All right, folks, thank you so much. Welcome to the last session of the day. Last but not least, we have the R1 RCM team. You had a lot of lot going on lately, but I'm sure we're gonna have back. It's my absolute pleasure in order to welcome Lee Rivas, CEO of R1. Welcome back. We're definitely going to talk about that. Thank you guys for coming. Thanks, Stephanie. I have to start with so many questions about the past few months. I want to go through this. That's an announcement. Yeah. What can you say, if anything? Definitely not much. Only what is available for people to read publicly. What I can say is, what matters to most of our investors is that I and the team are super focused on managing the business. A lot about focusing on customers, continuing down our operational and technology journey, and just as a management team, focused on maximizing value for our customers, our team members, and shareholders. So we're super focused. Well, maybe let's put this another way. I'm gonna ask you different ways. You're gonna hate me at the end. What is... When I think about the value of being a public company and why a lot of folks come to me and say they wanna go public- Yeah. It's because you get that extra kind of badge of honor around your financials and your transparency, you're going out to sell clients. Yeah. I know that's very important to hospitals. I know it's very important with peer relationships and with large important clients. Do you still see that value since you're the only public player? I think regardless, there's a ton of value. So here's how I think about our business in general, and then this comes on the back of lots of learnings from last year, okay? So I said, all of last year, very focused on stabilizing the customer base and in the face of some macro headwinds, building the technology platform, integrating Cloudmed, and you know, all the other things I talked about last year. My big learnings are this is a large addressable market, so providers today need us now more than ever. Two-thirds of providers don't outsource with any partner. There's a ton of opportunity for our modular and Cloudmed business, and we are in a really unique position with the combination of our global scale, our technology platform, and our domain expertise, as evidenced by some of our recent wins to serve the market. The other thing I'd highlight is, as a matter of course, you know, whatever the scenario is, public or private, you know, we have a strong financial profile. So I think what happened last year with lots of ups and downs, if you will, is an underappreciated aspect of our business, is we have extraordinary embedded EBITDA with the latest win, with the latest acquisition, Acclara, plus the modular growth in our business. We have enormous visibility into EBITDA in our business, whether we want a new end-to-end deal or not in the next three years. And then when you add to that, confidence in our margin profile, given the continued automation in our business. And then the last thing which Jennifer and I have talked a lot more about, which is the ability to generate cash and have a lot of focus on the balance sheet, all that leads to a strong company no matter what. So I leave 2023 with a lot of confidence going into 2024. Well, I actually had—I, I debated an investor about this just last night, where he was kind of giving me flak when my initial launch, I decided to go with an overly revised. And my argument was, you had incredible visibility in the next few years, right? Who else has double-digit growth, double-digit EBITDA, margin growth, visibility in the coverage universe? The counterargument was, that also makes you tied to be a public company, because every time you have a new win, it has to go take a little step back in order to do that. So how would you, how would you counter that? You're talking about step back in terms of the investment required and the... Yeah, the investment required, the hiring you do. So you have this wonderful visibility as long as you don't have any wins. Yeah. And then you have to redo the waterfall that you're trying to get us to move away from every time there's a new win. I would say one, there's definitely more diversified business going on today going forward. We have three legs of the stool. So we have the end-to-end business, we have a functional business, which we can go into more detail about, and we also have a strong modular business. The other thing is, if you look at the dynamics, which led in the past, is that there's a limited number of sort of these $10+ billion. So majority of the business going forward is going to be more in that $2 billion-$5 billion. So the headwind from pursuing end-to-end could be materially a much smaller impact on our business. And given the diversity and strength of the EBITDA growth, and margin potential of business, it's not gonna have that volatility that it would have had over the last three years versus the forward three years. But I think there's a higher predictability, higher ability to absorb that sort of headwind from onboarding from new business. And you look at the profile of the company, significantly over the next two to three years, we've already shown the cash flow capability of the company in the second half of the year. So this year, we had close to 40%, free cash flow conversion to adjusted EBITDA. So as we move through, we'll have better EBITDA visibility, better cash flow visibility, and less interruption from any sort of incremental end-to-end new business. Super helpful. And Lee, it's just about your business birthday, right? That's right. Put a bow on here. Happy business birthday. Thank you. ... We had a lot of things that weren't in your control last year. Yeah. Can you walk through how you tried to reframe them to at least be a little bit more in your control? You talking about a lot of what happened in 2023? Yes. Look, um- That first year. Yeah. How often did you wake up and say, "Oh, my gosh, what did I do? Yeah, no, there was a lot of noise in 2023 that was outside of our control, macro dynamic. You know, some things that, like this, the last four quarters. We very much hope this year is a lot less noisy, if you will. The things we can control are keep building our technology and data platform, keep focusing on AI, which I'm happy to talk about, onboard our new customer, finish the integration of Cloudmed, start the integration of Acclara, and allow ourselves to step back and say, "We fulfill an enormous need in the provider industry." And in a time where there's enormous financial pressure, labor constraints, inability to invest at scale in technology, our end-to-end customers need us now more than ever, but also the 500 plus customers of our modular business, 90+ of the top 100 customers we have with at least one solution sold, desperately need us now more than ever to drive more revenue and reduce costs. So, we've got to focus the team on exactly every... Only the things we can control. Speaking of cost in the healthcare system, Evan, can we talk about Change Healthcare? If you want. That thing's gonna haunt you for the rest of your life. I just- We will always, we will get through it. Change Healthcare, a lot of our provider-facing businesses came up and said that it creates some cash flow hiccups, it creates some collections issues, especially does that for maybe some of the smaller providers that aren't as set up to have multiple clearinghouses. So because you guys do have this NPR take rate dynamic, how can we think about the impact to your model? Impact to our model is TBD, based on timing of what happens with Change Healthcare. Here's why I have confidence. We are helping our customers come up with alternative options. That's the first thing, with the primary area around the claims clearinghouse capabilities and to some extent, billing editing. So we are, most of our customers have backup on claims processing, three or four private companies that do that work. For us, what we wanna make sure is that we help them process the claim, solve a short-term issue on cash, but not create a longer-term issue with more denials. More claims are rejected for administrative issues like putting, you know, not matching to the right payer codes or not having the right provider on a piece. So for us, if you think about our model, the impact, if there were any impact, it would be timing. The other impact area would be KPIs, with the primary, the obvious one being AR. You know our business well. Maybe at some point, denial, but even that is over time, timing. So the way we feel about... The way we're thinking about this is, number one, you know, really step back. Cybersecurity is a major issue for the industry. Make sure we and other large provider and businesses protect ourselves and put in all the tools we need from a technology perspective. Second, focus on helping our providers, and third, it's all the details on helping them come up with a backup plan. There's a lot, a lot of specifics relative to each customer, but to your point, the ones that probably impact you the most are the smaller ones, for the most part. So I understand how it could be impactful on the balance sheet, metrics are on the cash flow statement. But I also have to imagine, if this is a major crisis that really impacts clients' decision making, right? You only have so many board hours. These meetings go on forever. I would imagine that a lot of management's going towards how do they mitigate these issues with making sure their middleman is in working order. Did that push out any of the potential negotiations or conversations you were having? No. Look, it's early days. I mean, we're four, including sometime, four weeks in. From a current customer perspective, what they want is our help. If... And there, there's a couple of different scenarios. If you were already on another system, you're fine. Those systems that are on, I don't want to name EMRs, but the largest EMR, you're probably more fine than the others based on the billing editing capabilities. And/or if you had- They're not even public anymore. You can mention it however you want. If they had backups and they weren't single threaded through the clearinghouse, then they're fine. The ones that are a lot more impacted are ones that chose on the clearinghouse side, doing editing side, to be single threaded through one. That's where you end up having, taking a lot more time. We have at least one customer that is and a couple that are in the other categories. From a new business perspective, you know, I expect that we will over time see some impact, but for now, there's as much opportunity as there on the other side. So, for example, our Cloudmed business, you know, we don't want to take advantage of any opportunity, but the Cloudmed denial and AR business- Going to waste. is, you know, going to be hard at work when you think about scaling that business. So there is opportunity as we, you know, kind of sit back and help our customers and prospective customers. ... I can't say that it's only a related business that has the same branding. Change also has a pretty big revenue cycle business. Yeah, somebody came from Change. Evan? How do I put it? In some cases, I think we would compete, but remember, they're on both sides of the equation, on the payer side and on the provider side. And from the provider side, in some cases, they compete like insurance verification and things like that. But broadly, they, you know, a significant amount of theirs was either small physician-based business, or limited, actually limited technology actually on the provider side. Majority of the technology was actually on the payer side. So we're sort of the counterbalance to the payer side of the business from a technology standpoint. We'll see. We'll see how it plays out. How are you viewing the market opportunities for R1, looking past all these different noisy topics we've discussed? Yeah. I think there's a huge opportunity there. I mentioned the demand characteristics with providers. There's a lot of pressure on providers in today's environment with labor constraints. A lot of opportunity to help them from a technology perspective. If you kind of step back on how we have historically gone to market and how we go to market today, what Jennifer mentioned last week, a very flexible model. If you're a provider and you are struggling on the revenue yield side, we have a whole bunch of solutions that can help you resolve that, and that's why the cloud and business suite been so successful. If you are a provider that, maybe hasn't made or is not willing to make a decision to outsource your revenue cycle, but you are under cost pressure, you do have labor constraints, this is... We have many capabilities to help you with our resources, our IP around coding, AR management, denials. That's what we call managed services. And if you're a provider that, is willing to make the leap of faith, if you will, and talk to our other customers that have made that leap, the larger customers, including this last new one, and see what the value is from a cost standpoint and how they've maintained revenue yield or improved revenue, then we're very willing to entertain that discussion. So, for us, you know, long term, we see very strong growth characteristics. Long-term utilization trends positive, and we feel that like we are in a unique position from a scale, technology, and people perspective to win. When I think about the history of R1, back when they were more the Accretive Health, so we're going to do a history lesson. Yeah. Some of you guys were there. But when I think about that, there was always this push to be more of an end-to-end outsource solution. So it was much harder to leave once you had fully outsourced. And it sounds like they're almost coming full circle, and you're going back to the, you know, we'll meet you where you are. You can outsource, you could not, you know, you can be modular. We'll find different ways to sell. Is that because you've seen attrition risk either way when you go with a fully outsourced model? Or do you think maybe you're more able to sustain a non-outsourced model at this point? No, I actually think it's the answer is we can do a lot. We're still going to be very aggressive on pursuing end-to-end deals. But let me give you a few examples to bring this to life. The last large deal we've... And I'm trying to talk about customer names less, but we all know about it. Mm-hmm. Come on. Okay? Come on. that deal- We had a press release. That deal is a comprehensive revenue cycle deal that is helping a customer on the acute and physician side, manage a very complex mid-cycle coding and AR business. And when you do the math on the history of the company and get to the number that we used to talk about cost per click, you say, "Oh, that's not a full deal." The reality is, within our customer base, there is plenty of opportunity to keep expanding. As I look at the front end, I look at the part of the business we didn't get as an opportunity. If we do well the next couple of years with the base business, the cycle coding, the back end, that's an opportunity for us. And each large customer has a similar opportunity. So that's an example on the market. We will continue to pursue and then deal. So that's not changed, even though you hear me saying flexibility. On the other end, let's use the example I used on the earnings call. If we see a smaller system that maybe has more complexity, not to say we can't handle complexity, but has disparate host systems, multiple geographies, maybe is in some specialty, and we say: Wouldn't we better serve this customer, prospective customer, with a combination of revenue cycle product, revenue integrity product, Cloudmed products, and managed services, or we'll handle coding and AR for you without completely controlling it? That may be a better situation for that customer. So we're going to be very thoughtful about our prospective customer base on the end-to-end side. We're always thoughtful on all fronts, but that... Those are two examples on both ends of us meeting customers where they are today. When you announced the deal that we're not mentioning the name of, I'm sure you don't want this, but when you announced it, you did say on the call that it wasn't the only scale deal that was in the pipeline. Is there any color you can share on pipeline today or kind of... I know you don't want to stake- Yeah. No, I look, I feel very, very good about the pipeline. So the modular pipeline is strong. We had a very good year in 2023 that helped fuel revenue or on the modular book of business, which is why we've been very confident saying that's where we're going with the Cloudmed business, kind of mid-teen and so on. On the end-to-end side, there are, by definition, when you do the research, less large deals out there. When you kind of apply an 80/20 rule to the world of large systems, you get to that $2 billion-$5 billion range pretty quickly. And so we do have a healthy pipeline. The industry at large, you know, the rate of winning is kind of similar to ours, you know, one or so a year. The other thing to note is we wanna be very thoughtful about making sure we onboard Providence really well. We've finished onboarding with our other customers and not take on too much. We can do more, I would say we're back half a year, but that's the other consideration. When you look at Providence, you didn't really do the front end, right? Yeah. It's just the back end. Sutter, you've had some delays in the front end. The back end went by without a hitch. Is there any reason folks are avoiding the front end more than the back end, do you think? You know, it's on the surface one of the more strategic areas, but tactically because you're interacting with patients in front of registrars, it tends to be a little more sensitive from a change management perspective. That's it. So when you kind of step back, you know, the people that are handling back-end AR management, denials, reimbursement, you tend not to be working at a hospital system. They're in an office somewhere. Same thing with coding, although coding has sensitivities, right? Especially for physicians. The front end, depending on the area, tends to be more sensitive, so you're scheduling. We have incredible technology solutions with our R1 Entri to help them with scheduling, patient entry, financial clearance, insurance eligibility, but it tends to be more sensitive to a system in general. We're talking a lot about the labor. We haven't touched on the AI opportunities. It sounds like a lot of this we've discussed in the past can be, if not automated, greatly assisted via technology. What do you see as the low-hanging fruit today in the two minutes we have left? Yeah. Just to frame it, we think about our technology roadmap and journey in three big parts. One is the data and analytics platform that fuels our--that helps our operators do their work. Two is what you heard, R1 talk about the last several years, this automation journey around digitizing otherwise labor-intensive tasks. So anytime you see someone pointing and clicking, automating claims retrieval, medical records, approval, insurance eligibility to the extent we can find a payer website, all that. The biggest unlock actually is AI, and it sounds cliché, but the reason is when you have access to large amounts of unstructured data, and you see it as many times as we do with our Cloudmed business across all payer settings, across all geographies, all payer settings, all geographies, and all payers, you can apply models to streamline work that would otherwise be super labor intensive. So I've talked a lot about the seemingly benign task of summarizing an account, AR summaries. That's what I talked about in the earnings call. A similar example would be automating an appeal for a denial. It will always take people, right? But to the extent that we see tens of thousands of denials for a specific payer, for instance, pick any, effective denial, the fact that we apply a model to auto-write the initial version of appeal, save significant people hours and adds to our ability to drive revenue yield and reduce costs for our customer. So for us, that is a huge opportunity because we're so embedded in the customer workflow and because we see the amount of data we see through our cloud vendor. So that's one of the things I'm super excited about and the customers are excited about as well. We had Microsoft on stage here an hour ago. Yeah. One of the audience questions that came up was about revenue cycle management, and they did mention that it's something they want to get into, or something they'd want to get into with a partner. Yep. How are you partnering when you think about your strategy? We're partnering with Microsoft, and they're helping us with our models. So, it's a very productive partnership. I've been in touch with all of the guy presenting, and it's been very productive. Yes. Lovely. Yeah. All right. That's a very exciting place to stop. I know it's all the time we have. I hope you guys stay around so we can have you at our conference in the future. Okay. If not, I wish you guys the best. All right. Take care. Thank you, guys. Thank you.