Welcome to the Health Catalyst first quarter 2023 earnings conference call. At this time, all participants have been placed on a listen-only mode. The floor will be open for your questions following the presentation. If you would like to ask a question at that time, please press star one on your telephone keypad. If at any point your question has been answered, you may remove yourself from the queue by pressing star two. To get to as many questions as time permits, we ask that you limit yourself to one question. If you have any follow-up questions, please re-enter the queue. Others can hear your questions clearly, we ask that you pick up your handset for best sound quality. Lastly, if you should require operator assistance, please press star zero. I would now like to turn the call over to Adam Brown, Senior Vice President of FP&A and Investor Relations. Good afternoon and welcome to Health Catalyst's earnings conference call for the first quarter of 2023, which ended on March 31st, 2023. My name is Adam Brown. I am the Senior Vice President of Investor Relations and Financial Planning & Analysis for Health Catalyst. With me on the call is Dan Burton, our Chief Executive Officer; and Bryan Hunt, our Chief Financial Officer. A complete disclosure of our results can be found in our press release issued today, as well as in our related Form 8-K furnished to the SEC, both of which are available on the Investor Relations section of our website at ir.healthcatalyst.com. As a reminder, today's call is being recorded and a replay will be available following the conclusion of the call. During today's call, we will make forward-looking statements pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995 regarding trends, strategies, the impact of the macroeconomic challenges, including high levels of inflation and high interest rates, the tight labor market, our pipeline conversion rates, and the general anticipated performance of our business. These forward-looking statements are based on management's current views and expectations as of today and should not be relied upon as representing our views as of any subsequent date. We disclaim any obligation to update any forward-looking statements or outlook. Actual results may materially differ. Please refer to the risk factors in our Form 10-K for the full year 2022, filed with the SEC on February 28th, 2023, and our Form 10-Q for the first quarter of 2023 that will be filed with the SEC. We will also refer to certain non-GAAP financial measures to provide additional information to investors. A reconciliation of these non-GAAP financial measures to their most comparable GAAP measures is provided in our press release. With that, I will turn the call over to Dan. Dan? Thank you, Adam, and thank you to everyone who has joined us this afternoon. We're excited to share our first quarter of 2023 financial performance, along with additional highlights from the quarter. I will begin today's call with some commentary on our first quarter of 2023 financial results by sharing that we are pleased with the company's overall financial performance. Our Q1 2023 total revenue was $73.9 million, representing 8% growth year-over-year. Our Adjusted EBITDA was $4.2 million, with these results beating the midpoint of our quarterly guidance on each metric. Additional financial highlights from the first quarter include our technology revenue of $47.2 million, representing 12% growth year-over-year, and our adjusted technology gross margin of 70%. Now let me highlight some additional items from the quarter. You will recall from our previous earnings calls that we measure our company's performance in the three strategic objective categories of improvement, growth, and scale, and we'll discuss our quarterly results with you in each of these categories. The first category, improvement, is focused on evaluating our ability to enable our clients to realize massive, measurable improvements while also maintaining industry-leading client and team member satisfaction and engagement. Let me begin by sharing a couple of examples of client improvements from recently published case studies. First, as part of its Accountable Care Organization participation, UnityPoint Health needed advanced analytics capabilities to support its achievement of shared savings in its risk-based contracts. To achieve this goal, UnityPoint partnered with Health Catalyst, leveraging our Data Platform and robust suite of analytics applications to develop standard analytics processes, measures, and tools that are now used across its organization. This data-informed approach has driven material success in its Accountable Care Organization's risk-based contracts, including an average achievement of $35 million in annual shared savings as part of UnityPoint's Next Gen ACO shared savings participation in 2019 and 2020, largely the result of improved care processes and decreased post-discharge utilization. Blessing Health System, in an effort to meaningfully improve its revenue integrity and charge capture efforts, implemented our VitalIntegrity application, a component of our Financial Empowerment Suite. Benefiting from VitalIntegrity's rules management system, advanced reporting and analytics, and auditing processes, Blessing Health leveraged our software to not only integrate, centralize, and visualize charge capture issues, but also to identify root causes and quickly address them to reduce revenue leakage. Adopting our technology enabled Blessing to increase its revenue by $552,000 in the first full year and achieve a greater than 25% increase in charge capture team member productivity, creating capacity for increased performance audits, issue identification and resolution, while also successfully auditing 100% of all charges. As you can see illustrated in these recent improvement vignettes with UnityPoint Health and Blessing Health System, our solution continues to deliver meaningful hard dollar ROI across our client base, which is particularly important to our clients in this operating environment. In the improvement category, we have been fortunate to receive additional recent external recognition related to our team member engagement. For the 6th year in a row, the Women Tech Council named Health Catalyst to its annual Shatter List, the council's list of technology companies with active programs leading and accelerating progress towards breaking the glass ceiling for women in the industry. Our next strategic objective category is growth, which includes beginning new client relationships while also expanding existing client relationships. Related to our current selling environment, I have now over the last 10 months, personally had over 130 opportunities to visit face-to-face with senior executives at our top 100 clients. As I, along with our growth organization, have synthesized recent feedback from our clients and prospects. I would share that we continue to see similar headwinds and tailwinds related to our growth in 2023 as what we shared in our recent Q4 2022 earnings call. As it relates to headwinds, our health system end market continues to experience meaningful financial strain, primarily due to significant increases in labor and supply costs without a commensurate increase in revenue, leading to substantial margin pressure. We continue to anticipate this dynamic will persist for the next few quarters. Translating this to our business, we have seen a decrease in pipeline demand and some realized and anticipated elevated churn levels primarily for the parts of our solution portfolio that do not offer near-term financial ROI, such as our clinically focused technology offerings and our more traditional consulting Professional Services. As it relates to tailwinds, while we have seen that the financial strain has continued to pressure health system budgets. In our recent sales conversations, we have also received strong acknowledgment that our portfolio includes solutions that directly reduce health systems' current financial pressure, especially related to the segments of our offerings that have a clear near-term financial ROI, such as our Tech-Enabled Managed Services offering, our Financial Empowerment Suite technology suite, and components of our Population Health technology suite. Likewise, as I step back and reflect on our progress over the last few quarters, I am confident that our go-to-market focus on strategic, demonstrable ROI solutions is resonating across our client base and that the breadth and comprehensive nature of our end-to-end solution is well suited to serve our health system end market in this current market environment. Influenced by the headwinds and tailwinds that I just described, our Q1 2023 overall pipeline development and bookings conversion rates, inclusive of Tech-Enabled Managed Services, performed largely in line with expectations, and our sales pipeline continues to support the 2023 bookings expectations shared on our most recent earnings call. As such, we are reiterating our 2023 bookings expectations, inclusive of net new DOS subscription client additions in the low double digits and a dollar-based retention rate between 102% and 110%. Related to our full year 2023 bookings expectations, let me share some additional commentary which largely aligns with what we shared on our recent Q4 2022 earnings call. We continue to anticipate a higher proportion of our gross bookings will come from our existing client base as compared to historical levels, inclusive of upsells to both our DOS client base as well as upsells to our over 400 other more modular non-DOS clients. Aligned with what we shared last quarter, this expectation is driven by the current end market dynamics in which we have observed that many existing clients who have already realized a strong ROI and are aligned on a long-term partnership framework tend to be more receptive to expansion conversations in this financial environment. We continue to anticipate our 2023 Professional Services dollar-based retention achievement will be higher than our technology dollar-based retention rate, largely driven by our Tech-Enabled Managed Services expansion achievement to date and pipeline. Additionally, we anticipate that the elevated technology churn levels, primarily for the parts of our portfolio that do not offer near-term financial ROI, will be more heavily weighted towards the first half of 2023, inclusive of some smaller, more modular DOS relationships. Let me share that we continue to anticipate a higher portion of our net bookings will occur in the second half of the year as compared to our historical average, largely resulting from the anticipated timing of our larger pipeline opportunities, inclusive of our Tech-Enabled Managed Services pipeline. We continue to expect that our new DaaS client additions will have a lower average starting ARR as compared to historical levels, driven by the current end market dynamics influencing a greater proportion of clients to start with a more modular solution as compared to historical levels. Next, I'm excited to announce a meaningful expansion of our Tech-Enabled Managed Services partnership with our longest-standing client, Allina Health. This expansion, which includes more chart abstraction responsibilities shifting to Health Catalyst, increases our recurring revenue with Allina to now be approximately $11 million per year. We continue to appreciate Allina's multifaceted partnership and trust in Health Catalyst since the beginning of our relationship with them nearly 15 years ago. We are encouraged to see other potential areas of expansion with them in the future. We look forward to welcoming these teammates to Health Catalyst in the near future. Additionally, we are excited to announce a new DaaS client partnership with Sea Mar Community Health Centers, a national leader in health and social services, delivering high-quality integrated care for underserved communities, specializing in service to Latinos in Washington State. Sea Mar's services include a network of more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services. Sea Mar will leverage our technology, including our Data Platform, Pop Analyzer, Pop Insights, and self-service analytics, along with our Professional Services in order to make more proactive data-informed decisions throughout their patient care. We are honored to welcome this mission-aligned healthcare provider into our client base. Lastly, prior to turning the call over to Bryan, I would like to share a couple of additional updates related to new leadership promotions at Health Catalyst connected to our annual planning process and in response to the company's continued growth and expansion. First, as previously disclosed, Anne Marie Bickmore has been named Health Catalyst's Chief Operating Officer. In addition to her responsibilities as chief product officer, Anne Marie has served in various leadership roles at Health Catalyst since joining the company in 2012. Most recently as our Chief Product Officer since 2021. Anne Marie's contributions to Health Catalyst's historic success are significant, and I am thrilled to expand Anne Marie's set of responsibilities and leverage her proven ability to lead high-performing teams and develop innovative products to further the Health Catalyst mission. As a reminder, Paul Horstmeier, Health Catalyst's prior Chief Operating Officer, has taken a three-year leave of absence to serve as a mission president for The Church of Jesus Christ of Latter-day Saints. I would like to once more acknowledge and thank Paul for all that he has done for Health Catalyst over the course of more than a decade. We look forward to his return in a few years. Additionally, as previously disclosed, Ben Landry has been promoted to General Counsel and Corporate Secretary. Ben has been with Health Catalyst since 2019. Most recently serving as Assistant General Counsel. Ben has a proven track record of wise counsel and strategic thinking. I am confident he will enable Health Catalyst to continue its position as a leading healthcare company. I also want to thank Dan Orenstein for his many contributions to our company's success as General Counsel over the last seven years as he transitions to a strategic advisor role. Lastly, as part of our normal course annual planning cycle, we have simplified our business unit structure, leading to expanded responsibilities for TJ Elbert as the General Manager of our Data Platform business unit, Dan Unger as the General Manager of the Improvement Applications business unit, and Dan LeSueur as the General Manager of the Professional Services business unit. I'm confident in each of these leaders' capabilities in driving our growth and profitability moving forward. With that, let me turn the call over to Bryan. Bryan? Thank you, Dan. Before diving into our quarterly financial results, I want to echo what Dan shared and say that I am pleased with our first quarter performance. I will now comment on our strategic objective category of scale. For the first quarter of 2023, we generated $73.9 million in total revenue. This represents an outperformance relative to the midpoint of our guidance and it represents an increase of 8% year-over-year. Technology revenue for the first quarter of 2023 was $47.2 million, representing 12% growth year-over-year. This year-over-year growth was driven primarily by recurring revenue from new client additions and from existing clients paying higher technology access fees as a result of contractual books and escalators. This quarterly revenue performance was slightly higher than anticipated in our quarterly guidance due to a few technology environment go lives that generated a deferred revenue catch up occurring earlier than forecasted. Professional Services revenue for Q1 2023 was $26.7 million, representing 3% growth relative to the same period last year. This amount was also slightly higher than anticipated in our quarterly guidance, mostly the result of a timing-related pull forward from a few non-recurring revenue items that we had forecasted to hit in subsequent quarters. Given that this upside resulted from non-recurring revenue items that were primarily timing related, we do not anticipate that these quarterly revenue outperformance items will represent upside to our full year 2023 forecast. For the 1st quarter of 2023, total adjusted gross margin was 52%, representing a decrease of approximately 270 basis points year-over-year. In the technology segment, our Q1 2023 adjusted technology gross margin was 70%, a decrease of approximately 20 basis points relative to the same period last year. This year-over-year performance was mainly driven by headwinds due to the continued costs associated with transitioning a portion of our client base to third-party cloud-hosted data centers in Microsoft Azure, which increases our hosting costs, partially offset by existing clients paying higher technology access fees from contractual built-in escalators without a commensurate increase in hosting costs. In the Professional Services segment, our Q1 2023 adjusted Professional Services gross margin was 20%, representing a decrease of approximately 900 basis points year-over-year, and an increase of roughly 260 basis points relative to the fourth quarter of 2022. This quarterly performance was slightly higher than the expectations we shared on our last earnings call, mostly the result of the Q1 higher margin non-recurring revenue milestones mentioned previously. In Q1 2023, adjusted total operating expenses were $34.2 million. As a percentage of revenue, adjusted total operating expenses were 46%, which compares favorably to 54% in Q1 2022. Adjusted EBITDA in Q1 2023 was $4.2 million, with this performance exceeding the midpoint of our guidance and representing an increase of $3.5 million relative to the same period last year. This Q1 2023 Adjusted EBITDA results was mainly driven by the quarterly revenue outperformance mentioned previously, along with the timing of some non-headcount expenses that we anticipate will be pushed out to later in the year. Our adjusted basic net income per share in Q1 2023 was $0.05. The weighted average number of shares used in calculating adjusted basic net income per share in Q1 was approximately 56.3 million shares. Turning to the balance sheet, we ended Q1 2023 with $356.9 million of cash equivalents and short-term investments, compared to $363.5 million at year-end 2022. Additionally, the face value of our outstanding convertible notes is a principal amount of $230 million, and the net carrying amount of the liability component is currently $226.9 million. As it relates to our financial guidance for the second quarter of 2023, we expect total revenue between $70.3 million and $74.3 million, and Adjusted EBITDA between $0.75 million and $4.75 million. For the full year 2023, we continue to expect total revenue between $290 million and $295 million, and Adjusted EBITDA between $9 million and $11 million. Let me provide a few additional details related to our 2023 guidance. First, as it relates to our Q2 2023 revenue expectations, we anticipate that our technology segment revenue will be flat to slightly down quarter-over-quarter, primarily driven by the previously mentioned Q1 go lives that generated a deferred revenue catch up. For our Professional Services segment, we anticipate that our Q2 revenue will also be flat to slightly down sequentially, mainly driven by the previously mentioned pull forward to Q1 of a few non-recurring revenue items. In terms of our adjusted gross margin, we continue to anticipate that our adjusted technology gross margin will be in the high 60s in the second quarter. In the Professional Services segment, we anticipate that our Q2 Professional Services adjusted gross margin will be flat to slightly down as compared to Q1 2023. We anticipate our operating expenses will be roughly flat to slightly up relative to Q1 2023, mainly the result of some non-headcount expenses that we now anticipate will occur in Q2 as opposed to Q1 2023. Let me share a few additional details related to our full year 2023 guidance, which is largely consistent with what we shared on our Q4 2022 earnings call. From a revenue mix standpoint, we continue to anticipate Professional Services year-over-year revenue growth will slightly outpace technology year-over-year revenue growth, driven by the heavier weighting of our Tech-Enabled Managed Services bookings. In terms of our adjusted gross margin, we continue to expect that our adjusted technology gross margin will be in the high 60s through 2023. Also, we anticipate our adjusted Professional Services gross margin will be roughly 20% for the year, given that our anticipated utilization rates will continue to be lower than historical levels for the next couple of quarters, and that our mix of Professional Services is comprised of a larger percentage of Tech-Enabled Managed Services, which start out at a lower gross margin and expand over time. Lastly, we continue to anticipate our adjusted operating expenses as a percentage of revenue will be down between approximately 500-750 basis points year-over-year. Largely the result of our restructuring efforts and meaningful continued operating leverage with the largest year-over-year reduction occurring in SG&A. With that, I will conclude my prepared remarks. Dan? Thanks, Bryan. In conclusion, I would like to recognize and thank our highly engaged clients and team members. Without their consistent contributions to our shared mission, none of this would be possible. With that, I will turn the call back to the operator for questions. The floor is now open for questions. At this time, if you have a question or comment, please press star one on your telephone keypad. If at any point your question is answered, you may remove yourself from the queue by pressing star two. We ask that you pick up your handset when posing your questions to provide optimal sound quality. Thank you. Our first question is coming from Anne Samuel with JP Morgan. Your line is open. Hi, guys. Thanks for the question and congratulations on the great results. I wanted to ask about, you know, the hospital customers. You know, it seems like commentary that we've heard out of some of the more publicly traded hospitals that have reported so far has actually been a little bit better around labor, but still very focused on cost management. I was wondering if perhaps, you know, as a result of that, you're seeing maybe any shifts in what types of products your customers are looking to utilize or if it's still similar to what you saw, you know, in prior quarters. Yes. Thank you, Anne, for the question. We are also observing among our client base that over the last few months, there's been a slight improvement in their overall financial performance, though it is only slight, in our experience, both across the not-for-profit health systems and the for-profit health systems that we work with. We've also observed that there's been a slight easing of the pressure on labor expenses, that has been so significant over the last few years. In our experience and in my direct conversations face-to-face with these clients, it's still at significantly elevated levels of expense and expense growth relative to what we might have experienced five years ago, as an example. While the trend is slightly better, the overall performance of these health systems from a financial perspective is still, I would characterize as under meaningful financial pressure. That includes in the labor category, and to your point, in non-labor categories like supplies expenses and other expenses as well. There's still meaningful financial pressure. That is still largely from my direct experience and our direct experience recently in terms of face-to-face conversations with our top 100 clients, still the primary focus for these clients. As a result, as we shared in our prepared remarks, we continue to focus on those parts of our solution that offer that near-term ROI, and that still is the primary focus of our clients. We do anticipate over the coming quarters, that hopefully, as we continue to see some slight improvements, that there will be more of an openness to discuss other parts of our portfolio that also, you know, meaningfully contribute to improvement, but might not deliver as many short-term financial ROI elements as some of the other components of our solution. I would still classify the current environment as very much largely still focused on that near-term financial pressure and the near-term financial ROI that's needed. Thanks. That's a really helpful color. Thank you. Hopefully we start to see some green shoots soon. You know, you spoke about the opportunity to sell into your modular client base, and you have a lot of those customers now. I was hoping you could speak to what proportion of your low double-digit new DOS clients you expect to come from that base, and maybe what the cross-sell opportunity looks like down the line with that base, just given you have so many of those clients? Great question. We do think about the foundation of our growth over the next several years, really coming from our full existing client base. That includes obviously our 100 or so DOS subscription clients, but also the other 400 or so clients where we have a relationship that's more modular, to your point. There's an open door there that's a meaningful difference from, you know, starting from scratch with a prospective client. I would characterize that we're thinking of a large percentage of those net new DOS subscription client adds coming probably from that base of the 400+ non-DOS clients that we have, where we have that open door and an opportunity to visit with them about expanding the relationship. Though we will still have some meaningful adds we anticipate from prospective clients as well. One thing I would add, Annie, is in terms of the use case and focus areas that we're engaging with with those types of prospects and existing clients, to Dan's point. They focus again on those near term, hard dollar savings opportunities. things like our Financial Empowerment Suite, coupled with our Data Platform, as well as the meaningful kind of Technology-Enabled Managed Services opportunities that those health systems also can benefit from in terms of saving costs. That's really helpful color. Thanks so much, guys. Thanks, Anne. Our next question comes from Ryan Daniels with William Blair. Your line is open. Yeah, good afternoon. This is Jared Haas for Ryan. Thanks for taking the questions and congrats on a solid start to the year. was hoping to get a little more color on the Allina relationship. was just hoping you could maybe speak to how that's evolved over the years. I think you cited approximately $11 million per year. Could you just maybe help us understand what's incremental in terms of how big that expansion was? Yeah, absolutely. Thanks for the question, Jared. As we mentioned in our prepared remarks, Allina is our longest standing client relationship, and we're coming up on our 15th anniversary as a company and our 15th anniversary with them here in a couple of months. Over time, that relationship has evolved and changed and expanded really meaningfully. As we've mentioned previously, Allina was the first client to enter into a Tech-Enabled Managed Services relationship with Health Catalyst about eight and a half years ago. That relationship is expanding. The Tech-Enabled Managed Services scope is expanding with this most recent contractual expansion. As we mentioned in the prepared remarks, that expands our responsibility for chart abstraction and represents a, you know, a few million dollar expansion, which is meaningful in the context of that overarching relationship. As we mentioned in the prepared remarks, we're excited about additional opportunities to expand. I think in terms of what led to the expansion opportunity, at a foundational level, this is true at Allina, and it's true with all of our clients. The foundational element that opens the door for expansion is great delivery against the existing scope of responsibilities that we have. That always needs to be the foundation of our focus and that has been the case at Allina, and we've been grateful throughout the partnership to have really meaningful shared success together. Allina, like so many other health systems, is facing additional financial pressure. This was an opportunity to help them with regards to the financial pressures that they're facing with Health Catalyst being viewed as a trusted long-term partner where we had had success in this kind of a partnership model for many years. So, this was an exciting opportunity for us to expand in a relationship model that both sides knew was working well. It's one of the reasons why we're excited about potential for additional expansion opportunities in the future. Just to add to that, Jared, and Dan kind of alluded to the directional kind of size of that expansion, but this is an example where Allina has chosen to expand meaningfully over several years and over time, as compared to other examples where we can engage with a client who may take on a larger portion at once, like with Carle or INTEGRIS, those recent expansions that we had. Grateful to have kind of different options for clients in terms of the level of expansion over time. Absolutely. Yeah, that makes sense and appreciate all the color. Maybe I'll sneak one in on the other customer announcement. It seemed like there was a health equity component with the Sea Mar win. I'm wondering if you could maybe speak to the role of sort of data in helping clients achieve equity initiatives and maybe how you communicate that as a value proposition to clients. Thank you for bringing that up, Jared. health equity is something that we care a great deal about. We try to start with Health Catalyst first and foremost, and then extend to our clients a health equity component to our data and analytics and improvement, tech-enabled services that we offer to clients. We certainly always welcome clients who have a deep mission alignment. Sea Mar is certainly one of those clients that deeply cares about the patients and the members that they serve and has a passion around health equity. Data and analytics play such an important role in understanding where each health system is on their journey towards, you know, equitable care. We have a specific solution that we've now implemented across many clients that will also be available to Sea Mar to ensure that first we understand how well we're doing, where we're doing well, where we could improve, and then we specifically focus on those areas of improvement and see measurable improvement results as we focus in those areas. That's our intent and our shared focus with Sea Mar, among other areas of focus. It will continue to be our focus with many other clients as well. Our next question comes from Jessica Tassan with Piper Sandler. Your line is open. Hi. Thank you guys so much for taking the question. Dan, I know you've been visiting customers for the last maybe six or nine months, or actively visiting customers for the last six or nine months. Do you have a good sense at this point of customer intention with respect to kind of, contract persistence across the entire base? Then just curious to know, you know, what percent of the DOS base is going to have managed services attached by the end of 2023. Kind of when do we expect churn or retention rates to normalize and at what level? Sorry, that was a lot. Thanks. Yes, great questions. I'm just taking some notes there, Jess. Thank you for those questions. First, as it relates to those customer visits, yes, over the last 10 months, as mentioned in the prepared remarks, I've now had over 130 opportunities to have face-to-face discussions with our top 100 clients. That's not gonna stop. It's not just me, it's the team that's going out and visiting face-to-face with these clients. That very much informs what we shared in terms of both headwinds as well as tailwinds that our clients are facing. On the headwinds side, as we've mentioned in previous quarters as well, I continue to observe that there's meaningful financial pressure. While that's improving slightly, it's pretty slight in terms of operating margin performance, and there's still very, very significant financial pressure. That's one of the reasons why we see both on the tailwind side, elevated interest in elements of our portfolio that offer that near-term ROI, like Tech-Enabled Managed Services, like the Financial Empowerment Suite, like elements of our pop health Suite. We're excited and encouraged to see, you know, large, meaningful pipeline opportunities there, primarily with our existing clients. On the flip side, we see headwinds, as we've mentioned, in our prepared remarks today and over the last few quarters, as it relates to, particularly for us, more of our smaller, more modular client relationships, and particularly those modules in client relationships where those modules don't offer a near-term financial ROI. We see a little bit of elevated, continued elevated, somewhat elevated churn in that category. There are both headwinds and tailwinds. I would share that from a tone perspective, I've been appreciative of the way in which our top 100 clients in particular view Health Catalyst as an important long-term partner, are encouraged and excited about long-term expansion of that relationship. That's where I would classify maybe some of the headwinds as more near-term to midterm, which gets to one of your questions around, you know, normalizing churn. I do think maybe for two more quarters, we might see the results of some of that elevated financial pressure resulting in a little bit more modular churn than what might happen, you know, might have happened a few years ago. On the flip side, I feel like the tailwind interest in those parts of our portfolio that are meaningfully delivering against hard dollar financial ROI are more of a permanent tailwind, a long-term tailwind. Maybe that gets to your last question about, you know, where do we see the client base materializing from a Tech-Enabled Managed Services perspective. Right now, we're sitting at, you know, around 10% of our DOS subscription clients that have a Tech-Enabled Managed Services relationship. I certainly hope that five years from now, that number will be 100%, and we'll work very hard with our clients to enable them to tap into that, those advantages. As we've also shared, we're finding as we gather data on the pipeline conversion and the timing and cadence, that it takes some time to work through those expansion opportunities, and a one-year timeline might be a reasonable expectation. That is one of the reasons why we continue to forecast that more of our overall bookings will likely happen in the second half of this year as we really started those significant discussions about experience opportunities like TEMS, you know, starting in the July timeframe of last year. Just to add, yeah, Jess, great questions. To Dan's point, the 10% penetration rate roughly of the TEMS opportunity is applicable to our DaaS client base. We do anticipate, as Dan shared, a few more wins like we've seen the last few quarters with Carle, INTEGRIS, and Allina as we continue forward through the rest of 2023. We're encouraged by that pipeline. The other nice thing is that even with an existing TEMS client like Allina, there are still opportunities to expand further, be it in different areas with analytics, with further chart abstraction opportunities, and other areas that our clients are potentially interested in. That's also a nice potential runway for us as we deepen the TEMS footprint as well as expand within those clients. Just one note along those lines, Jess. We have the most experience, as you know, expanding in Tech-Enabled Managed Services relationships around areas like analytics and chart abstraction, data management. We have quite a bit of experience now there with many clients that are leveraging our capabilities and our teams to do that. We are finding that we have a number of clients that are asking us about some other adjacent areas where they might want us to consider Tech-Enabled Managed Services. We try to be very careful and thoughtful, as we consider those other growth opportunities and expansion opportunities to try to make sure that we have some tech components, that we can directly leverage to drive efficiencies. We feel strategically like this is an area that we would like to occupy and that we feel we can be differentiated long term. That is something that is included in our pipeline is a lot of opportunities in these core areas where we have a lot of experience, and then some opportunities that are adjacent to those areas as well. Thank you. That's, that's helpful. My quick follow-up would just be, with respect to the, ACO enablement or the data management to support, the ACO. What exactly is Health Catalyst doing to support kind of shared savings performance? Just, I don't know if you have today or have an opportunity to share in the economics of some of the savings you're generating. Thanks. Yeah, great question. We do have the opportunity to work with a number of ACO clients. Actually, the first improvement case study that we leverage is probably a great example. There's more details about the UnityPoint shared savings success story on our website. Maybe we can follow up and just send you some more information about that. That was a significant opportunity and a good example of what we have to offer from a Data Platform perspective, and then from an analytics and an expertise perspective to help our clients be really successful with those shared savings programs. Just on the financial side of that, Jess. Yeah, we have been open to some kinda shared savings, contractual elements with our clients in the past. We haven't seen a lot of uptake on that in terms of that contracting model. It's something that we're open to over time. Just typically what we see from clients is that they often just want to benefit from more of a locked in fixed kind of visibility on budget. That is something just to Dan's point, based on what we can deliver, that we're open to for clients. Thanks again. Thanks, Jess. Our next question comes from Elizabeth Anderson with Evercore ISI. Your line is open. Hey, guys. Thanks so much for the question. one of the things I noticed on your balance sheet this quarter is it seems as the accounts receivable ticked up sequentially by a fair degree. Could you talk about sort of what were the driving factors of that on a quarter-over-quarter basis? good question, Elizabeth. we typically don't speak to trends in that much detail on a quarterly basis for the reason being that, a lot of our invoicing per our contracts can be fairly lumpy from a timing standpoint. there can be, you know, larger one-time annual technology invoices, Professional Services invoices. we had a little bit of that in Q1 where that ticked up, but you should see that kind of move around as those get collected. I wouldn't take too much from it other than we do have a fairly lumpy kind of invoicing model. Got it. We shouldn't read that as a sign of like financial sort of stress on any of your customers' part? No, no, not outsized compared to what we've seen in the last, yeah, couple years. Okay, perfect. Just as a quick follow-up. I know you talked about, and that was very helpful, the details that you gave on the gross margin in the second quarter. Can you just talk about the sort of any particular puts and pulls on the gross margin in the back half of the year, particularly as we think about the technology segment? Yeah, definitely. Yeah, we were pleased to see the technology gross margin tick up a little bit in Q1, so roughly 70% was our performance. We did share in the prepared remarks, Elizabeth, that we anticipate that to be in the high 60s range for the next remaining quarters of 2023. The main drivers of that are primarily that we did have some kinda earlier revenue recognition in Q1 on the technology side than we had forecasted to occur later in the year. Some of that revenue was pulled forward and some of that dropped down to the gross profit level. If you kinda normalize for that Q1 dynamic, we do view our technology gross margins as in that high sixties range, which has ticked up from a couple years ago, but is kinda consistent with what we've shared the last couple quarters. Got it. Perfect. Thank you so much. Thanks, Elizabeth. Our next question comes from Stephanie Davis with SVB Securities. Your line is open. Hey, guys. This is Anna Kruszenski on for Stephanie. Thank you for taking our question. Congrats on the quarter. I'd first love to hear more about how the tech-enabled outsourcing timeline you're shaping up. Dan, you said that you're still expecting about a 12-month sales cycle for these deals, but curious if there's any potential to accelerate that given the Allina win in one case. Yeah. Thank you, Anna, for the question. We do see a kind of a spectrum of ways in which these things play out, but we're still limited in terms of the number of data points that we have. When we look at the data that we have thus far, it does average around that one year timeframe. On one hand, from a tailwind perspective, as it relates to the timeline, you know, these are existing clients in most cases where we have a deep relationship and there's a lot of trust. On the other hand, there's a lot of complexity, this affects, you know, individual people's lives. It's changing who their employer is in many cases. These are very large contracts in a number of cases. That often takes a little bit more of an approval process. Sometimes it goes up to the board. You know, one of the benefits I think of this kind of a model is our opportunity, my opportunity to get to know, you know, C-suite executives and even board members as part of these expansion discussions. That takes some time. What we have found is it's worth the time. It's worth not rushing these things in order to really set things up for success. You know, a lot of what we've also described when we set up these technical services relationships is that they're long term. They're often five-year contracts and renewable for five years. We wanna make sure that everyone feels really good about the structure, and sometimes that takes a little bit longer. In the context of the long-term relationship, it's worth it. That's where we've tried to kinda optimize for all the most important factors, even when, you know, sometimes we wish we could go a little bit faster. In the context of the long-term relationship, it's worth taking a little bit more time. Got it. That's helpful. Thank you for that color. If I could do a quick follow-up. Also curious about the sizing and rollout of the Sea Mar win, and should we be thinking about this as a potential strategy shift into expanding into the ambulatory space? Thank you for that question. We are excited about the work that we're able to do in the ambulatory space. We view that, you know, as a major trend, if you think about the next five or 10 years in healthcare delivery is such an important part of the delivery ecosystem. We're excited about any opportunity for us to do more in an ambulatory setting. We do believe that there's a lot to add, a lot of value to add within the ambulatory setting. Whether it's with, you know, standalone providers that only focus in that ambulatory setting or if it's with a larger health system that has a meaningful ambulatory footprint. Increasingly, most health systems are trying to increase their ambulatory footprint. We're trying to be a great partner in increasing our offerings and our focus in that ambulatory setting as well. We believe that it incorporates both technology that we can offer to improve ambulatory performance, operational performance, pop health performance, and it involves expertise and services, could even involve Tech-Enabled Managed Services in the future as well. We're really excited about the work that we're gonna do with Sea Mar. We're excited about continuing expanding work in the ambulatory setting that we're seeing across many of our other clients. Just to add to that. In terms of the size of the relationship, given the nature of the client, it is a little bit of a smaller relationship as compared to a DOS agreement with a large health system, for example, given the nature of this client. But it includes our Data Platform, our self-service analytics components. As Dan mentioned, we found that our Data Platform continues to be highly relevant for ambulatory systems like this, as well as for health systems who have an ambulatory component, because it often involves, you know, a variety of EMRs and a real data integration workflow that we excel at and can find value in. We're encouraged by that as well. That's great to hear. Thanks again. Thanks, Anna. Our next question comes from Richard Close with Canaccord Genuity. Your line is open. Yes. Thanks for the questions. Congratulations. Bryan, I was wondering if you could walk through the second quarter revenue range, maybe the low end and the high end, what gets you to each. It seems a little bit wide, relatively speaking, you know, when you compare it to the annual number. Just any help there would be great. Absolutely. Yeah, thanks, Richard. The dynamic that we're seeing there in Q2 primarily relates to what we saw in Q1, which as I mentioned was some pull forward on the technology and on the Professional Services side of revenues that we had previously forecasted a little later in the year. When you adjust for that and normalize for that, the Q2 number would've been a little higher and our year-over-year growth rates and the like a little bit higher. What we were trying to think through, Richard, on the sizing of the range, actually relates to that as well, where while the vast majority of our revenue recognition is recurring in nature, occasionally, in a given quarter, we do have some pull forward of non-recurring items on the services side or technology go lives that can have a deferred revenue catch up. We wanted to be cognizant of that in terms of informing our range for Q2. The other driver of the range can be timing of deal signing. If we have an expansion contract or new contract that occurs a little early in the quarter, that can drive some upside. I would point to kind of the midpoint of the range as a good proxy for what we're expecting, and then again, kind of the dynamic around some of that pull forward in Q1. Overall, we're encouraged by the performance and the overall increase in visibility that we have for the remainder of the year. Okay. Just as a follow-up on that visibility, can you just remind us, what percentage of the, you know, call it the annual number is recurring in nature or the highly visible revenue? Yeah. It's typically a little north of 90% in a given year. It's under contract and kinda in recurring revenue models. Great. Thanks. Thank you. Thanks, Richard. Our next question comes from Daniel Grosslight with Citi. Your line is open. Hi. Thanks for taking the question. You mentioned that lower tech dollar-based retention continues to be driven by modular churn of some of those more clinically focused modulars. I'm curious, given continued health system pressures, are you seeing any pushback from DOS enterprise clients on the automatic escalators each year? Have you changed the quantum of those escalators in recent contracting? Yeah, thanks for the question, Daniel. I think you've highlighted the tailwind and the headwind as it relates to tech dollar-based retention. I think on the headwind side, we have, as we've shared today and in prior quarters, seen some of that somewhat elevated churn in those more modular client relationships, smaller client relationships, even some of our smaller DOS client relationships that are more modular in nature. That's definitely a headwind that we believe will persist for a few more quarters at a little bit somewhat elevated levels. We, we do believe that will come down over time, and so we'll see some benefit from that as the financial pressure on these health systems subside over time. The tailwind, the help that we continue to see is, you know, most of our, of our contracts are more in that enterprise, more like an all-access, kind of tech relationship with our clients. Those do have those built-in escalators, and those escalators continue to help us as a tailwind as it relates to our dollar-based retention. Those, there are definitely tailwinds and headwinds that are combining together to kind of come up with an overall tech dollar-based retention for 2023. A little more pressure on that because of those near-term, headwinds, in the near to mid-term that should subside over time, though. To Dan's point, Daniel, we also shared that we expect our Professional Services dollar-based retention rate to be higher than technology this year. Also that's what drives more of the kind of variation in the range that we provided as those Tech-Enabled Managed Services contracts can be quite large and significant and really impact that range, and a little more lumpy and large in nature. The benefit there is that we're often, to Dan's comments, locking in and renewing a more enterprise relationship over a longer fixed term. That benefits us on the technology side as well as we migrate more of those clients to that model. Got it. It sounds like no real pressure on the escalators themselves. Just a quick housekeeping question. There is an $11.7 million of litigation expenses that you generally don't see. I'm just curious what's driving that charge this quarter. Yes. We disclosed in the Form 10-K. You'll also see some further detail in the Form 10-Q that we'll be filing shortly. A summary description of that litigation, which includes, you know, a large portion of that $11.7 million is an accrual. A small portion of that is actual outside legal expenses in preparation for that matter. We'd refer you to the Form 10-Q for a little bit more detail on that. Got it. Thank you. Thanks, Daniel. Our next question comes from John Ransom with Raymond James. Your line is open. Hey, good evening. I was wondering if there was an update on your LifePoint onboarding. Thanks. Yeah, absolutely, John. We continue to be pleased with the execution against that relationship. That is a relationship, as we've shared previously, where we are leveraging the cloud native Data Platform capabilities and components that are enabling this very large health system with a very complex data environment to be in a position to understand the opportunities for improvement clinically, financially, operationally, and then work with our teams to execute against those. This will take time, as it always does with all of our clients. It's hard to change. It's hard to produce massive measurable improvement. We're encouraged by the work that we're doing together. They're a great partner. We're encouraged that we will see over time some really meaningful results that come through that shared work. We're pleased with that relationship. As with all relationships, there are many challenges in a very complex data environment. As you know, LifePoint is a very large health system. It's a very heterogeneous data environment with multiple EMRs, multiple other data sources, a very complex data environment. We're grateful to be an important partner there in understanding that data, getting it into a single source of truth, and then using the data and analytics to guide where we prioritize our improvement efforts. Great. My follow-up would be, I mean, just given what I would assume to be the, you know, reset evaluations among the smaller HIT, you know, point solutions, is given your cash hoard and given the environment, is there a way to think about that opportunity? Is it more than 50% or less than 50% likely that you might go shopping for some other point solutions to augment your already pretty comprehensive suite of solutions? Yeah. Thanks for the question, John. It is an interesting environment, that's for sure, in the public markets and in the private markets. we continue to, you know, keep our ear to the ground, keep our eyes open. we also are informed by the size of the growth opportunity organically that's available to us, especially with our existing clients. I think we're really excited about really large expansions that we've recently announced with our existing clients, and we see a really large pipeline of opportunity for growth. Uh, organically with our existing clients. We also see that as you mentioned, John, we have a meaningful existing portfolio that offers a lot of advantages, so many of our clients are not yet fully taking advantage of the portfolio that we have. I think our prioritized focus is to keep growing organically. We see, you know, really meaningful 20%+ long-term organic growth possibilities for us that we're excited to run against. That's obviously, you know, very capital efficient as well. I think we're tuned into that. We're shareholders as well, myself included, we wanna make sure that we're creating great shareholder value, and we're excited about the growth possibilities that are before us from organic growth perspective. That's our priority for right now. If I could test your considerable patience, one more. You know, stock comp is something that's bubbling up as a little bit more of an issue. Could you speak perhaps to the longer term view of how stock comp will relate to your Adjusted EBITDA? Thanks. Yeah. I'm happy to share a few thoughts, and then Bryan, please add as well. You may have noted, John, that our Q1 stock comp as a% of revenue has come down meaningfully from where it was last year. We have spoken at a high level that we expect continued leverage in stock comp as a% of revenue in the months and years ahead as a company. As we look longer term, for other companies as they mature and grow in their profile, that we would also expect to see meaningful leverage, likely to see that stock-based comp over time migrate to the mid to high single digits as a% of revenue. That will take time. We're certainly on that path, demonstrating some leverage starting, you know, this last quarter in Q1. Thanks so much. Our next question comes from Sean Dodge with RBC Capital Markets. Your line is open. Hey, good afternoon. This is Thomas Kelliher on for Sean. Thanks for taking the questions. You do start to have more of these tech-enabled service offerings, and I appreciate that you can use your own tech and automation capabilities. As you grow this part of the business a little more quickly, are there any limitations to sort of how fast you can scale? Are you able to kinda leverage offshore resources for any part of these services if needed? Yeah. Thanks for the questions, Thomas. One interesting element of these Tech-Enabled Managed Services opportunities that scales well is the fact that in most of these cases, we're rebadging existing team members. They're already performing the functions that our clients are gonna be relying on us to perform. As a starting point, we just ask them to keep doing what they're doing. Over time, we leverage more and more technology to automate processes that might have been manual in the past and deliver more efficiencies and more speed. It scales quite well in the sense that the team already exists in most cases. Not in every case. In some cases, we're building out the team. In most cases, the team already exists, and they're being rebadged. In that sense, this scales quite well. I think there is a sense in which we wanna make sure from a quality perspective and a delivery perspective that we're outstanding, and that every one of our clients that chooses us for Tech-Enabled Managed Services will continue to be a reference for us. We're mindful of that, but we've been encouraged to see that business growing rapidly. Historically, we've been able to absorb that growth and continue at a high level from an execution perspective. We do have a model that doesn't primarily rely on offshoring, and that is actually one of the value propositions of choosing Health Catalyst. We keep team members locally forward deployed. Often our clients really care about those teammates. They've worked together with them for many, many years in a number of cases. The prospect of them keeping their jobs and continuing to focus on the mission that they care so much about in supporting this health system client is an important component of Health Catalyst's value proposition that we can do that and still offer cost savings primarily through tech. We are, as a company, pursuing various initiatives that involve global delivery, and we'll continue to pursue those initiatives. There may be some cases where we find that global delivery can help us in different aspects of our business. That could include Tech-Enabled Managed Services. We would make sure that our clients are supportive of that is something that will work well for our clients. That isn't today currently a primary component of our Tech-Enabled Managed Services offering. To Dan's point, Thomas, we do have a global team member base that's focused on, in particular, two areas. One is support of the technology, and the other is implementation of data and the technology. That fits well in terms of faster implementation cycles to get to that initial ROI and those savings a little more quickly as we deploy our technology across DOS clients as well as our Tech-Enabled Managed Services clients. We'll continue to invest in those areas as well. All right. Perfect. I'll leave it there. Thanks, guys. Thank you. Our next question comes from David Larsen with BTIG. Your line is open. Hi. Can you talk a little bit about Carle Health, INTEGRIS Health, and Allina Health? When do those roll on to the P&L? Then one of the, I guess, concerns I might have is when we've seen large revenue cycle deals in the past where, you know, a vendor is helping collect cash and they're earning a% of fees, eventually the hospital system wants to insource that. Dan, I think you've mentioned a couple times you're actually improving cost trend for these clients. Just any color around this would be very helpful. Thanks very much. Yeah, absolutely, David. As it relates to your first question, typically, as we sign these relationships and we begin, you know, with the rebadging process, from a services perspective, that's the first month where we start recognizing revenue, and that occurs monthly. If there's a tech expansion component to that, there's sometimes some specific deliverables that need to be in place for the tech revenue recognition to occur. Usually in that first month when the team members have been rebadged, that's when the revenue recognition occurs. I'll pause on that first question, Bryan, anything to add? For example, Carle signing at the end of 2022 has contributed in Q1 to the revenue dynamic. INTEGRIS, more in Q2. Allina, kind of late Q2, early Q3. That's kind of the rough cadence. Great. On the second question, as it relates to the structure of our relationships compared to maybe some rev cycle type relationships, there are some differences in the way that we structure our relationships. First of all, I think ours are a little bit simpler in their construct in that in most cases, we're typically offering some cost savings as part of that rebadge process, usually in the first nine months or so. It depends on how the health system client wants that cost savings to be manifested. Sometimes clients need it in that year that we're in, we focus more on delivering those cost savings, you know, within that calendar year as an example. Others want the certainty of knowing that there's cost savings built over time over the next five years, and they have really good visibility, and it's locked in, and they know exactly what it will be. We're open to a couple different models there. Fundamentally, those health systems are realizing cost savings as a result of working with Health Catalyst. As Bryan mentioned, sometimes there's a shared success component. There's a shared success, shared bonus that we might share in together in some cases. In a lot of cases, we're just focused on delivering well, and the contractual component is a cost savings component. What we've seen over time is as we deliver in an excellent way at extraordinary levels over time, that our clients are very happy to have Health Catalyst continue to manage the teams that are delivering. As we deploy technologies that enable automation to occur and for the solution to be better, faster, and cheaper, that has also led to our clients choosing to continue long term in that relationship. There's the contractual component, which is typically a five-year relationship that the client is committed to, that then, you know, they can renew over time. We've seen, you know, our clients have been interested in continuing and that's been more the rule rather than any sort of insourcing. Okay, great. Thanks very much. Then the dollar-based retention rate is still 102%-110% for the year and low double-digit DOS adds for the year for fiscal 2023. Is that correct? Any color on that now that we're halfway through the year? That's still, correct. We reiterated that full year guidance. Okay. Okay, thanks very much. I guess just the last one I had was there's been some discussions around, you know, your relationship with Snowflake and migrating to Snowflake-like solutions. I'm assuming that that has been in process for a couple of years. Is that correct? You basically progress at the pace that the client wants to progress at. Is that right? That's right, David. We have a few clients that are leveraging, you know, Snowflake capabilities, Databricks capabilities, other new technologies and capabilities and we continue to make that an option for our clients as we talk about the long-term migration path for them. As we've mentioned in previous quarters, what we found, especially over the last 10 months or so, inclusive of my 130 or so face-to-face discussions with clients, the vast majority of our clients are focused a lot more on how can we save money, how can we reduce the financial pressure, and let's focus on that right now, as opposed to, you know, scaling up new technology productivity capabilities, which do sometimes have an ROI but require some investment upfront, before you get that ROI. That's harder for most of our health systems to do. So to your point, we kind of follow their lead as it relates to what's most important to them, and in the vast majority of cases, they've been more focused on how can we deliver cost savings sooner. In terms of the financial component of that, Dave, we have, as we've shared these mid and long term profitability targets embedded the investment that we're making in the Snowflake and Databricks capabilities into our R&D and cash flow targets. We feel comfortable there as we work through that investment. As well as we've embedded some of that into our gross margin color on the technology gross margin side. There is some parallel cost processing on technology as we go through that migration over the next two or three years. There's also long-term upside in terms of scalability and elasticity of that platform driving efficiencies in our support and delivery costs and hosting moving forward as well. Okay, great. Thank you. Thanks, David. Our next question comes from Jack Wallace with Guggenheim Securities. Your line is open. Hey, thanks for taking my questions. Just wanted to talk about the TEMS pipeline a little bit and just stepping back here. You've announced the several large expansions over the last couple of quarters. Just wondering how those announcements have impacted your discussions with your existing and potentially some new customers for a TEMS relationship or your even expansion. Yeah. Thank you, Jack, for the question. They definitely help and, you know, they increase interest in our other existing clients. In particular, I would say most of our pipeline and most of our conversations that are leading towards, you know, expansion opportunities are with our existing clients where we have those relationships. There are a few where even prospective clients are interested in finding out a little bit more about technical managed services. They definitely help and this gets back to something I shared earlier. We are very focused at Health Catalyst as we sign each one of these contracts to make sure we deliver really well because this healthcare community is a small community. we all know each other and so it's critical for us to make sure that we're delivering really well, and then that'll keep opening up additional opportunities. Thank you. That's helpful. Then just wanted to ask a follow-up on an earlier question around the services revenue progression just over the last couple of quarters here and with the guidance for 2Q. My understanding was that, you know, Carle was a meaningful or at least a good chunk of the, what's called the ARR was hitting in the first quarter, and you realized there were some pull forwards also impacting the services line. I'm just thinking about the second quarter guidance, with a, you know, couple of go lives expected there as well. You know, what would, you know, why would that or I guess, what would be the conditions or the factors that would you make that a potential sequential down quarter on that line? is there attrition there, other one-time items that weren't called out or, are we just maybe, thinking that some of the are not going to contribute in excess of the one-time items in the first? Yeah, good question, Jack. You cut out a little bit, but I got the gist of it. Yeah, the Q2 commentary that we made in the prepared remarks for services was that we'd expect to be flat to slightly down compared to Q1 on the services line item. That's mainly to your point, driven by the non-recurring items that were projects that we completed a little earlier than expected in our initial forecast, which is generally a good thing. Like, we want to complete those as quickly as possible. We just don't yet anticipate that we backfill at that level in terms of Q2 or the full year guidance range. That's the main dynamic. There are other drivers that you mentioned and that we'd called out, which are, we have that continued somewhat elevated churn on our traditional consulting services model, and that's persisted in Q1 and Q2. Like we shared, we anticipate that, you know, for the next few quarters. Also we've shared that our bookings cadence is a little more back-end weighted, more toward the back half of the year. You should start to see more growth as those start to come online. We've not yet kind of included that in Q2, just given the timing of those will likely be later in the year. Got you. That's helpful. Thank you. I appreciate it. Yeah. Our next question comes from Scott Schoenhaus with KeyBanc. Your line is open. Hi, team. Thanks for the questions. It seems like you're getting nice operating leverage in sales and marketing after divesting your life sciences division. Is this more of a function of the higher proportion of upsells you're seeing from existing clients, rather than new client wins? Is this something that we should just expect in terms of ongoing sales and marketing efficiencies on a go-forward basis? Yeah, great question, Scott. I think it's yes to both actually, that it is 'cause we're seeing meaningful operating leverage as we focus a little bit more of our selling efforts on existing client expansion. It's yes to the second in terms of expecting that long term, because I think more and more over the next several years, the foundation of our growth as a company will come primarily from existing clients expanding with us. That's a higher leverage model. It's a lower cost model. As we've discussed in the past, you know, the Carle Health expansion is a great example where they quadrupled the size of their relationship and We still have one account manager there that is able to represent the entirety of the relationship between Health Catalyst and Carle Health. So there's tremendous operating leverage in these deep multifaceted relationships, and we see, you know, incredible growth opportunity there. So we're focused there. We also realize that having that operating leverage is an important component of this model really working. So we do have that mindset moving forward with respect to sales and marketing and frankly, that mindset going forward in the coming years across all our OpEx expense categories. That we're thinking in terms of meaningful operating leverage, enabling us to get to those, you know, 20%+ long-term EBITDA margins that we've talked about in the past. Thanks. That's really helpful. Lastly, have you seen any changes in your conversion timeframes from DOS Lite to full DOS customers? Are you expecting to be able to sell like full DOS solutions initially like the Sea Mar contract without having to first sort of sell the more DOS Lite offering? Yeah, another good question. I think one of the trends that we're seeing is as we mentioned in our prepared remarks, that with regards to prospective clients, you know, they are under financial pressure, and it's more doable for them to start at a lower price point. We are moving towards more of a modular relationship there. We're focused on modules that deliver near-term ROI, which I think increases the likelihood that we can expand the relationship over time. Whereas, you know, historically, you know, one or two, three years ago, I think we were open to beginning the relationship in lots of modular ways. Now we're pretty focused on those first modules delivering a real near-term hard dollar ROI. Our anticipation is that as we deliver with those clients, that there will be more of an openness to expand and deliver more ROI through that expanded relationship. We are hopeful that that will take place, but we still recognize that it's, you know, there's a lot of financial pressure that these health systems are under, and so we've got to be sensitive to that. Thank you. Thanks, Scott. Yeah. Our next question comes from Stan Berenshteyn with Wells Fargo Securities. Your line is open. Hi. Thanks for taking my questions. You continue to see dollar-based retention in a pretty wide range. When do you expect to get some better visibility into where that retention will shake out in the year? Yeah, good question. I think we think about that, Stan, first of all as an acknowledgment that within our pipeline, we do have some larger opportunities, and those include Tech-Enabled Managed Services opportunities, and those tend to be a little bit lumpier and a little bit harder to precisely forecast. As we mentioned also in our prepared remarks, you know, we do expect our bookings to be a little bit more back-half weighted this year than in historical years for a couple of reasons that we described, inclusive of us really beginning to proactively discuss things like Tech-Enabled Managed Services starting in the back half of last year. Our observation that it's typically, you know, around a one-year sales cycle for us to sign those contracts. I think as we sign more of those larger contracts and get a little bit more visibility, we may be in a position to narrow that range. We don't feel like we're in that position today, but we'll kind of keep you apprised and updated as the year progresses. One other thing that we mentioned in the prepared remarks, based on the size and shape and profile of the pipeline, we do anticipate that it's likely this year that our Professional Services dollar-based retention will be a little on the higher end, higher than maybe the average. The tech component will be a little bit lower than the average, blend together to that 102%-110% range. We'll see as the year progresses if we can tighten that range as we get a little bit more visibility into signed contracts, especially some of the larger ones. Got it. Maybe just a quick one on the cash flow statement. I think capitalized software in the quarter was about 25% below where you had an average run rate last year. I mean, it's $1 million, but still pretty noticeable. Where are you saving on CapEx, and how should we be thinking about the progression going forward? Yeah, great question. That has ticked down a little bit to your point from kind of prior year levels in terms of CapEx and investing in internal use software that we're capitalizing. That's kind of stemming from some of the cost savings and cost trimming efforts that we did primarily last year. Most of those impacted our SG&A line items, but to some degree, R&D as well. We do anticipate that run rate to continue through 2023. The bulk of the investments that we're making in R&D in this line item are related to the Snowflake and Databricks enablement and some standardization components of our Data Platform. Those will continue and then begin to ramp down in 2024. That's the current expectation, but that does give us more visibility in terms of efficiencies that we can drive in our operating leverage and in our cash flow as we march toward the 10% midterm EBITDA target for 2025, as well as our free cash flow contribution in 2025. Got it. Thanks so much. Thanks, Dan. Yeah. Our next question comes from Jeff Garro with Stephens. Your line is open. Hi. Good afternoon. Thanks for taking the question. Was hoping to get some more color on where Tech-Enabled Managed Services could expand beyond chart ex-abstraction? I'll frame it that, you know, I think in theory, Health Catalyst could manage the entire IT operation of a health system, but it sounds like you recognize some potential pitfalls in doing that. In expanding Tech-Enabled Managed Services, how would you balance the expertise related to all the systems and data sources that feed into DOS against that healthy desire to have some real tech enablement of any outsourced services? Great question, Jeff, and it's one that keeps me up at night in a good way. It is exciting when we have a client that asks us to maybe look into a new area. As you mentioned, we do have a lot of experience with Tech-Enabled Managed Services around chart abstraction, with Tech-Enabled Managed Services around data management and analytics. We've done that a lot, and I think we continue to see really meaningful growth opportunities in those two anchor areas. I think some other areas, like was mentioned earlier in the call, there's so much going on in the ambulatory space that's so important. You know, there's a lot of operational components to delivery in the ambulatory space that may have room for improvement. And so that could be an area where Health Catalyst, you know, works with health system clients and other clients that wanna really focus on the performance in that space. I think to your point, in other areas that require meaningful data and analytics to guide the activities of other corporate functions, could be other areas where we can leverage technology that we already have. You know, we have some technology that we referenced in the prepared remarks that delivers in some of the rev cycle areas, some other technology that delivers more IT efficiency. We have some technology assets. We have some clients that are asking us about, you know, a list of other potential areas. To your point, we realize that we need to make sure that we're convinced that we can be a differentiated long-term partner and really deliver for our clients before we move into one of these new adjacent areas. We're excited about the areas where we have experience and we have a track record. So that'll continue to be a primary focus, but we also wanna help our clients be successful. If they need us to go in a new direction in an adjacent area, you know, we're certainly open to at least exploring it. Great. That was super helpful. All from me. Thanks again. Thanks, Jeff. It appears we have no further questions at this time. I'll turn the floor back to Dan Burton for any additional or closing remarks. All right. Thank you all for your continued interest and involvement with Health Catalyst. We look forward to staying in touch in the months and quarters ahead. Take care. This concludes today's Health Catalyst first quarter 2023 earnings conference call. Please disconnect your line and have a wonderful day.