This is the same. Come on. The same? No, only four hours. Okay. Three and a half. It took me three and a half last night. Where do you want me to sit here? Wherever you want. Perfect. All right. Thanks, everybody, for joining us. 45th Annual TD Healthcare Conference. My name's Ryan Langston. I cover senior analyst for healthcare services, providers, and managed care. Happy to have DocGo with us, have the CEO, Lee Bienstock. Very quickly, DocGo is an innovative care delivery platform, includes mobile health, remote patient monitoring, and other ambulance-type services. DocGo provides services in nearly 30 states and across the U.K., a fleet of over 1,000 mobile units in the field, and has had several million patient encounters. Lee, thanks for being here. Wonderful. Thank you, Ryan. It's great to be here with you. Awesome. Maybe a good just place to start. You've been, I think, CEO now for about a year and a half, kind of came in as COO. Maybe just maybe give me a reflection on your time here and what it's meant and what you've been able to do, and then we'll get into some of the nuts and bolts. I'd love just kind of a recap over the past, call it, year and a half as you've taken the reins. Yeah, it's been a very exciting year and a half, very eventful year and a half. I think, really, as I've gone through as leading this company, which I'm so excited to be leading the company, it's really been clear to me a few things. One is this country is very sick, very, very sick. I think the U.S. spends an enormous amount on healthcare. I'm sure there was a common thread throughout the entire conference: 20% of GDP on healthcare. We have nothing to show for it. We saw, as you mentioned, we saw 1.5 million patients last year. It's very clear to us that there are patients in our country, there are neighbors of ours in our country that are not being served by the current healthcare system. They're getting sicker and sicker. The U.S. will see over 35 million hospitalizations this year. The only way to target and really, dare I say it, make America healthy again, the only way to do that is to really target the hospital admissions. There are so many patients that are being admitted to the hospital or ending up in the emergency rooms, and that's where they're the most expensive on the system. To me, over the last year and a half, I've really been emboldened to see that we've been helping payers and providers and really municipalities essentially avoid unnecessary hospital admissions. That's what's made me so excited. I think the opportunity is so enormous in front of us. We've helped divert over 65,000 hospital admissions since we really started working on this in earnest. We saved the system over $20 million-$50 million, and I think we're just getting started. That's great. Maybe kind of just wrap up, just reported, of course, last week. Maybe just give us a, don't have to go through the whole call, but just kind of a recap of the fourth quarter and maybe just kind of 2024 in general, maybe how you started, how you ended, and then we'll move on from there. Yeah. In the quarter, the quarter that ended Q4 of last year, we did about $120 million of revenue. The company was profitable on an adjusted EBITDA basis for the full year. To give a sense of how we ended and where we started, for the full year, we did about $616 million of revenue, over $60 million of adjusted EBITDA. As the year went on, we continued to invest pretty heavily in our infrastructure and our care gap closure programs and our ability to go serve more and more patients in the home. That showed up in our profitability in Q4. Really, we're going to continue to lean in, excuse me, we're going to continue to lean into those investments. When we started last year, we had a very small number of payers working with us. We had a list of 2,000 patients to go and serve those patients and close care gaps in the home. We ended the year with over half a dozen payers giving us lists over 700,000 patients. We are very enthused and emboldened by the opportunity. There is a tremendous number of patients in this country that need access to care that they are not getting. We invested pretty significantly over the course of the entire year and definitely into Q4. As we started Q1, we have continued to lean into that investment, and we see a big growth opportunity in front of us. I would say another big theme of last year, which I know we should talk about so investors know about it, is last year, we were serving a tremendous amount of migrant population, asylum seekers. We have very large contracts in New York City to help with the influx and really the humanitarian crisis of people coming to the city needing medical care, health screenings, shelter. At the end of last year, we wound down completely our contract with New York City's Housing and Preservation and Development Department. We are out of that completely. This year is going to be a transition away from those migrant contracts into more steady-state population health programs. On that investment you talked about, how, and maybe you can't characterize it sort of in one swath, but just how do we think about that? Is that sort of a pull forward of maybe some cost that maybe you're going to incur in 2025, or is this just as you sort of sat back structurally, you needed these types of investments, and 2025 would be sort of incremental on top of those investments? Yeah, I think the latter. I mean, first off, there's a couple of dynamics here. One is as we've sunset the migrant programs, right, the revenue, we've sunset that portion of the revenue. With it, we had some SG&A leverage that we're going to have to work through here, where the revenue, even though it's revenue that I think investors are more excited about, without the migrant programs, we have some SG&A leverage that we're going to have to solve for here throughout the year. Our gross margins were very consistent. As we were sunsetting these migrant programs, our gross margins stayed year over year at the same level. We've done a great job with that. I think we'll have to grow into some of this SG&A leverage here, so that will impact profitability in the sort of early quarters of this year. We have also invested in the care gap closure programs in our infrastructure to be able to go serve patients in the home. We are going to continue to invest in that. What does that mean? When we send the clinician into the home, we like to be a Swiss Army knife. We like to be able to close as many care gaps as we possibly can with that one visit. Our clinicians today are trained to close over 35 different care gaps in the home. That could be a diabetic retinal scan, a bone density scan, a colon cancer screening, med titration, vaccinations, annual wellness visits. The list goes on. We take great pride in our clinicians being able to go into the home and really be able to close as many care gaps as possible. The team was just bragging to me last week. We went and did an in-home visit for a patient, chronically ill patient. We closed six care gaps in one visit. Being able to do that offers a tremendous value to the health insurers that we're working with, not to mention how spectacular it is for the patient and the patient's health. We are going to continue to invest into that. The training for that is pretty significant for our clinicians. Before we send a clinician into the home, we have them shadow a clinician who's been doing it for a while. There is a logarithmic expansion that happens as we have more clinicians, more people shadowing. There is more investment there. We are going to continue to invest in that. I think we are going to continue to invest in more geographies. I know, Ryan, one of the things we've spoken about, you and I, has been, how do you decide which geography you go to? For us, it's pretty clear. We have our geographic roadmap and our product roadmap. We don't decide that. We let our customers decide that, right? Our health plans and our health insurers, they say, "We really need you in this part of the country. We really need you in this part of the state. We really need to solve for this care gap." We add that geography, we add that care gap to our product roadmap, and we invest into that and that expansion. We're going to continue to do that. Absolutely. We did that in Q4, which showed up in the financials, as you mentioned, and we're going to continue to do that in the early parts of this year. You wound down a couple of these contracts, talked about New York City. Does that open up capacity to sort of backfill some of those employees that were maybe managing that business now that they can kind of be diverted and go do other things maybe you did not have the capacity to do? Is that fair to think about it like that? Oh, absolutely. I mean, we have an enormous amount of social workers, case workers, nurses that work on providing the medical care for that population, particularly in the New York metro area, that we want to be thoughtful about transitioning that staff to new opportunities when possible. The last thing we want to do is sunset that, lose that staff, and then we have a big opportunity that comes our way, and now we have to staff back up again. We are trying thoughtfully on how to transition from those migrant contracts into some of the other programs that we are developing right now that we know there is a need for and giving our clinicians and then also our wonderful management staff the opportunity to transition to the next population that needs our help. That is what we are working on right now. Got it. On the new state expansion, let's say a payer comes to you and says, "Hey, we want you to go into this new state or this new geography." Just from my sort of simplistic view, it would seem there's a lot of upfront investment that has to go into that, whether it's vehicles, whether it's hiring, as you said, getting those folks up to speed, putting in a regional management structure, all of that different stuff. How do we think about that if, say, a payer comes and says, "Hey, we want you to go into the 31st state or the 32nd or whatever"? How do we think about those upfront investments? Do they share that with you, or do you just take that on and just kind of make sure that there's enough density there to make that back? Yeah, I think it really comes down to, as you said, density and then also the volume that that payer can give us. I will use California as a great example, right, which we did in Q4 of last year, which again, we shared with investors on our earnings call last week. We started with an anchor customer in California, and they gave us a tremendous amount of volume, which allowed us to grow and expand into that market. We set up new bases from Sacramento all the way down to San Diego, five new bases for us to launch our services from to serve communities around those bases. We filled that in with additional contracts with additional payers. Like we shared, LA Care, which is another very, very large payer provider in the South California and Southern California area. We just signed an agreement with the Inland Empire Health Plan, also in California. Now we came with an anchor customer, and we filled out the other volume and geography with additional customers. Now our efficiency just continues to improve as we add more and more customers in that area. That really is our model with how we think about expanding. We really will expand with an anchor customer. They have the density and the volume to support that expansion. We feel good about that. We are able to then offer services to all the other health plans or hospital systems that also need the same exact services in that same market. We get more density. We get even more density. We get even more capacity efficiencies. The margins just improve from there. That is kind of the approach we've been taking. We will see those margin improvements as we go throughout this year and certainly into next year. You know, the business model is, at least from an investor perspective, I'd say fairly unique. There's not really a lot of transport-type businesses. I mean, I'd have to go back to 2008 to the teens. We talked about AMR, right, with American Medical Response, Air Methods, right? How do you sort of explain the business model to sort of the investor community? And maybe who would you benchmark yourself against if someone says, "Hey, I see this DocGo company. I I want to learn a little bit more about them." How do we think about that with maybe less peers than maybe some other sort of subsectors in healthcare? Yeah, and I think that's something we have to do a better job of as a company. I think absolutely helping investors understand our business, what our strategy is, is something that's going to be a big focus of mine. It has been last year, but even more so this year, because I think there's a lot of tremendous things the company is working on. Patients absolutely love the service, which I hope we talk about, because our Net Promoter Score with our patients is 86, which in anything over 70 is deemed world-class. We know we're onto something here. There's a huge need for it, and patients are really benefiting from it. I think we have to really crystallize that message a lot clearer for our investors. That's something that I'm going to be focused on in the coming months here. The way to really think about it is we bring care to patients that do not have good access to care, and we bring it in a mobile fashion. When that patient needs to be brought to care, we will transport them to the facility that they need to be taken to. We built a proprietary tech platform that allows us to manage all of those vehicles in the field. You mentioned that we have about 1,000 mobile units in the field every day. It is a symphony, I call it, right? You have the right vehicle with the right clinician, with the right skill set, with the right training, with the right licensure, with the right diagnostics, all most importantly for the right patient need. How do you most optimally use that clinician so that he or she can see the most patients in that day with the highest quality? That is what our tech platform does. The way I think about it is we are a mobile healthcare company. We are delivering healthcare. It is very cliché to say, but we essentially are the Amazon of healthcare, the Uber of healthcare, so to speak, where we are delivering care to where it is needed. We have built a tech platform to allow us to do it. It is very cliché, but that is the way we think about it, where we are bringing care to patients. When they need to be brought to a different location, we do that. The only way to do that is using basically a vertically integrated tech platform like the way we have it. It's our clinician with our vehicle, with our licensure, with our diagnostics, all serving our patient with the health system or the health plan. We control those resources in the field. It's not some sort of jump ball, and it's not some sort of capacity issue. We're optimally stacking those patients in a way so that we can see the most. The way I explain it is if we see two or three patients in a day, we lose money, maybe break even. How do we get to that fourth, fifth, sixth patient? Using our tech stack to be able to do that is really the crucial component of it. If we can see that fourth, fifth, and sixth patient, we can make more money. We make profit, and then we take those profits and reinvest again into serving more and more patients. You mentioned it twice, which is good because it was my next one, technology, right? You have spoken in the past, I know, about above and beyond using technology internally, that you have licensed that software, I believe, out to some folks. I guess if you build a tech stack and you have this proprietary technology, is there a chance maybe strategically you do not want to go into 50 states, but you could potentially sort of monetize that software and license it and maybe build that on more of a grander scale? Is that a potential part of the strategy, again, just so you do not have to go into all those geographies? Yeah, I think so. One of the unique pieces for us, and we hear about it, our Chairman, Steve Klassco, he's the former CEO of the Jefferson Health System, who is a close customer of ours, close partner of ours. He said it really interesting to me. He says, "There are so many companies going and selling software or digital tools to hospital system CEOs, so many, right? What sets us apart is we'll sell you the software. We'll provide you with the software, but we also provide you with the boots on the ground with which to effectuate that software and make it useful in the field." That is a really difficult thing to do, right? We have to have those 5,000 clinicians. They have to be well trained. We have to have those vehicles. I say it. I have four children of my own, but all those vehicles are our children too. They have to come home at night. They have to be cleaned. They have to be tucked in. Some of them actually go back out for the overnight shift, and they have to be maintained, and then they have to be deployed again in the morning. They have to go out again. That part is not easy. I'm not saying the technology piece is easy, but the fact that we're able to do both is a big differentiator. I think it's possible that we will license the software into states that we don't have boots on the ground, that we don't deploy our services. That's something we've been asked to do. I think we're being very thoughtful about that. We don't necessarily want to empower a competitor. That's a big differentiator for us. We do not want to empower somebody in a market that we do plan on expanding into. We are going to be very, very thoughtful about that. We do have a pilot in development right now to license our software to a hospital system where we know it is very unlikely that we are going to be deploying our own physical services. We think there is an opportunity for us to expand it from there. A lot of hospital systems say they choose us. We are not the cheapest provider. We are the highest quality, and with that comes oftentimes a bigger price tag. They choose us because the software just allows them to optimally manage the patient flow and the bed management and everything, which we did not talk about. That is a big differentiator for us. I will just give a great example. One of our large health system partners, who's a big customer of Epic, goes to Epic and says, "We really like you to integrate with this DocGo tech platform." Directly from the patient's chart, a discharging nurse can click a button, and they can have us, an ambulance, come and pick up that patient. Now, why is that interesting? First off, the nurse knows exactly when to get that patient ready so that when we arrive, we're super efficient. We can take that patient to the next destination. The intake team at the hospital knows exactly when that bed's going to be available for the next patient, right? The housekeeping staff knows, "Okay, now it's time to come and get that bed ready." That patient doesn't have to stay, perhaps if they don't know when we're arriving, if they don't know when the medical transportation's arriving, that patient may have to stay an extra night in the hospital, which the patient doesn't want and the hospital system doesn't want. That confluence of that tech stack, it's not just about getting a patient from point A to point B. It's about getting a patient from point A to point B safely and with great quality, but then also making that bed available for the next patient. If you can use the beds you have more optimally, you can serve more patients, and you can run your hospital a lot better. One hospital system CEO was telling me that it costs $3 million to bring a new hospital bed online into the system. To add one more hospital bed into the system costs $3 million for the average hospital. Either you have to do that, or you can use the beds you have more efficiently, and then you do not have to spend that money. Obviously, it takes time and capital to add hospital beds to the system. Our whole goal is to help you use the beds you have more optimally. Hopefully, perhaps a patient that should not even be in the hospital does not even need to use that bed, so you do not have to add any more beds than are necessary. We'll get to patient service and some of that in a second because I want to touch on that. What you just said is kind of interesting. You go back to something you said, 65,000 patient diversions, I think I wrote down. Yeah. When I think of how healthcare has just been run typically, we're in a value-based care environment, but it's reactionary a lot of times. Fee for service. You have to do something to get paid for it. Yeah. I think where you're coming in, going to the patient's home, you could call that preventative medicine, right? Value-based medicine. Sixty-five thousand diversion sounds great. How do you sell that and your services to a municipality, a health system, a payer, and say, "Hey, we're not going to go from fee for, we're going to go from fee for service to preventative, and here's the data that we can show you." How do you lay that out to your potential customers? Yeah, we like to call it people are starting to copy us right now, but we call it a proactive healthcare revolution, right? Being proactive. You spend your whole life. Everyone tells you from an early age, it's better to be proactive than to be proactive, push. Our whole goal, we tell it, it's the culture of the company, and it's really the service we're espousing, which is really proactive healthcare. Because we feel like if you can intervene ahead of an emergency, it's way better for the patient. It's way better for Uncle Sam. They save a lot more money. It's way better for the payers. It's way better for really everybody in the system. It's the only way that you're going to get that 20% of GDP trending downward. That's the only way if patients are healthier. I think that's going to be the next revolution that happens here in this country. I think the new administration, I get asked all the time, it's obviously a very, very timely topic. People say, "How's the new administration and what they're doing?" I think this new administration wants to cut costs. The only way to do that is to have patients be healthier and have the clinicians, have the physicians, have the providers part of the outcome and be incentivized for the patients getting healthier, not sicker, like you were saying. Every diagnostic you do, you make more money. The patient wants as few diagnostics as possible, not more. How do we incentivize the whole system so that the patient is healthier and needing fewer tests and fewer treatment? That's our plan. I'll give you a great example with LA Care. It was one of our customers. We started with a pilot. We started working with them 18 months. I mean, these deals take time. These programs take time for the exact reason you were just explaining why, which basically we had a cohort of patients that were being discharged from the hospital. We knew that this cohort of patients that have a very high likelihood, it's called a LACE score. Basically, they have LACE scores of 8, 9, and 10 on a scale from 1 to 10. LACE stands for length of stay, acuity, chronic condition. These are sick patients, 8, 9s, and 10s. They have a very high likelihood of being readmitted to the hospital. On average, these patients were ending up in the hospital five times a year, right? Literally every other month, practically, they're in the hospital. As the patients were being discharged, they're being discharged into our program. We go and we check in on those patients every week and making sure that their transition of care from the hospital to the home is going smoothly and we're closing various different care gaps that are happening. LA Care said, "We gave you these 8, 9s, and 10s on the LACE index. We didn't give you these 8, 9s, and 10s. The cohort we gave you ended up in the hospital 62% fewer times than the cohort we didn't give you." It took some time to get that data. Now we have this great case study, and we have others, but now we have this great case study that says, "Look, the work we're doing is helping the patients. If we're helping the patients and we can't keep them out of the hospital, obviously they're much better off as mothers, fathers, and children for their loved ones. It is much better for the system. It is better for the payer. It is better for Uncle Sam. It is better for overall the system. That is the way we see it. By the way, the cohort we have is we're going to get a much bigger cohort because it's working. We are going to, again, invest into that. That is kind of the evolution of the company that you see happening right now. That's great. That's pretty cool. Patient service. You and I have talked about this before, but my simplistic example is Medicare Advantage. Star scores are always important, but ever more important now, getting harder and harder to achieve those four and four and a half stars. I envision that you can play a part in that to keep those star scores up with an MA contract. How else do you view patient service and sort of adding value, not just on the cost side, but on the quality side and promoter side and all of that? How does DocGo kind of fit into that continuum? Yeah. I mean, first off, we have something inherently going for us, which is patients want to be at home. In any industry, it's insane to think that the healthcare industry is last to the party on this. Any industry, if you meet your customer where they are, they're happy about that. You make them come to you in an inconvenient way, they're not going to be happy about it. Frankly, just right off the bat, it's not like some genius idea that we're coming up with. If you meet your customer, in our case, the patient, if you meet them where they are, they're just inherently happy. They prefer to do that. I'll give a personal story in a second. That's going for us right out the gate. When we go to the home, the patient obviously, very oftentimes, why are they not going to see the clinician? They have childcare issues. They have mobility issues. They have behavioral healthcare issues. Very often, one of the very higher incidents of comorbidity that we see is depression in our patients. Just by going to meet the patients where they are and being able to provide them with the care. We do it in a very innovative way, right? Our vehicle starts with the branding of everything. Our clinicians are well trained. They're very friendly. Our patients, 1.5 million patients did not meet me last year, and they did not see my smile. They saw the smiles and the compassion of our heroes in our company. I'm not the hero in the company. The hero in the company are the 5,000 clinicians that are going into the patient's home. They're well trained. They have a smile on their face. They're able to solve the care gap in real time, oftentimes more frequently. We have this whole experience where when a clinician goes into the home, they don't drape mud into your home. When someone comes to your home, that's a big responsibility. Big responsibility. We responsibility. We make sure we put booties on our shoes. The clinician has a whole suite of diagnostics that are available to them in their bag. They're enabled with technology that allows them to solve the patient need. I'll give two great examples. Right now, one of the care gaps that we do is a bone density scan. Now, oftentimes, how would a bone density scan get done? They're driving the patient into the clinic to provide the bone density scan. They take the bone density scan in the doctor's office, and they get the reading. That's great. It actually works tremendously. For us, it's a little different. We go into the home. We do the same bone density scan. We get the reading. At the same time, we're able to see that this patient, their home environment is actually unsafe for somebody that has osteoporosis. Loose carpeting. They have to go up and down the stairs. Now we're able to provide them more wraparound services. We're able to code. We're able to document and code things in a way that's much deeper and insightful than just if somebody came to the doctor's office. Patients love that because we're trying to address all their social determinants of health while we're in the home. Fundamentally, that's just a much, much better experience for the patient. That's why they love it. You know, on care gaps, you talk about it quite a bit. One thing I would think about is, I think 60? Is that it? Sixty care gaps you can close? Thirty-five today. Okay. Sorry. I don't know where 60 came from. It's going to take some investment, by the way, to get to 60. I'm not saying we're not going to do it, but yeah. Anyways, when I think of adding, and I think you mentioned to us recently, I think you bought a phlebotomy company to sort of add some, maybe add one more to that list. How do you think about, is it a step function? Have you sort of, I'll say, cleared out the easy ones? To To get the next 5, 10, whatever the number is, you got to make a big investment to get there, or you have to buy some more technology or buy a platform or just how do we think about growing those care gaps in terms of what the sort of investment profile looks like? Yeah. I think have we cleared out the easy ones? I think the right way to think about it is we've put together a model. We have our own physicians' practice. There are a lot of companies going and doing care gap closures that are doing essentially like what the company we just acquired, the mobile phlebotomy company. They can go in, and they can do a set number of care gaps where you don't need a physician's practice or an advanced provider overseeing that visit. I would say those aren't easy ones to do. To the ones that require physician oversight and diagnosis, that is what sets us apart in a big way. Because we have our own physicians' practice licensed in all 48 states. That piece is set up for us already. A mobile phlebotomist can go into the home and use the diabetic retinal scanner and get a reading. You still need an ophthalmologist or a clinician to read that reading and diagnose that reading. That is where we come in. A mobile phlebotomist cannot go into the home and do an annual wellness visit, your typical annual wellness visit, or deliver a vaccination or do some of the intervention or care gaps that are required by a physician or physician oversight to do. We have added those as well. We are able to run the gamut. When we do not need an annual wellness visit or vaccination, now we are going to be able to send the mobile phlebotomist to get that scan for us. We can do so more inexpensively. We can do so with much more expansion happening. When we do need the physician oversight, we're going to send the full version of our service offering. Now you start to see us optimize the margins more as we go through, send the right clinician with the right licensure for the right patient need. We did that on the medical transportation side. Now we're doing that on the mobile healthcare side with this acquisition of our mobile lab collection company as well. Got it. Few seconds left. I'll ask you the same question I've asked everybody. What are you most proud of your time at DocGo? I think I hope everyone's answering the same answer. For me, really, it's the patient promoter score and the impact on the patient lives that we're having. Not a week goes by that we don't find a patient who's at risk for vision impairment or blindness. Not a day goes by where we don't find a patient that has open care gaps. If we don't address it, they're going to get much sicker. They're going to end up in the hospital. For every patient that we're able to divert from the hospital, I'm most proud of that. Really, anybody leading a healthcare company, that should be their answer. Maybe I'd be curious if we can get a beer after and see what other people are saying. To me, that's what I'm most proud of. I think we're only getting started. For me to be able to brag, it's not even a humble brag. It's a brag. 1.5 million patient interactions last year, and we're just getting started. To see the breadth of services that we're offering, to see the demand for the product, it will take time to grow it out. We're transitioning from some of the more legacy contracts into the new frontier for the company. It will take time and investment. I'm very, very excited about being able to do that and expand into this in the rest of the year and the years to come. That's great. We'll have to leave it there. Lee, thank you so much. Thanks, everybody. Appreciate it. Thank you. Thank you. Thank you so much.