Good afternoon, everyone. Let's go ahead and get started. Thanks for coming to the Evolent Health presentation. For those of you whom I've not yet met, my name is Ryan Daniels. I'm the HCIT and Healthcare Services Analyst here that covers the company. I'm joined on the stage by Seth Blackley. Seth is one of the company's co-founders and the CEO, and John Johnson, the CFO, is in the front row. He'll be in the breakout session as well, which will take place up on the second floor in Adler. Just a reminder, our disclosures are on our website at williamblair.com, and again, we'll go for the Q&A up in Adler. Great time to have Evolent here. It's been, I would say, a tumultuous year. A lot of end market headwinds, which creates a really interesting dynamic because we've seen MA plans exit markets. Through no fault of their own, some customers have dissipated. We've seen things like Medicaid redetermination pulling lives out of the system. Through no fault of Evolent, kind of seeing customers again lose coverage, and more recently, some oncology cost trends that have spiked up. The other side of the dynamic is that it really creates a great selling environment, a lot of pipeline activity, and probably demand for the solutions, need for the solutions, value from the solutions has never been higher. From a longer-term perspective, although there's been some noise in the story, we think a great long-term growth outlook, really sophisticated product offering that is meeting these market demands, and we think there's a lot to come in the future. I think this is a great time to be looking at the stock and a really great time to have the company here. We appreciate you attending, and we appreciate all of you in the audience. With that, I'll turn it over to Seth, and then again, we'll go upstairs in Adler for the Q&A. Thanks. All right. Nice to see everybody. Thank you, Ryan. I was joking with Ryan before the presentation. I feel like I'm meeting a lot more value investors today than I'm used to, which I don't necessarily like, but it is an interesting time for the story. Before we start, what I thought I would do is briefly do a very layperson's description because I know this is a growth conference. Evolent's work is managing complex conditions across oncology, cardiology, and MSK. We're going to focus a lot on oncology today because it's Evolent's core business, our largest specialty, and one of our biggest growth areas. Just to frame the issue that we're helping solve, four out of ten people will be diagnosed with cancer in their lifetime. Four out of ten people in this room of us will be diagnosed, which means that everybody in the room either has a personal experience of cancer or a family member. We have all had it. We have had the experience of a diagnosis, and then wondering, where do I go to get the care? Am I going to the right place? Am I getting the right diagnosis and the right treatment plan? Right? We have all probably dealt with that with extended family members. Evolent's work fundamentally is to help make sure that that patient is getting the right diagnosis and the right treatment plan. If you go walk into an oncologist today off the street across America, on average, you're getting the right diagnosis, the right treatment plan 65% of the time, which is an amazingly scary statistic when you think about it, meaning 35% of the time there's something with either the diagnosis or the treatment plan that isn't right. We try to get that number from 65% up to close to 85% on average. That is the work we do, improving adherence to evidence-based medicine. I'll explain how we do that, the way we make money off it, who we sell it to, and the like as I go through. That fundamentally is the value proposition of the business. Just a little bit on the profile of the organization as I start, and I'll hit a couple of these metrics that I'll preview, and then I'll take you into more detail. Evolent's primary customer base are the insurance companies. Our largest customers, Humana, Centene, Molina, the Blue Plans, and the like, are our customers. We help them manage the quality and adherence to the evidence that I described a moment ago across oncology, cardiology, and MSK. Ultimately, we do that work through the treating oncologist. I'll explain how we do that. At the end of the day, our motivation is the patient, getting the right care for the patient. We do this through a staff, as you can see here, of 4,500 people on the team at Evolent, highly mission-oriented, 1,500 are clinical, 350 physicians on staff who are reviewing these cases case by case. Eight million times a year, we're reviewing a case in oncology and cardiology and MSK and the like. I mentioned the 20% improvement that we seek to drive. That, on average, drives lower costs for the patient. Sometimes it's higher. Sometimes we're recommending something for the patient that is more expensive. On average, we're helping drive down the cost, and we're doing it in a way that physicians are satisfied and patients are satisfied. This is what I'm going to walk you through today as we go through it. I'll skip past this slide briefly because I want to focus today on oncology, which is our biggest specialty. Just to be clear, as I mentioned, oncology, musculoskeletal conditions, and cardiology, those are the three big conditions that we manage through the work at Evolent. Let me dive into oncology, as I mentioned. This is the basic value proposition. If you're a health plan and you work with Evolent, there are a couple of things that we're going to be doing to help drive value into your network and in your system. Number one, in the top left is get that 65% adherence to best practice medicine up to 85% on average in a market. You guys may know this. In cancer care, there are 300 journal articles published every month. Imagine trying to keep up with that if you're an oncologist. The average oncologist is reading about four of those 300 articles. The pace of scientific innovation is hard to keep up with, and that's one of the reasons you see this huge problem, which only 65% of the time is the right care being delivered. We're able to make those changes case by case, as I'll describe in a minute, while having the treating oncologist satisfied with the work we do. You can imagine if I'm an oncologist or I like somebody looking over my shoulder, you know, to say, "Hey, I think there's a different care plan that's possible." You can imagine that could create tension, but really proud of the fact that we're able to do that with a high satisfaction rate. Primarily, I believe we're able to do this because the evidence is so complicated and the changes are happening so frequently that we're able to bring value to the treating oncologist. The last thing that we're doing, increasingly new product that we just announced in May, is an app and a product and a set of navigators wrapped around the patient and the family. Imagine there's a diagnosis. You're in care now. You're at home, and you have a fever, and you're wondering, "Should I go into the hospital? Should I call my oncologist?" If you had a family member deal with this, these things happen all the time. We have an app that allows the member to track these symptoms at home. They can push a button and be connected to one of the Evolent nurse oncologists who can have a conversation with them and help them triage. On the other side of the equation, the things that we are driving down are the cost. On average, about 20% reduction in the total cost of these conditions across a three-year period. Doesn't happen in year one. Some of it happens in year one, but across three years, through educating the oncologist or the cardiologist or the orthopods, being able to drive down that cost over time. Again, certain cases, we may be driving up the cost. These are average numbers. Decreased use of what we call low-value regimens. Low-value regimens are therapeutic choices, and most of the cost in oncology is the cost of the drug. Folks may have heard of a drug called Keytruda. It's $35 billion for one drug. It's bigger than McDonald's. One drug, one brand. It's a checkpoint inhibitor for immuno-oncology. The last thing that we drive down, people were aware after the tragedy in December at United with Brian Thompson being murdered that physicians and patients don't like care being denied, right? Particularly in a life-threatening area. I think the work we do, the way we do this, the 8 million interventions we make a year with the satisfied physicians, I'm really proud of the fact that we're able to do this kind of work, and the denial rates typically go down, meaning the speed with which we're approving care and getting the patient what they need, that is better than the status quo in the market, which to me is a really important factor. Okay? I know it took a little while on that slide, but I think it's important. What that has led to for the business, we'll talk about the EBITDA and the headwinds that we've had with the market over the last few years in managed care, but the sales opportunity in the market right now is incredible. Across all three conditions, but particularly in oncology, today we're about $2 billion of revenue. We have a direct cross-sell opportunity, meaning an existing client, an opportunity, a population, a line of business that we don't yet have. If we cross-sell all of our customers our products, that is a $50 billion cross-sell opportunity, which is about a third of the TAM. The total opportunity is $150 billion. A third of it we can get out with our existing customer relationships, those logos you saw on the first page. That, to me, is a big-time opportunity. If we do a good job for our clients, we have an opportunity to earn more business. The reasons for all this, again, on the right, if you go talk to any health plan right now, ask them what their number one problem is, it's going to be the cost of oncology. I think that's a big opportunity for us, again, to continue addressing that. You can see some of the reasons why. It goes back to the rapid pace of scientific innovation, the cost of the therapeutic, and the like. Big-time opportunity in the market that's driving big demand. I mentioned on the last earnings call in May that the weighted pipeline for Evolent from a year ago has more than doubled, which again is driven by these factors. Very briefly, what do we do? How do we do the work that I mentioned? There are three components to our product. One is clinical decision support. That means I'm a physician. I'm getting ready to treat a patient. Could be with cardiology, could be a musculoskeletal surgery, could be cancer. Right as I'm getting ready to make the decision on what treatment plan to put in place, Evolent's team, through our technology, our AI, but most importantly, our teams are reviewing that case and going back with recommended changes on some subset of the cases. We do not recommend changes on most, but on the ones where we think there's a big opportunity, through clinical decision support in real time, right before the treatment starts, we are making those recommendations. The payer requires the physician to come to us with their care plan through their EMR or through extracting their clinical data. We receive it. Our algorithms look at it. We flag the cases that need an intervention of some kind. The biggest and the best interventions are through one of our physicians calling the treating physician. That's the biggest opportunity where there are more complex cases and it needs what I would call a peer-to-peer consult. Second part of our value proposition is the provider alignment. For the oncologist, the cardiologist, or the orthopod, do they have the studies, the benchmarks, and the incentives to do the right thing? I said 65% of the time, the right care is being delivered. How do I get that number to 85%? One of the ways you do it is you make sure the physician is able to benchmark their data, look at their cases, not one at a time, but across maybe a quarter or across six months. We do that work. We send people into the offices with the data and the information to sit down with the physicians. We also create financial incentive programs. Adhere to the best evidence, and the most latest evidence will pay you a bonus. Those are the sorts of things we do as part of our product in column two. Column three is the member navigation that I mentioned earlier, which is, again, an app and a wraparound set of services for the patient and the family member in the home 24 hours a day. We've launched that so far for oncology, and we'll do so over time for the other two products. All right. Let me click into these three areas, give you a little bit more detail. Number one, which is the clinical decision support, how do we do this work? The first thing we do on the left side of the page is we develop a view on what is the best evidence. We collect that from the categories of work listed on the left side. Anybody know what ASCO is? It's the largest association for oncology. They're meeting right down the street here in the convention center this week. Incredible innovation going on. We take the ASCO guidelines as a for instance, but also all of these other categories of information, including real-world data, to develop what we think of as our level one pathways. Level one pathway means, "Hey, if you follow this evidence, this is the best thing for the patient from a quality perspective first and from a cost perspective second." Take that to the middle. Okay. Now take it down to an individual case. There's a patient diagnosed with, let's make it up, non-small cell lung cancer. That's the diagnosis. How can I treat that patient? As you can see on this page at the top, compendia means that is what CMS will pay for. That is what is approvable. In this case, there's, I don't know, nine different regimens, 10 regimens that you could follow, all of which are approvable, all of which the evidence and literature says these are fine. We review all 10 of those and say, "Okay, which ones are really the best for the patient?" We identify the next five. We then look at toxicity. Toxicity means, am I going to get a hospitalization or an adverse event because of the treatment? We take out the ones that are not efficacious and have high toxicity. At the very end, we look at what the cost looks like. At the end, our level one pathways are either B or E. If the physician's not prescribing B or E, that would be one of those 35% of the cases where we're going to make a phone call or send a message electronically to the patient to try to get that shift. Again, quality first, but we do think about cost. You can see the effect of that on the cost on the right-hand side, which is when a patient is on level one versus level two, average cost per case is significantly lower. Again, these are average. Sometimes it'll be higher, but on average, it's significantly lower. Akin to what you might see in manufacturing, where high quality, the Deming principle of high quality actually is lower cost. That's the case in these high-cost conditions. Let's move second to the provider alignment, that second column. I mentioned the peer-to-peer engagement, the education, and the alternative payment models. Those are the three things we do to help drive the right outcomes. As you can see in the middle of the page, only about 3% of the time are we going to the physician and say, "Hey, this is really a bad idea. You can't do it or you shouldn't do it," a denial. We will sometimes say that if you're doing something really dangerous for the patient, we'll flag it. 97% of the time, either electronically or through the peer-to-peer process, we're convincing them that, like, "Hey, there's a better path here for the patient, quality first, toxicity second, and cost third." In those cases, we're able to make those changes. You look at the data on the right, look at the percentage of the time the peer-to-peer changes. They have no requirement to change, but 81% of the time, we pick up the phone, a change gets made, which is fantastic. I think, importantly, this satisfaction rate that I mentioned earlier, I think, is really important because it tells you that the oncologist thinks that we're credible. I think that's really important. Third and finally, I'll just touch briefly on our partnership that we have with Careology, which is a leading consumer application developed in the U.K. originally for the National Health Service. We have the exclusive U.S. license to distribute the product. We integrate that fully with our oncologic nurse care team and triage the patients so that they can get 24/7 access. These services that we've just introduced are in place for a couple hundred thousand of our lives today. It's not hugely penetrated, but we believe it'll be a growth category for us. The savings in this is really about avoided emergency room visits and avoided hospitalizations. This is a slightly different value proposition than, "Hey, are you on the right drug?" which is a part B cost and is more about, can we keep the patient at home and healthy rather than running off to the hospital? Real quick, we thought we'd put in one quick case study. Does anybody know what a checkpoint inhibitor is? There's probably a few healthcare investors in here. In cancer care, there's a couple broad types of treatment. Historically, everybody hears about chemo. Chemo is poisoning the body to kill the cancer cells, which also poison the body. It's difficult on people. It's a blunt instrument, right? Checkpoint inhibitors are a newer category of oncology care called immunotherapy. It switches on the immune system to attack the cancer cell. Checkpoint inhibitors specifically work by switching on a specific mechanism for attacking the cancer cell. It has been a massive growth opportunity. Keytruda is a checkpoint inhibitor. Opdivo is a checkpoint inhibitor. Tecentriq is one. You've heard these brand names, perhaps. This is going to be a $200 billion industry in a handful of years, the checkpoint inhibitor space. It's been growing at 15%-20%. We are able, through the work that we do, identifying the right patient, the right disease base, and the right evidence, in one of our clients, to decrease the cost of these checkpoint inhibitors by 4%. When the market's been going up at 15%-20% and we are going negative 4% while getting better quality for the patient, that's what we do. That's the value proposition that we bring to our patients. We can get in more detail in Q&A about how exactly we do that. All right. Let me turn a little bit to the business. Now that you understand the product, I'd say we have a couple elements to the growth algorithm. The first is we've committed to what we call 15%+ top-line growth organically over time. We feel like we'll continue to be able to drive this number for many years to come. We have less than 5% market share. If you look at, think about our TAM, we have 180,000 of the 2 million cancer cases in the United States we take care of. There is 90%+ of the cases we do not yet take care of and manage. We think we have the best product to do it. I think we're going to be able to continue growing the business aggressively over time, including with the Performance Suite, which if you're new to the business, the Performance Suite is our product where we will actually guarantee the savings to the plan. The ability to make that guarantee has been a big part of our ability to continue to sell the product. That part of our business in particular has been, I'd say, very strong over the last year in terms of pipeline. The second part of our formula is around margin expansion. I think that covers it. Growth and margin expansion gets most of what you need in life. The margin expansion side is driven by two components. One is automation and AI. We're never going to use AI to make a clinical determination, but we will use AI to make our process more efficient. If something in the past required manual review, maybe AI can say, "Hey, this is going to get approved anyway. Let's not spend time on it with a manual cost, and let's automatically make it sure that it's going through for the plan and for the patient." Another way to use AI is to say, "Hey, it used to take us 20 minutes to do this review. Now we can do it in 12 minutes because of AI." There is a bunch of savings that we see on the AI front that are about efficiency that, again, do not use AI to actually make clinical decisions. The second really important part around margin expansion is our Performance Suite, our risk side. Today, this year, our kind of rough margin is about 7% on that line of business. The mature margin in that business is about 10%. So, we're under-earning, I'd call it, our Performance Suite margins based on the issues Ryan talked about. There's been a ton of headwinds in managed care. It's been probably the hardest underwriting cycle for any managed care organization for the last couple of years that it's been in a few decades. Our ability to get back to our sort of more mature margins is the second big piece. That translates into our outlook, which obviously we reiterated today, and we feel really good about that outlook, as John said. All right. Just in wrapping up, the biggest place we get questions in our one-on-ones, and we'll probably have in the Q&A, is sort of comparing the two business models we have within the company. One is our tech and services model, which is a fee-based—think of it like a tech and services product, right?—with 50% type margins. The other product, as I mentioned, is our risk product, which is called the Performance Suite, which is a majority of our revenue dollars but has a lower margin percentage because of the model that I described. What you'll notice, a couple of things I call out, while the margin percentage for tech and services is higher, look at the target mature flow-through margin PMPM dollars. Twenty cents right on the tech and services side and a buck fifty to $4 plus on the Performance Suite side. What that tells us, and I think many of our investors who know us well, is that growing that part of our business is the best outcome for us, but it's also best for our partners. You're going to get most savings for them, the best clinical outcomes for them. A lot of the questions that we've had around our ability to grow that product and continue to manage the margin in that product, we feel really good about that. As I mentioned, the pipeline will indicate that. There are a few things that we changed coming into this year based on the kind of managed care market that we've seen, which is really high cost in 2023 and 2024. We basically took the bell curve on the way we take risk and narrowed it on both sides. Meaning, historically, we would take risk above 100% MLR and below 90% MLR, if you know the MLR statistics, meaning we could make a lot of money when things are going well, and we could lose a lot of money when things were not going well. We would take that and tighten the curve around that with what we call corridors, along with some other contractual adjustments that we made. We think that is a better product for a public company and going forward in this market. One question we've had is, "Hey, will you be able to sell that product?" We've had very good success thus far. I mentioned about the pipeline earlier, people attaching to this product. We feel very good about where that Performance Suite product sits and the ability to drive it into the marketplace. Last thing, just briefly, we're very focused on the balance sheet as well. I think there's a couple priorities that we have. The main priority, in addition to some basic product investments, organic product investments, which I think of as software investment, largely capitalized software, is going to be around delivering, right? Just taking the free cash flow of the business over time to have our leverage ratio fall. You can see some of the targets that we've listed here over time. I want everybody to hear that loud and clear that that is a huge priority for us. The leverage will come down over time. The team and I are very focused on making that happen. I'll just close on this statement, which you go to our website, you'll see it. We guide everything we do with a mindset, which is, "What if this were a family member?" I sort of made it a little bit personal at the beginning. Four of ten people in this room will get cancer. Some of us will. Whether it is that or one of these other conditions, we think if we make sure that we are taking care of our patients like family members, that will drive the right trust in the marketplace, but also ultimately is the thing that also benefits the system on affordability. That is our true north. With that, I will wrap up, and we will take some Q&A. We've got a couple minutes. If there's any questions from the audience, we can get that before we go to Kathy from the Performance Suite. Yeah. The question was, how do the alternative payment models work, and what are some specific examples? For those who aren't close to the market, let's use oncology as an example. The oncologist receives 6% of the cost of the injectable drug. If you have to go in and get an infusion for your cancer care, which many patients do, the oncologist is getting 6%. If you're on a checkpoint inhibitor that costs $180,000 a year, the treating oncologist is getting 6% of that in the form of a payment. ASP plus 6 is how it's known in the market. I don't think most oncologists—J, your question—they're not doing things that are untoward. I think the vast majority are trying to do the right thing. If we're going to them and saying, "Hey, the cost was $200,000 a year. You were going to make $12,000 of income from your 6% payment, and we're asking you to do something that costs $10,000," and that's a real example. Unfortunately, those huge discrepancies exist. That loss of close to $12,000 of income is a real issue. What we'll typically do is say, "Hey, look, we'll make you whole in the $12,000." We'll make sure that your, in this example, income stays at $12,000. The cost of the therapeutic is going to fall from, in that example, $200,000- $10,000. Again, $190,000 of savings offset by $12,000 of increased payments. It's obviously a win-win for the payer. The patient, as you guys probably know this, often pays up to 20% of these costs. You can imagine what it means to get a copay for a $100,000 or $200,000 injectable. You guys may know this. The number one cause of bankruptcy in America is healthcare costs. Oncology is the number one driver of that. It's these expensive drugs. I think it also is the right incentive for the patient, which is, if it's the right answer, let's make sure we don't ding the physician for doing the right thing. It's good for quality, good for the system's cost, and then good for the patient's pocketbook. That combination is how we do it. There are other mechanisms where we will pay an incentive just around overall adherence rates to the evidence, which is more of a comprehensive program versus a one-off on high-cost drugs. There are a couple of different ways we do it, but it's fundamentally around adherence to evidence. Yeah. The question was, what happens when one of these big ones like Keytruda goes generic? A couple of things, Chris, I'd say on that. One is biosimilars, which is the generic version of these part B injectables, often are only 15%-20%-30% cheaper, which is, I think, an interesting point. It's not like they go to 90% reduced cost. The cost will come down a little bit. Number two, through a bunch of legal appeals and mechanisms, usually that timeframe gets extended a couple of years. Our view is that's probably more like 2030 before it really affects. The last two points, pharma's smart, right? They are very thoughtful about how to do this. They have a new product coming out, which is a subcutaneous version, meaning you don't have to sit in the chair and get the drip IV. You just get a shot. That will be considered a new product. It is better for the patient, right? I do not want to sit in the chair for an hour, two hours. I will just get the shot and be on my way. That is going to have a patent extension attached to it. The last point, of course, is that a lot of these things, as you probably know better than me, Chris, there are so many different innovations coming that, as always happens, one will go down a little bit through biosimilar, even with the things I mentioned of subcutaneous and with the extensions. The next thing will be coming. I think gene and cell therapies are going to be explosive. AI is going to make these gene and cell therapies explode, I think, because they are going to be more and more tailored over time. The ability for computers to basically run trials and crunch the data around what works and what does not, I think, is going to have a whole new class of things over time. Our belief is that the specialty pharma market is going to be a huge market for a long time. We'll go ahead and move up to Amber for the breakout session. Thank you, team. I appreciate it. you, team. I appreciate it. you, team. I appreciate it. Thanks. This presentation has now finished. Please check back shortly for the archive.