seniors. With the job I do, I can make sure that I maintain that health, and it makes me feel good that after all those years them coming in, they're like, "I could have been doing this all my life." It's just to show that with the proper help, people can, like, stay active. We're putting our centers in places where patients can access healthcare. Being able to see my patients and, I get to spend more time with them. It's amazing. I love what it's doing for the patients. It's just beautiful, the sense of community that we have here. It's really unlike anything that I've ever seen. I believe Cano is gonna be America's primary care. We will now take a 10-minute break and look forward to seeing you back shortly. Thank you. Ladies and gentlemen, the 2022 Investor Day for Cano Health will now recommence. Welcome from our break. My name is Maggie Arias-Petrel. I am the Regional Vice President for Cano Health West. It is my pleasure to be presenting to you this morning and to talk about my home state of Nevada. I will tell you that I have been involved in the medical field for over 30 years, and I am very impressed with the approach that Cano Health has for the Latino community, the underserved, and the minorities, which happen to be a big part of my state, about 40%. The passion, the purpose, the mission, and the vision of our founders inspire me to take the leadership in this market, and I'm extremely excited about all the accomplishments that we have been able to achieve thus far. Let's see some of the challenges that my state has. Obviously, our population has the highest in the nation with 49%... 40th ranking among the United States, to be precise, in terms of lack of healthcare. Some of the elements have been the shortage of medical providers, medical schools, hospitals, et cetera, and that has been a big major contributor to not allow us to have that access of healthcare. Cano Health is committed to tackle the healthcare challenges in our state. We have come to bridge the gaps by bringing our medical centers where our members come, enjoy, get healthy. We're also bringing bilingual, bicultural medical providers and associates that deliver the highest quality of care. Our patients come first. You will ask, "Why is Las Vegas an ideal market for Cano Health?" I'll tell you that is the growth, the penetration, and the urgent needs that are present. The population in Nevada holds a majority in the minorities, such as the Latino, African American, Asian, Pacific Islanders, et cetera. Therefore, we have a big underserved community. Cano Health has tailored every service needed for our seniors, such as comprehensive primary care, physiotherapy, mental health, dental, wellness, transportation, et cetera. Our goal is to keep our patients healthy, happy, and productive. Our staff and medical providers are bilingual and bicultural. We attract, engage, train, and retain our associates who understand our mission and vision. As you can see in this heat map, these are our locations. Our footprint in Las Vegas has expanded since our first entry in September of 2020. Our city is experiencing a tremendous growth post-pandemic. Thousands of Californians are relocating to our state to take advantage of the lower cost of living, housing, amenities, and of course, let's not forget the state tax. The needs for the underserved have increased, and Cano Health has also been experiencing the growth along with the population. We currently have nine centrally located centers in areas where healthcare access was not available before. We are supported by all local elected officials and the cities of North Las Vegas, Las Vegas, and Henderson. Let me be clear. There is nothing like Cano Health in my state. This model previously just did not exist. Our operational achievements are remarkable, taking into consideration that it's a new market for Cano Health. We have made strides in terms of patient annual visits, bringing this bicultural and bilingual workforce, retention, empowerment of our associates to pursue higher education and therefore to be promoted within the organization. I will take a little time now to share the story of our associate, Luvia Rodriguez, who started back in September 2020 with the organization as a medical assistant with a little challenge with English, but we empower him. We make sure he went to college higher to pursue his higher education on nursing. He just received his degree this past weekend, and now he's on his way to continue and become a nurse practiti oner. He would like to be one of the Cano Health providers. Las Vegas market has a strong and main membership and has grown tremendously since our entry, as you can see in this slide right here. Our membership has increased from barely 54 when we enter the fourth quarter of 2020, and we're up to 1,874 in the first quarter of 2022. At the same time, our medical cost ratio or third-party medical expenses divided by premium revenue has declined to a 63% in Q1 of 2022. This is a testament of the impact that we have on our patients when we provide an intensive primary care that better controls their chronic conditions and reduces their emergency room visits and hospitalizations. We expect to continue increasing our membership and improve the outcomes as we develop our market. Let me bring to you an example of our One of our members, Fanny, who joined Cano Health back in November of 2021 to our Tropicana Center in Las Vegas. She came to us with diabetes, depression, insomnia post-pandemic. She came with an undiagnosed neuropathy. Throughout all these times that she's been going to the doctor, she never got diagnosed with this, yet she couldn't walk. She had problems moving. She had a lot of issues with that. It was not until she came to Cano Health when she noticed a difference. We are truly changing people's lives. Testimonials like Fanny, we have many. Word of mouth is our best advertisement. What I could tell you is that we're focused on continuing growing, adding more centers, and it's an important effort underway and creating a pipeline of medical providers across the state. Obviously, that's one of our biggest problems that we have at the present moment. We have created important partnerships with UNLV, with Touro University, and we will be starting rotations in our medical centers on Q3 of 2022. We are driving our growth by maximizing our available capacity. Post-pandemic and our state recent growth is allowing us to continue the scale and density with additional centers to serve our population. Our expectations are to have 20 centers by the end of 2024. With that said, I can tell you that for me personally, it's been my honor and my pleasure to continue working for the betterment of my community. We hope to extend Cano Health to the West even more. Thank you. Now, I would like to introduce my colleague, Bob Camerlinck. He's the President of Healthy Partners Medical Centers. All right. Thank you, Maggie. I am Bob Camerlinck, President of the Healthy Partners brand of the Cano Health family. I had the privilege of joining Cano in June 2020 via acquisition, although I like to call it a merger. We joined in June 2020, but I started my business, my career in the medical field, value-based care in 1994, actually opened my first medical practice. I owned and operated an IPA for a little bit, and then in 2003, we started what is now Healthy Partners. So at the time of the acquisition with Cano, we had 20 wholly-owned practices and over 100 affiliate providers. So the affiliate model's been very good for me. It was a great growth model for me, a great business model, and wanna spend a couple of minutes explaining why I think it's gonna be a well, will continue to be a great model for Cano. And it's also a good model for our providers and our patients as well. Let's start with what is an affiliate provider. I know we've talked about affiliate providers a little bit, but affiliate provider is basically a physician who owns and operates his own practice. They typically take fee-for-service Medicare, commercial, MA, Medicaid, those types of practices. These individual practitioners generally do not have access to be able to direct contract with a Medicare Advantage payer. Obviously, by working with Cano, we can help them get access to those payers. Because the membership is actually assigned to Cano, we actually recognize 100% of the revenue. We are responsible for third-party claims, hospital specialists and the like. Via the downstream agreement with the affiliate providers, we do pay them a monthly compensation and a percentage of shared savings and a quality bonus. Currently, Cano has over 1,000 affiliate providers caring for 92,000 members. Of those members, about 54,000 are Medicare Advantage members and 36,000 direct contracting members. I'll go over the DCE, direct contracting entity a little bit more in a couple of minutes. As I mentioned, the affiliate model is a good model for our providers. It gives them access to Medicare Advantage payers. We have access to a lot of different MA payers. By contracting with Cano, they have access to those payers. By having access to those payers, that obviously gives them the ability to grow their patient panel, and to grow the revenue of their practice. They also get access to us and our extensive knowledge and resources to help them provide excellent patient care, increase patient satisfaction and outcomes, all while reducing costs. Typically, the providers' fee-for-service-based model, we talked about the volume. They get paid as you see patients, so per visit. You know, the only way for them to really increase revenue is to see more patients increase volume. That's not a great model for the patients or the provider. Through our MA model with our contracts with our downstreams, they're paid a monthly capitation. The monthly capitation gives them a little bit more steady revenue stream. They also have the ability to earn shared savings, which would obviously help increase the revenue of the practice. All this has to obviously be good for Cano, and it is, right? Having affiliate relationships gives us the ability to build its scale and density in certain areas, which having scale and density gives us the ability to leverage with the payers, the insurance companies and specialists. For us on the affiliate side, we're able to, you know, grow membership, EBITDA and revenue, all with very little capital infrastructure, very capital investment. It also helps us expand our DCE model. If we have an affiliate relationship already with an MA relationship with an affiliate, it's easy to add the DCE line of business as well. Through these relationships with the affiliate providers, it also becomes a good opportunity for an acquisition or potential tuck-ins for our medical centers. In the past, like I said, we had the affiliate relationships, and they were generally Medicare Advantage relationships, but now we have a new line of business through the DCE, the direct contracting, to offer to our Medicare fee-for-service members. DCE was launched in 2021 by CMS. The goal of it was to try to provide value-based care to Medicare fee-for-service beneficiaries. Their goal is to have 100% of Medicare fee-for-service beneficiaries on some type of value-based plan by 2030. Which seems like a very good opportunity for us, considering we're only one of 41 participants in the DCE plan right now. The DCE members are assigned to the providers through retrospective claims data or they can also assign voluntarily through voluntary alignment. Similar to the MA plan, the membership is assigned to Cano so we're able to recognize 100% of the revenue. We're also still responsible for third-party claims and such. Similar to our MA model, the providers are assigned a downstream contract. We pay them a monthly capitation, and they can earn additional shared savings, you know. Shared savings is realized, obviously, by improving quality and reducing costs. Part of our responsibility working with these providers under the DCE model is to help them increase visit frequency, reduce hospital ER costs, where a lot of the utilization costs are. We also offer IT support, peer-to-peer advisory services, chronic care management, and several other services really with the goal to help, you know, provide improved outcomes all while reducing costs. We've seen a lot of growth in the DCE side, and we obviously expect that to continue. You see we started in 2021 with about 8,000 lives. In 2022 is our first full year in DCE. We're up to about 41,000 lives, which accounts for about 15% of Cano's total membership. From a revenue perspective, in 2021 we did about $90 million in revenue, and in 2022 we're projected to do $650 million in revenue. Annu alized, that's about a 5x growth. The EBITDA margins on the DCE right now are low single digits%. But obviously we expect that to increase significantly as we integrate the patients and the providers into our population health platform. Our DCE growth is mostly driven by our affiliate providers. The DCE and affiliate providers in 2021, we had about 4,200 lives. In January 2022 or in 2022 we have almost 36,000 DCE lives. We expect this trend to continue. It's certainly easier to add a DCE line of business to an existing MA affiliate or to sign a downstream contract than it is to buy or build a medical center. We expect that trend to continue. Obviously, DCE is helping us expand our footprint nationwide. We have a large presence in South Florida. Also have DCE relationships in New York, New Jersey, Texas, California, and other states as well. Having DCE relationships in these states and these other markets is critical market intel for us, right? It helps us deploy our buy, build, manage growth model we've been talking about in a very effective way, and thus to grow profitably. I guess in summary there, our affiliate model, we believe, is a flexible, low-cost growth model with a pipeline for acquisitions. Our expansion into DCE aligns with what we're good at, and it helps us to further fuel our growth. It also helps us provide value-based care to our Medicare fee-for-service members. What's next for DCE? I like to say not a lot because unfortunately for DCE, ACO, it's DCE in January 2021 is actually transitioning to ACO REACH. We expect the economics of the ACO REACH program to be very similar for Cano and for our affiliates. We are currently contracting for next year with our affiliates, obviously expect continued growth with our providers, with our affiliates, and improved profitability as our program matures. That's all from me, and I'd like to bring up our Chief Financial Officer, Mr. Brian Koppy. All right. Good afternoon, everybody. Thanks again for your time and making yourself available for today's presentation. So before I jump into my financial review, just wanna recap a little bit of what you heard today, and then we'll jump into a Q&A session at the end. Marlow introduced Cano Health's care model, which combines access, quality, and wellness, along with our build, buy, and manage flexible approach, which positions Cano Health as a leading value-based care provider in the market. Jason then discussed our growth strategy, which has demonstrated strong organic growth through a disciplined approach to market entry, which also enhances our scale density. Pedro then came on and talked about CanoPanorama, which is our technology that puts the patient at the center of everything we do, which was then followed by Merlin Osorio and Dr. Aguilar, who talked about our care management and our clinical programs that use CanoPanorama to deliver superior health outcomes for our patients. Finally, you heard from Gina, Maggie, and Bob, who discussed our patient-centered focus within our medical centers, within our new market expansions, as well as our affiliates. With that as a backdrop, I wanna walk you through how Cano Health has created a self-funding operating model, a multifaceted growth strategy, and a strong long-term organic earnings opportunities that can be supplemented by an effective M&A strategy. As Marlow showed you these numbers, we have a very strong financial results over the years, and we continue to project strong 2022 financial results. Members in the range of 290-295 thousand, $2.8-$2.9 billion of revenue, and adjusted EBITDA of $230-$240 million. That's for the full year of 2022. We had a strong start with our Q1 results, and we continue to expect to achieve our outlined guidance. On this slide, we're reflecting that we are maintaining our full year guidance. Our CapEx is expected to be within our previous range of $40-$60 million, but it's likely to be around $50 million within that range. Our de novo losses for the year are expected to be about $70 million. Our outlook continues to give us the confidence that we will have positive cash from operations in 2022. As we stated before, we do not need additional financing to achieve our 2022 outlook. One of the most important aspects of Cano Health is our diversified approach to facilitate value-based care arrangements through both our medical centers and our affiliates, and you've heard a lot about that today. Each of these independently are important growth drivers for Cano Health and provide for different means of growth depending upon the market needs and market opportunities. With all value-based care arrangements, they benefit each of the constituents within the healthcare sector, and that's how Marlow introduced. Value-based care is great for the healthcare system. Our payers, they can mitigate their financial exposure by having attractive fixed margins and high-quality patient outcomes. Providers, they're able to receive stable and predictable incomes as an employed physician or by remaining independent, they receive monthly capitated payments and shared savings as an affiliate. Of course, our members, they receive the most benefit. They receive high-quality medical access and high physician engagement with their health so they can live longer, happier, and healthier lives. Finally, of course, Cano Health, we benefit as we are able to make the system more efficient and earn attractive and reasonable returns on our investment. I thought it'd be helpful to, as, after you heard Gina and Bob speak, to put it all together for you. This slide shows our members, our membership for first quarter 2022 between our medical centers and our affiliate members. You see in total, we had 269,000 members. For medical centers, it was 177,000. For affiliates, it was 92,000. Just focusing on our key product of Medicare Advantage. You see in our medical centers, we have 66,000 Medicare Advantage members, while 54,000 are cared for in our affiliates. That's approximately 66% within our medical centers and 34% within our affiliates. Keep in mind, a large portion of our affiliate membership recently came in as part of our Medicare DCE enrollment this past quarter. Our affiliate Medicare DCE membership consists of 36,000 members, or 13% of the total, but more importantly, 39% of our affiliate membership. As you see on the schedule, we do see some Medicare DCE members in our centers, roughly about 5,000 or 6% of the total membership. Combined together, our Medicare Advantage and our Medicare DCE membership makes up approximately 60% of our total membership. Now let's take that same view and look at revenue. Total revenue for the first quarter was $704 million. That consists of $345 million from our medical centers, or roughly 49%, and $359 million from our affiliates, or roughly 51%. About 63% of our first quarter 2022 revenue was from Medicare Advantage, including Medicare DCE. Medicare revenues make up 81% of our total revenues. Now put it all together, membership, revenue, and earnings. You could see on this slide, if you look at our medical center earnings represent approximately 63% of our adjusted EBITDA results before corporate expenses, while our affiliates represent approximately 37% of our results before corporate expenses. In fact, if you were to annualize our first quarter 2022 revenue, our estimated 2022 adjusted EBITDA medical center margin would be approximately 16%, and our affiliate margins would be approximately 9%. Additionally, as we continue to scale and grow the business, our corporate overhead expenses as a percentage of revenue will continue to go down. That's simply because through the last year or so, as we've gone public, we've incurred additional expenses related to our corporate resources and staffing of our public enterprise. Furthermore, what's important to understand, as you saw on the membership and revenue breakdown, these results include multiple products. Let's take a look at our primary Medicare Advantage product. We see significant earnings opportunities within both the medical center model and the affiliate model. Here, we look at a single mature Medicare Advantage patient in both the medical center and the affiliate. As we engage with our members and manage their care, as Merlin Osorio and Dr. Aguilar discussed, we see significant opportunity with mature Medicare Advantage member margins in the medical centers at approximately 24% and within the affiliate model, approximately 12%. The medical centers patient adjusted EBITDA margins are significantly higher than the affiliates margins, driven primarily by demographics and higher patient engagement. Clearly, our affiliate margins are strong. As I pointed out on the analysis of our projected 2022 results, between our medical centers and affiliates, both are profitable today. Let's talk about our geographic footprint. At the end of 2021, we had 130 medical centers. We talked about at the end of the first quarter, we added seven medical centers, bringing the total to 137. So far in Q2, we've added four with more to come, bringing our total as of June seventh to 141. We continue to expect to add 54-59 medical centers this year, which would bring our total medical center count to approximately 184-189 centers. Importantly, these centers will be in the current geographies we serve today. Let's look at our M&A track record. For those of you that don't know, as Marlow mentioned, we've been around for a while, since 2009. We have a critical capability within the organization around M&A and buying. As you can see, since the early days, we have identified, acquired, and successfully integrated a number of large platform acquisitions, as well as a large number of tuck-in transactions, all contributing meaningfully to our current success. Overall, we've acquired 37 transactions between 2017 and 2021, an incredibly successful track record. But our success in M&A is driven by our proven playbook that activates multiple earnings levers to drive growth and profitability. We think of these as our five levers of M&A growth. When we look at acquisitions or transactions, we say, "Can we grow the membership? And particularly, can we grow our Medicare Advantage and now our new product line, DCE? Can we bring Cano Health quality to the transactions and increase the standards for higher HEDIS metrics? Utilization, how can we improve and leverage our care management and our clinical teams to improve member engagement and outcomes? Population health, can we deploy CanoPanorama to ensure proper procedures, protocols, and KPIs are implemented and tracked? Finally, operational excellence. Of course, you're gonna look at a transaction and see if you can synthesize and reduce expenses overall. Together, one or multiple of these levers can be pulled with each of the transactions that we look to do, we've done in the past and will look to do in the future. Let's look at medical centers and how they performed. As we look at our medical centers, whether they are from building new medical centers, consolidating our existing facilities, acquiring small nearby practices to operate or manage, such as our tuck-ins, or they've come from large acquisitions of platforms, each has significant embedded adjusted opportunity within the business. Here on the left side of the schedule, you'll see the profitability ramp of a typical de novo in the blue bar. With the first couple of years, we lose some money, and then it turns to profitability by year three. In the green bar, you see an acquired medical center or a tuck-in. With the initial year, break-even is slightly positive and a gradual ramp thereafter. Clearly, over time, you can see in either scenario, the medical centers provide earnings opportunities as they mature. Now, on the right-hand side, we illustrate the implied EBITDA adjusted opportunity. The de novo opportunity as these centers reach maturity at 5+ years or so, is approximately $185 million. The acquired or tuck-in opportunity as we grow these centers under the Cano Health model is approximately $315 million, bringing our total embedded medical center adjusted EBITDA opportunity to roughly $500 million. Now you can see why we're very bullish, very optimistic about the opportunity we have in front of our business, and we are just beginning. In summary, we believe there's a great path to long-term value creation within Cano Health. We have created a self-funded operating model that not only provides the cash to fuel growth, but has significant embedded opportunity within the medical center and the affiliates. We have a growth strategy that focuses on the member and provides the necessary flexibility to grow. Access, quality, and wellness drives enrollment growth and improved outcomes. Our buy, build, and manage growth avenues provide the flexibility and the optionality to successfully manage our growth. Through speed, scale, and density, we're able to target and secure the most profitable markets. Overall, and importantly, the strategy gives us the strong financial performance to drive consistent, sustainable, and predictable revenue and earnings growth for the long term. With that, I thank you. Appreciate your time today. We're gonna take about a 10-minute break, and we'll be right back with our Q&A session. Thank you. Ladies and gentlemen, please take your seats. The Q&A will now begin. Okay. Really appreciate everyone coming back, and we're here to answer your questions, so take it away. I see a couple hands already. Josh? All right, thanks. Josh Raskin at Nephron. I guess I have two questions to start. The first would be, if you could tell us how to think about opportunities to potentially work with health systems and maybe their large captive, you know, wholly owned provider groups as well? Well, I think there's a great opportunity because we have this comprehensive leverage solutions that we can bring to different communities, to different types of clients that include health systems and other at-risk groups. Because we operate our own centers, we can also manage centers. We're able to build to suit, and we have demonstrated the ability to do so not just with a product line, a single line of business, if you will, Medicare. We've done it for Medicaid, for ACA, for DCE. Thus, having the comprehensive offering of serving multiple demos, multiple product lines in multiple different ways positions us very well to be a solution for at-risk groups. Do you expect that to be part of the growth trajectory in the future or do you think that's more longer term? Absolutely. You should expect that to be part of the growth trajectory as we continue to add clinical capacity, build new centers, build to suit, tuck-in practices, make acquisitions, and certainly take affiliates. Those affiliates may be small practices, may be larger healthcare systems as well. Gotcha. My second question, I apologize, it's a couple parter here. Of the 800 affiliate providers that you guys talked about, I'm curious how many of those can transition in your mind to employment? And is that a goal and sort of how long does it take? I know you also spoke about that transition, you know, in your slides at least, that Cano keeps more of the value in the center-based model. How do you keep the provider whole in that, or how do you make sure they understand financially that it's? You know, that's just as good an answer. Sure. Thanks, Josh. First, we have 1,000 plus affiliate providers now in about a dozen states. Let Bob take that question away. Typically, we said before, about 10% or so of our best-performing providers to potentially tuck in from a membership perspective, not in terms of number of practices. It's a great value prop for them to now be fully within the Cano Health-owned medical center family. That additional resources to further improve care delivery. Bob, you wanna elaborate? Thanks, Marlow. I think like Marlow mentioned, it is, you know, typically around 10%, and, you know, I was talking with a gentleman earlier, you know, some of the centers are relatively new, and some of the doctors are young and not looking to be acquired. Certainly when they get to that point, and we mentioned for most of the affiliates have right of first refusals, we have a right of first refusal on most of them. We're able to first certainly take the first look at it, but we also have, obviously, very good relationships with the providers, so if they are acquired, they obviously intend on, or in most cases, continue working, so they wanna work with somebody that they have a relationship with. Those tend to work very well. Yes, sir. Hi, it's A.J. Rice from Credit Suisse. Can you just talk? I mean, we obviously hear about health plans trying to be out there buying physician practices. There are a number of other players. Can you talk about the competitive landscape for both the tuck-in deals and potentially a strategic deal? What would a strategic deal potentially look like for you guys, given where you're at today in your development? Are you seeing more competition? We also hear that coming out of the pandemic, there may be more practices available, and I wonder if you see that or not. Can you make some comments on those? Yeah. For the smaller practices, the tuck-ins that you saw that Brian presented throughout our history, there's not much competition there. Back in the day, the hospitals were doing the buying as they needed referral sources, and because that's a radically different model, a utilization model, that hasn't proved out to turn out very well. What we're seeing is really consistent for the last six-plus years, which is not much competition at all when it comes to the individual provider practices. You have groups that are, let's call it, in the physician enablement space, and we have an affiliate organization, and Bob spent quite a bit of time talking about that. You have groups that are just kind of owned medical center employee model approach. The on-ramp that we give by saying, "Hey, you can become part of the Cano family, be an affiliate, have the benefit of these contracts and services, improve your operations, and then we'll tuck you in, create more value for you, for your staff, for your patients." That is uncommon across the country, so not too much competition there. Medium-sized groups, there is going to be more competitions because those make more sense to payers and others, private equity that like to be in the space. We see in general for the medium and the larger opportunities, that you all have written about, can speculate on what's gonna happen. Consolidation is going to happen in the industry. We feel great about where we are in the trajectory, the value creation, the first innings of our national expansion. We have seen in the middle to larger category valuations becoming increasingly attractive. Jason talked about this as it relates to new center builds versus tuck-in and maybe having us be more opportunistic in the medium-size category. You know, we continue to keep our eyes open for larger opportunities. If they make sense for our shareholders, that's something that we'll take a good look at. Yes. Oh, hey. This is Adam Ron with Bank of America. I have two questions. One thing, I think you previously talked about 15%-20% long-term EBITDA margins. But it looks like you're still talking about 24% on MA, which is consistent with what you were previously talking about. I just want to confirm that it's not a lower long-term outlook on profitability. Maybe it's just mix and does the current mix of business make sense, like, going forward of affiliates to be roughly the same contribution they are now? Yeah. Absolutely. Mix growth, and to an extent, geo has something to do with that. As Brian presented, and I'll have him elaborate on it, the MA mature members is about 24%. As we're saying, 15%+ on a consolidated basis of that will be a function of that growth, and mix is what we're talking about to your point. Brian, do you wanna- Yeah. No, I think that you're spot on. It's member mix. Keep in mind, we have the Medicare DCE membership that comes in at a lower margin, and Bob talked a little bit about that. We certainly will enhance that over time, but that mix plays an important part. When you look at that mature and Medicare Advantage member, we still believe that the long-term margin will be in that 24% range. The second part of your question, yes, the ratio of the staff model or the owned medical center margin to the affiliate margin will remain relatively the same. We've talked about before that you can get better medical cost management and optimization when you are able to standardize that clinical delivery system. There are efficiency frontiers to providing technology or just physician enablement when everybody's kind of doing their own thing with their own EHR, or even the same EHR, but they have different clinical protocols, different hours, different patient populations served, not really acting as one in such a proactive way. Now there's certainly improvements to be made on our current margins in both the affiliate and the medical center model. The ratio between the two will remain relatively equal to what we're showing today. Okay. Yeah. Then the other long-term target that I think looked a little different is you were previously talking about 30% revenue growth, and it sounds like you still see that through 2025, but thereafter, now it's 20%. Previously, you were also talking about building 225 clinics by 2023, and I think the new outlook is a little lower than that. Is the lower revenue growth after 2025 reflective of the fact that maybe through 2025 you'll be building fewer clinics than previously, and since membership takes time to ramp, you won't see that same out year build, as before? Just curious what drove the lower center growth into 2023 than previously comm unicated. Sure. Yeah. First, when last year we talked about our growth, 30+%, as you know, initially it included acquisitions. What we're saying today is 30% fully funded organic growth through 2025, and 20+% organic growth, fully funded, thereafter. Of course, there's incremental opportunity. No, the growth in many ways has accelerated beyond our expectation. If you look at our projections and how we have performed quarter-over-quarter, is why we're particularly optimistic. Just to repeat, the original projections and expectations included a mix of the buy and the build. What we're talking about here is fully funded organic growth in whichever avenue that we choose to stand up the box, whether we build it from scratch, or we renovate a center, or we tuck in in an affiliate or a locally adjacent practice. Brian, on the mix, as to what made us shift more than anticipated to tuck-in versus de novo. You wanna add to that? Yeah. I think it's just a smart financial decision. You wanna grow your capacity at the highest return on that investment. What's important as we will continue to do is build capacity to meet that demand. As Marlow said, organically, that's what we think we can achieve. Certainly, as Jason laid out, our M&A strategy is not going away. It's gonna be a critical component of our growth going forward. Thanks. This is Jason Cassorla from Citi. You guys guided to 25 new medical centers for 2023. You noted at least $1.5 million of CapEx spend per center for de novo or tuck-in either way. Should we think about the dynamics around $40 million of CapEx spend for 2023, or are there nuances to CapEx that year that we should be considering at this point? Yeah. Great question. There's a couple components to CapEx, and we talked about it's really important. We build capacity to meet the demand. Don't always think about it as a new box is the only way to increase demand or increase capacity. We will actually literally expand an existing center, and we call those renovations or additional expansion capacity. You're gonna have some additional capacity on that. You know, I'd put 2023 CapEx, you know, in that $50 million or so range. Got it. Okay. Thanks. Just a quick follow-up on a question before. Just trying to understand the DCE business. So you talked about 24% margins for the medical center and mature on MA, 12%, for the affiliate model. Is there any reason at this point, I know the program's pretty early, but is there any reason why DCE margins couldn't get up to that level, or are there nuances in the program that you see now that maybe would suggest a lower relative margin profile over the long term? It's a new program. Mm-hmm. I don't think that we can give you an estimate that is based on empirical data when we know the history of the MA program itself has evolved in such a way that what we're seeing today is radically different than what it was 20 years ago. Everyone, you know, that's familiar with the value-based care industry, Medicare Advantage, Medicare Part C, understands that initially there was no risk adjustment, and then there was additional provider tools and different components in the bidding process. A lot of what we're seeing in DCE is starting to mirror those improvements in that infrastructure that CMS has built. We applaud their effort for their 2030 goal of having all Medicare members under value-based arrangements, because we know that improves care, and that is able to bend the cost curve. What we can say today, based on our initial experience in 2021, is that we have low single-digit EBITDA margins on a pretty high revenue for this year and with growing from that point in 2023 and beyond, in that we had improvement through the year as we plug in those patients to our platform. We are not ready, I don't think anybody is, to give long-term margin estimations in such a new program, but we're very optimistic, and we see it as a great part of our story. Hi, Andy Mok from UBS. First, on the de novo growth strategy, can you help us better understand how mature affiliate physicians factor into that strategy? Is the goal ultimately to orient de novo clinic builds around mature physician groups, and align those two models over time? The goal is always the same, to build scale and density, to serve the most patients the least amount of time, the least amount of risk, and the greatest clinical and financial results. Through achieving that scale and density, if that naturally means we're tucking in affiliates generally being already the most mature within our infrastructure, because we're gonna take some time to evaluate their performance and they're also going to decide whether it's right for them to be now employed providers. You typically get more of the mature variety of the affiliates that are tucked in. Rarely, I don't think there's one example of, well, I gave you a contract last month, now you get these assigned members, and you're starting to use our care management or Panorama services, and then, okay, let's do a contract to tuck you in, and now you become an employed provider. That would be exceedingly rare. It hasn't happened. It's a matter of using the growth avenue that makes the most sense for that market. It's the path of least resistance. It's the best return on investment. Again, the beauty of it is that it benefits all stakeholders. Got it. A follow-up. On page 96, I think you compared illustrative economics for a mature member in one of your own medical clinics versus an affiliated member. There was about a $110 PMPM differential. I was hoping you can help us better understand the drivers of that premium differential. Yeah. The most of that's geographic and member acuity. You tend to get a higher acuity member in the medical center, and just the age demographics are a little bit different. That's the primary driver. Okay. I think the direct patient expenses for the affiliates and the owned clinics were fairly comparable. What exactly is captured in the direct patient expense for affiliated members if they're not receiving care in one of your centers? Do you want- Yeah. I don't know if you want. Yeah. Third party claims, right? The direct patient expense reflect the quality bonuses, the share of surplus that we pay to them. The PCP cap is embedded within our third party, whereas for our affiliates, direct expenses is what we are paying them as part of that care delivery, which is similar to the salaries and resources that we invest to directly care for our patients at our medical centers. Got it. Thanks for the clarification. Hi. Thanks. Jess Tassan from Piper. I wanted to follow up actually on that question about the affiliate versus owned expenses. I think there's a little bit of a difference just in OpEx per patient at an affiliate versus an owned center. Just interested in what drives the OpEx difference and what that implies for patient growth profiles in each of those two different settings. Yeah. As Brian said, there are differences in demographics that are regional. There are differences in mix, dual versus non-dual. In general, you're gonna have less direct expenditure for an affiliate rather than when you take care of your own members, but you're gonna have less tools to manage that member's health as well. As we've said before, the medical cost ratios are going to be higher for affiliates than what you can achieve at your own staff model centers. While there is to the established business, to the previous question, further maturation that will improve margins to achieve something close to the illustrative single mature patient, and that's a single mature patient over time, and you can see what we're able to do to improve care, bend the cost curve over time. You're seeing really the relationship among the two, whereby you have a greater margin at the staff model centers, but it's not exactly one-to-one because you're gonna have more affiliates in more rural areas. You're gonna have more affiliates when you serve, you know, less percentage of dual eligibles. Brian said the acuity. Somebody that requires more care and more services is going to be naturally gravitated not to the traditional model of care, where you have a fairly limited PCP offering, and those are typically the affiliated practices that you all are familiar. They're gonna be more gravitating toward, you know, that holistic approach, access, quality, and wellness in one of our staff model centers. There are these general differences as I described, but it would be incorrect to paint a one-to-one picture because of important differences in the demos and regions and even overall product lines and clinical services and protocols that are offered under each avenue. That's helpful. I just have two quick follow-ups. I think on that same slide, it's referring to a per mature patient in each of the two models. Should we think about the OpEx that's indicated there as kind of a retention level of OpEx per mature patient, or should we think about that as sort of a retention level of OpEx per mature patient? Just a quick follow-up would be on the $110 of corporate adjusted EBITDA, negative 110 for 2022, just interested to know what expenses are kind of contained in that bucket. Thanks so much. Brian? Yeah. I mean, the corporate expense, it's traditional corporate overhead. It's finance, it's legal, it's compliance, it's general operating costs, healthcare benefits, traditional corporate overhead expenses. As far as your other question, I mean, that's just a average expense for those affiliate members or the medical center members. Just kind of a good rule of thumb, whether- Optimized cost at maturity. Yeah. Hi, I have a question from the internet from Gary Taylor. Dr. Aguilar's kidney function data was interesting because it presented actual clinical data. Can you speak to other clinical metrics like HEDIS measures for A1C and others? Dr. Aguilar. Yeah. Well, that's a great question and I'm glad he asked that because as we shared with you all, really what makes a great difference of what we do is the management of disease, and he cited the clinical data we had for kidney function. This is a metric you just can't magically come up with. The kidney is an organ that doesn't forget. You miss your blood pressure medicines for a few weeks, the kidney remembers. You take too many anti-inflammatories, the kidney remembers. Your sugar's too high, the kidney remembers. It'll show it to you. What we demonstrated is our model consistently does an impact in clinical outcomes. For example, A1C. A1C is the standard measure we use to check how you're doing with diabetes. We look at a 7% target. If your sugars are over this 7% margin, we consider that out of control. Medicare Advantage says if your number is over 9, that we call that horrible or terrible control. We actually looked at that at Cano Health, and we said, "If you're a new patient that comes to Cano, what happens to you over time?" It turns out in the United States, it's embarrassing. If you come to your primary care doctor and your sugars are poorly controlled, your A1C, this metric is very high, it takes the average clinician 2.6 years to change a prescription. 2.6 years to change what you're on. That means you continue with this poor control year after year after year while you're getting care. That's not care. That's an office visit. That's not managing disease. We looked at that in terms of what happens when a new patient comes to Cano Health and what happens to you over time. We published the evidence at ADA because we wanted to address something that the ADA, the American Diabetes Association, has been pounding America with for the last several years, and it's called clinical inertia. The failure to do something, the failure to act on these results. We're able to publish that if you come to Cano, within 12 months, we had statistically significant reductions of this metric, this measurement of A1C, if you're a terrible control, if you're moderately elevated, or if you're mildly elevated within 12 months. This is something the kidney remembers. If your sugars are high, the kidney will show it to you. In fact, in the data we showed that we presented a couple days ago in New Orleans at the international sessions, we're able to demonstrate that the A1Cs were above seven, and they got into the sixes. The blood pressures were elevated, got a little bit lower. The weight high, weight came down. We're able to show not any clinical trial, we want you to bring the patients in, do this, and we expect you to do. Just the way we manage disease and observing what Cano did, we're able to demonstrate the model. The sugars got better, weights got better, blood pressure got better, and therefore, the kidney did not suffer. We have published data on blood pressure, published data on diabetes, published data on readmission, published data on COVID mortality. We do this because we want the industry to learn that a primary care setting based on a model that manages diseases can have great clinical outcomes, and sick patients are very costly. The reasons why we're so profitable is we don't have to pay for all that bad care next year because we invested this year. It's a great question. I'm glad you asked. Oh, question over there. Thanks. It's Jason Cassorla at Citi again. Just a follow-up. Can you talk about the 30% revenue growth? I know you disclosed for your MA population about 7% CAGR, PMPM growth. You know, how should we think about that 30% in this near term kind of dynamic between split between membership and PMPM growth? And then how would you think about that over the long term in terms of your 20% growth, just the components of building to your long-term organic revenue growth controls? Yeah. I mean, I think you guys can get a sense of where CMS is going with 2023 premium increases. I'll let you guess after that. You never know. We do know that it's a federally funded program, and the program is not gonna go away anytime soon. We expect continued performance from that perspective. You know, we continue to build capacity, and a lot of this comes with the capacity. Our cen ters in c ertain locations are getting full. We're adding capacity there, and others are just starting, as Maggie just mentioned earlier. Vegas has got great growth opportunities there, and so does the other markets, as in Texas and as we enter into California and others. All have great growth opportunities for us to build into that revenue opportunity. Our focus is seniors. We said at our first quarter conference call that we expect about 60% of our members to be Medicare. As far as next year goes, we'll update guidance at that point on this and other topics as to where we see next year. The focus of our company is and remains serve the most amount of patients in the least amount of time with the greatest clinical and financial results. That means growing through a flexible model and becoming a solution to health systems or at-risk groups, entire communities, governments. This is about transforming healthcare and redefining primary care. You heard from Dr. Aguilar. A big differentiation for us is that a big part of our leadership and certainly from us as founders, we're primary care physicians ourselves. We get it. We've seen the suffering of patients. What drove me initially to found the first Cano office was that I not only made a promise to my ailing grandmother and she wasn't getting the care that she needed, but also that I saw a great unmet need during the Great Recession in 2008 and 2009, and I believe we're solving for that need. Let Maggie talk to you a bit more as to what we're doing for Las Vegas, because it is truly remarkable what we're accomplishing in such a short period of time, and how everyone in that city is just incredibly thankful, engaged, appreciative, that the model of care we're bringing is making significant impacts that are far beyond healthcare that, as we like to say, is preserving and enhancing the American dreams for entire family. Thank you, Dr. Marlow, and it's true. For Las Vegas market, there was nothing like Cano before. We were used to going to the doctors and having to wait to be seen and just going to the doctor when you're sick. Therefore, we were at 49th in the state. We have conversations with our governor, with our city officials, and everybody has pretty much welcomed Cano because there is nothing like Cano, especially for the minorities, for the Latinos, for everybody that was lacking that access to healthcare. We've already seen great results, and we would like to basically bring this model across the West. Again, there is nothing like Cano, even though there are some other pro-healthcare providers out there and other systems, but they're not really tailored to take care of the minorities and the underserved. That is the difference, and that's what I would tell you in terms of our market. We take care of our patients the way that the other systems have not been able to. We become their family, we become their provider of choice. As I mentioned in my presentation, we like to keep our patients healthy, happy, and productive, which is what we would like to showcase for the rest of the West. What Maggie is really sharing is we entered a new market within a year and a half, bringing the Cano model and the way we deliver and manage care within our system, within our platform, with the pop health support and care management. Imagine in a new area, we're able to reduce hospitalization by 13% at $14,000 a pop. We're able to reduce ER visits, clinical outcomes, just getting there because the model carries itself with it. It's like I share with a lot of people, it's like making mocha. You get mocha from this famous coffee in Barcelona or Los Angeles or New York. It tastes the same. Bringing our model brings that level of delivery of managing disease, of managing the patient's illness, not just seeing the patient and turning them over. These results are the expected results, reductions in ER visits, reductions in hospitalization, reductions in heart attacks, strokes, heart failure. All the things that cost us, we save because we do disease management. Not just say, "It's nice seeing you again. I'll see you in six months." That's not managing disease. Managing disease is what we do best, and that's why we're able to publish these kind of outcomes. Look around. Is anyone doing this? They say, we provide great care, but is anyone doing what we're doing? We are publishing the data so you can see it. Hi. Thanks. Just one more follow-up. I'm curious on CanoPanorama. It's probably for Dr. Aguilar. How often are you updating care protocols, you know, within your system? And then how often are you adding new modules, you know, sort of big wholesale changes? And how does that training get rolled out? All right. Before Dr. Aguilar starts, that's actually a combined question because Pedro will talk to you about all of the updates, the dozens of updates that occur on a regular basis. Of course, Dr. Aguilar in the dozens of specific disease management programs that we have and that constant, not only updates to protocol. But also the CME, the collegial environment that is so necessary to ensure that the mocha, as he says, tastes the same, you know, everywhere. We're able to get these uncommon results whether at our centers, using our growth avenues, different demos. Dr. Aguilar. Let me give you a perfect example. While I was at the American Diabetes Association, there's a big concept now about BMI, body mass index. There's a debate whether we should lower your body mass index or treat fat adiposity. Here we're having a debate with everyone around the world discussing what should we do, and there's now a push at actually lowering body fat rather than just lowering your BMI. Copy the slides, send it to our Healthy Heart team, who has a weight reduction program, so we can begin implementing what is being discussed at the ADA currently to implement in our models tomorrow. We don't wait for someone to tell us what to do. We watch, observe, and adapt immediately, whether it's current data, recent publications. Marlow sends me five o'clock in the morning. I don't know what time he wakes up. You know, "Hey, Rich, have you seen this data?" I go, "Yeah, yeah, I saw it yesterday." "Oh, no, let me take a look at it." I send it to my teams, and we begin rolling it out, and we have that discussion at our next monthly meeting, where all our clinicians across the entire platform, 450-460 attending, and we share this information, so they adopt and apply. We embed it in our system, whether we add more information in our protocols, whether we pass information along to PopHealth so they can acquire this information for us. We adapt to the current standards of care. Like a lot of people in the industry say, "Rich, how did you begin that?" Well, I saw it presented. I saw it published. I don't need to wait for some committee to tell me about it. It's relevant data, and we applied it immediately. That's how we stay ahead of the game. We continually observe those results. Internal, external data, it's about that evidence-based practice from our backgrounds, UC Irvine, Cleveland Clinic, we both published studies. It's about ensuring, empowering providers to practice the medicine that we were trained for, that we always wanted to practice. That's a continued evolution, as Pedro says. Pedro, talk about how routine the updates and the breadth and scope of those to CanoPanorama. Well, with the HIE alert, for example, the system updates every 15 minutes, so we get live data. The system interfaces or interacts with multiple modules within the system. Every time new data comes up through the payers, it updates immediately, and that's it. It's a constant communication in terms of with real-time data. It's not a delay. It's not anything that we do not know about. It's just how it interacts and how fast the systems communicate between each other in order to provide the best quality data available for a clinician and the operational team in order for them to improve the outcomes of the patient. You know, Pedro, just recently, we became engaged with Tobacco Free Florida. It's a big program to get people to stop smoking. I go to my PopHealth. "I need a list of all our patients who smoke." I get that list immediately. We send out to the clinical team. Recruit your patients. Anyone that smokes, we can involve them in this program to teach them with smoking cessation education. Because if I control your sugar with medication, I control your blood pressure with medication, I control your cholesterol with medication, I can reduce all this risk. If you smoke, that smoking neutralizes all the work I do. We work with PopHealth. He provides me the data. We disseminate to our clinical team. The office managers get these patients. Everyone's on alert, and we exercise these protocols immediately. Why? Because we work collectively with timely, actionable data that we get, whether it's from recent publications, recent conferences, and we apply this. Imagine if you're working for Cano Health as a clinician, and you're in San Antonio or California, Chicago, and your clinical leadership is keeping you up to date with recent articles, recent protocols, and we implement that. They feel empowered because they know that a clinical leadership is running them, not an administrative team. We have doctors that are overseeing and watching the way we manage patients, because managing disease gets the kind of outcomes that credentials them, that certifies them nationally for providing this kind of care, that your data is actually getting published, and it drives them to provide that high level, that high bar of care. Work with PopHealth, we work with the care management to make sure we deploy these new recommendations across the platform. We have a question from Jack Slevin at Jefferies. Appreciate the color on some of the clinical programs geared towards specific diagnoses or disease categories and all the work you've done on Healthy Heart. How should we be thinking about this as it relates to subcapitation or how you'll plan to contract in some particularly meaningful specialties going forward? Does it vary looking at the medical center patients versus affiliates or by geography? Yeah. Well, let me start with that, and we have a contracting function within our growth department that Jason can elaborate on. Yes, it's built to suit. We typically bolt on the networks of our payer partners. That's just the beginning. We go to work from there understanding what are the needs of that individual community. If there's a plethora of cardiologists, for example, we still love our cardiovascular prevention program. W e don't have to have cardiology in-house if we can easily get it and it's high quality and we're getting the data. I think the question really comes down to what are the signature services? Gina touched base on that, and our center ops team does a wonderful job of managing to solve the patient issues, the access to care problems, the quality problems, the wellness components. Gina, if you would like to expand on, you know, how we think about building to suit at our medical centers to meet the patient needs. I think what's important is that we focus on what patients actually want, and each market is really tailored differently. We know that our signature services are important because they're part of our preventive and wellness component, so we know that we add them. As you go into different markets, we'll add different specialties. We'll partner up with different groups that are like-minded and value-based. Although we'll have sessions in our centers, we could also put them as a preferred network. We partner up differently in each of the markets. What's great is that patients realize, not only will I have access to these services, but we also assist them in partnering up together with our primary care in one same place. Thanks. Jonathan Yong, Credit Suisse. I was just looking at slide 100, and the EBITDA between de novos and acquired medical clinics, even at year 5+, there's this pretty healthy spread. I guess, one, what's the difference? Two, when, if at all, should the de novo and acquired medical clinics run at the same run rate EBITDA? Go ahead. Yeah. Think of those, if you go back, you're looking at the green bar versus blue bar in year five, you know, it's really just a difference as a function of. This is why it's a challenging exercise to do, but it's geographic challenges. Changes will affect that, whether they're in Florida, whether they're outside of Florida. Just the maturity of some of those centers. So me of them are well over the five years, so you know, that's just a ramp up for a number of those. It's really differences in the overall location, the overall mix, and just the full maturity of those various centers causing some of those differences. It goes back to scale and density. What's the scale and density? The patient unit economics that you had when we're saying 5 plus years, so don't know how much longer. But yeah, on a relative basis, apples to apples are gonna perform very similar. But as Jason presented, the ramp to maturity, the cash burn, the speed to market, the clinical capacity, that's really what's different in the initial years. We balance that out to have the appropriate growth for that market that is firing on all cylinders. Okay. Is this on? There it is. I know you took a pause on de novo clinics this year. When do you kind of expect to come back to that, given the current macro environment? Thanks. Yeah. I wouldn't say we put a pause on de novo clinics. We're still, you know, 40+ clinics this year. You know, I think it's just as we look at the market, each market is different. Maggie may not need a de novo, but she's looking at a tuck-in, or she may have a good acquisition pipeline that she wants to pursue. So we need to be very flexible, very smart about it, and nimble. That's really what we've done this year. As the economic changes have occurred throughout from this last year to this year, it makes a lot more sense to do some of these smaller tuck-ins versus a full blown-out de novo, given the longer lead times, the construction costs, just other supply challenges that we may see in some of the markets. We're growing, once again, to meet the demand, and we'll do it whichever way makes the most sense. Right. I think this is a really important point because we're not building a center to achieve growth necessarily. We're solving for the growth that we'd like to fund through the different growth avenues that we have. How do you achieve the clinical capacity to meet the market demand and achieve your growth objectives in the most capital efficient way? I really want you all to think about that as to how we operate and have operated our business. If next year the market leaders, whether it is, the West, or the Northeast, the South, tell us, "Hey, we're seeing better capital efficiency, with, tuck-ins," or, "Hey, you know, there's this platform acquisition that can build, buy, or manage independently, and I can get immediate scale and density," we should be taking a look at that and make sure that, makes the most sense for our shareholders at the time. The flexible growth model, the multiple product lines that we operate within a large and growing market with recurrent revenue streams that is a necessary service is what is so attractive, so appealing about our business. With that, we're out of time. We'll be around. Love to show you some of our other showcases that we have here, and really appreciate everyone taking the time at this 2022 Cano Health Investor Day.