Morning. Ready? Great. Good morning. My name is Lisa Gill. I'm the Healthcare Services Analyst with JPMorgan. Sorry, it's Tuesday morning. We have with us this morning LifeStance Health. With us this morning is Danish Qureshi. Qureshi, as well as Ken Burdick. After we go through their presentation, we will do a quick little fireside chat here at the front of the room. With that, let me turn over to you, Danish. Thank you. First let me start out by making clear that we may make forward-looking statements during this discussion today. As part of that, this slide covers some of the related disclaimers. LifeStance Health is a leader in the outpatient mental health sector. We founded the company in 2017, really with a mission to increase access to trusted, affordable, and personalized mental health care. Long term, our vision is a truly healthy society where mental and physical health care is unified to make lives better. There's four things that really differentiate LifeStance in the marketplace that I wanted to cover. First is that LifeStance is a leading national platform with unmatched scale. By the numbers, what that means, if you look at Q3 of 2022, we employed over 5,400 clinicians. We generated trailing twelve revenue of $820 million, positive adjusted EBITDA of $54 million, and operated over 600 physical locations in addition to a very heavy telemedicine component. The second key thing that differentiates LifeStance in the marketplace is our multidisciplinary clinician model, which means that we employ, and the key word there is employ, clinicians, across the full spectrum of psychiatrists, nurse practitioners, psychologists, and licensed therapists. The third area that differentiates LifeStance is our tech-enabled platform, which is really built to support our hybrid delivery of care, which means if you're a patient, you can receive care both in person, again, at one of our 600 physical locations or online through our telemedicine platform. The fourth key differentiator of LifeStance is the fact that we operate on an in-network, commercially insured basis, which cuts to the heart of our mission of increasing access to affordable mental health care. As you look at LifeStance, we have been on a unbelievable growth trajectory since the beginning of the company. Again, founded in 2017, we have grown over the past six years to over $800 million in revenue and over 5,000 clinicians. Importantly, we now have presence in 34 states, which gives us access to 90% of the U.S. population. If you are a patient living in any one of these states, again, 90% of the U.S. population has access either in person within driving distance of one of our 600 locations or online in through our telemedicine platform, which is really unmatched in the industry as far as scale goes. As we look forward to the future, we'll continue to focus on our key priorities of increasing the size of our clinician base through organic recruiting engine, as well as an increased focus on productivity, which means making sure that we are utilizing the time that clinicians give us in the best way possible, reducing administrative time, reducing cancellation rates, and better matching our clinicians with patients that are looking for their specific subspecialty of care. Despite LifeStance being a leader in the market, the reality is this is a significant market opportunity. Today, there are over 50 million patients in the US with a mental health issue that a LifeStance Health clinician could address. What that equates to is a total addressable market over $100 billion. That market is growing at double-digit rates, and that's really driven by, one, a reduction of stigma related to patients seeking care. Two is an increased level of awareness of the importance of mental health care to overall health. Three is both regulatory and reimbursement tailwinds across the industry. LifeStance is really uniquely positioned as a scaled player in this marketplace to take advantage of this large market that again, we have just scratched the surface on. We were really founded to solve four key challenges in the marketplace. One is a lack of access to care that overall increases the disease burden on society. Two is a lack of affordability, meaning that even if a patient can find access to care, the reality is the majority of the market remains highly fragmented and is operates on a cash pay basis only. The third is a lack of scale and organization that really leads to clinician burnout and turnover amongst smaller practice groups. The fourth is a lack of care coordination, which ultimately leads to poorer outcomes and high cost of care. The way that we solve these challenges are through our hybrid model of care, which lowers the barrier for patients to get access, meaning that, again, you can go to one of our physical locations anywhere in the country, or if you want, you can receive care online, whichever is easier, more convenient, less of a burden for you as the patient. We also have invested through our online platform in a data-driven approach to matching patients with the appropriate clinicians to ensure that from the very first visit, you are paired with a clinician that is the right fit for your specific diagnosis. The other way that we tackle the affordability problem, as I mentioned before, is we operate on a 100% in-network basis with commercial insurance. Our patients are able to use their medical benefits that they are paying for through their monthly premiums, and do not have to go out-of-pocket in a cash pay environment, which is what the majority of the industry operates as. Our culture of clinical collaboration and the use of our digital tools to help reduce administrative burden on our clinicians helps to take advantage of the scale that we have generated and make this the optimal place for clinicians to be employed. Finally, our multidisciplinary team of mental health clinicians and our coordination with primary care physicians helps increase outcomes and reduce costs to the overall system. With that, I'll pass it over to Ken. Well, that was impressive, Danish. Danish just covered six years in six minutes. I'll see if I can be as concise. Good morning, everybody. I'm Ken Burdick, I'm the newcomer at LifeStance. I've been on board for four months. My two colleagues that you see were both here from day one. It's an incredible story. I'm gonna spend more time talking about going forward. Before I do that, in a highly fragmented space, Danish, as the Chief Growth Officer, and Kevin, as our Business Development Lead, have really built something that's incredibly unique, 5,400+ clinicians in an industry where 95% are independent practitioners. Now that we have that size and scale, we're sort of moving into chapter two. One thing I want to mention at the outset is, our CFO is not here, and just so there's no speculation, he has a detached retina. Dave Bourdon can't fly. I suggested he take a train. He wasn't crazy about that idea, but we're thrilled to have Dave on board. He comes with 20 years of deep healthcare experience with public companies. The story of building this scale, about 40% through acquisitions, about 60% through organic growth, meaning literally, Kevin's seen one clinician at a time through a very powerful recruiting engine. As I come on board, I sort of see a company that has done a phenomenal job growing. Our challenge now is that we've actually sort of exceeded the infrastructure, and not just the infrastructure for today's growth, but certainly the infrastructure as we think about the opportunity ahead of us. I believe that we're about 1% share, so even though we're large, there's so much white space. It's, it's incredibly exciting. For the next couple of years, this middle column, it's a lot of blocking and tackling because we have to translate this size and scale into something that's highly valued by all the constituents, starting with our patients, then our clinicians, then the payers that we contract with, and obviously, our investors. While it's not particularly sexy, what you're gonna be hearing much more of from LifeStance is the things that we are doing to drive, first, a scalable platform, focus on end-to-end process improvement, some simplification, and I'll give you an example of that, and standardization. Once we do all those things, which again is just rolling up your sleeves, then we can start to bring automation to bear on some of our core administrative processes. All that work is gonna take place roughly in the next 18-24 months. Pleased to say that well before I started, Danish moved from the Chief Growth Officer to the Chief Operating Officer right about the middle of the year, and he started this track of, okay, we've now achieved the scale. We've gotta improve our operational performance and strengthen our infrastructure. There was a head start, certainly before I arrived. What we're really positioning this company for is, as we build out and fortify that foundation, we will then set ourselves up for the next big growth run, because there's so much runway ahead of us that we wanna be prepared for that. If I think about the next couple of years, in addition to the blocking and tackling that I referenced, one of the things that I'm excited about is the work that we're gonna do to establish a more strategic relationship with payers. I spent 40 something years in the payer space, so I know that space reasonably well. We have hundreds and hundreds of payer contracts, which surprised me when I arrived. We're gonna pare that down. When I said that on the Q3 earnings call, what I didn't clarify is that we can pare that down and have a very minimal impact on total visits. Let me make that abundantly clear this morning. The bottom 50% of our payers represent 5.7% of our visits. We're not talking about paring down by 50%, and certainly not anytime soon, but the point is, we can simplify our business by not trying to administer all those contracts, where so many of them, I mean, literally, more than 100, have a de minimis number of visits attached to them. There are ways to simplify and standardize that will absolutely not get in the way of the patient's experience and the clinician's experience. One of the things that is exciting that really is now in flight, so it's not like you have to wait two years before you start seeing exciting things coming from LifeStance. Since Kevin leads it, I'm gonna ask Kevin through the Q&A to reference this. You could call it PCP partnerships. You could call it collaborative care. We tend to call it integrated behavioral health. We are really excited about this opportunity we have to align and partner with large primary care practices so that patients are really getting holistic care. Having been in healthcare for 40 years, I can tell you as an insurer, for the first 30 years, I didn't get it, and most insurers didn't get it. What we didn't understand is we looked at our costs, and we saw all these physical costs, you know, cardiac care and lungs and orthopedics, et cetera. Then we looked at the behavioral spend, and it really wasn't that significant. Quite honestly, we didn't spend a ton of time on it. We've now come to realize, and I realized it mostly when I started working with a Medicaid population, is that you can't manage somebody's physical chronic conditions if simultaneously you aren't managing their mental health conditions. The comorbidity, so the presence of both in the population is about 30-35. In Medicaid, it was about 40%. It's highly prevalent. Now insurers, you probably hear many of them talking about the importance of behavioral health. That's for two reasons. They recognize that to optimize total cost of care, you do have to make sure you're paying attention to chronic mental health needs. Number two, they're struggling with access issues, as Danish referenced. The employers, their customers are saying, "You don't have a sufficient network." We're really well-positioned to address that issue. I wish we could fast-forward to three years from now, because three years from now, when we've done that hard work, that heavy lifting, that's when we can really take this size and scale and data and create true differentiation and optimization. What excites me about that is that the data and the analytics that we will be able to provide can, for maybe the first time in the mental health space, really start to support the value proposition with patients, with payers, et cetera. You'll have to hold and be a little bit patient until then, but I'm looking forward to that stage. In terms of this exhibit, there's really just one thing that I think is important, and that is what's bolded here. We have no plans near term for either a debt or equity raise. We are gonna operate with a significant amount of discipline as it relates to capital deployment. What do I mean by that? A company that has grown about 40% through acquisitions, we are going to dramatically reduce our M&A at least for the next year. While that will certainly have a positive impact on capital deployment, we're actually doing that more because during this reset period where we really wanna get our arms around what we've already grown, we'll beef up the organic engine recruiting one clinician at a time. As you probably understand, when you start doing M&A, every acquisition brings its own flavor, its own variation. In the process of standardizing what we already have, we're not gonna keep adding to the variation. Once we've gone through that, we will regen that engine that Kevin has built and does so well. For 2023, you should expect to see far, far less acquisition activity than you have historically. I wish I could say it was more exciting, but when I think about the next two years, I think about operational discipline, prioritization and focus, clear goals and accountability, which these guys could speak to because I'm a fanatic about that. Strengthening our core capabilities. There are lots of ways that we can expand going forward, but right now we're gonna stick to our knitting: outpatient, hybrid, mental health. There is so much runway that at this point, I say Danish and myself spend a fair amount of our time trying to get everybody to say, "Let's just stick with what we have." Yes, we can go into this new service area. We can treat this new customer segment, but not right now. We just have to strengthen our existing business. In terms of investment highlights, these are the things that I think about. This truly is a very unique company. We have unprecedented patient demand. It's one of the areas that has bipartisan support. Most recent bill out of Congress was very favorable to the mental health space. This is not gonna be a story about quick win. I've worked in large companies all my life, my DNA is just wired for long-term value creation. That's what we're gonna be about. While we are one of the largest, we're not very well known. I had not heard of LifeStance before I was approached with this opportunity. I'm excited about building a national brand where people think about LifeStance as the place to go for outpatient mental health that is affordable, that's personalized, and that uses evidence-based medicine. That will be a journey that we're on, but that journey also starts with creating a consistent experience for our patients. When we take these 86 acquisitions, many of which have been integrated, but there's still some variation in administrative processes. When we standardize that and we can create that consistent patient experience, that will then jumpstart our efforts to create that national brand. It's an exciting future that we have ahead of us. We're thrilled. I'm thrilled to be here. I didn't appreciate how unique this company was, but in the past four months, I've learned, as Danish mentioned, that most of outpatient mental health is self-pay, and that many clinicians don't accept insurance. That was unique to me. I love the mission. I think the model makes a ton of sense, and it's all about execution right now. Thanks for your time. We're gonna now answer some questions. Okay. Thank you very much, and thanks for all the comments. Ken, you kind of started the conversation around, you know, you've only been here for four months, but when we think about LifeStance, can you maybe just talk about what you've seen now that you're on the inside versus your expectations when you took the job four months ago? Sure. Some of that I've referenced. Like I didn't realize how unique the business model was. It just, it had never dawned on me that you had all these clinicians that didn't accept insurance, so you had so many people paying out of pocket. When I think out of pocket, I think about deductibles and co-insurance, and that's it, not paying the full freight. The other thing that I probably should have expected, but I've been pleasantly surprised at, I ran a company called WellCare, and we were focused largely on Medicaid population with some Medicare Advantage. I thought that we were purpose driven, and we were, but as compared to LifeStance, there's really no comparison. Every employee that I have met feels so strongly about the mission. As Danish and I were talking about this morning, many of our employees have had direct experience with the mental health system, so they have a passion about creating greater access. If any of you or any of your loved ones have tried to access the mental healthcare system, you know that typically you're talking about months that you have to wait, not weeks, but months. A lot of out-of-pocket dollars. Yes. That's, that's a huge issue. Let's see. I guess the other thing which I didn't fully expect, and I addressed in my remarks, was up until Danish becoming the Chief Operating Officer, it really was growth, growth. That was the mantra, that was the priority, that was the metrics. Going forward, while growth will continue to be important, it's gonna be a much broader set of metrics that we use. I'll call it a balanced scorecard, and it's gonna have service levels, and it's gonna have retention, and it's gonna have profitability, every bit as important as growth because I think you have to deserve the right to grow. We will do that when we execute up to our capabilities. You know, one of the key differentiators for LifeStance was that kinda hybrid model of, you know, I can come into your office, and I can see a clinician, or I can do it from the comfort of my home. How are you feeling about the competitive landscape today? Is that still a key differentiator in the marketplace? I'm gonna let Kevin take that. Yeah. Got it. Was it Kevin? Okay. Thanks, Lisa. By way of a quick introduction, I'm Chief Development Officer. I joined the company at its inception, about six years ago now. I oversee all of the growth functions, M&A, clinician recruiting, referral marketing and partnerships, and enterprise partnerships. With respect to the competitive landscape, we're still seeing a ton of interest from all of the key stakeholders in behavioral health. That said, we're not seeing any major new entrants in the hybrid space. We think that our physical locations, our payer contracts, our formal and informal relationships with referral sources are a big competitive advantage for us in that space. Then offering both in-person and virtual care for our patients and for our clinicians allows them the flexibility that they're looking for, both in their care as well as in how they wanna work. Kevin, maybe just talk about, you know, where we are on virtual healthcare. I know, like, the plan was to kinda get back to 50/50. It was still much higher than that. Where do you think it is? Well, where is it today, and where do you think it's gonna go? I can tackle that. you know, pre-pandemic, we were running about 5% of our total visits, being virtual, 95% in person. At the peak of the pandemic, it was the inverse. Right now we're running around the high 70s being telemedicine, the remaining being in person, but we are seeing that steadily return. For us, the reality is we're agnostic. We've really built a hybrid model that's meant to be flexible wherever a patient or a clinician wants to receive or deliver care. The only thing that really changes for us is how we drive operating leverage through our real estate footprint, which is something that we spend quite a bit of time on now thinking about how to optimize. you know, we've talked in the past about value-based care and your relationship with primary care doctors. I think you commented about how important mental health is as a component of overall healthcare. Can you maybe just talk about your journey around value-based care? I think you were running some pilots at one point, and the relationships around primary care physicians. Yes. We are running some pilots, I would say none of them at scale. Having spent so much time on the medical side, even though it has been dominant in discussions now for, I don't know, five to seven years, value-based care still is a small minority of the care that's delivered in the United States today. Still largely fee for service, and that's on the medical side. On the mental health side, it's in its infancy. Right now, when we talk to employers and we talk to payers, they would view value-based care if we just said, we're gonna guarantee that somebody can get access to an appointment in two weeks. You know, value sort of in the eyes of the beholder. I do think that over the next several years, with the data that we can bring to bear, we're gonna be able to show reduction in total cost of care, which is what people typically think of. Right with value. That may be the first time that in the mental health space, people are able to really attach an ROI. I have this thesis that one of the reasons why mental health has historically been underfunded is because, you know, unlike a broken leg or a heart ailment that John Corso treats at Tampa General Hospital, it's much more difficult to say, "Yes, because of the work that we've done, this is now fixed." I'm really enthusiastic about what we're gonna be able to do going forward, and part of that's because of this collaborative care. This is really catching on, and it's an exciting development where in some places we actually are co-located with primary care. Once you can start sharing progress notes and treat the whole patient, that's gold. That's really valuable. You know, one of the things that we've talked about, you know, over the last year especially, is just the clinician environment and hiring clinicians. You've called out capacity constraints in recent quarters. You know, you've worked to balance those demands in the marketplace. Can you maybe just talk about what we're seeing today as far as, you know, capacity goes? Has it had any impact on utilization? In particular, like, you know, if clinicians was always the one big metric that we watched, is that still the right metric to watch when we think about growth for the company? Yeah. Why don't I start off by tackling that and maybe Kevin can add in as far as it relates to organic recruiting. You know, our focus right now is ensuring that we really drive two key priorities. One is continued focus on growing our overall clinician base with a heavy shift now towards organic recruiting as the primary driver there. The second piece is productivity, which is made up of capacity, the total time that clinicians are giving us, as well as utilization, so how we are effectively filling that time. The focus over the past kinda six months since I entered into the COO role has really been on the productivity side to ensure that as far as utilization goes, we are minimizing the amount of time lost to administrative tasks, that we are reducing the number of cancellations and no-shows that end up wasting valuable clinician time, as well as ensuring that we are optimizing the amount of time that is being spent seeing patients through our matching algorithm. You've heard me talk about in some of the earnings calls, the rollout of OBI, which is our online booking intake engine. What it really does is ensure that from the very first appointment, our clinicians are matched with the appropriate patients and vice versa, so that there is stickiness, that there is a higher quality of care that's delivered and ultimately, everyone wins in that process. Kevin, do you wanna add on around organic recruiting, what you're seeing? To put what we're doing around the statement about investing in our organic growth team is we've taken a systematic look and review at the journey from first contact with a potential clinician all the way through their first 90 days with us at the company and made significant investments and improvements along the way, starting with the clinician team. Understanding the profile, both professional and personal of what makes a great recruiter, enhancing that team to ensure that we have the right people on the team. Looking by geography, do we have the right number of clinician candidates? If not, optimizing the number of clinician candidates to support the goals. Ensuring that the process, from first touch, from a marketing approach all the way through interview, signing a contract is seamless. Once they've signed a contract, the onboarding process, some of which we have full control over, some of which we don't through credentialing, is as seamless as possible. Once they've started, that we have touch points up until the clinician is full and their schedule is full with patients to their satisfaction. Do you feel like this is helping retention rates as well? Uh- The touch points that you're We believe that it will. Yeah. Just to add, all three of us will take a shot at this question. It's a little bit counterintuitive. There is extraordinary demand for mental health services, Danish referenced that we have a no-show cancellation rate that... I don't... Do we share that number? Yeah. 15%. If you've waited months to get an appointment, it just didn't make sense to me. I think it speaks to there's still some level of stigma. It's clearly changing, but that's something where some of the work that we're doing to standardize and automate and simplify, we're gonna be much more adept at both reducing that no-show cancellation rate and when it occurs, filling that slot. There is a level of logistics that you might not realize as important. I was, I guess, naive enough to think that in a business where the demand so outstripped the supply, there would never be an issue around filling a clinician schedule. There is. You know, Ken, you mentioned less M&A activity, but on the Q3 call, you talked about a strategic shift towards slower de novo openings and even some closures, again, emphasizing profitability. As you assess new locations and existing locations, can you maybe talk about what some of the key metrics are for opening a new location or even closing an existing location? Well, these two guys are much better able to speak to that because that's what they do. I will confirm what you said, though, is that we will moderate the growth, at least for the next year as we strengthen the foundation and get these operational processes in place. We will still do de novo. Do you wanna take the de novo? I think it is worth Danish talking about as we experience the continued prevalence of telehealth visits, we're now looking at our footprint. We got 600 centers. Do we need 600? Probably not. Again, we're not gonna cut it down from 600 to 400, but who knows? There will be a handful or more where we say we just don't need to have a physical location. Longer term, I know I'm taking all your thunder, we take a look at the footprint. Do we need the same footprint that we'd... It's just we're gonna run the business more tightly with an eye toward long-term margin expansion. I mean, maybe let me chime in on the optimization of the footprint, Kevin, to the degree that it affects organic recruiting. You know, across our 600 locations today, we have some that are running on an in-person basis at full capacity. Those are the markets that we'll continue to open and invest in new de novo centers. We have others that, you know, for all intents and purposes, they may be half full, in-person care may not be as maximized as it could be. In the past, when the focus has just been on growth, we've ignored optimization of the footprint. We said we never want physical real estate to be a limiter to growth. This year into the future, we will be very focused on making sure that every exam room is used to its fullest and that we are driving operating leverage inclusive of closing centers that may have enough in that specific MSA, where we don't require a center that has been opened, primarily acquired centers that may be sub-optimized in space or layout. Anything you want to add around organic recruiting? Historically, we had tried to match one clinician per one clinician exam room, and that was a constraint to growth in any one market. As we go forward, that will not be a constraint, and we'll be working to, as Danish mentioned, optimize the use of those, exam rooms through hoteling and other means. One of the near-term headwinds that you've talked about is that to profitable growth is related to investments in the business to actually support that growth. Can you talk about the focus of those investments? Do you expect this level of investment to continue beyond 23? Is this just near term, or is this gonna be a longer-term kind of headwind? I think, it's beyond 2023. Okay. It's probably, think in terms of 24 months. I think 2023 and 2024, we will be heavily investing in all the things that we've referenced this morning. I believe that as we exit 2024, we're gonna be in a great position. We will have made not just the process improvements, but then we will have supported that with automation and new tools, such that I don't see this as a long-term headwind. I think for the next couple years, we have to buckle down, like mention blocking and tackling, and we do need to make some investments in order to do that. Things like OBI that Danish referenced, I mean, there's at least a handful of processes that we know we can dramatically improve when we simplify, standardize, and automate. Ken, just going back to your comments on managed care, that was a really interesting stat. 50% of the contracts only make up 5.7% of the volume. As you think about really calling back on those managed care relationships, will it be market by market? I mean, will you wanna have, like, a national presence, so you have the big national players and then decide by those individual markets? How do we think about how that'll be affected? Yeah. Great question. It, it's actually payer by payer. I mean, to have hundreds of payer contracts and having to load those in and administer them... Yeah. it's a heavy burden. The criteria, as I think about it, would be first volume. Okay. All right? If we have a payer contract and there's three visits a year through that payer contract, that's gonna be on the chopping block. Okay. Volume isn't the only thing. Second, it's a very important issue for us that we get delegated credentialing. Okay. If we don't have delegated credentialing, it can take months and months. Right. If we have a new clinician that we've just recruited, and they're sort of sitting around waiting to get started. Right. That's a problem. That will be a criteria as well. Then reimbursement would be the third criteria, that we look at. I guess beyond reimbursement, just the level of partnership and the ease of doing business with that payer. Again, I'm probably gonna over-index because in the Q3, I did such a poor job of explaining. This will have a de minimis impact on total- Mm-hmm. visit volume. More of a potential cost benefit. Absolutely. from the other side. That's right. As we think about 2023, we think about plan design from health plans and employers that are self-funded, is there anything unique around mental health for 2023? I know that this is a big area of focus, right? Across the country coming out of the pandemic, but are you seeing anything new or different in contracting or plan design? We're not really seeing anything different other than there is clearly a increased focus on mental health benefits from all payers. You see a lot of pressure from employers in increasing the overall benefits and the adequacy of the mental health network- Right. that a payer provides. That's been ongoing for the last kind of five years, the founding of LifeStance. You really see it picking up pace. Some of the regulatory tailwinds as well are clearly working in the overall favor of the market and to LifeStance's advantage as well. Great. We have about a minute left. When we're sitting here together in 2024, what do you feel that investors will appreciate about LifeStance then that they don't necessarily appreciate today? I'll answer this two ways. When we're sitting here in 2024, I think people will be surprised at the strength of our organic recruiting engine. Mm-hmm. When I say we're gonna pull way back on acquisitions and M&A, it could lead people to believe that we're not gonna grow. That's not the case. I think, hopefully, there will be visible signs, very tangible signs, that this operational discipline that I've talked so much about is really starting to bear fruit. Three years from now- Right. I think people will be able to look back and say, "Wow, this notion of unifying physical and mental healthcare is really starting to gain momentum. Mm-hmm. We have these value-based contracts at some level of scale. That to me is we're gonna do the hard work now. Right. so that we can get to that destination. I think collaborative care, we ought to be on the forefront of that, given our size and scale. Well, thank you very much. Thank you everyone for joining us today. I really appreciate it. Thank you. Thank you. I have an 8:15 I have to introduce to all the way downstairs. It was so nice to meet you. Good to see you. Good to meet you.