Welcome to the Quest Diagnostics Q2 2023 Conference Call. At the request of the company, this call is being recorded. The entire contents of the call, including the presentation and question-and-answer session that will follow, are the copyrighted property of Quest Diagnostics, with all rights reserved. Any redistribution, retransmission, or rebroadcast of this call in any form without the written consent of Quest Diagnostics is strictly prohibited. Now, I'd like to introduce Shawn Bevec, Vice President of Investor Relations for Quest Diagnostics. Go ahead, please. Thank you. Good morning. I'm joined by Jim Davis, our Chairman, Chief Executive Officer, and President, and Sam Samad, our Chief Financial Officer. During this call, we may make forward-looking statements. We'll discuss non-GAAP measures. We provide a reconciliation of non-GAAP measures to comparable GAAP measures in the tables to our earnings press release. Actual results may differ materially from those projected. Risks and uncertainties that may affect Quest Diagnostics' future results include, but are not limited to, those described in our most recent Annual Report on Form 10-K, and subsequently filed Quarterly Reports on Form 10-Q, and Current Reports on Form 8-K. For this call, references to reported EPS refer to reported diluted EPS, and references to adjusted EPS refer to adjusted diluted EPS. Any references to base business, testing, revenues, or volumes refer to the performance of our business, excluding COVID-19 testing. Growth rates associated with our long-term outlook projections, including total revenue growth, revenue growth from acquisitions, organic revenue growth, and adjusted earnings growth, are compound annual growth rates. Finally, revenue growth rates from acquisitions will be measured against our base business. Now, here is Jim Davis. Thanks, Shawn, and good morning, everyone. We had strong base business performance in the Q2 with nearly double-digit revenue growth year-over-year. Demand for our services remains strong across all regions, boosted by the collaborations we have formed with health plans, hospitals, and physicians amid an environment where people are returning to care. We are particularly encouraged by the revenue growth in our base business of nearly 10% from our health system customers. In the Q2, we made substantial progress improving the profitability of our base business compared to the Q1 and prior year, despite persistently high employee turnover. Total adjusted operating margin improved more than 170 basis points compared to the Q1, despite a decline of approximately $80 million in COVID-19 revenue. This morning, I'll discuss highlights from the Q2, then Sam will provide more detail on our financial results and talk about our updated financial guidance for 2023. Let's turn to some of the highlights from the quarter. As we shared at Investor Day, our strategy is to drive growth by continuing to meet the evolving needs of our core customers, physicians, hospitals, and consumers, as they navigate the changing landscape in healthcare. We will enable this growth with an intense focus on faster-growing clinical areas, including molecular genomics and oncology. In addition, acquisitions will continue to be key drivers of our growth. Finally, our strategy includes driving operational improvements across the business with strategic deployment of automation and AI to improve quality, efficiency, and service. Let's review progress we've made in each one of these areas. In physician lab services, we delivered strong base volume growth from physicians, largely through our partnerships with health plans, which have expanded our access to the market. A growing number of these involve value-based arrangements and are generating faster growth and share gains than the traditional relationships. These arrangements position us as a more strategic partner with health plans as we work together on leakage, shared savings, and redirection programs. NewYork-Presbyterian's recently acquired outreach assets brought us new volume from the physicians. In hospital lab services, base revenue from health systems grew nearly 10% in the quarter. The professional lab services business had a very strong quarter as we saw solid growth from both new and existing PLS relationships. We are particularly encouraged by progress with our new PLS partnerships with Northern Light Health, Lee Health, and Tower Health. As hospitals continue to experience financial challenges, we are here to help, whether through professional lab services, reference testing, or purchasing the hospital's outreach assets. We are now seeing growing momentum with a significant pipeline of potential deals with large health systems. In consumer health, we had strong base business growth on QuestHealth.com. We continue to optimize our marketing efforts to target our customers more strategically and now expect consumer-initiated testing to be profitable through the balance of 2023. Also, during the quarter, we launched Genetic Insights, our first consumer-initiated genetics health test on questhealth.com. This saliva-based test leverages our expertise in next-generation sequencing to analyze three dozen genes for inherited risk of conditions ranging from breast and colon cancer to carrier status for Cystic Fibrosis and Tay-Sachs Disease. We are encouraged by initial demand for this new offering, which adds to our growing test options for health-minded consumers. As discussed at Investor Day in March, a key pillar of our strategy is to support faster growth across all customer segments through highly specialized advanced diagnostics. These offerings include molecular genomics and oncology tests, such as germline testing to assess prenatal and hereditary genetic risk, and somatic testing for tumor sequencing. Advanced diagnostics also encompasses other key areas, including neurology, women's reproductive health, and cardiometabolic health. In neurology, we continue to achieve strong growth from our innovative Quest AD-Detect portfolio of Alzheimer's blood tests, which help identify early indications of beta-amyloid and APOE status. AD-Detect strongly positions Quest Diagnostics to lead in this rapidly evolving Alzheimer's testing landscape. Emerging therapies for Alzheimer's Disease represent a new era in treatment and testing for this disease. Like many diseases, early intervention in Alzheimer's may promote better outcomes. Our AD Detect portfolio enables accessible and convenient evaluation of Alzheimer's Disease risk, potentially at early- stages and the monitoring of progression. AD Detect is now available to our physician customers in the U.S., and we believe it also has the potential to generate strong consumer demand. In addition, we continue to see strong growth in our cardiometabolic, endocrinology, infectious disease, and carrier and prenatal genetic screening services. In June, we completed our acquisition of Haystack Oncology, which positions us to enter the high-growth area of minimal residual disease, or MRD testing. Haystack has developed a highly sensitive technique for early detection of residual or recurring cancer, with the potential to improve outcomes for patients being treated for cancer. The integration of Haystack is on track, and we continue to expect to introduce our first MRD test in early 2024. We intend to launch this test from our Oncology Center of Excellence in Lewisville, Texas, where we also recently introduced our Solid Tumor Expanded Panel for tumor sequencing and therapy monitoring. I'd like to say a little more about our M&A strategy. Haystack is a capabilities acquisition, and as we've said, it will initially be dilutive to earnings per share. However, our primary focus in M&A continues to be on traditional hospital outreach purchases and tuck-in lab deals that are accretive to earnings in the first year. To underscore what I said earlier, our M&A pipeline is robust as hospital systems face continued margin pressures due to labor challenges and a shift from inpatient to outpatient care. Turning to operational and productivity improvement, our Invigorate program is well on its way to delivering our 3% annual productivity savings target. As we discussed at Investor Day, Invigorate includes deploying automation and AI to improve quality, efficiency, and service. In the quarter, we implemented our automated microbiology solution in Lenexa, Kansas. Next up is Lewisville, Texas. When complete, four of our major laboratories will use automated microbiology lines with embedded artificial intelligence, identifying positive and negative cases, leading to improved quality and productivity. We are also excited by results of a pilot in our Clifton lab that showed AI speeds data collection and specimen processing, and expect to implement this AI solution across all of our major regional labs later this year. In genomics, we're utilizing AI in bioinformatics to improve and speed variant classification and prioritization. These are just a couple of the many examples of our use of AI and automation to continuously improve our operations. We believe generative AI has great potential to deliver insights and content, not only to better target and serve customers, but also to create innovations that help standardize our lab operations. We are encouraged by preliminary results of pilots that use generative AI in our customer service center to automate caller sentiment analysis and quality control, and in our marketing operations to improve market research and customer targeting. Before I turn it over to Sam, I'll close by saying that we always knew 2023 would be a challenging year as we transitioned away from COVID-19 testing and supported the nation's return to care. Our dedicated employees on the front lines and everyone else who supports them have done a magnificent job of bringing our purpose to life, working together to create a healthier world, one life at a time. I'm really proud to be leading this Quest Diagnostics team. Now I'll turn it over to Sam to provide more details on our performance and our updated 2023 guidance. Sam? Thanks, Jim. In the Q2, consolidated revenues were $2.34 billion, down 4.7% versus the prior year. Base business revenues grew 9.5% to $2.3 billion, while COVID-19 testing revenues declined approximately 88% to $41 million. Revenues for Diagnostic Information Services declined 4.9% compared to the prior year, reflecting lower revenue from COVID-19 testing versus the Q2 2022, partially offset by strong growth in our base business. Total volume, measured by the number of requisitions, grew 0.2% versus the prior year, with acquisitions contributing 50 basis points to total volume. Total base testing volumes grew 7.4% versus the prior year, as we continued to see a broad-based return to care throughout the quarter. Revenue per requisition declined 4.9% versus the prior year, driven by lower COVID-19 molecular volume. Base business revenue per req was up 2.5% due to more tests per req, changes in test mix, and benefits recognized with certain value-based arrangements. Unit price reimbursement was flat in the quarter, consistent with our expectations. Reported operating income in the Q2 was $348 million, or 14.9% of revenues, compared to $388 million, or 15.8% of revenues last year. On an adjusted basis, operating income was $389 million, or 16.7% of revenues, compared to $435 million, or 17.7% of revenues last year. The year-over-year decline in adjusted operating income is related primarily to lower COVID-19 testing revenues, partially offset by growth in the base business. Compared to the Q1, we made strong progress improving the profitability of the business. Adjusted operating margin expanded 170 basis points sequentially, while total revenues were essentially flat versus Q1. We also absorbed higher SG&A costs related to an increase in the market value of the obligations in our supplemental deferred comp plan in the Q2, which lowered adjusted operating margin by 30 basis points. This has no impact on EPS. We continue to closely manage the costs of our corporate and support functions. Since last fall, we have taken a series of actions to reduce support costs, which will save more than $100 million this year. Those savings largely began in Q2 and were on track with our estimates in the quarter. Frontline employee turnover improved marginally earlier this year, but the pace of improvement has not met our expectations, and it remains well above historical levels. We continue to feel the effects of the tight labor market, which has had an impact on productivity and wages. Turnover continues to be a drag on productivity despite the strong base business growth. Reported EPS was $2.05 in the quarter, compared to $1.96 a year ago. Adjusted EPS was $2.30, compared to $2.36 last year. Cash from operations year-to-date was $538 million versus $882 million in the prior year period. The decline in operating cash flow was primarily related to lower operating income. Turning to our updated full- year 2023 guidance. Revenues are now expected to be between $9.12 billion and $9.22 billion. Base business revenues are expected to be between $8.92 billion and $9.02 billion. COVID-19 testing revenues are expected to be approximately $200 million. Reported EPS is expected to be in a range of $7.52 to $7.92, and adjusted EPS to be in a range of $8.50 to $8.90. Cash from operations is expected to be at least $1.3 billion, and capital expenditures are expected to be approximately $400 million. Here are some things to consider for the remainder of the year. We've raised our base business revenue guidance to reflect our strong performance through the H1 and our expectations for the remainder of the year. Note that the year-over-year comparison for the base business becomes more difficult in the H2 2023, as we begin to lap some PLS wins later in the year. Also, we are not expecting demand for respiratory panels to be as strong as we saw in last year's influenza season, which could be a headwind to revenue of nearly 100 basis points in the H2. We expect revenue and adjusted EPS to be more even in the Q3 and Q4, which is a slight departure from our typical earnings seasonality due to the following factors: Unit price reimbursement is expected to improve in the H2. Our CIT business turned profitable in Q2 and is expected to be more accretive to both revenue and earnings as we move throughout the H2 2023. Cost actions taken throughout the H1 of the year will continue to improve the overall profitability of the business. Finally, as I noted earlier, we continue to experience higher frontline turnover and a tight labor market, which has had an impact on productivity and wages. Higher SG&A costs related to our supplemental deferred comp plan also lowered operating margin by 30 basis points in the H1 2023, but had no impact on EPS. As a result, our updated guidance reflects an adjusted operating margin of approximately 16.5% for the full year. With that, I will now turn it back to Jim. Thanks, Sam. To summarize, we had strong base business performance in the Q2, with nearly double-digit revenue growth as our collaborations with health plans, hospitals, and physicians enabled us to benefit from strong demand amid a broad return to care. We made substantial progress improving the profitability of our base business compared to the Q1 and prior year. This was slightly offset by persistently high employee turnover, which weighs on productivity and increases cost. Finally, our updated guidance reflects our expectations for revenue growth and improved profitability in the base business. Now we'd be happy to take your questions. Operator? Thank you. We will now open it up to questions. At the request of the company, we ask that you please limit yourself to one question. If you have additional questions, we ask that you please fall back into the queue. To be placed in the queue, please press star one from your phone. To withdraw, press star two. Again, to ask a question, please press star one. Our first question comes from Jack Meehan with Nephron Research. You may go ahead. Thank you. Good morning. Good morning. Good morning. I wanted to start and ask about kind of the health plan commentary. Is it possible to tease out how much of this growth could be share gain related versus just strong underlying demand? Somewhat related, we have heard more discussion about national payers being more active around payment integrity. I was just curious if you're seeing that at all. Could that be a positive or negative for Quest? Hey, thanks, Jack. You know, it's always hard to discern in this industry what is share gain versus demand, you know, return to care and things like that. We don't get perfect data on it, but our sense is it's some of both. On the share gain side, you know, we look closely at our growth through each of the commercial payers, when we see gains that are above and beyond, you know, the average, we see the benefits of those programs, those value-based programs that we work with them, which is around leakage, it's around focusing on physicians that are using out-of-network labs. We see the benefits of those programs and therefore conclude it's share gain. Certainly, there's been some strong return to care. On the payment integrity side, I can tell you that look, it's a never-ending effort here in Quest Diagnostics to continuously work denials, to make sure that we understand the payer policies, what are the diagnostic codes that support those policies, and then work back through our physician base to make sure that the tests that they're ordering are appropriate tests. We haven't seen any discernible impact with some of those policies you're referring to. We work collaboratively with the payers to understand them and then work back with our physician base to try to correct any errors. Super. Sam, one question on margins. Sorry if I missed this. What does the guide now assume for margins for the year? Can you just talk about what you're assuming in terms of the pace of productivity improvement? Thanks, Jack. We are assuming for the year operating margins to be at approximately 16.5%. You know, in terms of productivity, we've seen good benefits from our Invigorate program, and we expect those to, if anything, continue for the rest of the year and even accelerate in Q3 and Q4. We are seeing good momentum on our Invigorate programs. We're seeing, you know, the $100 million of SG&A savings that we've talked about. We're seeing those materialize as of the beginning of Q2, and they will continue for the rest of the year as well, for a total year impact of $100 million. On the other side, we are also seeing, as you heard in the prepared remarks, you know, a tough labor, and turnover and, you know, macro environment. you know, turnover continues to persist to be higher than we expected, and that's, you know, that's driving pressure also on margins. We are expecting approximately 16.5% for the year in terms of OM. Yeah, Jack, I would just add, obviously, you can see the margin improvement from Q1 to Q2. That comes through pretty clear. You can do the math on the base margin improvements from Q2 of last year to Q2 of this year. When you make the assumptions on the dropdown of the COVID revenue, which, you know, you're in the range with the numbers you've used in the past. We're really pleased with the base margin improvement from Q2 of last year to Q2 of this year, and very pleased with the improvement from Q1 of this year to Q2 of this year. Thank you. Our next question is from Elizabeth Anderson with Evercore ISI. You may go ahead. Hi, guys. Good morning, and congrats on a good quarter. My question is, I realized there was a ton of noise this quarter on the deferred comp and how that nets out. Could, one, like, what is your assumption in terms of what's embedded in your guidance for the back half of the year? I appreciate that it can be different based on what happens to the future stock price, but I just want to understand whether you're just sort of continuing the forecast of last year's trajectory into this year or 2Q going forward or what have you. Secondarily, how do you think about, you mentioned the labor productivity and sort of you know, still elevated turnover. How do you think about sort of the cost-benefit of analysis of perhaps, like, investing more in wages or something like that versus the productivity, gains that you would, you could potentially receive from that? Thank you. Okay. Thanks, Liz, and appreciate the congrats. Let me talk about DCP, Deferred Compensation Plan, and I'll turn to Jim for productivity and some of the trade-offs that you're referring to there. In terms of DCP, let me just clarify, you know, what it is and the impact. First of all, the expense that we saw, which impacts SG&A, is the related to the increase in the market value of obligations in our supplemental deferred comp plan. That does not have an impact on EPS because it is offset on the non-operating income line with a benefit. It's a net neutral on EPS, but it does impact operating margin. You know, sometimes we don't see it materially impact us. It's related to market movements. This quarter, it impacted us materially to the tune of 30 basis points impact on operating margin%. If you exclude that, it would be our operating margin percent would have been 17%. If you compare it to last year, because last year, and this is where it gets maybe a bit more complicated, but last year we actually had a benefit in terms of expenses on related to deferred compensation plan market value, you know, the fair market value change. Compared to last year, Q2, it's an impact of 1%. Actually, if you compare Q2 2023 OM versus Q2 2022 OM, we would have been relatively flat in terms of operating margin percent quarter-over-quarter last year, even despite, you know, the drop in COVID-19 revenues, the significant drop to the tune of approximately $300 million that we saw year-over-year in terms of COVID-19 revenues. As you look towards the rest of the year, Liz, we don't forecast deferred compensation plan. I mean, that's not something that we forecast. We assume it's a net neutral impact, both on the P&L, on EPS, and on operating margin. You know, the impact that we saw in the H1, which is roughly about 50 basis points of operating margin, or 30 basis points, I should say, is, you know, carried through for the rest of the year. You know, that 16.5% full- year operating margin is impacted by the DCP in the H1. That's the best way I can characterize it. Yeah, Liz, on the labor front, you know, at Investor Day, we showed a chart that said pre-COVID-19, our turnover of what we call our frontline roles, which is phlebotomy, logistics, specimen processing, our call centers, was in the 14% range, our total turnover. We showed a chart that said in the Q4, it was upwards of 23%. It's come down modestly in the first part of the year, but still, hasn't come down to the levels obviously, of pre-COVID-19 or to where we would like them. You're right, it's a trade-off between increasing wage rates and the price and the cost you pay for this turnover. You know, we've estimated that each turnover, each person, you know, can cost us upwards of $8,000 to $10,000, depending on the role. That's simply the lost productivity or the time it takes to get somebody from day one to as efficient in that role as a person who's been in the role for two years. It's about $8,000 to $10,000, which, if you do the math on that, you know, could have a upwards of a $20 million impact in the H2 of this year. We're at the high end of our wage rate guidance that we gave. We said 3% to 4%. We're certainly at that high end. You know, if we need to make adjustments, we obviously look at the ROI on that. And, you know, we're faced with those decisions, and in certain markets, we will make adjustments to get the turnover, you know, to a place that we're comfortable with. Got it. Thanks so much. Yep. Thank you. Our next question is from A.J. Rice with Credit Suisse. You may go ahead. Thanks. Hi, everybody. Maybe just to pivot over and ask you about your health system business. I think last quarter you said in aggregate it was growing about 7%, and this quarter, the press release says it's just under 10%. I suspect with NewYork-Presbyterian and so forth coming online fully the back half, it might be even higher than 10. When you think about your margin targets and what you're shooting for, can you comment on how the growth in that side of the business is impacting margins and the opportunity? If there's any updated thoughts on the pipeline that you're seeing, maybe give us that as well. Yeah. Thanks, AJ. Just on the NewYork-Presbyterian book of business, when we buy that outreach book of business, it actually is in our physician bucket, not our health system bucket, because it's physician offices and, you know, we bill third-party payers for that. Our health system business in the quarter was really helped by the PLS side. Our reference book of business was strong as well, but our PLS growth was very, very strong, cited by the three deals that we mentioned in the script, with Tower Health, Lee Health, and Northern Light, being some of the newer ones. It was, you know, that generated substantially more growth in the quarter. As we've always said, PLS has slightly lower operating margins than our normal physician office book of business, but we really like the ROIC on that, okay? It's got a strong return on capital, and that's why we continue to do this. In terms of, you know, the outlook, our funnel of opportunities is strong. We hope to have more closed in the H2 of this year on both the PLS side as well as new reference wins. We're optimistic that the health systems portion of our business will continue to grow. Yeah, and one additional comment, AJ. With regards to the expectations in the H2 on PLS, you know, as Jim said, we are seeing strong growth in that business. In the H2, you know, from a year-over-year perspective, you know, we had some big wins in the H1 of last year as well, that ramped up in the H2 of last year. From a year-over-year perspective, we do lap some of those PLS wins, and that mutes our revenue growth to some extent. You know, we're seeing really great momentum on the PLS side of the business. Okay, thanks a lot. Thank you. Our next question is from Patrick Donnelly with Citi. You may go ahead. Sam, again, you know, that 16.5%, is that now the right number to work off in terms of the long-term guide? I know you talked about, you know, a few of the moving parts, the unit pricing, maybe looking a little better, labor hitting it. Any of these things one time that would wear off? On that pricing, and I know you guys negotiate kind of a quarter of the contracts annually, can you just talk about, you know, the pricing environment at the moment? Yeah, no, it's 16.5% would be the launching point if you're thinking about the three-year outlook, Patrick, and the improvement that we guided in the Investor Day, which is, you know, the 75 basis points to 150 basis point improvement. That's still the right number to, you know, be thinking about longer term off of the 16.5% launching point at the end of this year. In terms of, you know, a couple of things that you mentioned, you know, one-time items, I think we talked about the DCP, which was more significant in Q2, and for the H1 of the year, you know, maybe you can call that one-time, but although it is recurring, but, you know, we don't forecast for it. Sometimes it's a benefit, sometimes it's a negative in terms of on operating margin%. You know, last year in the H1, it was actually a benefit. This year in the H1, it's a negative. Pricing environment is very good. It's really good. We're seeing, you know, good momentum with the health plan, value-based contract arrangements that we have. We expect the pricing environment actually in the H2, or the pricing benefit in the H2 to improve versus the H1. Now, you know, as we think about 2024, we've talked about before that PAMA is still an uncertainty. You know, until we have more certainty around whether there's another PAMA delay or a SALSA Act that gets passed, you know, there's still some uncertainty there for 2024. Operator, next question. Thank you. The next question is from Brian Tanquilut with Jefferies. You may go ahead. Hey, good morning, guys, congrats on the quarter. Hey, Sam, maybe I'll follow up just on Patrick's question, right? As I think about your previous comments on 2024 guidance, or targets for operating margin, does this push out what you had previously kind of guided to for 2024? Maybe kind of related to that, as I think about the $100 million of corporate savings that you've outlined at the beginning in Q2, I mean, is there more to squeeze, or is this sort of the target run rate and, you know, we're just going to see it flow through the P&L into next year as well? Thanks. Thank you, Brian, first of all, for the question. With regards to 2024, you know, we didn't guide 2024. We, we gave some long-term targets around what we expect our operating margin to look like over the next three years as we continue to execute on productivity improvements, Invigorate, and apply cost savings into the business, the $100 million that you referred to, which, by the way, next year will be part of our run rate. You wouldn't expect to see an improvement year-over-year in 2024 versus 2023, because except for maybe Q1. You know, I would say the 16.5%, as I mentioned to Patrick, becomes the launching point for the future. We do expect with continued Invigorate offsetting inflation with, you know, the cost reductions in the business that we've applied and now will continue, and that are generating the, you know, the expected improvements. We do expect to drive improvement in our operating margins long term. There is the uncertainty about PAMA, which is what drives the range of either 75 basis points to 150 basis points improvement over the three years. Yeah, and then in terms of the cost takeout, the $100 million, look, we're always looking to be the most efficient we can and obviously spend every dollar as wisely as we can. We're also gonna continue to invest in this business. We've made strong investments in CIT, and I think as you heard in our script, it's paying off for us. We got really nice growth out of that. It's now turned profitable. The Alzheimer's Disease test that we've brought to market, that requires investment, and we're gonna continue to invest in that space. We're gonna continue to invest in molecular, genomics and oncology because we're getting growth in that space, and with the Haystack Oncology acquisition, we're gonna continue to invest there to try to get that test to market as quickly as possible and build a stronger presence. We're always gonna balance the two, but we're investing in this business for the future. Thank you. The next question is from Pito Chickering with Deutsche Bank. You may go ahead. Hey, good morning, and thanks for taking my question. There's been a big debate among both the corporates and investors on the sustainability of the current trends of, you know, the utilization. Can you sort of talk about what you're seeing in July? Sorry if I missed this, but how much of the Q2 organic growth was sort of organic versus the PLS transactions, and how should we think about organic growth continuing in the H2 of the year? Yeah. We're optimistic that the growth will continue here in the H2 of the year. July to date has been strong, consistent with what we saw in June. We generally don't break apart our PLS growth from the growth in our core business. We've said externally that our PLS business is about a $600 million franchise. We said the health system market grew at 10%. PLS grew north of that, reference grew less than that. I think you can get a sense for what that contributes to our total growth. But we're optimistic on the prospects with our health systems. The funnel of PLS opportunities remains strong. Health systems, need our help, and we think we've got a great offering that helps meet their needs. Peter, maybe I can give a couple additional comments on sort of H2 versus H1, which is, I think, where you're driving at here. Listen, we've had a great H1, you know, close to 10% revenue growth. As you think about the H2, there are a couple of things to keep in mind. First of all, we had, you know, some easier compare in the H1 versus 2022. Obviously, we were in the midst of COVID-19, base business was, you know, impacted by that. There was some easier compare in the H1 that we don't expect to repeat in the H2. On the prepared remarks, we talked about the COVID-19 influenza panel, which, you know, is about a 1% negative impact on growth in the H2, you know, definitely compared to the H1. We talked about lapping some PLS wins, which also has a muting effect on our growth in the H2. When you factor all of these combined, obviously, you can look at our implied growth in the H2 based on guidance, and it's well lower than the H1, and it's driven by some of these factors that I just gave you. In terms of July, you know, we are still seeing higher than, you know, our traditional utilization, so we're still encouraged by what we're seeing in terms of utilization in July. You know, we're being appropriately conservative in the H2, you know, in terms of, what the, what the utilization will look like. Great. Thanks so much. Thank you. The next question is from Andrea Alfonso with UBS. You may go ahead. Thanks. It's Kevin Caliendo. I guess if I can just bridge all this, if we just go back to the starting point with 17% to 16.8% following the acquisition of Haystack Oncology. Now it's 16.5%, we had this sort of one-time issue in the quarter with DCP, which took that down. You're also calling out some labor trend issues. Maybe, is the delta, the expectation around the labor costs and churn? Like, is there a way to quantify that, should we expect that to continue going forward? I'm just trying to bridge all of these things think about the impact of 2024 and how we get this sort of margin expansion that was originally expected for 2024 with these sort of headwinds that are playing out. Yeah, Kevin, let me take the labor piece, and then I'll turn it over to Sam here. On a previous question, we talked about pre-COVID-19, our attrition rate of our frontline positions was in the 14% range. In December, Q4 was 23%. It's a chart we showed in Investor Day in March. It's slightly better than that. We have quantified it. We've said it's about $8,000 to $10,000 per employee, and in the H2 of the year, we think it can be, you know, upwards of a $20 million impact versus where we would want it to be at this point in the year. Now, is the labor markets easing? You know, unemployment rate sits at 3.6% right now. The Federal Reserve has signaled that they're trying to actually get the unemployment rate back upwards of 4.1% to 4.5%. The interest rates are gonna take a notch up again today. We think there's going to be easing in the markets going forward, but it's hard to predict. Right now, I think we're being appropriately conservative on the guidance in the H2. Kevin, let me give you some commentary around H2 versus H1 margins, you know, and why you should have confidence in the margin outlook that we gave, the approximately 16.5% for the year. First of all, just to remind everybody, in Q2, our margins expanded by 170 basis points sequentially, despite an $80 million drop in COVID-19, roughly $80 million drop in COVID-19. We had some great momentum in terms of operating margin. As we look towards H2 versus H1, here are some of the dynamics that you should factor. Our CIT business, you know, which was net dilutive on operating margins in the H1, becomes accretive in the H2. We expect to see that business as we're very encouraged by the momentum, it's actually become profitable in Q2, and it's going to be accretive for the H2 of the year. Pricing is a net, also net accretive and will continue to improve in the H2, and it's definitely a step up from the H1. You know, SG&A, we started to achieve those $100 million annualized savings in Q2, and so we expect to achieve, you know, the remainder in Q3 and Q4. We didn't have that benefit in Q1 of this year. You know, we talked about DCP, and I don't want to focus too much on that, but it was a headwind in the H1, which we don't expect in the H2. You know, offsetting that is the fact that we have some lower COVID-19 revenues in the H2, because right now, per our guidance, we're expecting approximately $40 million in the H2, which is definitely well south of the $160 million that we achieved in the first. As you look at this momentum of all of these things, plus the ramp-up of Invigorate improvements that we expect to see in the H2, and yes, there is some Haystack Oncology dilution, which is to the tune of about $0.15 to $0.20 for the year. Right. As you look at all of these factors, we're very confident about the ability to achieve the outlook that we gave in terms of operating margins. Kevin, the last thing I'd add is, when you think about price in this business, we tend to always think about commercial payers and Medicare and Medicaid. You have to remember that there's another $2.5 billion on an annual basis, where we price directly to health systems, to physicians, and then we have it, you know, $800 million worth of other businesses between Employer Solutions, our Drug Testing Services, our Wellness Programs, and our ExamOne which serves life insurance companies. We are getting price in those segments of our business, and as Sam indicated, you know, our price performance will be better in the H2 than it was in the H1, primarily from the lift we're getting, and that's on that side of our portfolio. Super helpful, guys. Thank you so much. You're welcome. Thank you. Our next question is from Lisa Gill with JP Morgan. You may go ahead. Great. Thanks very much. Good morning. I just want to go back to your earlier comments around value-based care, where you talked about leakage out-of-network opportunities. Can you maybe just talk about how you see this over time, and how you see the evolution of value-based care as it pertains to labs? Is this a margin-enhancing opportunity or just more of a volume opportunity? One, you know, how do I think about that? Two, secondly, you know, I've heard you talk about the pipeline of health systems. Is there any way to size what that current pipeline looks like? Yeah. On the first question, I just wanna make sure we're not confusing terminology here, value-based care and value-based incentives. When we talk about value-based care, these are generally arrangements where Medicare has put lives directly into these ACO REACH programs, or Medicare Advantage plans, delegate lives into large integrated physician groups. In both of those situations, we are contracting directly with these ACO REACH organizations and directly with these large physician groups. We believe that those value-based care programs that Medicare and Medicare Advantage are driving are very good for the lab business, because generally, they delegate lives at a fixed price, and in fact, labs become much more useful in terms of helping physicians ensure that diseases and conditions do not progress. We feel good about that. I think what we're generally when we talk about the health plans, and we talk about these things called value-based incentives. These are programs that we structure with the health plans to help them reduce leakage to out-of-network labs and to help us redirect requisitions that are flowing into more expensive health system laboratories and have those requisitions flow directly into Quest Diagnostics. When we are successful in those efforts, there can be value-based incentives that we earn when we help them earn when we achieve those targets of reducing leakage and moving work from higher-priced hospital labs into independent labs like Quest Diagnostics. We seek to do more of both of those programs, value-based care programs with ACO REACH, and these value-based incentive programs with our large payers. Thank you. Operator? Yep. Our last question is from Eric Coldwell with Baird. You may go ahead. Thanks. Good morning. I have two, first one, a bit higher level, more strategic. UnitedHealthcare Preferred Laboratory Network was updated in July. I saw that they removed Mayo Clinic Laboratories. Were there any other notable changes in that contract or your relationship there? Broadly on that same topic, what's the outlook for other MCO opportunities to narrow networks or move the national labs like you and Labcorp into, say, more preferred roles? Are there opportunities being discussed in the market today? Yeah. On the first part of your question, We did not note any other notable changes with respect to the Preferred Laboratory Network. We still remain part of that Preferred Plan Network, and that's our plan going forward. In terms of narrowing networks, you know, when we speak to all our commercial payers, we always think it's better from their perspective to have both independent labs in network. That actually improves their ability to make sure that requisitions are going to lower cost, lower price environments, which is good for the payer, it's good for the employer, and it's good for the patient. We don't see any change in that trend to narrow networks that restrict access to independent laboratories. Having said that, there's laboratories that play on the fringe that could be expensive, single type test environments, and, you know, I think payers are always looking at specialty labs versus independent labs that can do some of that specialty work as well. Okay. My other question, I apologize if... I think you got close to answering this a few times, and I've been toggling a couple of events this morning. Did you quantify or could you quantify the reduction in investment spending seen year-over-year in the Q2, and also the portion of the incremental $100 million plus cost action that you actually captured in Q2, so we have a sense on what's left for the rest of the year? Yeah, sure, Eric. No, we didn't quantify the reduction in investment spend. We did have lower investment spend in Q2 versus Q2 of last year, but we haven't quantified how much it is. With regards to the SG&A benefits and the $100 million, you know, I think the assumption that you can make is it's about- ... and a one third of that $100 million that was realized in Q2. We expect the same to occur in Q3 and Q4. Okay. Yeah. I just wanna remind everybody that, you know, we're gonna continue to invest for growth in this business. As we mentioned again in the script, we've invested in CIT, we're really starting to see the fruits of that investment. We look at a metric called return on ad spend. It's now positive, we're gonna continue to invest there because we believe it's driving growth, it's now driving profitable growth. We talked about our Alzheimer's Disease diagnostic portfolio. We're gonna continue to invest in that area, these blood-based tests. We have the AB 42/40 test up and running. We have the APOE test up and running. These are blood-based tests. These are gonna be more useful than CSF or PET scans, and less costly, you know, to the environment. We're gonna continue to invest in the molecular side of our business. We're gonna continue to invest in the oncology business. All of these things are gonna position us for the higher growth segments of the laboratory industry and assure our long-term outlook. Thank you very much, guys. Yep, you're welcome. We did have one more question come in. Our last question is from Derik De Bruin with Bank of America. You may go ahead. Hi, good morning. This is John on for Derik. Sure. We've talked about this quite a bit, but talked about the focus of the M&A pipeline will be on the deals you've traditionally done before, and it seems you certainly have plenty to come in the coming quarters, and you have a lot to do, lot to balance. Of course, you're investing in Alzheimer portfolio and whatnot. As you look to launch your first MRD product in 2024, could you talk about potential deals or products that you see would complement your current oncology portfolio that you don't have in your current internal pipeline? Well, we think with the combination of Haystack, which, as you noted, is centered on minimal residual disease testing, post-cancer diagnosis. You know, we've brought up our own internal assay for therapy selection. From a therapy monitoring and therapy selection standpoint, you know, we believe we're very well positioned for future growth. We continue to invest on the genetic side of our business, hereditary genetics, genetic offerings for diagnostic purposes, and then the family planning and prenatal genetics is also an area that continues to receive focus. We believe we're well positioned on the cancer side. We continue to make some investments on the genetic side. That's where the, you know, we think we're well positioned. Again, our focus right now, you know, we'll continue to focus on hospital outreach deals and other small tuck-ins that are accretive to our business. Thank you. Operator. Thank you. That was our last question. All right. Well, thank you, everyone. We again believe we had a strong quarter here. The outlook for the H2, we've taken up our revenue guidance. Feel good about that. Thank you for supporting Quest Diagnostics. Have a great day. Thank you for participating in the Quest Diagnostics Q2 2023 Conference Call. A transcript of prepared remarks on this call will be posted later today on Quest Diagnostics' website at www.questdiagnostics.com. A replay of the call may be accessed online at www.questdiagnostics.com/investor, or by phone at 203-369-3035 for international callers or 888-566-0058 for domestic callers. Telephone replays will be available from approximately 10:30 a.m. Eastern Time on July 26, 2023, until midnight Eastern Time, August 9, 2023. Goodbye.