Great. Thank you, everyone, for joining us for the next session here. Really pleased to have Jennifer Williams, Chief Financial Officer of R1 RCM, joining us today. You know, maybe, maybe to start, probably the, the big question is, you know, obviously a lot of news coming out, you know, sort of proposal made by New Mountain, which kind of sets, you know, I'd say maybe like a floor on, you know, what people can think about the, the value of the company. I, I guess more importantly, how, how is management thinking about the business at this point? Obviously gave guidance, again, gave the outlook for this year, but in general, you know, maybe put that in the context of how you see the business, how you're thinking about this proposal versus, maybe start there. Yeah. Lee and I remain very confident on the business and the outlook and what we're doing. 2024, very similar to 2023, is a big year of execution with the onboarding of Providence and integration of Acclara, etc. Specific to the New Mountain proposal, so New Mountain filed a 13D last week and requested a waiver to file a proposal for the company. It's very much a board matter. The board is evaluating options and will determine the next best steps for the company. I'm confident that they're gonna make the right decision for customers and shareholders. From a management perspective, what Lee and I are telling the management team is we need to continue operating and focusing on execution of the company and make sure that we're not distracted and we remain very focused on executing against the strategic priorities that Lee talked about last week. Yeah. And I think one of the more interesting things under Lee and yourself, right, is kind of shifting the idea away from, you know, just that end-to-end is the end goal, right, and this move towards kind of more flexible offerings. I think we see that a little bit in Providence. Perhaps we'll see that more with Sutter. But, you know, maybe talk about that in the context of what is the market demanding right now? What is, you know, the end markets look like? You know, where are we at perhaps? And is that what's driving this push, or, you know, what need do you think this is really filling? We have a very strong business offering in both our end-to-end solutions and our modular solutions. I do think that the modular solutions are still a bit underappreciated in the market. Probably 80% of the questions we get are still around the end-to-end business and specific customer contracts and what's happening with them. Lee is, you know, as mentioned in the comments last week, you are gonna hear this terminology around flexible solutions and flexible offerings as we move forward. But what does that really mean? If you look at one end of the spectrum, you've got end-to-end offerings, which are a fully outsourced solution offering or some sort of outsource offering where employees are rebadged, revenue cycle employees for our customers are rebadged. On the other end of the spectrum, you have our modular solutions that are much faster to revenue, higher margin, more technology embedded in the solution offerings. But they solve individually, those modular offerings solve a very specific use case or a very specific need for our customers. And this flexible solution offering that you'll hear more about and Lee even mentioned a new win that we had in Q4 is some hybrid approach in the middle. It may be embedding some Cloudmed offerings and also a couple of pain point areas within the revenue cycle. Maybe it's coding or AR follow-up, but certain pain points within the revenue cycle operations, but maybe not all of it, they outsource or we take a managed services approach. Having the breadth of solutions and offerings across our portfolio allows us to engage with customers in different ways and what makes more sense. On the deal that Lee talked about last week, that initially came into our pipeline as an end-to-end opportunity. They originally approached us about a full outsource opportunity. But as we got into the conversations and the diligence with them, what we realized is that's not really what they wanted to do, and it wasn't probably the most ideal solution for them. So we ended up in more of a functional model where we're going to do some activities and functions within the revenue cycle, the middle of the revenue cycle, and then on the back end deploy some of the Cloudmed solutions. That's helpful. If we think about, then, the modular side of the equation, right? I guess, you know, what is the general duration of a client? Is it because if you're solving for a specific use case and you sign up for a certain Cloudmed solution, you know, after a year's time, you've solved that issue, does that typically then roll off? 'Cause I think in some cases we've seen that. And perhaps that's what makes people focus on the end-to-end 'cause there's much longer time horizon and visibility on the revenue. Maybe give us some, you know, how often do clients typically renew their Cloudmed subscriptions? You know, maybe a little bit more on how that works and to give some visibility on that. Our modular solutions are typically call it three-year contracts, once we execute them. But in most cases, they are renewed. We are still providing solutions to them 4, 5, 6 years out. CFOs love the modular contract model. Number one, it's faster revenue. There's no implementation cost. So it's really a risk-free approach from a CFO's perspective because they aren't paying any upfront costs. And the way the contract model works is typically they only pay when there's value that we find on their behalf, more of a contingency fee model or fee-for-performance. And so it's a really easy sell to CFOs because there's very little risk for them. But the value to them is immediate. And so to your question about the renewals, it's really hard for them to turn it off because there's an immediate impact to the value that we've been providing to them unless they have the staffing or they have another solution that can pick it up. So they see a gap in their top line revenue because that value goes away. So we don't see a lot of attrition. The attrition rates in our modular business are low single digit, which makes it a great offering, high margin, nice recurring revenue, even if it's not necessarily long-term contracts but high renewal rates. Right. So even though we have the short duration contract, it's almost like we could think of it as kind of, you know, longer recurring, revenue in that sense. That's right. Okay. Well, that's really helpful. So maybe then let's talk about, maybe a little bit about, the guidance perhaps. You know, you gave a range on EBITDA typically $650-$670. Maybe talk a little bit about what gets us to the top end versus the bottom end, and any, maybe so let's start there. Sure. So we did give the range of EBITDA for 2024, $650 million-$675 million. That includes a pretty significant investment in year for our new contract win for Providence. And, so we're really excited about that. We'll start to see revenue in the second half of the year, but there will be investments right out of the gate in Q1 related to that. As far as sensitivities on what could get us to the higher end of the range or the lower end of the range, really think about it in four key areas. One is onboarding. I just mentioned Providence and the onboarding of that, but also a number of modular solutions. So as we continue to book modular revenue, how quickly do we get it implemented? And when do the bookings come in? How quickly do we get it implemented and start realizing revenue on that? So the timing of onboarding and the timing of bookings could be one lever that, you know, brings us to the higher end of the range or the lower end of the range depending on timing. The second is cash collections and the growth in cash collections. We've assumed low single digit growth across our customer base. But depending on volume and acuity, mix of inpatient, outpatient, and also just overall acuity and mix of payer pricing and just overall payer mix, those are things that could drive cash and could drive it to the higher end or the lower end depending on timing of volume growth, what the mix looks like on acuity, etc. So that's a big one because base fees are driven by cash collections are the largest percentage of our revenue. I'm sorry. Yeah. There are actually two more. One is related to just the timing of attrition. We've talked about some of the near-term headwinds in the business around attrition and so the timing of those transitions, both facility divestitures with some of our customers and our new contract win for Providence.. And then the last one, which is harder to quantify but certainly one we shouldn't forget about, is just macro, payer timelines, what that looks like from a macro perspective, some of the things we have less control over. A great example is what's going on with Change here recently and some of the outages that we're seeing in the market and what the impact that can have to the overall industry and then what the impact that could have on cash coming into our providers, etc., as we think about that. Still in the early days, but. Can you give a sense on how many of your providers are using Change versus other switches? I mean, Change has a large market share. Sure. And so a lot of our customers use Change in some sort of capacity. In some cases, it may be for a certain region of their market or their facilities. In other cases, they are more significantly concentrated or less significantly concentrated. It kind of depends by customer. Overall, they have, I think, about, you know, 50% of, of the market in, in claims processing. And, and I would say it's probably similar for us. So right now, my understanding is Change. They just shut it down at the moment. So what are the workarounds that you're able to work with clients to get to payers? I know that I know on the pharmacy side, people can switch to RelayHealth. I don't know if RelayHealth does much on the medical claims side. There are other providers. Mm-hmm. To the extent that they aren't solely with Change, as an example, and they have other providers that they're already using trying to flip. Mm-hmm. Over to them. In other cases, we're looking at, you know, other workarounds, you know, and trying to assess what we think the timing is for them to be back up. If we think about sort of in the guide then, right? I mean, is it still within you'd expect the range of guide? You know, the, the like, how does this impact you guys? Or is this something that would be more next quarter versus this quarter? It's the way that we're thinking about it right now is it's timing. So obviously, there's a backlog of claims that are building up across the providers. At some point when the systems are back up, they'll flow through to the payers and then have to go through the normal cycle of getting paid. Depends on how quickly the payers turn things around and what their contingency plans are for the backlog that they're gonna have to process when it comes back up. But it really should be a based on timing of when the cash comes in. Again, our business is based on cash collections with a lag. And so depending on when the cash comes in, it could move between quarters. And then the other piece that we're watching is what that means for incentive fees and the timing between quarters on that. So it'd just be a timing issue you'd expect total incentive fees though across, you know, a certain period to be evened out. That's right. Yeah. And it just depends on how long they're down and what the recovery looks like. Yeah. Depends on whether there's any significant impact to 2024. We're gonna continue to stay updated and we'll continue to update the market as we know more. You know, obviously, you talked to one of the things, being cash collections. You're, you're the assumption you're making is low single digit utilization. But, you know, you look at broadly healthcare utilization data, you know, has remained quite strong here even into January. You know, kinda starting to see double-digit growth, revenues at some health systems at the start of 2024. How is that factored into what your assumptions are? 'Cause it seems like that would you're, you're being fairly conservative in that regards. Well, it varies based on customer, market, care setting. There are a lot of factors that go into it. And again, our base fees are based on cash collections and on a four-month lag, a four-month lag from when the cash comes in. So when you look at the claim volume and by the time it flows through the payers and ultimately results in cash to the provider, then it's a four-month lag to our base fee revenue. And it also depends on not just volumes but acuity, mix of inpatient, outpatient. You know, there's been news of acuity increasing in some inpatient environments for some customers in the market. But you also have to look at inpatient versus outpatient as well. So it's really a mix of all of those items. And we do see it vary based on customers. In 2023, although there were some months when there were strong reports of high volume and utilization, the next month, sometimes you would see a dip where it wasn't as strong. But overall, over the course of 2023, we saw low single digit utilization. That's what we're assuming for 2024 as well. Got it. You know, one question we get a lot, these days is because of all the moving pieces, right, the attrition pieces coming on off, you know, some of the startup costs coming on, it's hard to understand what really the organic growth of the business really looks like. Maybe can you help us frame what you think organic EBITDA growth is currently and what you think is sustainable, and maybe, how does that relate to then also top line growth? Sure. If we look at the two different solution lines, on our end-to-end business, we just talked about our existing customer base growing low single digits. And we this year have some attrition related to transitions that we've talked about. But you know, on a normal year and normal cycle, I would expect low single digit growth from our existing customer base. And then we also believe. On the top line. On the top line. Then also, we'll continue to win our fair share of business over time. Providence is a new customer. We'll start to see revenue in the second half of the year, top line for that. We have a couple of years of embedded growth as that contract continues to ramp. On the modular side, we've said double-digit growth, in the teens. I would expect that we'll continue to see that growth in the modular business over the next couple of years from a revenue perspective. From an EBITDA perspective, we'll continue to see growth in 2024 driven by maturity of the margin for some of our recent wins over the last couple of years and then also by continued double-digit revenue growth in the modular business with a higher margin. That will continue to drive EBITDA growth. We also have synergies that we've talked about over the last year with Cloudmed. We realized $30 million of synergies in 2023. We expect that we'll continue to see synergy realization in 2024. Then we'll start to see synergy realization with Acclara as well. That will drive continued organic growth in the business. When you say organic growth is if we kinda put all those things together, you know, we kinda came to the estimate that probably more in the low double digit range. Is that kind of a reasonable assumption if we take kinda take the moving pieces apart? Yes. That's a. That's a. That's a fair assumption. This year, our EBITDA growth is expected to be in the mid- to high-single-digit year-over-year growth range. But this year, we have significant upfront investment. Right. Related to the Providence contract that we're gonna be deploying and onboarding and start to see growth in the second half of 2024. In terms of margin enhancement, let's talk about automation and AI. I know it's something very important to Lee, as well. You know, he laid out a few areas where AI and large language models can really enhance the rev cycle process, right, being in denials, you know, automating appeals, etc. You have the partnership with Microsoft. There's a big roadmap here. Maybe talk us through a little bit about how quickly some of these capabilities can be brought into service. You know, in the past, you had given sort of long-term EBITDA margin targets. You know, Legacy R1 had, I think, a 30% target. You know, it was kind of updated closer to 35% with just mixing in the Cloudmed margins. If we can really deploy AI and LLM into any significant degree, where could those margins then start going? We're still very confident in our medium-term margin targets of 30%, which is the medium-term. Yeah. Target that we had given. If you back up to 2018, we've actually been on this automation journey for quite a while. R1 launched a DTO initiative or Digital Transformation Office Initiative in 2018. And at the time, embedded in the long-term margin was automation efforts mostly related to automating manual task or RPA back in 2018. And we've been on that journey now for 5 years. And we've seen a lot of opportunities and a lot of realization in the business associated with automating manual task. Now, the latest is generative AI and large language models and what that means. With the acquisition of Cloudmed in 2023, we were able to consolidate a lot of the data and put the foundation together to really be able to drive additional opportunities through these large language models. We've done most of the foundational work to be able to migrate to the cloud. And that work is underway. We've brought together a lot of the data that we need to be able to build these large language models and make them successful. And so in 2024, we're beginning the development. We have the partnership with Microsoft that we announced at the end of last year. And we're beginning to build out a couple of use cases. Lee talked about those in his prepared remarks last week, a handful of cases that we have underway. And you know, we're in the early innings is what I would say on the AI front and what the art of the possible is. Yeah. From a margin perspective. But we're very excited about the opportunities that we could see. I guess, you know, maybe just thinking out loud, right, is there a scenario like, if, if the computer or AI can basically, you know, read a denial, can look up the appropriate language in the benefit design, write an appeals notice, right, and if we think about all the efforts in RPA as well, you know, at what point do you still need people in the claims process? Is there a scenario where a lot of times can be just fully automated even if claims are getting denied? I think we'll always need people. But the belief is that as we continue to grow over time, we don't need as many people with new contracts as we continue to grow as we would otherwise. Again, we're in the early innings. Yeah. But we're very bullish on what this could mean, particularly around some of the first use cases that we're deploying around denial automation and writing denials and being able to do most of that work in an automated fashion. And then next action on AR follow-up where it's very time-consuming to read a medical record and see what all's happened and transpired and understand what you need to do next to get that claim paid. And by deploying some of the AI opportunities, it will allow our teams to be much more productive in processing. Yeah. That's helpful. Wanted to jump to sort of capital deployment priorities. Obviously, with the acquisition, you had about $2.3 billion in debt, leverage is a little over three. You highlighted that debt paydown sort of is the near-term priority. But maybe just refresh us overall, once we kinda get that in order, how you think of capital priorities. So cash generation has been a big focus of the companies over the last year. And we're very pleased with the progress that we've been able to make. We were able to pay down the revolver and de-lever in 2023. So we had no outstanding amounts on our revolver. At the end of the year, we paid down $100 million against the revolver in addition to the mandatory repayments on our debt. So we de-levered in 2023, ended at about 2.25 times leverage at the end of the year. That leverage will is expected to go back up with the acquisition of Acclara. Yeah. So we acquired that business for $675 million in cash in January. We closed that transaction. So the priority is very much one, investing in growth of the business. We have a large new contract we're deploying. We have significant investments this year. We're growing our modular business double digit. And we're going to continue to invest in the growth, the organic growth of the business. But de-levering and debt paydown is a close second, from a capital allocation and capital priority this year. I'd like to see that leverage while it will be a little north of three times. Mm-hmm. As we start out the year. We've said that we were comfortable with that for the right opportunity. And we believe it was the right opportunity and the transaction that we did with Acclara and the contract with Providence. But we will focus on getting leverage down to that 3x, you know, back to that 3x leverage ratio. In terms of this new flexible offering model going to market this way, are there any other investments that you think you need to make, either internal or, you know, could we see some other incremental M&A, maybe not at the size of Acclara, but, you know, sort of tuck-ins to be able to give this full speed? Or do you feel like you already have what you need? We believe we have largely what we need. We have the right capabilities to be able to win in the market. The flexible model is just how we contract and go to market. But we have the solution offerings that we believe we need to be successful. We're seeing a strong pipeline on both the end-to-end and the modular front. And, you know, as we get into the details and the contract negotiations with the various providers that are in our pipeline, that flexible offering will be something that kind of comes to fruition as we go through the process. You talked about the one client signed the fourth quarter that kinda came in looking for end-to-end but ended up closing more on this hybrid kinda model. You know, when you look at the pipeline currently, have you guys already identified which clients, even though they might have already entered at some point as an end-to-end, are probably more fit for a hybrid? Or is this, and, I guess, secondarily, as you go to market now, you know, how are you pitching, like, this whole flexible offering as well upfront? And, like, I'm just curious how clients are kinda responding to that message. I mean, we're still in the early days. Yeah. Of that. But what we're seeing is, again, we have there, there's a need for our offerings in the market. When clients come to us, it's because they're trying to solve some problem within their revenue cycle. In some cases, they don't know exactly what they need or they want. They may have an idea, but as we get into the details of what they really need and where the pain points are, that's where, in many cases, it comes out what the right model for them would be for them. So I don't know that I wouldn't say that we're necessarily seeing more activity on the flexibility of the model. But what we're seeing is it allows us, rather than saying, "We don't really think that the end-to-end offering is suitable for you, but we have something else that makes sense." And so providers don't necessarily know exactly what they want. So it's up to us to help them as experts in the space, understand what they really need. Yeah. When we think about end-to-end, right, so we're thinking about from patient registration all the way to the cash collection. When, you know, anecdotally, it sounds like in some cases, health systems look at patient registration as maybe more of a core function of themselves. Or they wanna keep it 'cause it maybe is the interface to their patients. Is that generally the one that you find where health systems, if they wanna hold onto something, is that what they gravitate to and would prefer? 'Cause I think that's sort of the case with Providence, right? And I wonder how common that could be going forward. Yeah. I think it depends. Every provider's gonna have a different landscape and environment and what, you know, they view and their philosophy is on rev cycle and what's core to them. With Providence, we didn't take the front end, but that was due to things that were very specific with Providence. With Sutter, the second phase is mostly front end, in facilities, roles and functions that are in the facilities. And for their CEO, that's something that's very core to what they do and interact with the patients. So those are some of the conversations. Going back to the flexible model, though, there are other solutions other than just rebadging the whole front end that we can do. We can deploy more of a managed services or just some of our technology. So there are other options. And as an example, that's one of the things that we're talking about with Sutter right now is how we engage with them, what the scope looks like, and what the timing looks like. Great. I think in the last minute, I wanna see if there was anyone in the audience that might have a question. Al. Modular personnel assignments. Is that the same salesperson or do you need to trade or rehire? Are they incentivized differently on selling modular? Okay. The question is, whether it's the same, same person that's selling both modular and end-to-end and if the incentives are different? So we do have two different commercial teams that are selling modular versus the end-to-end. But they're very much collaborating across the two and determining in this flexible model, as an example, if our end-to-end team is in there and determines, "Hey, this is some kind of a hybrid approach," they're absolutely incented to do the right thing for the customer and make sure that the model is ultimately one that will be successful for both us and for the provider. So while they are two sales teams, they're very much working together to make sure that we end up with the right solution. Maybe time for one more? No? All right. Well, I think we're right on time anyways. So, Jennifer. Okay. Thank you very much. Thank you, everyone, for joining us. Thank you for having me. Great. Thank you.