Hi, everybody. I'm Elizabeth Anderson, Technology Distribution Analyst, here at Evercore. Very pleased to be joined by Lee Rivas, the CEO, Evan Smith, IR, and Jennifer as well, CFO of R1. Maybe in terms of just to sort of place to start, where are we in terms of, like, broader demand for sort of the traditional transition to outsourced RCM solutions? Like, you know, has that started to slow down as hospital profitability has been getting a little, little better of late? Is that sort of, you know, talking about the, like, broader arc of the trend there? It would just be helpful to level set where you what you guys are seeing since you're out and about talking to so many different hospitals. So, Elizabeth, what I would say overall is demand is still very, very strong. So let me, let me touch on the demand drivers, the conversations we're both having with CFOs, CEOs. And while I'm at touching on demand drivers for outsourced services- Mm-hmm. Just touch on the dynamic when the conversation is still on the insourced version. Yep. So the conversations we've had through this year have all been very, very consistent. So, a couple things: inflationary costs on their largest cost line, labor, administrative, and clinical staff. Inability, in many cases, to hire administrative staff, especially in areas like AR or denials management or coding. Yep. Continued pressure, and this is the nuanced dynamic we've talked about a lot, moderated payer timelines, but we're still not back to the kind of pre-COVID normal situation. Mm-hmm. And so what you have, especially, and this is the one other nuance, especially in the nonprofit world- Mm-hmm There's still stress in the system, if you will. Stress among CFOs, CEOs on the equation. You know, pre-COVID was inflationary cost up 2%, volume rate negotiations, 4%. I could count on a healthy mix of inpatient versus outpatient, and we could make 1%-3% margin. Mm-hmm. That whole tone and equation has shifted with the factors I mentioned, and therefore, there are many very substantive discussions, including some late-stage discussions with large systems, on needing our help. So let me just let me pause there for a second and just give you this nuanced view. We have access to 95 of the top 100 systems, which are in our sweet spot, by definition, 4 billion- Access means they have some service of yours. They have some service. Yep. We've said that, you know, there's a lot of opportunity for R1 modular solutions, with, on average, some around two out of nine solutions sold into that base. Mm-hmm. But for those top 100 plus the other 400, the discussion is typically with the head of Revenue Cycle- Mm-hmm -can be at the CFO level, where they need our help in the, insource version, if you will. Right? So you keep control- Yeah ... we help you with a revenue safety net. Mm-hmm. We help solve this revenue yield problem at relatively low friction, because there's not a lot of onboarding or data requirements to get up to speed. Oh, by the way, you know, you only pay us when you recover additional sources of revenue from miscoded claims to underpaid claims to denied claims, what have you. Mm-hmm. That discussion has led to several opportunities- Mm-hmm -which we believe over time will fulfill a thesis on the combination of Cloudmed and R1- Mm-hmm -which translates to, you know, the potential for large end-to-end deals to come to fruition. Mm-hmm. The point is, with the financial pressure on systems, that leads to a lot of demand, both for our insourced version, which is the R1 Modular, or the outsourced version, which is what you know as end-to-end. Yep. Okay, maybe there's a lot to dig into in that statement, I think. Yeah. One, as you talked about payer timelines, I think that's obviously sort of a continuing issue and not necessarily just for you guys. Yep -across the space broadly. Like, do you think that's just kind of we're at a new normal now, and that's just what it's gonna be, or there are sort of specific things that you think, okay, you know, another, you know, we'll continue to normalize, maybe at a slower rate than we should. There's nothing that would, like, impede us from getting back to sort of those more traditional levels. Yeah, let me touch on one point first, then, Jennifer, maybe you talk... one point I did make on demand is, when you have these pressures on systems, and you have this payer timeline pressure to some extent, although it's moderated, it still exists, that increases the level of demand for both insourced and outsourced services, but it also puts pressure on our account teams to manage current customers and make sure we're telling the story on what's controllable for us. Like, what, how can we help you with your, with your revenue cycle, but also what's less controllable, some of these macro dynamics? But the, the key here is, especially with our largest customers, there's a realization that it is almost impossible for them to manage this without our help. Mm. So we deliver better unit economics, better revenue yield. We also have a macro view of payer behavior across the country, across all care settings, that gives them visibility and to say, "Oh, here's what's happening within my market- Yeah “Within,” pick a state, whether it’s California, “Here’s what’s happening in my geography.” So I just wanted to point that out as a, not directly answer your question, but just a dynamic with our current customer base. On the payer timeline? ... specifically, it has moderated. Mm-hmm. If you go back and look at, it's not a perfect proxy, but if you go back and look at the public payer data on Days Claims Payable- Mm-hmm. -that's available. Yep. You saw it peak in Q3 of 2022. Mm-hmm. It's come down slightly quarter-over-quarter, but it has kind of moderated over the last quarter. That's kind of what we assumed, that it would slowly come down, and we would see modest improvement quarter-over-quarter. Mm-hmm. But we are, we aren't seeing, and we did not expect to see, for our own expectations, some drastic improvement. I do think some systems assumed that there would be a faster, you know, kind of recovery, if you will, back to the pre-COVID- Mm-hmm ... than what they're seeing, and I think that's part of what's putting some pressure on systems. So they expected a lot more cash- They built their budget- Budget and according... Yeah. As part of their budget planning. Yeah. And part of that, just to, like, hash out why it's not a perfect match or correlation, is because Days Claims Payable for payers don't include, like, rejected claims that you would then re-process, right? So I guess just thinking about rejected claims and changes in Prior Authorization requirements, seems like that's been relaxing over, you know, a while now, but it seems like it took a bit of a marked step down this year. Are you seeing any benefit from that? Or are you anticipating any future benefit from, you know, reduced burden on Prior Authorization? Very- I mean, look, this is one of the most widely talked about, you know, points of friction in healthcare and just prior auth in general. Mm-hmm. You know, I would just follow the same line of thinking as Jennifer. We are assuming moderate improvement throughout, including with little, you know, little but very meaningful items like prior auth. We've seen some improvement, but for every area of improvement, we see some offset. Yeah. And so what I tell our customers when we're looking at line item by line item prior auth, we just say: "Look, we can deploy more resource, if needed, with our additional capacity. More importantly, we're going to try as much-- apply as much technology as possible," to things like... I was just having this discussion on, you know, to streamline their process on verifying insurance, right? Coverage discovery. I was just having a discussion with one of our largest customers, where there were three steps in their cycle. Let's reduce that to one, the thing they could control, and let's apply as much automation upfront to do that simple task, which is part of authorization, which is verifying you have-- you're eligible, or you have some insurance coverage. So it's hard to answer your question and say: "Yes, therefore, there's improvement," because it's so nuanced, depending on- Yeah ... each customer. There's a lot of moving pieces. Right. Yeah. Is there anything also that you've sort of learned from this, you know, these transitions, that, like, change how you would set up your performance or incentive fees to sort of be more things that are in your control versus systemic things, or is that not necessarily entirely feasible? No, no, there's a lot I would, I think about on this. So, reflect back in January when I first took on this role. I said there were, you know, three or four major priorities, where one was stabilize the customer base coming off a very tough macro and execution year in 2022. Two was build the commercial pipeline, both on the modular and, and then a piece of our business. Mm-hmm. Three was build the technology platform, especially around automation, large-scale data analytics, to provide more visibility to our customer base, to process claims, to manage their workflow. Mm-hmm. Four was to integrate Cloudmed, to make sure we hit on all our synergy targets. Mm-hmm. And while I feel, you know, very positive about what we have accomplished this year, there's also been a lot of noise. So you have, you know, I don't need to point it out, but you've got noise around Envision or Short Report Mm ... and APP, right? So those are kind of big issues that affect next year. Yep. Here, here's my insight on all this. Let me give you the positive insight, and then let me give you kind of this kind of piece that I think we have to think about going forward. On the positive side, I am convinced that, especially relative to our competition, there is no scale platform in the provider industry that can do what we do, with a combination of better unit economics with our global model, better revenue yield with Cloudmed, and the application of technology. However, it's not a however negative, it's just the way I would think about it is, we need to think about how do we phase customers, and do I even need phasing? Mm. Okay? So personally, when we engage with a large system, I will- we will not think of this as in phases. We will pace it as long as we need to, but I'd like to win deals that are the full, full deal- Mm-hmm ... but we get to pace it at whatever pace we want to pace it. So that's the first thing. And on the building on this pacing item, we won a lot of business in one year. So think about 2021, there was not any business. 2022, all of a sudden, there's $13 billion, and of the $13 billion, you've got a bunch of smaller deals. My learning in all this is twofold. One is, take our time pacing that first year. Make sure we learn their processes, learn their technology, so when we hit the ground, we're already running. And two, my other learning is, when it comes to the new business pipeline, be very thoughtful about what we allow to enter in our pipeline and what we win. So what I would tell you now is, you know, while-... Physician is still a strategic part of our business. We need to be across all care settings. We need to go where, you know, where the market is moving. We also need to be very aware of regulatory trends, what's happening with things like No Surprises Act, and, you know, areas that might affect our prospective customers. Mm-hmm. We need to be aware of how fragmented they are today, and take on business that we can handle and that we can onboard very successfully. So I would point to some of our largest onboardings as the most successful. Mm-hmm. It's not that we can't handle small or smaller, right? But we're going to be very diligent on what we're getting into going forward. Got it. And, since you brought up new wins, so we've gone 13 minutes in this conversation without discussing it. I think you know what question is coming. As we relate to the sort of $4 billion in new NPR wins that we're talking about for this year, is there sort of, like, from the market, like, a less of a sense of urgency? Because, like, you know, some of these trends have, like, lessened, although they're still there or. You know, how do we, how do we think about that? You know, I actually, my anecdotal sense is there's more urgency. Okay. Now, I'll come back to just timing, but more urgency because we, we are still building our pipeline with, you know, call it multi-billion dollar systems, kind of that medium-sized level system- Mm-hmm ... that are saying we are very challenged. Either entering into RFP processes and saying, "We need to explore," or they know us through Cloudmed and want to do something less competitive, right? Mm-hmm. So one thing I'd say is, it has not slowed down. Now, that said, you know, just let me reflect on timing. At the beginning of the year, we said, Jennifer and I said, "Hey, back half of this year. Mm-hmm. The reality is, we still feel very good about closing what I said the last earnings call. You know, you heard me say, I didn't just say $4 billion, I said more than $4 billion. Yep. Still believe we will close that in the coming weeks or months. What I want to be careful of is, and especially going forward, right? There's no magic number to close anything within 12 months, as evidenced by, look at our competitive set, what our competitors close. Not many close something every year. They actually close something in longer sales cycles. And for us, long-term with the business, with the maturity of some of these customers that are long, long-term contracts, whether we close it, you know, December or January or February, it doesn't matter that much in the long run. So I think Jennifer and I also need to be thoughtful of, going forward, how do we articulate our business and the value creation going forward for our customers and shareholders? And so it's something we'll be thinking about going forward. I guess just one more question on the pipeline. Not about timing, but I think you guys were just talking about being more selective about what goes in your pipeline. Can you give any color as to what is in that $4 billion pipeline? Is it sort of your core bread-and-butter strength? Is it physicians? Is it emergency group practices? Like, what's- I would say for the large part, core bread-and-butter. You know, mid to large acute, sometimes acute comes with physician groups. Mm-hmm. But that is the core. You know, we've said in the past, our bread-and-butter is $4 billion -$5 billion-ish. billion-ish. That's coincidental with the number this year. That usually means you're a, you know, one state, usually large state, three hospital-type system. You've probably consolidated to one EMR. You probably have not standardized, but you probably centralize your revenue cycle somehow, some way. And probably have a smallish physician group presence, you know, somewhere in that system. So that would be the, the sweet spot. There are several of those. There are also some smaller, in the $1 billion -$2 billion range. Got it. Okay, that's helpful. Maybe switching topics a little bit, can you tell us, talk a little bit more about the recently launched LLM applications? How should we think about the rollout of these gen AI solutions to the broader staff base? Yeah, I'd love to. So, this is a great topic for us. I believe we are early in innings of large-scale transformation of revenue cycle through technology. Mm-hmm. The innings before AI were companies like Cloudmed that have a large data platform, large-scale data platform of rules you can apply to episodes of care, and therefore predict charges, you know, the prices, the rates of reimbursement. So there's a-- and that will continue, like, data and analytics as applied to our business, seeing the 500 million patient interactions we see annually will continue. The thing my predecessor started, which was also very prudent, was large-scale automation. Now, it sounds benign to do, apply robotic process automation, but when you're processing, you know, tens of millions of claims, you know, to do something as simple like retrieving a record, or retrieving a payer record, is actually super valuable from an RPA standpoint. It reduces the amount of labor required to do that task. AI is super interesting because, everyone wants to talk about it. Here's what we believe: we believe we have a right to win with access to $55 billion of workflow through the end-to-end, and $900 billion of NPR access to customers and the data we see in claims, medical records, episodes of care. We believe the partnership we struck with Microsoft is the right partnership. They were already our cloud, Azure partner. Mm-hmm. They also have access to LLMs that are valuable to us. And so we are early innings, and just to give you a flavor, we can apply, because we see so many codes across the breadth of NPR, we can apply autonomous coding, so automate coding upfront and streamline that process. One example that sounds unexciting, but I think is the most, one of the most exciting examples we have, is reimbursement account summaries. So we have thousands of people on staff that are looking at reimbursement summaries, and these are, you know, no longer in pages print, but they're, let's just call it tens of digital pages of information to be able to process a reimbursement. We have deployed an LLM that summarizes this account and streamlines the rate at which that person can process that claim or that reimbursement. Translate that to our broader business, this is what gives us confidence we can hit our margin targets. Mm-hmm. This is what gives us confidence we can have a better speed of revenue for our customers. We can show this to our customers and wow them and say, "Wow, we would never have been able to do this because we didn't have the LLM. We don't have data outside of our system, and we probably couldn't invest that much into this." So there's a bunch of examples you'll hear me talk more about, but that's one of, one of many. Got it. And if we think about how this may impact margin and sort of the timing of those impacts, what would you say? Well, we've been on this journey to least point since 2018- Yeah. ... as part of the more RPA. So some of the productivity improvements and automation margin enhancements are kind of built into that medium-term, 30% target margin. Mm-hmm. In the early innings of LLM, now that we have access to so much more data through Cloudmed and can start to build some of these models, we're exploring what does that look like, and ultimately, what does that mean for longer term margins? How much more opportunity is there as we continue to grow the business and win an incremental margin opportunity where we already have people, but we're not having to hire people at the same rate? So it's a little too early to know exactly what the opportunity size is, but it's, you know, we're, we're looking at the biggest areas of opportunity first. Yeah, and it's certainly more near-term than when they say, like, "Oh, AI will be your doctor," you know, things like that. Right. It's got a much faster timeframe, you know, than other sort of use cases there. Okay, maybe turning to Cloudmed, you know, what modules are resonating most with customers these days in terms of some of the pipeline over the next coming year that you mentioned, and why? Yeah, this goes back to the point I was making about insource, outsource, and- Yeah ... meeting providers wherever they are in their journey. We are, you know, I feel privileged to lead a team that has the best, you know, revenue yield set of products through Cloudmed. But I would also highlight that some of the legacy R1 modular solutions are just as powerful because you can go to a client and say, "Okay, we get that you want to control your revenue cycle. You can still allow us to manage coding or AR under your management with our captive model outside of the U.S." So there's a lot of positive. The biggest three product groupings, just to remind everyone of Cloudmed, is Underpayments Optimization. That's a really powerful part of our business, just to analyze a claim after it's already been filed. Our coding accuracy solutions, which are mostly around errors that happen in one type of code, a DRG, or in charges, charge capture, we call it. But actually, the fastest-growing, which makes sense, giving some of these payer dynamics we talked about, given some of, you know, the nature of outsource versus insource, is AR and denials management. So years ago, when Jennifer and I were running Cloudmed, one of the first acquisitions we did was the best East Coast and West Coast denial management firms that had built their own data platform. We then consolidated those two businesses under one data platform so that we could understand denials across the country by payers, by care setting, and so on. That's been one of the most successful and fastest-growing parts of our business. It basically goes to a head of revenue cycle, it could start at the CFO saying, "We have a big problem. We're understaffed in AR and denials management, so account review, AR follow-up and denials management. We either need an outsource partner or we're not quite ready for that. Let's try what's in the market," and we, Cloudmed, have the leading solution in that area. Going back to the pipeline question that you asked and the kind of mix of what's in our pipeline and how to think about it, this is a great opportunity for us because we truly can meet providers wherever they are in their journey, and we can look at it and say, "This might not be a good model for an outsourced solution, true end to end. There's too much noise. You don't have consolidated processes. You're not on core systems." But we can begin to bundle some of the Cloudmed solutions, provide fast revenue value and yield for you, get in, build a relationship, and then help them determine, ultimately, could they move to the next stage of the journey? So we're seeing a lot of demand, and we also have more flexibility now because we have more scaled capabilities that we can serve clients. That makes sense. Maybe give it—switching topics again, into given the 5% growth churn we've seen on the net operating front with respect to APP and Pediatrix and the divestitures of Quorum over the past year, what level of growth churn are you seeing on the modular side? Is that kind of less than what we would say on the end-to-end? Obviously, this year is a little bit of an extraordinary year. So, like, how do we think about that on, like, a, like, non-extraordinary year basis? This year is definitely an anomaly. Just based on some of the things that are going on in the industry, APP, certainly an anomaly. We don't see a company like that go out of business and decide to cease operations. On the modular side, it's typically not as sticky. These are not long-term contracts, unlike the end-to-end. Mm-hmm. They're faster revenue, pretty low risk for CFOs to invest in. There's really no investment, no implementation, so it's faster value. Yeah. And while you wouldn't expect them to be as sticky, they actually are, because as soon as you unplug the service, they see a value hit immediately. And we only charge, or they only pay for the service as the value comes in, as they actually see additional revenue yield in their numbers. And as a result, the attrition rate, which is what we really measure on the modular side, has been in the low single digits. And that's been a very consistent trend, you know, over the last several years. So it's, you know, a very good business model that makes it really easy to win in the space. I guess related to that, just in terms of exposure on the modular side, were any of those customers kind of contributing on the modular side, APP, Quorum, Mednax, PS? No. Okay. Yeah, we didn't have Cloudmed. Then just to confirm, is the—I know Cloudmed is sort of at-risk. I don't know if that's the best term to use, but it's at risk, and you kind of take a share of findings. Is that the same on the legacy? Can you remind us if that's the same on the legacy modular for R1, or is that kind of fixed payment, not really at risk, sort of you pay for it, and then hopefully value comes? In some cases, it's at risk. In most cases, it's usually a percentage of collections, or, in some cases, it's kind of like a fixed- Fixed payment.. ... fixed fee. It varies. You mentioned some examples of Cloudmed and legacy cross-selling on the last call. Now that the go-to-market efforts are a little bit more consolidated, how do you sort of, what, is there anything different about that sort of cross-sell opportunity in your mind? Is this something that sort of helps to sustain the growth rates in modular, or is it, you know, could even potentially accelerate growth rates going forward? Yeah. So just to, you know, remind you what we said back then, we have a commercial model that has really worked within Cloudmed, helping grow that business over time, 20%+. Mm-hmm. We then integrated the R1 modular solutions and sales teams into that model. Mm-hmm. I think I said this two quarters ago, we've already seen some success, because, I mean, think about what's happening: there's only so many buyers and customers. Yep. Like, there's the CFO, who doesn't want to be the buyer for most things and is handing off to the CIO, CTO, or the head of revenue cycle. So effectively, in revenue cycle, your buyer is the head of revenue cycle. That person only has so much capacity to take calls about any specific product, and usually knows what he or she wants before the call comes in. So we have a person or teams of specialists that already have a relationship with this head of revenue cycle, and even though we say it's a large market, it's actually—there's a hefty 80/20 rule in the provider space. Like, when we say 500 providers, we effectively have most of the important parts of the market, that buy at least one solution. And so the key is, do really, really well with whatever solution and deliver a ton of value to a customer. And I'm happy to say that business historically has had some of the highest KLAS scores, the highest just Net Promoter scores, and so our customers generally really, really like us. That allows us to have conversations about other products. And, you know, it's a sophisticated sale whereby we're timing it, we're not throwing everything at them at once, but we have several examples of some of the new products in someone's, you know, a commercial person's bag, if you will, is, let's say, the VisitPay, the old VisitPay business. We've already seen success of a long-standing relationship, and I'm thinking to myself, a Northeast system that is a long time Denials Management, now a DRG and underpayment client, that we converted to a new R1 modular client. So that is happening across the board, and we feel really good about that. The one we don't talk about, and we can't really talk about until we have one of these wins that we can point to and say, "Okay, here's an example of an end-to-end win that was a direct result of a long-standing Cloudmed relationship," I expect to have, you know, be able to tell that story at some point soon. That was also part of the deal thesis. Yeah. Right? Yeah. That we would eventually- Absolutely ... be able to convert these customers that are highly satisfied into broader end-to-end relationships. Yeah. The third one we don't talk about as much, but this is recent in my mind, because it was with a customer, is cross-selling Cloudmed modular solutions into a large end-to-end customer, and that's happening and going really well. Which do you think will happen first? Oh, that's already happening. Yeah. So we look- That's already happening. We don't, we're not – you know, we're not public as saying when we have these wins- Right ... but that's already happening within our base. I think I've asked you guys this question, so apologies again. But when that happens, what is the pricing structure? Because typically, the end-to-end is, you know, a bundle. It could be either. It could be in scope or out of scope. It just depends. Okay. DRG, for example, tends to be out of scope, 'cause that wasn't part of the original R1. Underpayments is probably in scope, so it just depends. When it is in scope, does that change the margin profile, like pre- and post-addition of that? No, it's gonna help us. It's gonna help us on incentive fees, it's gonna help us on revenue yield. Yeah ... it helps us on multiple dimensions. Yeah. Maybe looking at free cash flow conversion now that you're sort of well over a year past, the Cloudmed acquisition, how should we think about the overall strategic initiatives and restructuring costs as it relates to sort of converting EBITDA to free cash flow? Maybe I'll toss that one to Jennifer. Sure.... So our free cash flow is improving. Yep. We expected it to, as well, as the integration efforts start to be largely complete at this point. This year we'll land in the kind of mid-20% free cash flow conversion as a percentage of EBITDA. Mm-hmm. As we move forward into 2024 and beyond, I would expect that will continue to improve, and the drivers of that will be lower costs, other expenses related to integration, some of the strategic initiatives. So most, at this point, as I said, the Cloudmed integration costs are mostly complete. Okay. There will be a little bit of a tail into 2024. Technology's always the long pole in the tent on integration, and then synergy realization, so cost to achieve those synergies. I would expect that there's still some costs moving into 2024 related to cost to achieve synergies associated with the Cloudmed transaction. Otherwise, all the GNA functions are integrated, and those synergies have been realized. Our facilities and the rationalization of facilities, we've done all of those closures at this point, so those are largely complete. So I would expect that those costs go down in 2024, which is gonna drive up the conversion. We've said in 2025, we expect to be in that 50% range. So just think of it kind of ratably between, you know, mid-20s this year to 50%, and 2025 is probably in that 30%-35% range next year- Okay. ... is what we would expect. And then most of those strategic costs should be out of the system by- Yes ... by 2025- By 2025. By 2025. Okay, and then, like, going forward, sort of at that point, we should just think of sort of normal... There's no specific projects you have at that point going, besides just, like, ongoing, you know, you know, improvements in the business and like, the, those are the main drivers of that improvement at that point. That's right. And growth in the business- Some of the synergies continuing to flow. That's right. To flow- Growth in the business, incremental EBITDAs flowing through to free cash flow that we would use to pay down debt, that we would use for, you know, to reinvest back in growth of the business- Yeah ... just based on our contract model. And, you know, we'll continue to be opportunistic from an M&A perspective where it makes sense. Either it's a core strategic fit for us, or to at least point on modular capabilities, where it either adds scale to a capability that we have, or it's a new capability that we can add to the toolkit to sell into the 500 customers, 95 of the top 100. Got it. Are there … Like, what, what would you say are sort of the, maybe the holes you have on the modular side, or that's not really the way you think about it? There's not that many holes. That's why- that's what we're saying. Yeah. You know, if there was, you know, opportunities, it would be more organic or bolt-on. You know, mostly in mid-cycle, I'd say, you know, just kind of as we think about some of the developments in coding with autonomous coding, for example. But a lot of that we can do ourselves. So a lot of what we see in the market is overlapping. Maybe there's a couple areas where, you know, we either outsource, you know, internally use a vendor, or we'd have to build it. There's a few areas, but not that many. That makes sense. Then sort of from a capital structure perspective, are you, are you starting to get into the leverage range that, like... Like, Like, how do you think about, like, what the right leverage range is for you guys going forward? I mean, we're comfortable. Leverage has been decreasing. Yep. So at the time of the Cloudmed's transaction close, it was around three, a little north of three, and it's down to a little north of two and a half times- Mm-hmm.. ... at this point. Yep. We have seen it come down. We've also paid down about $40 million against the revolver, incremental to the required repayments- Mm-hmm ... to date this year, so an additional $40 million. And I would expect that we would continue to do that. As far as where we're comfortable, you know, I've said kind of in that 3x-3x range. Look, if there's an opportunity that comes along that's the right strategic fit or gives us a new capability, kind of meets those criteria that we've outlined, 3.5x is kind of the top end of the range of where I would want to be. But then I would expect that we would quickly de-lever- Mm.. ... from that point forward, based on free cash flow generation. So no more Cloudmed-sized acquisitions for the near term at least? Don't expect- Yeah ... another Cloudmed-sized transaction. Right. Just thinking about, like, strategic initiatives, I know there's, like, a Philippines offshoring sort of initiative. Are there any others that we should think about? Maybe not next year, but just longer term, what are the opportunities for, like, establishing more sites overseas? You know, I think the big priority is going to be on continuing to scale our customer base on the end-to-end modular side. So there's part of that. We've talked a lot about that. The technology agenda will be a big part of this, not just AI, but automation, building our. We continue to build out our data platform. We will have to expand as we grow into same or maybe expanded geographies in both India and Philippines. Mm-hmm. That's just part of our long-term roadmap, which is just natural course of growing this business. But there's no, like, structural change where you'd want to, like, transition people- No ... anyway? Okay. So that was, like, maybe 2022 and 2023, and now it's sort of- Yep ... overlapping at this point. That's right. Got it. If we had to think about sort of your top three or something, strategic priorities for 2024, like maybe within that map and more broadly in the business, like, what would you say those are at this point? ... Yeah. So, you know, big, big picture, priorities, I think technology will rise to the number one or two, item in terms of priority. So that's- Internal technology. Internal technology. Got it. As we think about that, that'll be a big part of it, just creating a more frictionless revenue cycle, less labor intensive, less need for people over time. So that's gonna be one top of mind for us. Two is going to be just growth of both the commercial, of both the end-to-end and modular businesses, so continue to build our pipeline. And, you know, you'll hear me say, meeting providers where they are in their journey, and that specifically means being okay, us talking just as much about our modular in-source business, not just Cloudmed, but the R1 module, which will just become a natural, bigger part of our EBITDA, a bigger part of our commercial engine. And then scaling the end-to-end business at the pace that we want to scale it. So we would love to get away from this, you know, annual NPR discussion that boxes it into, you know, at any given year, and having something by December 31st. So that'll be a second big piece of it. And, you know, the third piece of it will just be continue to stay ahead, you know, get past operational stability, but continue to stay ahead of just the operational rigor required to manage revenue cycle in a time, just like we talked about at the very beginning, that is, you know, putting pressure, especially on nonprofits. Got it. And if we think about sort of the modeling, I know you're trying to get away not only to sort of get away from, like, disclosing NPR on sort of a customer basis, and I understand the competitive reasons behind that. How do you think about, like, if we're on the outside of your business, trying to model it, trying to model the growth, trying to model the EBITDA, you know, contribution going forward, like, how would you sort of think about what- how to do that in the absence of sort of that NPR? Let me just give you my general... You can answer this, but first of all, I'm very confident top line, we're growing. We can grow at or above market. Mm-hmm. Okay? The question is, like, what does any given year look like? Yeah. Okay, so top line, I want to start thinking about this in kind of three-year increments. Okay. Over three years, I believe our business grows, you know, well above market. Okay, so and that's the combination of modular and end-to-end. So that's one thing I just park. I'm also very confident in the margin targets to get to 30%. You know, whether there's more, we'll talk about later, but, like, that is the combination of the unit economics we deliver with our global scale plus technology. And I think large language models, AI, give me even more confidence in that. And so those are two things I would highlight that kind of just help me frame how we're thinking about it. But I don't know, Jennifer, if you want to add a couple things. Yeah. I mean, in the near term, obviously, these are long, sticky, very strategic partnerships. And so we want to look at the business kind of more on those three-year increments. With that said, we're obviously going to have to give some color around when we have new wins and what that looks like, and how to think about the onboarding pace of that, et cetera. Mm-hmm. The margin target will kind of follow, right? That we know we invest in the first year, and then we mature the margin over the next couple of years. But really where we want to shift to is driving consistent growth within a range, right, and, you know, at or above market. So we're looking at, you know, growth within some kind of a range, which implies that you've got to be winning business consistently. But whether we, you know, take this year as an example, the $4 billion, whether we win it in November, December, or January, in the grand scheme of things, it doesn't really matter. Maybe it moves revenue in the near term, a quarter. Yeah. But over a 10-year period, it's driving the same amount of value. So it's about, in the near term, making sure that we're looking at the right metrics, we're driving the right economics for the business in the long term, and not holding ourselves to very short-term at the, you know, kind of being at the mercy of short-term metrics. So it will be around margin targets and how we get there, and we'll have to give some color around it. But we're still trying to kind of decide how we land on that. Is it revenue growth- Mm-hmm ... over some three year period? Is it still tied to some kind of, you know, NPR, or what does that imply NPR has to be? But definitely not on an annual basis. Got it. Just one last question, speaking of the mercy of short-term metrics, what do you need to see in terms of getting more clarity, in terms of Sutter, you know, starting phase II? Like, what do you need from them, or what do they need from you to, like, kind of know that, hey, we're gonna start whatever the date is, let's say, like, November next year? I think phase I, I think there was some clarity, like, you guys knew, you know, October or November is when we're gonna start, and I think that was voiced. What do you need to get to that same point where you guys can say, "Hey, this is the day where we start Sutter, phase II? Yeah, so we're both very close to this. Number one, keep doing a good job on phase I. phase I deployment going well. Yep. Two, you know, we've got a very highly respected, very competent CEO and who's very new, okay? Mm-hmm. And a CFO who's interim, who's also very good, but interim, and a new head of revenue cycle. So it's going to be working with them to say, "Here's the ideal timing for you and for us." And look, my other learning, and that's just, you didn't ask this question, but going forward, as we think about new deals, doing less of specific phasing and more saying, "We win the entire business, you commit to us the entire business, we will decide over time what the right phasing is, and not commit publicly what the timing is on specific phasing." So, I doubt you will hear me say, as we think about winning business, you know, there'll be phases. I'll just say, "This is the entirety of the scope. Let me project to you what will happen in year one, two, three, or maybe even year four or five. Mm. 'Cause they may not be ready- Yeah to onboard in year one or two. So that's it. It's just constantly working directly with the new CEO. That makes sense. So maybe just one last question in terms of the overall business. What do you think is the most misunderstood part of R1 as we sit here today? I think it's the nature of our current customers. So when there is pressure on the end-to-end—so two different pieces. I think people underestimate how happy our modular customers are, especially Cloudmed, and why those customers are so high. And I just don't get nearly as many questions on that part of the business. It's going well. There are no questions- It's very good. They're going well. On the end-to-end side, there's so much noise. Yeah. The reason is because when there is macro pressure on providers and, and/or they've misforecasted going into the year, it's easy to blame the vendor. Now, what we have to do a better job at, and I was just literally in the room with a large customer in this last week, is say, "Okay, here's the spots where we can do better. Here's spots where you, your team, and what you can control can do better. And here's what's happening at a macro level with your payers and your geographies. Here's what's happening with MA plans and the shift there. Here's what's happening on all the downside pressure in your business." And that's not to say an excuse, it's just, let's be way more honest about what's happening. So that, to me, is the most misunderstood, because it would be very easy just to call any low-level person at a current end-to-end customer and say, "Well, you know, they're not doing a good job," when in fact we're, you know, five years into a 10-year contract, and we've already transitioned thousands of employees, or two years into a 10-year contract and done the same. And I think, you know, having, you know, PDX out there or something like that, leads people to the wrong conclusion that, oh, this isn't as sticky as it is, or, you know, there's some other issue in the business. And that, to me, is, is far from the truth. This is a very sticky, durable business with a lot of embedded earnings power. Makes sense. Thank you so much, James. Good. Thank you, guys.