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spk22: Good morning, and welcome to Healthstream's fourth quarter and full year 2023 earnings conference call. At this time, I would like to inform you that this conference is being recorded and that all participants are in listen-only mode. At the request of the company, we will open the conference up for questions and answers after the presentation. I will now turn the conference over to Molly Condra, Vice President of Investor Relations and Communications. Please go ahead, Ms. Condra.
spk24: Thank you. Good morning, and thank you for joining us today to discuss our fourth quarter and full year 2023 results. Also in the conference call with me this morning is Robert A. Frisk, Jr., CEO and Chairman of HealthStream, and Scotty Roberts, CFO and Senior Vice President of Finance and Accounting. I would also like to remind you that this conference call may contain forward-looking statements regarding future events and the future performance of HealthStream that could involve risk and uncertainties that could then cause the actual results to differ materially from those projected in the forward-looking statements. Information concerning these risks and other factors that could cause the results to differ materially from those forward-looking statements are contained in the company's filings with the SEC, including forms 10-K, 10-Q, and our earnings release. Additionally, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling to net income attributable to Healthstream is included in the earnings release that we issued yesterday and may refer to in this call. So with that start, I'll now turn the call over to CEO Bobby Frist.
spk06: Good morning, everyone.
spk04: I'm having a few connection issues. There might be a glitch here and there. We'll push through it, though, do the best we can.
spk26: What will the earnings call?
spk04: I'm really excited about how we finished the full year 2023.
spk06: There are lots of exciting things to cover, and we'll do that in great detail in the next 30 minutes. We delivered record top line revenue of $279.1 million and record adjusted EBITDA of $61.3 million. In our guidance for 2024, we expect to surpass both of those high watermarks as we further expand our ecosystem with exciting new products, new sales channels, and new target markets. The significant development in our market expansion strategy directly to individual users, such as physicians, nurses, and nursing students. Our ASTREAM platform allows us to approach individuals with the learning most applicable to them. Around this year, we've been assembling the commercial positions on our newly-released CTE courses site, powered by the ASTREAM platform. While we're on that site, we're going to stick our eyes into the ASTREAM resources. We also amplified our ability to reach and to sell to individual nurses through NurseGrid Learn, which is linked via our popular NurseGrid app. As a reminder, NurseGrid is the number one most popular app for nurses based on ratings and downloads in the Apple Store. with approximately one in six nurses in the U.S. regularly using it. During the third and fourth quarters of 2023, over 1,800 orders were placed by nurses.
spk04: Some of the top products sold to you and can apply to you in CE Unlimited. Yeah, I'm having some connection issues I'm getting feedback from, so again, we'll push through best we can.
spk06: I'm excited about our early success in selling direct to healthcare professionals with our new e-commerce-enabled H-Stream platform. I believe that the ability to participate in our ecosystem throughout one's healthcare journey includes new opportunities for caregivers to advance both their skills and their quality. I'll have a reminder about our business and who we are for the benefit of anyone who is new to HealthStream. First and foremost, HealthStream is a healthcare technology company. dedicated to developing, credentialing, and scheduling the healthcare workforce through SaaS-based solutions, each of which are becoming more valuable because of the interoperability they're achieving through our HStream technology platform. Historically, we sell our solutions on a subscription basis under contracts that average three to five years in length, which is very acceptable. In fact, 96% of our revenues are subscription-based, As I just mentioned, we have also started to open our sales channels directly to health care professionals and nursing students across the continuum of health care training. We are profitable, have no interest-bearing debt, and a strong cash balance of $71.1 million. We are solely focused on health care, and more specifically, the health care workforce. The 12.3 million health care professionals and nursing students in the United States comprise the total addressable market for our SAS.
spk05: Oh gosh. Alright, I'm going to need to.
spk06: It looks like we're having bigger connection issues than I thought, so I apologize for that. I'm going to have to go find another dial in.
spk04: Give me just a second.
spk06: Hey Molly, I'm going to ask if you can hear me that you pick up since the script is written. If you could pick up in the paragraph or maybe even since you know where I dropped.
spk24: Yes.
spk06: So I can get back in. Go ahead and start from the top.
spk24: Sure.
spk06: Thank you, Molly.
spk24: So I'll start where Bobby left off, if I understood that correctly. So in the fourth quarter, revenues from our scheduling application, Shift Wizard, grew 31% over the prior year quarter as customers continued to report high customer satisfaction. Since purchasing Shift Wizard in October 2020, we have selected it as our primary scheduling application. and significantly expanded its ability to perform at enterprise scale. And it's only going to become more powerful, more differentiated in the market in the coming year. In the fourth quarter, we welcome many new customers for ShiftWizard, including Norman Regional Hospital, Friedman Health Systems, and Phelps Health. Revenues from credentialing, privileging, and enrollment application credential stream grew 52% in the fourth quarter versus the same period last year. In the fourth quarter, we contracted 37 new customers for our credential stream solutions. These new credential stream customers included many highly respected healthcare organizations like Intermountain Healthcare, Lira Health, and Dayton Children's Hospital. So there's still a great deal to talk about, but right now I'm going to turn it over to CFO Scotty Roberts for a more detailed look at our financial performance and expectations.
spk19: All right. Thanks, Molly, and good morning. I'm going to start my portion of the call today with a recap of our financial results for the fourth quarter, and then I'll go over our financial outlook for 2024. Unless otherwise noted, the comparisons will be against the same period of last year. We continued to deliver solid results as we closed out the fourth quarter of 2023. Revenues were 70.6 million, up 3%. Operating income was 4.3 million, up 38%. Net income was $4.6 million, up 87%. Earnings per share were $0.15 per share, up from $0.08 per share. And finally, adjusted EBITDA was $16 million and was up 17%. Our revenues increased by $2.1 million, or 3%, coming in at $70.6 million compared to $68.5 million in last year's fourth quarter. Our revenue mix continued to tilt in the direction of subscriptions versus professional services. In fact, revenues from subscription products accounted for 96% of total revenues and were $67.9 million, increasing by 4% in the quarter. Professional service revenues declined by half a million, or 17%, which had a negative impact on our growth rate of approximately 80 basis points. So now let me provide some more color about the revenue results. As Bobby and Molly mentioned earlier, we saw a good mix of growth contributors throughout our portfolio, but I want to call out and quantify a couple areas that kept our growth rate for the quarter lower than it would have otherwise been and lower than we expect to see it in 2024. The first area that I'll highlight is associated with our ANSOS scheduling products. The suite of products was down half a million, or 13%, in the quarter. Our focus continues to be on stabilizing existing ANSOS customers and migrating them to ShiftWizard, our SAS scheduling application, which grew its revenue by 31% in the quarter. Future declines associated with the remaining $14 million of ANSOS-related revenue are contemplated in our 2024 guidance. The second area that I want to mention is our quality manager solution, which accounted for approximately five and a half million of subscription revenue for the full year of 2023. And it was down 0.4 million or about 23% in the quarter. We acquired this product in 2019. And unlike most of our products, it's sold to the skilled nursing facility market. And while most areas of healthcare have rebounded since COVID, skilled nursing facilities in particular, have continued to experience financial pressures. ANSOS, quality manager, and professional services declines offset some of the exciting growth that we experienced in products like Credential Stream and Shift Wizard. Now, our remaining performance obligations were $541 million as of the end of the year, compared to $517 million the year before, and we expect approximately 42% of the revenue backlog to be converted in 2024. Our gross margin was 66% compared to 65.7% last year, and this was in the range that we expected. Moving on to operating expenses, the reorganization of the business as a single operating segment at the beginning of the year led to efficiencies and cost synergies in our operations that are reflected in our financial results for the quarter. We were able to maintain our operating expenses, excluding cost of revenues, to a modest increase of 0.4 million, or 1%. And most of this year-over-year increase was from depreciation and amortization, which was up 10%, and product development was up 1%. Our G&A and sales and marketing expenses were down 6% and 1%, respectively. Adjusted EBITDA was 16 million, which was up 17%. And adjusted EBITDA margin improved to 22.6% compared to 19.9%.
spk20: last year.
spk19: Now let's go over the balance sheet metrics. We ended the quarter with cash and investment balances of 71.1 million compared to 71.8 million last quarter. During the quarter, we deployed 6.6 million for capital expenditures, paid 0.8 million to shareholders through our dividend program, and we repurchased 6.8 million of our common stock under the share repurchase program announced in September. For receivables management, our day sales outstanding were 42 days for both the fourth quarter of this year and last year. While we've had a relatively steady performance with receivables, during the past year, our bad debt charges increased by approximately $600,000, which about $350,000 occurred in the fourth quarter. Our total bad debt charges for the full year approximated $1 million, or about 0.37% of revenue. Now switching over to cash flows. For the full year, our cash flows from operations improved by 12.8 million, or 25%, coming in at 64 million. And free cash flows improved to a record high of 36 million compared to 26.1 million last year, an increase of 38%. We have a strong balance sheet with over 71 million of cash, no debt, and improving free cash flows. With available capital to deploy, we applied this disciplined approach to our capital allocation strategy, which includes M&A, dividends, and share repurchases. While we did not complete any acquisitions during 2023, we maintained an active M&A program to evaluate potential transactions that fit our investment criteria. In addition, deploying capital through cash dividends and share repurchases are ways for us to improve shareholder value. In February of 2023, our board of directors adopted a dividend policy, which we returned 3.1 million of cash back to shareholders last year. And yesterday, our board of directors declared a quarterly cash dividend to be paid in March, increasing the payout by 12% over the previous quarterly dividend. As for our share repurchase program, during the quarter, we made 6.8 million of share repurchases, and we have 1.1 million remaining under the program. Our current share repurchase program will expire on the earlier of March 31, 2024, or when the maximum dollar amount under the program has been expended. In the fourth quarter, HSTREAM subscriptions increased by 85,000 over the previous quarter to a total of approximately 5.8 million. Now, as we turn our attention to metrics that are more relatable to revenue growth and our medium-term financial objectives, We are planning to retire the HStream subscriptions metric with this report. We believe that HStream subscriptions have served as a good indicator of our ability to deploy our platform at scale, and we are now turning our attention to the future financial performance that scale can drive. As we've said before, HStream subscriptions are not intended to be used to calculate revenue per subscription or revenue per subscriber. A key reason for that is because not all products that result in revenue gains or losses require eight-string subscriptions, and subscriptions do not necessarily correlate on a one-to-one basis with subscribers. We continue to believe that the medium-term financial objectives that we introduced at our September of 2022 investor meeting are key performance indicators for our business. So let's refresh on our medium-term objectives. metrics which support them, and our performance against those metrics in 2023. Our revenue growth objective is to be in the 7% to 10% range, with 5% to 7% coming from organic growth and 2% to 3% from inorganic. For 2023, we achieved revenue growth of 5%. Our gross margin objective is 65% to 68%, and we achieved 66%. And our adjusted EBITDA margin objective is 21 to 24%, and we achieved 22%. We're excited to now give our financial guidance for 2024, which we expect to deliver on each of the three medium-term objectives I just described. We expect consolidated revenues to range between 292 and 296 million, We expect adjusted EBITDA to range between 64.5 and 67.5 million, and capital expenditures are expected to range between 28 and 30 million. This guidance does not include assumptions for any acquisitions that we may complete during the year. Our revenue guidance range implies a growth rate between 4.6 and 6.1 percent, and we expect steady performance across the year. our ability to upsell and cross-sell solutions to existing accounts, improve our net revenue retention, and acquire new customers, including targeting the nursing school market and increasing sales through our commerce channels are elements that we believe will help us achieve these revenue targets. We expect gross margin to be around 66% for the year, and subscription revenue mix from solutions that we own versus partner solutions which we pay royalties and investments in our platform infrastructure, such as cloud hosting and software, will be the primary influences on gross margin. As for staffing, we have just under 1,100 employees and approximately 50 open positions as of the beginning of the year. So labor costs are expected to increase steadily across the year. We expect both product development and sales and marketing to increase in the 4% to 6% range. have plans to increase our marketing efforts this year including our trade show presence and engagement directly to students and professionals we expect that our gna costs will increase one to two percent and finally we estimate the effective tax rate will be in the low to mid 20 range that concludes my comments for this quarter's call thanks for your time this morning and i'll now turn the call hopefully back over to bobby for some additional updates
spk06: Okay, great. Thanks, Scotty. I think I'm on a better connection now. I have to have a little discussion with my Google connection, but we're good to go. What I'm going to do is repeat my opening section because we need a good record of it, and then I'll pick up with the third section, my final section. If I break out again, I'll ask Scotty to do the same. Just go back to the top of the script and get my first section in the record and finish with the third section of our presentation. So, good morning. Thank you, Molly, for the handoff earlier. Welcome to our fourth quarter and full year 2023 earnings call. I'm excited about how we finished the full year 2023. We delivered record top line revenue of $279.1 million and record adjusted EBITDA of $61.3 million. In our guidance for 2024, as Scotty just mentioned, we expect to surpass both of those high watermarks as we further expand our ecosystem with exciting new products, new sales channels, and new target markets. A significant development in our market expansion strategy in 2023 is our additional focus on selling directly to individual end users like physicians, nurses, and nursing students. Our 8Stream platform now allows us to approach individuals with the learning most applicable to them. I'm going to check real quick and see how that came through. Scotty or Molly?
spk18: You're coming in just fine, Bobby.
spk06: Okay, great. Around mid-year, we began selling primarily to physicians on our newly released CME Courses site, powered by the HStream platform. On that site, we've seen a surge in site visits and purchases, with the most popular purchase being the new DEA-mandated opioid course, with over 2,700 orders placed in the fourth quarter alone. During the last two quarters of 2023, we also amplified our ability to reach and to sell to individual nurses through NurseGrid Learn, which is linked via our popular NurseGrid app. As a reminder, NurseGrid is the number one most popular app for nurses based on ratings and downloads in the Apple Store, with approximately one in six nurses in the U.S. regularly using it. During the third and fourth quarters of 2023, empowered by our new H-Stream commerce capabilities, over 1,800 orders were placed by nurses. Some of the top products sold directly to nurses via NurseGrid Learn include our stable program, Our regulatory courses we call SafetyQ and ComplyQ and CE Unlimited. I'm excited about our early success in selling direct to healthcare professionals with our new e-commerce-enabled HStream platform. I believe that the ability to participate in our ecosystem throughout one's healthcare journey, including as a student, which is a new target for us, when they're an employee at a healthcare facility, or as an individual finding us between jobs even now with this new commerce capability, we kind of create a continuous revenue opportunity out of the millions of subscribers in our network. And I think this gives them opportunity to kind of continuously develop them and engage with our ecosystem throughout their career. Before we go further, I wanted to provide a high-level reminder about our core business, and especially for the benefit of those who may be new to HealthStream. First and foremost, HealthStream is a healthcare technology company dedicated to developing, credentialing, and scheduling the healthcare workforce through SaaS-based solutions. each of which are becoming more valuable as they become increasingly interoperable through our new H-Stream platform technologies. Historically, we sell our solutions on a subscription basis under contracts that average three to five years in length, which makes our revenues recurring and predictable. In fact, as of today, 96% of our revenues are subscription-based. As I just mentioned, we have also started to open our sales channels directly to healthcare professionals and nursing students across the continuum of healthcare training. We are profitable, we have no interest-bearing debt, and a strong cash balance of $71.1 million. We are solely focused on healthcare, and more specifically, the healthcare workforce. The 12.3 million healthcare professionals, which now include about a million nursing students, in the United States comprise the total addressable market for our SAS solutions. In the fourth quarter, revenues from our scheduling application, ShiftWizard, grew 31% over the prior year quarter as customers continue to report high customer satisfaction. Since purchasing Shift Wizard in October of 2020, we have selected it as our primary scheduling application and significantly expanded its ability to perform at enterprise scale and has only gone to become more powerful and differentiated in the market in the coming year. In the fourth quarter, we welcome many new customers for Shift Wizard, including Norman Region Hospital, Freeman Health System, and Phelps Health. Revenues from our credentialing, privileging, and enrollment application credential stream grew 52% in the fourth quarter versus the same period last year. In the fourth quarter, we contracted 37 new customers for our credential stream solutions. These new credential stream customers included many highly respected health care organizations like Intermountain Healthcare, Lyra Health, and Dayton Children's Hospital. There's still a great deal to talk about, and since Scotty's covered his section, I'm going to jump right down to my concluding remarks. One second. All right. Now, during investor call in October, I mentioned that we grow our business by expanding market share and increasing wallet share. In the first half of the call, I talked about expanding our markets by selling directly to an audience of physicians, nurses, and nursing students. Now I want to provide a good example of how we expanded wallet share through better retention strategy, expansion, and cross-selling at a key customer account during the fourth quarter. One of our valued customers on the West Coast chose to expand their Learning Center and H-Stream subscriptions from 6,200 users to about 8,000 users. They also renewed their purchases of several content offerings like their health equity and belonging education for their staff, the checklist software tool they use for different compliance efforts and competency validation, their safety queue and comply queue, again, regulatory training content, and even EBSCO's clinical skills program and dynamic health. Not only did this customer commit to a long-term five-year renewal on those products, they decided to further leverage the power of the H-Stream marketplace by adding our CE Unlimited product with the Jane AI technology. And I just love that this customer continues to trust HealthStream for the kind of the more complete education and training of its workforce. So you heard that some of this was in compliance, some in clinical skills, some in soft skills and business skills. So it's exciting to see the breadth that they use this for that area. But in Q4, the customer actually also purchased Shift Wizard, our scheduling application. And this is the first time they've entered that part of our ecosystem using our Shift Wizard application. So I'm encouraged by the cross-selling that occurred when the Shift Wizard purchased it because it represents how we're focused on that cross-selling effort in all of our accounts. But in particular, this one was exciting. And, you know, I'll end this example by noting that the recurring revenue from this customer grew by 55%. through that renewal process to about $216,000 in the quarter. So it's a pretty good-sized account, and it grew about 55% when it renewed, and it added not just more learning products, but also the cross-sell or the up-sell, the purchase of the scheduling applications. And we're really excited because now we're beginning to demonstrate how those applications, although limited and powered by new H-Stream technology, some limited capabilities of how our different systems can work together. I do want to talk just for a minute about our evolving AI strategy. Going forward, we expect AI to impact how we develop products, the capabilities of our products, and even kind of some of the models for our products, like the learning model gets adjusted with the application of AI technology. So we're really excited that we're making incredible progress with our Jane AI product. And we really are putting our energy and AI around the Jane platform, which is used to develop and identify competency gaps for nurses. So it's a really great place to apply AI technology because we have proprietary taxonomies that can be used in navigating a custom pathway for someone. We can use the natural language processing to interpret their written feedback when they take our GI competency testing. And so this product is really exciting. Over the last 24 months, we've received numerous awards since its introduction. And in the fourth quarter, it was recognized for three more prestigious national awards, bringing the total number of awards for Jane to 11. And so, you know, I'm definitely excited about this award-winning product and its recognition for pioneering new methods of learning and application of AI to the learning journey. And what I'm most excited about, though, is that in the next quarter or so, we're bringing a new version of Jane to market that's specifically tailored for nursing students. And if you remember, last quarter we announced that we were going to target the nursing school market and the nursing students in that market. And I think the new version of Jane that we're preparing for that market is going to be particularly impactful for those students early in their career. And so we're really excited about our emphasis on the use of AI in the learning journey, in particular the award-winning Jane product, and the new modifications to that product to make it appropriate for both professional staff in hospitals and nursing students in nursing schools. In closing, I do want to highlight that our board recently approved, or just yesterday, an increase in the cash dividend to be paid out to shareholders. They approved the dividend payment of 0.028 cents per share, which is about a 12% increase over the previous quarter's dividend of 0.025. The upcoming dividend is payable on March 22nd to hold as a record on March 11th. And so if you're not in the stock, you can still come in and earn that dividend and go on this journey with us. We continue to be confident in our ability to accomplish our innovative organic and And our inorganic growth strategy, as we mentioned, we have about $71.1 million of cash, while also returning cash to shareholders is part of our objective. So we're excited about the dividend program. If you're interested in a profitable, highly recurring revenue, SASPath Healthcare Technology Company, that for 2024 expects to deliver steady growth and is determined to share some of its gains directly with shareholders in the form of a dividend, one that we just increased, Maybe Healthstream is a company and stock for you. And so that's my marketing pitch. I've always got to do a little bit of selling. Look, we're on the journey together and I've been building this company for a long time and I've never been more excited about the prospects for the company as our technologies evolve and incorporate the latest, like the evolving AI landscape. And our teams are amazing. We have 1,100 employees that are building incredible products and taking them to market with great passion. So we're really excited as we launch into this new year. I'll turn it over to the operator for Q&A. I hope that that came through. If it didn't, we'll probably have to schedule another day like an investor day or something to make sure we get all this great information on the transcript. I'll turn it over to the operator for questions.
spk22: Thank you, sir. The question and answer session will begin at this time. If you're using a speakerphone, please pick up the handset before pressing any numbers. Should you have a question, please press star 1-1 on your push-button telephone. If you wish to withdraw your question, please press star 1-1 again. Your questions will be taken in the order that they are received. Please stand by for your first question. And our first question comes from Matt Hewitt with Craig Hallam. Your line is open.
spk16: Good morning, and thank you for taking the questions. Maybe first up, just a point of clarification. I think, Scotty, you mentioned there was $14 million left in ANSOF legacy contracts. I'm just curious, will those contracts be up for renewal or conversion, I guess, this year or does it expand beyond this year? I'm just trying to figure out what the headwind is that you're facing maybe a little bit this year.
spk06: Yeah, I'll start to take that and then let Scotty add to it. The total remaining kind of business with ANSOS is about 14 million. And it is our hope and expectation and our work and focus of our work to retain all that business until which time we can eventually upgrade them to the newer technologies like ShiftWizard. And so it is our objective. Now, that said, in the last 24 months, as Scotty noted, we've experienced attrition in that group and lost them not to the market, not to the translation over to ShiftWizard. So we're working really hard to position the upgrade to ANSOS as ShiftWizard. If you remember, it's a legacy installed product. It is aging technology. And we're working hard to keep the customers satisfied with where they are. renew them as their contracts come up for renewal, but also transition them when they're ready to transition to the Shipped Wizard product. So we hope to stem some of this rate of loss here in the coming course and get them transitioned over to Shipped Wizard as well. So I hope that set a framework, and if Scotty wants to add anything, he can.
spk19: Yeah, Matt, I mean, it's a mix of contracts that are what we call in their auto renewal phase. That's a common practice for that type of previous sale. And then a good mix is also of customers that have entered into agreements for multiple years of renewal for that solution. So I don't have the numbers in front of me to speak to, but there is a mix of contract links in the base.
spk16: Got it. That's helpful. Thank you. And then Bobby, as you look at it, as you start to sell more and more directly to the end user, particularly the nurses, historically you've signed, and I think you mentioned again today, you're typically signing three- to five-year contracts with your hospital customers. But with nurses in particular, those aren't three- to five-year contracts. So how does that change your visibility, and what can you do to ensure? Obviously, it's a big market. and getting in early with those end customers is obviously ideal. But how does that change your visibility, and what can you do to maybe increase that? Thank you.
spk06: Yeah, a couple things. One, these technologies power commerce, B2B commerce, as well as direct-to-consumer. And so there's two opportunities here. And the main one I'm going to cover first is focusing on the nursing students while they're in the two- and three-year programs to become nurses and getting the schools – to have the commitment to put those nurses through kind of those nurse students through ready to work programs and so the main focus of this is to get it where they could both be find a clinical rotation in a hospital and of course they pay a little fee for that through my clinical exchange buy a few content bottles like the Red Cross program before they become a nurse so they enter the market with the certificate and the certificate generally has about a two-year lifespan and And we've entered into at least one major multi-year contract with a nursing school that has committed to provision some of these services to the students on a steady basis, ongoing basis, before they become a nurse. And then as they transition from there, they can carry, using HSTREAM technology, that portfolio, that record forward with them into work. So that's the main focus of these commerce capabilities. The new student, Jane AI, for example, We'd rather the school contract to provision it to the students. Now, the second capability is the one I opened with, which is fun and exciting. It's kind of a gap filler. So if someone is between jobs, they notice their license might expire if they don't take certain education for their continuing education, they can still use their H-treme ID, log in, and pay for themselves, of course. And we did report a lot of activity on there, both by learning to target doctors and students. That revenue will be a little less predictable. It is good margin, and it is incremental, and it's picking up a gap, say, between jobs or when they're not working in a place that uses our enterprise software. So it's kind of a gap filler. I call it money while we sleep because it's all automated, you know, credit card purchases. It will be less predictable, but you can see that we filled a lot of gaps in the fourth quarter with both of those types. So The emphasis will be, of course, on the B2B engagement with the schools that are interested in developing nurses, the students into nurses, and then placing them in their first jobs in hospitals. So that will be the real focus. And we mentioned the modified Jane product that's coming out. And our initial, we have an initial big win with a big nursing system that has committed to put, we believe they're piloting to put all their students through the Jane program and We'll know more about that probably at the end of the year, but that will be the real B2B goal as well. Hope that helps clarify. But that incremental revenue that we opened with is just fun and exciting incremental revenue for content we already own to audiences that would have normally disengaged with us, say, between jobs. So if a nurse worked at a hospital on our learning system and built a transcript, they take six months off, and then they take another job at a hospital that also uses HealthStream. They could pick up their education there. But now with our commerce abilities, they might, in between that, log in directly and consume a course maybe required by their state licensure. And so it's a gap filler and a time filler. It's incremental. It will be a little less predictable, but it is good margin. And so I hope that helps at least understand what we're going for. You know, it's a little bit of context, too, for the concept of trying to make all of these business subscriptions and the people behind them kind of continuous lifetime customers of the Healthstream ecosystem. And so hopefully it kind of clarifies that gap-filling capability we have, and it will be a boost to revenue here and there. Thank you.
spk17: That's very helpful. Thank you.
spk22: Thank you. Our next question comes from Jared Haas with William Blair. Your line is open.
spk11: Yeah. Hi, good morning. This is Jared Haas. I'm for Ryan Daniels. Thanks for taking our questions. Bobby, maybe just to start, I was hoping to unpack a little more color just around recent sales cycle trends. It seems like others that we've heard in the healthcare IT space have started to flag maybe some improvements in the selling environments with health systems, you know, maybe relative to what the environment was like going into 2023. So, just be curious if that's something you've experienced in any meaningful way. Has that translated into, you know, any sort of favorable inflection from a selling perspective?
spk06: Yeah, sure. It's in different pockets, and so we did try to highlight some of that in the call. I don't know if some of that got muddled out, but let me kind of repeat and think through some of it. I think we did talk about, at least for some of our legacy products, where they have some decline, and we specifically addressed the skilled nursing market. So that market as a whole is under a bit more duress. We see a little bit more churn in the customer base, like the smaller ones maybe combining with larger ones or even going out of business. So in the skilled nursing market, it seems to still have some remaining financial stress and a little bit harder to sell to. And so we saw some declines in the quality manager product that Scotty mentioned. But we did also open by highlighting, actually I had to repeat it so it's at the end, but highlighting the subscription growth to Shift Wizard and Credential Stream, both of which, as you heard, 31% and nearly 50% year-over-year growth. which is reflected in the strength of the pipelines for those products. And so, you know, I guess I'd say it has some variability, but in some of the bigger enterprise purchasing, particularly in credential stream and shift wizard, we saw, we see strong pipelines. And, and so maybe there are certain sub segments of the market like skilled nursing. We're learning more about nursing schools and their buying cycles. And so there'll be more on that in the future. So I won't comment too much on that because we're both have new products and a new focus on selling to those. So there's some variability in there. I'd say generally, though, the patterns of reviewing products for purchasing, the availability to sell is obviously much improved from the middle of COVID, where people simply weren't taking calls. And so I'd say there are kind of normalized new models of selling, and customers are receptive to seeing the new and exciting products that we have.
spk11: Okay, that's helpful. Thank you. And then maybe just one on the 2024 outlook and, you know, looking at the revenue guidance, it looks like the range from the low to the high end is a little bit narrower relative to the guidance for 2023. I'm curious if there's anything we should infer in that just in terms of the level of confidence that you have at this point in the year, maybe relative to last year, or anything that's changed from a visibility perspective. I know you're still working through the ANSAS sort of headwind, and maybe there's some nuances as to how that kind of impacts the forecast, but maybe we'd just love to unpack anything that's going on from a visibility perspective at this point in the year.
spk06: I mean, generally, as we open, the business is very predictable. There are some variables, and again, we noted those, like ANSAS, that are less predictable. We've tried our best to factor in the the topics that Scotty covered on some of the challenging areas. And I think in general, we're getting a little better and feel a little more comfortable with a slightly tighter range. And so I guess we're just getting a little better at forecasting. Also, it's interesting. And we talked about the direct to consumer commerce, too. A lot of that's data driven. And so, for example, we mentioned how that opioid course was just selling really well. I mean, there is kind of a requirement around that, and we're getting better at the targeting, so we're a little better at predicting those sales, which might normally be considered almost totally or less controllable. And so I'd say using better targeting for selling and maturing a bit in our forecasting, we hope that we're able to tighten that range and give a little better guidance. So we'll see how that plays out, but our expectation is that we can hit that range.
spk10: Okay, that's perfect. Thank you.
spk22: Thank you. Our next question comes from Stephanie Davis with Barclays. Your line is open.
spk00: Hi, guys. This is Anna Krasinski. I'm for Stephanie. Thank you for taking our questions. I want to go back to the 2024 guidance. Just curious if you could talk a little bit more about the drivers of more sequentially stable growth and margins given your cost optimization and network expansion efforts.
spk06: I'll let Scotty take a little of that. I think just in general, yes, we've gone as we've migrated from essentially to this one health stream model. We've been able to find operating synergies in the business by operating more like a single platform company. We were able in early last year to restructure some of our operations and deduplicate some of what used to be segment reporting. And so some of those efficiencies are still in the model, and we've benefited from them this year. We're just getting better kind of operating. So you see better management of our G&A, for example, in the last 12 months, and therefore maybe more predictable as we look into next year. We hope, again, more stability. There are a few variables to that, as we just talked about a few of them in the sales model. Also, a few challenges in sub-markets like the skilled nursing industry. We did see a little higher bankruptcies in the market, which again adds a little bit of variability to the predictability, things that are essentially beyond our control. But the things that are within our control, I think we're getting better at controlling, both from a G&A standpoint, even CapEx. There's an increased focus on deployment of our capital into software development and a better, I'd say, rank ordering of prioritization of projects that we think we're going to hopefully get better and better at deploying our capital. And so I think all that is just hopefully a maturing business that's getting better at how it operates and studying more for efficiencies on how we get where we're going. For example, these new e-commerce selling ability provide more financial leverage. As we sell with click-to-purchase functions, we can lower our total cost of sales. And I think that's kind of another type of efficiency we expect to get as we deploy the new platform models that we're building. Okay.
spk00: Got it. Thank you. That's really helpful. And then as a quick follow-up, just curious if you could rank your capital allocation priorities across inorganic opportunities, dividends, and share purchases for next year?
spk06: Oh, gosh. Well, I mean, the first priority is building organic products, like the Jane AI product that we're going to take into the nursing school. So first priority for capital and capitalized software development is in building and enhancing existing products and building new products. We've talked about taking ShipWizard more to enterprise class. We've talked about adjusting our Jane product, enhancing the AI technologies, and entering new markets with it. So our capital, the bulk of our capital goes into exciting new product development. That is the place where it should go. And then second to that would be, I guess, the inorganic opportunities. And our last acquisition was a little over a year ago. It turned out to be a really strong winner there. small, bite-sized, tuck-in, incremental to our platform strategy. So very excited. And I think that will be kind of the second priority is to, you know, we won't force anything. As demonstrated last year, we did no acquisitions last year. But we're constantly looking and expect to continue an active M&A program, especially the kinds that kind of leverage our platform technologies and where we're going, the three primary application areas where we are. So, it strengthens those three areas or enhances our infrastructure, our targets for us. So, that'd be the second. And then I would say, you know, we executed a really good buyback program. I think we've done three in our 20-plus years, 24 years being public. Actually, all three of those buyback programs are in the money, which I think would be atypical of a lot of management buybacks, management board-driven buybacks. So, All of our buybacks have been good deployments of capital, knock on wood, so far. And so that would be maybe the third priority. And that program does lapse in March. And no visibility on whether it's time for our board to put another one in place. But right now we have an active program that expires in March. And then last of the dividends, I think it's a very small dividend, but it sends the message of capital discipline. I think taking a little bit of money off the top for shareholders, And then applying the balance of it to all the things I just talked about, I think puts a little bit of capital discipline. And it says, look, first order to remember is to make money for shareholders. And we put a small dividend in place to send a very clear message that we can manage our free cash flows, build new products, enter new markets, do small acquisitions that fit, while also paying out a little, sharing the profits along the journey. It is a journey. I've been doing this a long time. And I think it just brings shelters more onto the journey to share a little bit as the journey evolves. So those would be our four priorities. One, two, three, four, the way I articulate them. Thank you.
spk22: Thank you. Our next question comes from Richard Close with Canaccord Genuity. Your line is open.
spk15: Yeah, thanks for the questions. Congratulations on a steady 2023. Scotty, I was curious on modeling revenue with HStream subscribers going away. Just wondering what the best way to forecast going forward and how we track the company's progress of penetrating the 12.3 million employee TAM and increased wallet share that you're talking about. I guess pulling back on the HStream the model sort of evolved into a black box. Are you considering providing any other metrics like ARR growth or net revenue retention or anything to help us out?
spk06: Yes, we're studying that now. So a couple of things there. First is just a reminder, and I think in spite of our best efforts to explain where we are on the journey, I want to remind you the first thing is that the metric that we had out there that we just retired was for subscriptions, not subscribers. And so it really was intended to show the platform kind of expansion, but not as an infrastructure for calculating ARPU or revenue per employee, because we hadn't yet gotten to the place and we fully intended to over time get to the place where we could convert and talk about subscribers, like the number of unique healthcare persons on our network. And, and we, we, uh, And so we're just not, it was a great metric almost like for a single product to talk about its expansion. But it was not correlated to revenues for the reasons Scotty mentioned. And it was not, it doesn't correlate to subscribers. And we saw some potential misapplication of it to calculate revenue per subscriber. And so We think it served its purpose. We're getting our technologies out into the market, and almost all the report subscriptions sold to our regulatory courseware gave us sense for that. But it is not a proxy for subscribers, and it can't be related to revenues yet because it's not fully deployed, meaning there are several products that derive revenues that don't add to the subscription number. So for that reason, subscriptions aren't subscribers. and it's not fully deployed, it can't be used as a denominator in a revenue per employee model. So we are going to look to this year at additional both financial metrics to focus on. We already report a full gap, of course, and one of those we're studying is ARR. So we'll look towards the middle of the year to see if we can get to that kind of metric, which I think would help all of the analysts and everyone understand the recurring revenue nature of the business and the growth trajectory. So yes, Richard, we're working on that. But I think it's time to take this metric, as we mentioned, kind of off the table because it was symbolic of the growth of the platform extension, but not relatable to people yet and not relatable to revenue. And we saw some of that starting to happen. So we just think we need to move our focus probably towards something like ARR. That was the discussion in the last quarter. And we've got to, you know, test, back test and see how that metric, how we're going to measure it. But that would be a goal would be to add some new metrics by the middle of the year.
spk15: Okay, great. That would be helpful. And then on Ansoft, I had, I guess, a couple of follow-up questions on that. Is the remaining $14 million, is that just maintenance and support revenue? that's the first question. And then if there's any details in terms of the success rate of converting to the Shift Wizard product would be helpful. And then finally, the average term, I guess, length of time on the remaining contracts.
spk14: Sure. A couple of things there. The contracts have a lot of
spk06: Essentially, a lot of them are old, installed, and they have a maintenance fee that's non-SAS, but there's some recurring nature to it, and they have auto renewals unless they cancel. And so there is a recurring nature to it, and it does include some of those maintenance fees, basically. So the second is on the conversion rate. I'd say to date, obviously, unfortunately, not very successful at all at that, but a renewed focus by our teams. Also, as we talked about in prior calls, we're enhancing ShiftWizard to better meet the needs of these enterprise customers of Ansauce. And I think every single quarter now, and actually every month on ShiftWizard, there's a new software release, and it's moving us ever closer to full enterprise capabilities. So I think there'll be a better opportunity to transition. So again, not very successful in the migrations today, as you hear from the loss that we've been reporting. We do expect and we have full energy on stabilizing that 14 million and we're going to try to reduce the attrition rate and also succeed better this year in the conversion rate. So, this isn't a story of, I don't think, going to zero. It's an effort to stabilize and stem the loss while also transitioning them to the newer exciting technologies of ShiftWizard. And ShiftWizard is very well received in the market. For its current capabilities, it's just winning share. we just need to enhance some of its core functionality and we've made a lot of progress on that, uh, enhancing core functionality around kind of enterprise level data analysis. And so I think we look forward to by the middle of year having great progress on that. So there'll be a better destination, a better destination to migrate everybody to. I'll turn it over to Scott if you want to add anything.
spk19: Yeah, I'll just make a comment or two, Richard. I mean, I think, uh, You know, I tried to address with Matt earlier in the call kind of the nature of the contract length that kind of vary from, you know, auto renewals to some that have, you know, signed multi-year contracts. I don't have the duration, you know, run out in front of me, but there is a good mix of, you know, auto renewals plus, you know, customers under term. I would say too that our objective is to continue to support the customers. We do want to migrate them to ShipWizard, but we also want to acknowledge that there's still customers on that application and we're still there to support their use of it. And so that's another, you know, consideration. And, you know, I think, you know, as we talked about, you know, the 14 million, it's, you know, we wanted to just provide that number to provide context. As Bobby said, don't expect it to go to zero. We just wanted to size it up for our investors to understand the magnitude of it.
spk15: Okay, that's helpful. And then under the direct-to-consumer, just on that portion of revenue, I know it's small, but it's a different sale. How are you thinking about customer acquisition costs on the direct-to-consumer market? Maybe it's a little less than a typical direct-to-consumer because if they're in between jobs, they already have exposure to you. Just trying to get your thoughts on that.
spk06: Yeah, I would say for the next couple of years, our thoughts are really just to try to keep the people that I would call, quote, in-network to stay in the network when they're between jobs. And as I mentioned, pick up this new audience of students before they become professionals. And so it really isn't to broadly, openly market to people to self-register. It's to capture using existing data from the customers that have been in-network to find them between jobs. Or, you know, when they leave a job, they can now leave and carry information their HealthStream transcript with them, and that's different. And so they kind of, if they work somewhere for a couple years and they leave, they can still log back in using their hStream ID and see that they had 10 courses. And so now all we're doing is saying, oh, you can log back in and carry your transcript with you like a portfolio or a wallet. You can take it with you. But you can also say, well, hey, you know, I might as well click at the bottom here to keep my license current and take an additional course. And that's happening right now with doctors. on that DEA course that we mentioned, and it's happening with nurses when they take a little bit of CE, or even when they're about to take a new job, they refresh on something before they go back into the new job. So really, it's more of a gap filler than it is a broad consumer. You said consumer. I call it direct-to-professional, D to P, and it's really just trying to keep people in network all the time. as opposed to just kind of broadly marketing out into the wild open right now. Now, maybe we get there someday, but really the job right now is just to make that transcript portable, make them lifetime engaging with HealthStream instead of just engaging with us when they're in their job.
spk15: Okay, thanks. Very helpful. And if I could slip one more in. I thought on CredentialStream it was interesting you announced – Alira Health, a digital health company, that seemed a little bit different. Are you seeing an uptick in opportunities in that segment on the direct-to-employer benefits area?
spk06: We are seeing, at least with the insurers, we're seeing some opportunity there. And so I would say yes. Kind of categorically, there's interest in a couple of areas that maybe are not just purely the acute care hospitals. And so there are a lot of – I guess I'd characterize them as new, but I just say we're getting better at pursuing a broader opportunity and not just the acute care hospital market. So the answer is yes.
spk13: Okay. Thank you.
spk22: Thank you. Our next question comes from Constantine Davids with Citizens J&P Securities. Your line is open.
spk09: Hi, thanks. Good morning. Just a couple follow-ups here on scheduling. Can you just maybe characterize where you're seeing growth with Shift Wizard? Because it's been pretty impressive in 23. And I guess just a little further on that, is it sort of large IDNs, complex, you know, academic medical center-type installations, or smaller hospitals and then are you typically replacing a manual kind of homegrown scheduling system or some other standalone technology solution?
spk06: Well, a couple of really interesting things in that space for us. One, I would just describe it if there's kind of such thing as the very large enterprises and then there's the middle market and then there's the small urban or rural hospitals and community hospitals. It's kind of the middle there that we're getting really strong on. You could probably call them regional health systems. The other thing is that we have this great relationship that's growing with Workday where they're bringing us in to help kind of them have a complete offering, and we've turned out to be really good partners in supporting customers' needs. And so we're getting brought into Workday accounts with them and to round out services, and we just found that to be a great partnership. So kind of a good referral, almost a referral program for us, a good source of leads and compatibility. We just work really well with that team, and our applications work together well and present well together. So that's been really exciting and fun. Usually we're taking out competitors in the market that have aging technology, and we've got this emerging new good paradigm, great user interface with ShiftWizard. So organizations like UKG and API where we compete, we generally are replacing something. And so I hope that answers your questions. And in general, we're trying to expand the capabilities at ShiftWizard to handle ever larger and larger systems. We do have some large systems as customers, and we just need a more robust, basically reporting and data analytics suite, which we have in learning, which is great. So we're going to use a lot of that infrastructure to launch applications better class of data analytics and learning around scheduling, which we think will meet the needs of even the larger health systems. So we're excited about that. And that should be a this year event. We're making good progress on that as well. Again, as I mentioned, with monthly releases of ShiftWizard, very exciting. We'll have a webinar and hundreds of people will attend for each monthly release to see what's coming on ShiftWizard. And it's just gaining traction and momentum and excitement as we add enterprise class features so we can go after even larger customers.
spk09: great and then um just a follow-up i guess to richard's question around metrics have you um or can you talk about just how many uh hstream ids have been claimed at this point is that something you can provide it's it's interesting it's over a million but we got a lot of work to do there's a lot of and we've been building tools for a long time now deduping tools uh we've been building tools to let people
spk06: know if they're if they're if they worked at one health system they could claim their records another and combine them so they have this unified transcript as an individual so it is really exciting but it's kind of still nascent uh i mean there's several steps in the process first we have to wire the application we have dozens of applications to the htrem architecture using so it uses the htrem id and then we have to get the professionals to kind of claim any other uses like we call it putting keys on keychains so once you have an hstream id you're able to then go and say oh well i also use this application and so kind of merge that information uh almost the way you do at google where you get universal access to all their apps but for us it's a limited set of apps now so we have over a million uh what i'll call reconciled ids and there's going to be millions more over time but that is going to take time and that's you know until we can get to that pure subscriber count You know, historically, you think of us as a B2B software, you know, three separate tech stacks. But increasingly, the tech stacks are interrelated through the HStream platform and the HStream ID. And we're kind of, you know, mid-stages maybe deploying both the technology and the reconciliation of IDs. So over a million unique HStream IDs have been issued, which is really exciting. But there's millions more to go. And we expect steady, quarterly progress on that. And, of course, when we get to some place where we're excited, where we have enough momentum, that can become a metric. And that could be the basis for some kind of ARPU. But there are two things that have to happen. One, more of our applications have to connect to it, and then more of the users have to reconcile. And we've been building – this is a very complex topic, and we've been working on it for years – You have to have the reconciliation tools, the account joining tools, the keys on keychains, the management tool sets. And we're actually getting very good at those. And the LTMID deployment models, we're getting very good at all that. And so we expect it to kind of continue to spool up.
spk09: And I guess just last question along those lines, where do you think you are in the journey, Bobby, whether it's in baseball terms or some other language? But just having all the apps on the platform, common architecture, you know, making them all interoperable and seamless. Just how far along do you think you are?
spk06: Oh, and well, in the baseball analog and I'm not a huge baseball person, but I'd say third inning, you know, it's, but it's going faster. So it's one of those things. It's not linear. Like each, each inning isn't the same length. I think it's the kind of thing that can kind of be maybe geometric or maybe, maybe, maybe exponential, but, but definitely geometric where it's, it should go faster than linear. And so while we're in maybe three out of nine innings, the fourth should be faster than the third and so on. So I think it can continue to spool up. Thank you.
spk22: Thank you. Our next question comes from Vincent Colicchio with Barrington Research. Your line is open.
spk30: Yeah, good morning, Bobbie. Most of my questions have been answered. Just curious on the credential stream side, With the success you're having, has there been any competitive response in terms of trying to match your differentiation there?
spk06: We have lots of things to do in our roadmap to continue to differentiate, but right now, I think we've got a really exciting product. In fact, to the point where, as I mentioned, organizations like Workday are thinking of us as the best of breed and bringing us into their deals. I'm excited about where it is. Now, where it's short, and we've talked about this, is some of its enterprise feature sets, particularly around data management reporting. If you're a large organization with 50, 60, 70 hospitals, you have different demands on how you distribute information, and you're solving labor issues across markets and across regional deployments. We're going to get more sophisticated on that this year, but those are the advances that we have. Now, The true differentiators are still yet to come. So we're beginning to incorporate some of the technologies of our platform, for example, the license service. I hope that by the end of the year, for example, we'll be using the license service that was built in Credential Stream to verify a nurse's license before we schedule them. And so we have that capability, as you know, in our platform to check licenses. And so it'll be a further differentiation as we connect ShiftWizards to services like the license verification service that is a function of our hstream platform so that's an example of a differentiation yet to come that i hope is this year that will continue to distinguish us from our competitors and they're they're of course a roadmap full of those ideas as well hey vince are you asking about a credential stream on that your question i think he was actually i just got a note from someone So I guess the same holds true for credential stream as it takes advantage of connectivity to the learning center, for example. We're in the middle of going back to customers that have both our learning system and our credentialing system and showing them the interoperability of the early stages of interoperability between those. For example, how logical is it, but if you earn a credential in the learning network, it should auto-populate as a credential into your credentialing system. And so the same kind of answer holds is that There are plenty of differentiations to come this year that show interoperability and several that are in place now that we're beginning to market actively.
spk30: So, Bobby, will you still respond to my question because I got cut off?
spk06: I think in both cases, I try to give examples of both shift wizard and credential stream that are going to be increasingly competitively differentiated by how they access services of the HStream platform, whether it's the HStream ID to create interoperability, for example, your data following you from one system into the other. The example I just gave was a learning credential earned in the learning system following you into the credentialing system and maintaining its primary source verification status, or a scheduling system that relies on the platform technology to check a license before you're scheduled. And so to verify your license is active, before we schedule you. And so those are two examples of interoperability that are, one is actively being marketed and the other is to come this year. But increasingly, the differentiation will come from how these applications interoperate or operate together and how data moves between them and how services built in the platform power up distinguished features in the application. This is true in learning, scheduling, and credentialing. In all cases, We hope to further differentiate it. I think there's also kind of a broader value proposition of getting these applications that are operable. I think it's more appealing to a COO, a CTO, a CFO when they see a suite of software working together instead of individual separately implemented tech stacks. And so we're looking for operational synergy, implementation synergy over the coming months and years.
spk30: And one last one. How would you characterize pricing in the acquisition market? Is it rich? Is it improved? What would you say?
spk06: Well, let's see. We didn't do a deal in the last 13 months. And during that, I guess I would say in the last quarter or two, I think a little bit of softening and some excitement, maybe deal pipelines can pick back up. But, you know, the private companies always hold on as long as they can to the past. And so, you know, Maybe one of the concerning factors was that in the first half of the year. But I don't know how to say it. If you have a hot company that's a SaaS model and it's emerging and growing fast, you're going to be able to demand a premium for your business when you sell it. And so I think that is almost always true. Maybe fewer companies meet that criterion, and they're also burning cash. So I think those companies, there's going to be some deals out there, I think, as companies try to recap at lower market caps in the next year or so. Nice. Thank you.
spk22: Thank you. If there are no further questions at this time, I'd like to turn the call back over to Robert Frist, CEO, for any closing remarks.
spk06: Thank you to our analysts for following our story and helping us tell it. Thank you to our 1,100 employees for making all this happen. We'll look forward to our continued reporting and growth as a company. Thanks for going along the journey, all you shareholders. We'll see you on the next earnings call.
spk22: Thank you for your participation. This does conclude the program. You may now disconnect. Everyone, have a great day. you Music. Thank you. Good morning, and welcome to Healthstream's fourth quarter and full year 2023 earnings conference call. At this time, I would like to inform you that this conference is being recorded and that all participants are in listen-only mode. At the request of the company, we will open the conference up for questions and answers after the presentation. I will now turn the conference over to Molly Condra, Vice President of Investor Relations and Communications. Please go ahead, Ms. Condra.
spk24: Thank you. Good morning, and thank you for joining us today to discuss our fourth quarter and full year 2023 results. Also in the conference call with me this morning is Robert A. Frist, Jr., CEO and Chairman of HealthStream, and Scotty Roberts, CFO and Senior Vice President of Finance and Accounting. I would also like to remind you that this conference call may contain forward-looking statements regarding future events and the future performance of HealthStream that could involve risk and uncertainties that could then cause the actual results to differ materially from those projected in the forward-looking statements. Information concerning these risks and other factors that could cause the results to differ materially from those forward-looking statements are contained in the company's filings with the SEC, including forms 10-K, 10-Q, and our earnings release. Additionally, we may reference measures such as adjusted EBITDA, which is a non-GAAP financial measure. A table providing supplemental information on adjusted EBITDA and reconciling to net income attributable to HealthStream is included in the earnings release that we issued yesterday and may refer to in this call. So with that start, I'll now turn the call over to CEO Bobby Frist.
spk06: Good morning, everyone.
spk04: I'm having a few connection issues. There might be a glitch here and there. We'll push through it, though, do the best we can. I'm really excited about how we finished the full year 2023.
spk06: There are lots of exciting things to cover, and we'll do that in great detail in the next 30 minutes. We delivered record top line revenue of $279.1 million and record adjusted EBITDA of $61.3 million. In our guidance for 2024, we expect to surpass both of those high watermarks as we further expand our ecosystem with exciting new products, new sales channels, and new target markets. The significant development in our market expansion strategy directly to individual end users, such as physicians, nurses, and nursing students. Our ASTREAM platform allows us to approach individuals with a bunch of learning moves that are most applicable to them. Around this year, we've been settling for commercial positions on our newly-released CTE course site, the ASTREAM platform. While we're on that site, it's a better fit for our end users and their family purchases. We also amplified our ability to reach and to sell to individual nurses through NurseGrid Learn, which is linked via our popular NurseGrid app. As a reminder, NurseGrid is the number one most popular app for nurses based on ratings and downloads in the Apple Store. with approximately one in six nurses in the U.S. regularly using it. During the third and fourth quarters of 2023, over 1,800 orders were placed by nurses. Some of the top products sold .
spk04: Yeah, I'm having some connection issues I'm getting feedback from, so again, we'll push through best we can.
spk06: I'm excited about our early success in selling direct to health care professionals with our new e-commerce-enabled H-Stream platform. I believe that the ability to participate in our ecosystem throughout one's health care journey includes new opportunities for caregivers to advance both their skills and their critical reminder about our business and who we are for the benefit of anyone who is new to HealthStream. First and foremost, HealthStream is a health care technology company. dedicated to developing, credentialing, and scheduling the healthcare workforce through SaaS-based solutions, each of which are becoming more valuable because of the interoperability they're achieving through our H-Stream technology platform. Historically, we sell our solutions on a subscription basis under contracts that average three to five years in length, which is very acceptable. In fact, 96% of our revenues are subscription-based, As I just mentioned, we have also started to open our sales channels directly to health care professionals and nursing students across the continuum of health care training. We are profitable, have no interest-bearing debt, and a strong cash balance of $71.1 million. We are solely focused on health care, and more specifically, the health care workforce. The 12.3 million health care professionals and nursing students in the United States comprise the total addressable market for our SAS.
spk05: Oh, gosh.
spk06: All right, I'm going to need to... It looks like we're having bigger connection issues than I thought, so I apologize for that. I'm going to have to go find another dial-in.
spk04: Give me just a second.
spk06: Hey, Molly, I'm going to ask if you can hear me, that you pick up, since the script is written, if you could pick up in the paragraph. Sure. Or maybe even, since you know where I dropped it.
spk24: Yes.
spk06: So I can get back in. Go ahead and start from the top.
spk24: Sure.
spk06: Thank you, Molly.
spk24: So I'll start where Bobby left off, if I understood that correctly. So in the fourth quarter, revenues from our scheduling application, Shift Wizard, grew 31% over the prior year quarter, as customers continued to report high customer satisfaction. Since purchasing Shift Wizard in October 2020, we have selected it as our primary scheduling application, and significantly expanded its ability to perform at enterprise scale. And it's only going to become more powerful, more differentiated in the market in the coming year. In the fourth quarter, we welcome many new customers for ShiftWizard, including Norman Regional Hospital, Friedman Health Systems, and Phelps Health. Revenues from credentialing, privileging, and enrollment application credential stream grew 52% in the fourth quarter versus the same period last year. In the fourth quarter, we contracted 37 new customers for our credential stream solutions. These new credential stream customers included many highly respected healthcare organizations like Intermountain Healthcare, Lira Health, and Dayton Children's Hospital. So there's still a great deal to talk about, but right now I'm going to turn it over to CFO Scotty Roberts for a more detailed look at our financial performance and expectations.
spk19: All right. Thanks, Molly, and good morning. I want to start my portion of the call today with a recap of our financial results for the fourth quarter, and then I'll go over our financial outlook for 2024. Unless otherwise noted, the comparisons will be against the same period of last year. We continued to deliver solid results as we closed out the fourth quarter of 2023. Revenues were $70.6 million, up 3%, operating income was $4.3 million, up 38%, Net income was $4.6 million, up 87%. Earnings per share were $0.15 per share, up from $0.08 per share. And finally, adjusted EBITDA was $16 million and was up 17%. Our revenues increased by $2.1 million, or 3%, coming in at $70.6 million compared to $68.5 million in last year's fourth quarter. Our revenue mix continued to tilt in the direction of subscriptions versus professional services. In fact, revenues from subscription products accounted for 96% of total revenues and were $67.9 million, increasing by 4% in the quarter. Professional service revenues declined by half a million, or 17%, which had a negative impact on our growth rate of approximately 80 basis points. So now let me provide some more color about the revenue results. As Bobbi and Molly mentioned earlier, we saw a good mix of growth contributors throughout our portfolio. But I want to call out and quantify a couple areas that kept our growth rate for the quarter lower than it would have otherwise been and lower than we expect to see it in 2024. The first area that I'll highlight is associated with our ANSOF scheduling products. the suite of products was down half a million, or 13%, in the quarter. Our focus continues to be on stabilizing existing ANSOS customers and migrating them to ShiftWizard, our SaaS scheduling application, which grew its revenue by 31% in the quarter. Future declines associated with the remaining $14 million of ANSOS-related revenue are contemplated in our 2024 guidance. The second area that I want to mention is our quality manager solution, which accounted for approximately five and a half million of subscription revenue for the full year of 2023. And it was down 0.4 million or about 23% in the quarter. We acquired this product in 2019. And unlike most of our products, it's sold to the skilled nursing facility market. And while most areas of healthcare have rebounded since COVID, skilled nursing facilities in particular, have continued to experience financial pressures. ANSOFF's quality manager and professional services declines offset some of the exciting growth that we experienced in products like Credential Stream and Shift Wizard. Now, our remaining performance obligations were $541 million as of the end of the year, compared to $517 million the year before, and we expect approximately 42% of the revenue backlog to be converted in 2024. Our gross margin was 66% compared to 65.7% last year, and this was in the range that we expected. Moving on to operating expenses, the reorganization of the business as a single operating segment at the beginning of the year led to efficiencies and cost synergies in our operations that are reflected in our financial results for the quarter. We were able to maintain our operating expenses, excluding cost revenues, to a modest increase of 0.4 million, or 1%. And most of this year-over-year increase was from depreciation and amortization, which was up 10%, and product development was up 1%. Our G&A and sales and marketing expenses were down 6% and 1%, respectively. Adjusted EBITDA was 16 million, which was up 17%. And adjusted EBITDA margin improved to 22.6% compared to 19.9% last year. Now let's go over the balance sheet metrics. We ended the quarter with cash and investment balances of 71.1 million compared to 71.8 million last quarter. During the quarter, we deployed 6.6 million for capital expenditures, paid 0.8 million to shareholders through our dividend program, And we repurchased 6.8 million of our common stock under the share repurchase program announced in September. For receivables management, our day sales outstanding was 42 days for both the fourth quarter of this year and last year. While we've had a relatively steady performance with receivables, during the past year our bad debt charges increased by approximately 600,000, which about 350,000 occurred in the fourth quarter. Our total bad debt charges for the full year approximated $1 million, or about 0.37% of revenue. Now switching over to cash flows. For the full year, our cash flows from operations improved by $12.8 million, or 25%, coming in at $64 million. And free cash flows improved to a record high of $36 million compared to $26.1 million last year, an increase of 38%. We have a strong balance sheet with over 71 million of cash, no debt, and improving free cash flows. With available capital to deploy, we apply a disciplined approach to our capital allocation strategy, which includes M&A, dividends, and share repurchases. While we did not complete any acquisitions during 2023, we maintain an active M&A program to evaluate potential transactions that fit our investment criteria. In addition, deploying capital through cash dividends and share repurchases are ways for us to improve shareholder value. In February of 2023, our board of directors adopted a dividend policy, which we returned $3.1 million of cash back to shareholders last year. And yesterday, our board of directors declared a quarterly cash dividend to be paid in March, increasing the payout by 12% over the previous quarterly dividends. As for our share repurchase program, during the quarter, we made 6.8 million of share repurchases, and we have 1.1 million remaining under the program. Our current share repurchase program will expire on the earlier of March 31, 2024, or when the maximum dollar amount under the program has been expended. In the fourth quarter, HSTREAM subscriptions increased by 85,000 over the previous quarter to a total of approximately 5.8 million. Now, as we turn our attention to metrics that are more relatable to revenue growth and our medium-term financial objectives, we are planning to retire the hStream subscriptions metric with this report. We believe that hStream subscriptions have served as a good indicator of our ability to deploy our platform at scale, and we are now turning our attention to the future financial performance that scale can drive. As we've said before, 8-Stream subscriptions are not intended to be used to calculate revenue per subscription or revenue per subscriber. A key reason for that is because not all products that result in revenue gains or losses require 8-Stream subscriptions, and subscriptions do not necessarily correlate on a one-to-one basis with subscribers. We continue to believe that the medium-term financial objectives that we introduced at our September of 2022 investor meeting are key performance indicators for our business. So let's refresh on our medium-term objectives, the metrics which support them, and our performance against those metrics in 2023. Our revenue growth objective is to be in the 7% to 10% range, with 5% to 7% coming from organic growth and 2 to 3% from inorganic. For 2023, we achieved revenue growth of 5%. Our gross margin objective is 65 to 68%, and we achieved 66%. And our adjusted EBITDA margin objective is 21 to 24%, and we achieved 22%. We're excited to now give our financial guidance for 2024. which we expect to deliver on each of the three medium term objectives I just described. We expect consolidated revenues to range between 292 and 296 million. We expect adjusted EBITDA to range between 64.5 and 67.5 million. And capital expenditures are expected to range between 28 and 30 million. This guidance does not include assumptions for any acquisitions that we may complete during the year. Our revenue guidance range implies a growth rate between 4.6 and 6.1%, and we expect steady performance across the year. Our ability to upsell and cross-sell solutions to existing accounts, improve our net revenue retention, and acquire new customers, including targeting the nursing school market, and increasing sales through our commerce channels are elements that we believe will help us achieve these revenue targets. We expect gross margin to be around 66% for the year, and subscription revenue mix from solutions that we own versus partner solutions which we pay royalties and investments in our platform infrastructure, such as cloud hosting and software, will be the primary influences on gross margin. As for staffing, we have just under 1,100 employees and approximately 50 open positions as of the beginning of the year. So labor costs are expected to increase steadily across the year. We expect both product development and sales and marketing to increase in the 4% to 6% range. We have plans to increase our marketing efforts this year, including our trade show presence and engagement directly to students and professionals. We expect that our G&A costs will increase 1% to 2%, And finally, we estimate the effective tax rate will be in the low to mid 20% range. That concludes my comments for this quarter's call. Thanks for your time this morning. And I'll now turn the call hopefully back over to Bobby for some additional updates.
spk06: Okay, great. Thanks, Scotty. I think I'm on a better connection now. I have to have a little discussion with my Google connection, but we're good to go. What I'm going to do is repeat my opening section because we need a good record of it. And then I'll pick up with the third section, my final section. If I break out again, I'll ask Scotty to do the same. Just go back to the top of the script and get my first section in the record and finish with the third section of our presentation. So good morning. Thank you, Molly, for the handoff earlier. Welcome to our fourth quarter and full year 2023 earnings call. I'm excited about how we finished the full year 2023. We delivered record top line revenue of $279.1 million and record adjusted EBITDA of $61.3 million. In our guidance for 2024, as Scotty just mentioned, we expect to surpass both of those high-water marks as we further expand our ecosystem with exciting new products, new sales channels, and new target markets. A significant development in our market expansion strategy in 2023 is our additional focus on selling directly to individual end users like physicians, nurses, and nursing students. Our H-Train platform now allows us to approach individuals with the learning most applicable to them. I'm going to check real quick and see how that came through. Scotty or Molly?
spk18: You're coming in just fine, Bobby.
spk06: Okay, great. Around mid-year, we began selling primarily to physicians on our newly released CME Courses site powered by the HStream platform. On that site, we've seen a surge in site visits and purchases, with the most popular purchase being the new DEA-mandated opioid course with over 2,700 orders placed in the fourth quarter alone. During the last two quarters of 2023, we also amplified our ability to reach and to sell to individual nurses through NurseGrid Learn, which is linked via our popular NurseGrid app. As a reminder, NurseGrid is the number one most popular app for nurses based on ratings and downloads in the Apple Store, with approximately one in six nurses in the U.S. regularly using it. During the third and fourth quarters of 2023, empowered by our new H-Stream commerce capabilities, Over 1,800 orders were placed by nurses. Some of the top products sold directly to nurses via Nurse Good Learn include our stable program, our regulatory courses we call SafetyQ and ComplyQ, and CE Unlimited. I'm excited about our early success in selling direct to healthcare professionals with our new e-commerce-enabled HStream platform. I believe that the ability to participate in our ecosystem throughout one's healthcare journey, including as a student, which is a new target for us, when they're an employee at a healthcare facility, or as an individual finding us between jobs even now with this new commerce capability. We kind of create a continuous revenue opportunity out of the millions of subscribers in our network. And I think this gives them opportunity to kind of continuously develop them and engage with our ecosystem throughout their career. Before we go further, I wanted to provide a high-level reminder about our core business, and especially for the benefit of those who may be new to HealthStream. First and foremost, HealthStream is a healthcare technology company. dedicated to developing, credentialing, and scheduling the healthcare workforce through SaaS-based solutions, each of which are becoming more valuable as they become increasingly interoperable through our new H-treme platform technologies. Historically, we sell our solutions on a subscription basis under contracts that average three to five years in length, which makes our revenues recurring and predictable. In fact, as of today, 96% of our revenues are subscription-based. As I just mentioned, we have also started to open our sales channels directly to health care professionals and nursing students across the continuum of health care training. We are profitable, we have no interest-bearing debt, and a strong cash balance of $71.1 million. We are solely focused on health care, and more specifically, the health care workforce. The 12.3 million health care professionals, which now include about a million nursing students, in the United States comprise the total addressable market for our SAS solutions. In the fourth quarter, Revenues from our scheduling application, Shift Wizard, grew 31% over the prior year quarter as customers continued to report high customer satisfaction. Since purchasing Shift Wizard in October of 2020, we have selected it as our primary scheduling application and significantly expanded its ability to perform at enterprise scale and has only gone to become more powerful and differentiated in the market in the coming year. In the fourth quarter, we welcome many new customers for Shift Wizard, including Norman Region Hospital, Freeman Health System, and Phelps Health. Revenues from our credentialing, privileging, and enrollment application credential stream grew 52% in the fourth quarter versus the same period last year. In the fourth quarter, we contracted 37 new customers for our credential stream solutions. These new credential stream customers included many highly respected health care organizations like Intermountain Healthcare, Lyra Health, and Dayton Children's Hospital. There's still a great deal to talk about, and since Scotty's covered his section, I'm going to jump right down to my concluding remarks. One second. All right. Now, during investor call in October, I mentioned that we grow our business by expanding market share and increasing wallet share. In the first half of the call, I talked about expanding our markets by selling directly to an audience of physicians, nurses, and nursing students. Now I want to provide a good example of how we expanded wallet share through better retention strategies, expansion, and cross-selling at a key customer account during the fourth quarter. One of our valued customers on the West Coast chose to expand their Learning Center and H-Stream subscriptions from 6,200 users to about 8,000 users. They also renewed their purchases of several content offerings like their health equity and belonging education for their staff, the checklist software tool they use for different compliance efforts and competency validation, their safety queue and comply queue, again, regulatory training content, and even EBSCO's clinical skills program and dynamic health. Not only did this customer commit to a long-term five-year renewal on those products, they decided to further leverage the power of the H-Stream marketplace by adding our CE Unlimited product with the Jane AI technology. And I just love that this customer continues to trust HealthStream for the kind of the more complete education and training of its workforce. So you heard that some of this was in compliance, some in clinical skills, some in soft skills and business skills. So it's exciting to see the breadth that they use this for that area. But in Q4, the customer actually also purchased Shift Wizard, our scheduling application. And this is the first time they've entered that part of our ecosystem using our Shift Wizard application. So I'm encouraged by the cross-selling that occurred when the Shift Wizard purchased it because it represents how we're focused on that cross-selling effort in all of our accounts. But in particular, this one was exciting. And, you know, I'll end this example by noting that the recurring revenue from this customer grew by 55%. through that renewal process to about $216,000 in the quarter. So it's a pretty good-sized account, and it grew about 55% when it renewed, and it added not just more learning products, but also the cross-sell or the up-sell, the purchase of the scheduling applications. And we're really excited because now we're beginning to demonstrate how those applications, although limited and powered by new H-Stream technology, some limited capabilities of how our different systems can work together. I do want to talk just for a minute about our evolving AI strategy. Going forward, we expect AI to impact how we develop products, the capabilities of our products, and even kind of some of the models for our products, like the learning model gets adjusted with the application of AI technology. So we're really excited that we're making incredible progress with our Jane AI product. And we really are putting our energy and AI around the Jane platform, which is used to develop and identify competency gaps So it's a really great place to apply AI technology because we have proprietary taxonomies that can be used in navigating a custom pathway for someone. We can use the natural language processing to interpret their written feedback when they take our GI competency testing. And so this product is really exciting. Over the last 24 months, we've received numerous awards since its introduction. And in the fourth quarter, it was recognized for three more prestigious national awards, bringing the total number of awards for Jane to 11. And so I'm definitely excited about this award-winning product and its recognition for pioneering new methods of learning and application of AI to the learning journey. And what I'm most excited about, though, is that in the next quarter or so, we're bringing a new version of Jane to market that's specifically tailored for nursing students. And if you remember, last quarter, we announced that we were going to target the nursing school market and the nursing students in that market. And I think the new version of Jane that we're preparing for that market is going to be particularly impactful for those students early in their career. And so we're really excited about our emphasis on the use of AI in the learning journey, in particular the award-winning Jane product, and the new modifications of that product to make it appropriate for both professional staff in hospitals and nursing students in nursing schools. In closing, I do want to highlight that our board recently approved, or just yesterday, an increase in the cash dividend to be paid out to shareholders. They approved the dividend payment of 0.028 cents per share, which is about a 12% increase over the previous quarter's dividend of 0.025. The upcoming dividend is payable on March 22nd to hold as a record on March 11th. And so if you're not in the stock, you can still come in and earn that dividend and go on this journey with us. We continue to be confident in our ability to accomplish our innovative organic and And our inorganic growth strategy, as we mentioned, we have about $71.1 million of cash, while also returning cash to shareholders is part of our objective. So we're excited about the dividend program. If you're interested in a profitable, highly recurring revenue, SASPath Healthcare Technology Company, that for 2024 expects to deliver steady growth and is determined to share some of its gains directly with shareholders in the form of a dividend, one that we just increased, Maybe Healthstream is a company and stock for you, and so that's my marketing pitch. I've always got to do a little bit of selling. Look, we're on the journey together, and I've been building this company for a long time, and I've never been more excited about the prospects for the company as our technologies evolve and incorporate the latest, like the evolving AI landscape. And our teams are amazing. We have 1,100 employees that are building incredible products and taking them to market with great passion. So we're really excited as we launch into this new year. I'll turn it over to the operator for Q&A. I hope that that came through. If it didn't, we'll probably have to schedule another day like an investor day or something to make sure we get all this great information on the transcript. I'll turn it over to the operator for questions.
spk22: Thank you, sir. The question and answer session will begin at this time. If you're using a speakerphone, please pick up the handset before pressing any numbers. Should you have a question, please press star 11 on your push button telephone. If you wish to withdraw your question, please press star 11 again. Your questions will be taken in the order that they are received. Please stand by for your first question. And our first question comes from Matt Hewitt with Craig Hallam. Your line is open.
spk16: Good morning, and thank you for taking the questions. Maybe first up, just a point of clarification. I think, Scotty, you mentioned there was $14 million left in ANSOF legacy contracts. I'm just curious, will those contracts be up for renewal or conversion, I guess, this year or does it expand beyond this year? I'm just trying to figure out what the headwind is that you're facing maybe a little bit this year.
spk06: Yeah, I'll start to take that and then let Scotty add to it. The total remaining kind of business with ANSOS is about, is 14 million. And it is our hope and expectation and our work and focus of our work to retain all that business until which time we can eventually upgrade them to the newer technologies like ShiftWizard. And so it is our objective. Now, that said, in the last 24 months, as Scotty noted, we've experienced attrition in that group and lost them not to the market, not to the translation over to ShiftWizard. So we're working really hard to position the upgrade to ANSOS as ShiftWizard. If you remember, it's a legacy installed product. It is aging technology. And we're working hard to keep the customers satisfied with where they are. renew them as their contracts come up for renewal, but also transition them when they're ready to transition to the ShipWizard product. So we hope to stem some of this rate of loss here in the coming quarters and get them transitioned over to ShipWizard as well. So I hope that set a framework, and if Scotty wants to add anything, he can.
spk19: Yeah, Matt, I mean, it's a mix of contracts that are what we call in their auto renewal phase. That's a common practice for that type of previous sale. And then a good mix is also of customers that have entered into agreements for multiple years of renewal for that solution. So I don't have the numbers in front of me to speak to, but there is a mix of contract links in the base.
spk16: Got it. That's helpful. Thank you. And then Bobby, as you look at it, as you start to sell more and more directly to the end user, particularly the nurses, historically you've signed, and I think you mentioned again today, you're typically signing three- to five-year contracts with your hospital customers. But with nurses in particular, those aren't three- to five-year contracts. So how does that change your visibility? And what can you do to ensure, obviously, it's a big market, and getting in early with those end customers is obviously ideal. But how does that change your visibility, and what can you do to maybe increase that? Thank you.
spk06: Yeah, a couple things. One, these technologies power commerce, B2B commerce, as well as direct-to-consumer. And so there's two opportunities here. And the main one I'm going to cover first is focusing on the nursing students while they're in the two- and three-year programs to become nurses and getting the schools – to have the commitment to put those nurses through kind of those nurse students through ready to work programs and so the main focus of this is to get it where they could both be find a clinical rotation in a hospital and of course they pay a little fee for that through my clinical exchange buy a few content bottles like the Red Cross program before they become a nurse so they enter the market with the certificate and the certificate generally has about a two-year lifespan and And we've entered into at least one major multi-year contract with a nursing school that has committed to provision some of these services to the students on a steady basis, ongoing basis, before they become a nurse. And then as they transition from there, they can carry, using HSTREAM technology, that portfolio, that record forward with them into work. So that's the main focus of these commerce capabilities. The new student, Jane AI, for example, We'd rather the school contract to provision it to the students. Now, the second capability is the one I've opened with, which is fun and exciting. It's kind of a gap filler. So if someone is between jobs, they notice their license might expire if they don't take certain education for their continuing education, they can still use their H-treme ID, log in, and pay for themselves, of course. And we did report a lot of activity on there, both by learning to target doctors and students. That revenue will be a little less predictable. It is good margin, and it is incremental, and it's picking up a gap, say, between jobs or when they're not working in a place that uses our enterprise software. So it's kind of a gap filler. I call it money while we sleep because it's all automated, you know, credit card purchases. It will be less predictable, but you can see that we filled a lot of gaps in the fourth quarter with both of those types. So The emphasis will be, of course, on the B2B engagement with the schools that are interested in developing the students into nurses and then placing them in their first jobs in hospitals. So that will be the real focus. And we mentioned the modified Jane product that's coming out. And we have an initial big win with a big nursing system that has committed to put, we believe they're piloting to put all their students through the Jane program and We'll know more about that pilot at the end of the year, but that will be the real B2B goal as well. Hope that helps clarify. But that incremental revenue that we opened with is just fun and exciting incremental revenue for content we already own to audiences that would have normally disengaged with us, say, between jobs. So if a nurse worked at a hospital on our learning system and built a transcript, they take six months off, and then they take another job at a hospital that also uses HealthStream. They could pick up their education there. But now with our commerce abilities, they might, in between that, log in directly and consume a course maybe required by their state licensure. And so it's a gap filler and a time filler. It's incremental. It will be a little less predictable, but it is good margin. And so I hope that helps at least understand what we're going for. You know, it's a little bit of context, too, for the concept of trying to make all of these business subscriptions and the people behind them kind of continuous lifetime customers of the Healthstream ecosystem. And so hopefully it kind of clarifies that gap-filling capability we have, and it will be a boost to revenue here and there.
spk17: Thank you. That's very helpful. Thank you.
spk22: Thank you. Our next question comes from Jared Haas with William Blair. Your line is open.
spk11: Yeah. Hi, good morning. This is Jared Haas. I'm for Ryan Daniels. Thanks for taking our questions. Bobby, maybe just to start, I was hoping to unpack a little more color just around recent sales cycle trends. It seems like others that we've heard in the healthcare IT space have started to flag maybe some improvements in the selling environments with health systems, you know, maybe relative to what the environment was like going into 2023. So, just be curious if that's something you've experienced in any meaningful way. Has that translated into, you know, any sort of favorable inflection from a selling perspective?
spk06: Yeah, sure. It's in different pockets, and so we did try to highlight some of that in the call. I don't know if some of that got muddled out, but let me kind of repeat and think through some of it. I think we did talk about, at least for some of our legacy products, where they have some decline, and we specifically addressed the skilled nursing market. So that market as a whole is under a bit more duress. We see a little bit more churn in the customer base, like the smaller ones maybe combining with larger ones or even going out of business. So in the skilled nursing market, it seems to still have some remaining financial stress and a little bit harder to sell to. And so we saw some declines in the quality manager product that Scotty mentioned. But we did also open by highlighting, actually I had to repeat it so it's at the end, but highlighting the subscription growth to ShiftWizard and CredentialStream, both of which, as you heard, 31% and nearly 50% year-over-year growth. which is reflected in the strength of the pipelines for those products. And so, you know, I guess I'd say it has some variability, but in some of the bigger enterprise purchasing, particularly in credential stream and shift wizard, we saw, we see strong pipelines. And, and so maybe there are certain sub segments of the market like skilled nursing. We're learning more about nursing schools and their buying cycles. And so there'll be more on that in the future. So I won't comment too much on that because we're both have new products and a new focus on selling to those. So there's some variability in there. I'd say generally, though, the patterns of reviewing products for purchasing, the availability to sell is obviously much improved from the middle of COVID, where people simply weren't taking calls. And so I'd say there are kind of normalized new models of selling, and customers are receptive to seeing the new and exciting products that we have.
spk11: Okay. That's helpful. Thank you. And then maybe just one on the 2024 outlook and, you know, looking at the revenue guidance, it looks like the range from the low to the high end is a little bit narrower relative to the guidance for 2023. I'm curious if there's anything we should infer in that just in terms of the level of confidence that you have at this point in the year, maybe relative to last year, or anything that's changed from a visibility perspective. I know you're still working through the ANSAS sort of headwind, and maybe there's some nuances as to how that kind of impacts the forecast, but maybe we'd just love to unpack anything that's going on from a visibility perspective at this point in the year.
spk06: I mean, generally, as we open, the business is very predictable. There are some variables, and again, we noted those, like ANSAS, that are less predictable. We've tried our best to factor in the the topics that Scotty covered on some of the challenging areas. And I think in general, we're getting a little better and feel a little more comfortable with a slightly tighter range. And so I guess we're just getting a little better at forecasting. Also, it's interesting. And we talked about the direct to consumer commerce, too. A lot of that's data driven. And so, for example, we mentioned how that opioid course was just selling really well. I mean, there is kind of a requirement around that, and we're getting better at the targeting, so we're a little better at predicting those sales, which might normally be considered almost totally or less controllable. And so I'd say using better targeting for selling and maturing a bit in our forecasting, we hope that we're able to tighten that range and give a little better guidance. So we'll see how that plays out, but our expectation is that we can hit that range.
spk10: Okay, that's perfect. Thank you.
spk22: Thank you. Our next question comes from Stephanie Davis with Barclays. Your line is open.
spk00: Hi, guys. This is Anna Krasinski. I'm for Stephanie. Thank you for taking our questions. I want to go back to the 2024 guidance. Just curious if you could talk a little bit more about the drivers of more sequentially stable growth and margins given your cost optimization and network expansion efforts.
spk06: I'll let Scotty take a little of that. I think just in general, yes, we've gone as we've migrated from essentially to this one health stream model. We've been able to find operating synergies in the business by operating more like a single platform company. We were able in early last year to restructure some of our operations and deduplicate some of what used to be segment reporting And so some of those efficiencies are still in the model, and we've benefited from them this year. We're just getting better kind of operating. So you see better management of our G&A, for example, in the last 12 months, and therefore maybe more predictable as we look into next year. We hope, again, more stability. There are a few variables to that, as we just talked about a few of them in the sales model. Also, a few challenges in sub-markets like the skilled nursing sector. We did see a little higher bankruptcies in the market, which again adds a little bit of variability to the predictability, things that are essentially beyond our control. But the things that are within our control, I think we're getting better at controlling, both from a G&A standpoint, even CapEx. There's an increased focus on deployment of our capital into software development and a better, I'd say, rank ordering of prioritization of projects that we think we're going to hopefully get better and better at deploying our capital. And so I think all that is just hopefully a maturing business that's getting better at how it operates and studying more for efficiencies on how we get where we're going. For example, these new e-commerce selling ability provide more financial leverage. As we sell with click-to-purchase functions, we can lower our total cost of sales. And I think that's kind of another type of efficiency we expect to get as we deploy the new platform models that we're building. Okay.
spk00: Got it. Thank you. That's really helpful. And then as a quick follow-up, just curious if you could rank your capital allocation priorities across inorganic opportunities, dividends, and share purchases for next year?
spk06: Oh, gosh. Well, I mean, the first priority is building organic products, like the Jane AI product that we're going to take into the nursing school. So first priority for capital and capitalized software development is in building and enhancing existing products and building new products. We've talked about taking ShipWizard more to enterprise class. We've talked about adjusting our Jane product, enhancing the AI technologies, and entering new markets with it. So our capital, the bulk of our capital goes into exciting new product development. That is the place where it should go. And then second to that would be, I guess, the inorganic opportunities. And our last acquisition was a little over a year ago. It turned out to be a really strong winner there. small, bite-sized, tuck-in, incremental to our platform strategy. So very excited. And I think that will be kind of the second priority is to, you know, we won't force anything. As demonstrated last year, we did no acquisitions last year. But we're constantly looking and expect to continue an active M&A program, especially the kinds that kind of leverage our platform technologies and where we're going, the three primary application areas where we are. So anything that strengthens those three areas or enhances our infrastructure are targets for us. So that would be the second. And then I would say, you know, we executed a really good buyback program. I think we've done three in our 20-plus years, 24 years being public. Actually, all three of those buyback programs are in the money, which I think would be atypical of a lot of management buybacks, management board-driven buybacks. So All of our buybacks have been good deployments of capital, knock on wood, so far. And so that would be maybe the third priority. And that program does lapse in March, and no visibility on whether it's time for our board to put another one in place. But right now, we have an active program that expires in March. And then last of the dividends, I think it's a very small dividend, but it sends the message of capital discipline. I think taking a little bit of money off the top for shareholders, And then applying the balance of it to all the things I just talked about, I think puts a little bit of capital discipline. And it says, look, first order to remember is to make money for shareholders. And we put a small dividend in place to send a very clear message that we can manage our free cash flows, build new products, enter new markets, do small acquisitions that fit, while also paying out a little, sharing the profits along the journey. It is a journey. I've been doing this a long time. And I think it just brings shelters more onto the journey to share a little bit as the journey evolves. So those would be our four priorities. One, two, three, four, the way I articulate them. Thank you.
spk22: Thank you. Our next question comes from Richard Close with Canaccord Genuity. Your line is open.
spk15: Yeah, thanks for the questions. Congratulations on a steady 2023. Scotty, I was curious on modeling revenue with HStream subscribers going away. Just wondering what the best way to forecast going forward and how we track the company's progress of penetrating the 12.3 million employee TAM and increased wallet share that you're talking about. I guess pulling back on the HStream the model sort of evolved into a black box. Are you considering providing any other metrics like ARR growth or net revenue retention or anything to help us out?
spk06: Yes, we're studying that now. So a couple of things there. First is just a reminder, and I think in spite of our best efforts to explain where we are on the journey, I want to remind you the first thing is that the metric that we had out there that we just retired was for subscriptions, not subscribers. And so it really was intended to show the platform kind of expansion, but not as an infrastructure for calculating ARPU or revenue per employee, because we, we hadn't yet gotten to the place and we fully intended to over time, get to the place where we could convert and, and talk about subscribers, like the number of unique healthcare persons on our network. And, and we, we, uh, And so we're just not – it was a great metric almost like for a single product to talk about its expansion. But it was not correlated to revenues for the reasons Scotty mentioned, and it was not – it doesn't correlate to subscribers. And we saw some potential misapplication of it to calculate revenue per subscriber. And so – We think it served its purpose. We're getting our technologies out into the market, and almost all the report subscriptions sold to our regulatory courseware gave us sense for that. But it is not a proxy for subscribers, and it can't be related to revenues yet because it's not fully deployed, meaning there are several products that derive revenues that don't add to the subscription number. So for that reason, subscriptions aren't subscribers, and it's not fully deployed at It can't be used as a denominator in a revenue per employee model. So we are going to look to this year at additional both financial metrics to focus on. We already report a full gap, of course. And one of those we're studying is ARR. So we'll look towards the middle of the year to see if we can get to that kind of metric, which I think would help all of the analysts and everyone understand the recurring revenue nature of the business. and the growth trajectory. So yes, Richard, we're working on that. But I think it's time to take this metric, as we mentioned, kind of off the table, because it was symbolic of the growth of the platform extension, but not relatable to people yet, and not relatable to revenue. And we saw some of that starting to happen. So we just think we need to move our focus probably towards something like ARR. That was the discussion in the last quarter. And we've got to test, back test, and see how that metric how we're going to measure it, but that would be a goal, would be to add some new metrics by the middle of the year.
spk15: Okay, great. That would be helpful. And then on Ansoft, I guess a couple of follow-up questions on that. Is the remaining $14 million, is that just maintenance and support revenue? That's the first question. And then If there's any details in terms of the success rate of converting to the Shift Wizard product would be helpful. And then finally, the average term, I guess, length of time on the remaining contracts.
spk14: Sure. A couple of things there.
spk06: The contracts have a lot of, essentially, a lot of them are old installed and they have a maintenance fee that's non-SAS, but there's some recurring nature to it and they have auto renewals unless they cancel. And so there is a recurring nature to it. And it does include some of those maintenance fees, basically. So the second is on the conversion rate. I'd say to date, obviously, unfortunately, not very successful at all at that, but a renewed focus by our teams. Also, as we've talked about in prior calls, we're enhancing ShiftWizard. to better meet the needs of these enterprise customers of ANSOS. And so, and I think every single quarter now, and actually every month on ShiftWizard, there's a new software release, and it's moving us ever closer to full enterprise capabilities. So, I think there'll be a better opportunity to transition. So, again, not very successful in the migrations today, as you hear from the loss that we've been reporting. We do expect and we have full energy on stabilizing that $14 million and we're going to try to reduce the attrition rate and also succeed better this year in the conversion rate. So this isn't a story of, I don't think, going to zero. It's an effort to stabilize and stem the loss while also transitioning them to the newer exciting technologies of ShiftWizard. And ShiftWizard is very well received in the market. For its current capabilities, it's just a winning share. we just need to enhance some of its core functionality and we've made a lot of progress on that, uh, enhancing core functionality around kind of enterprise level data analysis. And so I think we look forward to by the middle of year having great progress on that. So there'll be a better destination, a better destination to migrate everybody to. I'll turn it over to Scott if you want to add anything.
spk19: Yeah, I'll just make a comment or two, Richard. I mean, I think, uh, You know, I tried to address with Matt earlier in the call kind of the nature of the contract length that kind of vary from, you know, auto renewals to some that have, you know, signed multi-year contracts. I don't have the duration, you know, run out in front of me, but there is a good mix of, you know, auto renewals plus, you know, customers under term. I would say, too, that our objective is to continue to support the customers. We do want to migrate them to ShipWizard, but we also want to acknowledge that there's still customers on that application and we're still there to support their use of it. And so that's another, you know, consideration. And, you know, I think, you know, as we talked about, you know, the $14 million, it's, you know, we wanted to just provide that number to provide context. As Bobby said, don't expect it to go to zero. We just wanted to size it up for our investors to understand the magnitude of it.
spk15: Okay, that's helpful. And then under the direct-to-consumer, just on that portion of revenue management, I know it's small, but it's a different sale. How are you thinking about customer acquisition costs on the direct-to-consumer market? Maybe it's a little less than a typical direct-to-consumer because if they're in between jobs, they already have exposure to you. Just trying to get your thoughts on that.
spk06: Yeah, I would say for the next couple of years, our thoughts are really just to try to keep the people that I would call, quote, in network to stay in the network when they're between jobs. And as I mentioned, pick up this new audience of students before they become professionals. And so it really isn't to broadly, openly market to people to self-register. It's to capture using existing data from the customers that have been in network to find them between jobs. Or, you know, when they leave a job, they can now leave and carry information their HealthStream transcript with them, and that's different. And so they kind of, if they work somewhere for a couple years and they leave, they can still log back in using their HStream ID and see that they had 10 courses or, and so now all we're doing is saying, oh, you can log back in and carry your transcript with you like a portfolio or a wallet. You can take it with you. But you can also say, well, hey, you know, I might as well click at the bottom here to keep my license current and take an additional course. And that's happening right now with doctors. on that DEA course that we mentioned, and it's happening with nurses when they take a little bit of CE, or even when they're about to take a new job, they refresh on something before they go back into the new job. So really, it's more of a gap filler than it is a broad consumer. You said consumer. I call it direct to professional, D to P, and it's really just trying to keep people in network all the time. as opposed to just kind of broadly marketing out into the wild open right now. Now, maybe we get there someday, but really the job right now is just to make that transcript portable, make them lifetime engaging with HealthStream instead of just engaging with us when they're in their job.
spk15: Okay, thanks. Very helpful. And if I could slip one more in. I thought on CredentialStream it was interesting you announced – Alira Health, a digital health company, that seemed a little bit different. Are you seeing an uptick in opportunities in that segment on the direct to employer benefits area?
spk06: We are seeing, at least with the insurers, we're seeing some opportunity there. And so I would say yes. Kind of categorically, there's interest in a couple of areas that maybe are not just purely the acute care hospitals. And so there are a lot of – I guess I'd characterize them as new, but I just say we're getting better at pursuing a broader opportunity and not just the acute care hospital market. So the answer is yes.
spk13: Okay. Thank you.
spk22: Thank you. Our next question comes from Constantine Davids with Citizens J&P Securities. Your line is open.
spk09: Hi, thanks. Good morning. Just a couple follow-ups here on scheduling. Can you just maybe characterize where you're seeing growth with Shift Wizard? Because it's been pretty impressive in 23. And I guess just a little further on that, is it sort of large IDNs, complex, you know, academic medical center-type installations, or smaller hospitals and then are you typically replacing a manual kind of homegrown scheduling system or some other standalone technology solution?
spk06: Well, a couple of really interesting things in that space for us. One, I would just describe it if there's kind of such thing as the very large enterprises and then there's the middle market and then there's the small urban or rural hospitals and community hospitals. It's kind of the middle there that we're getting really strong on. You could probably call them regional health systems. The other thing is that we have this great relationship that's growing with Workday where they're bringing us in to help kind of them have a complete offering, and we've turned out to be really good partners in supporting customers' needs. And so we're getting brought into Workday accounts with them and to round out services, and we just found that to be a great partnership. So kind of a good referral, almost a referral program for us, a good source of leads and compatibility. We just work really well with that team, and our applications work together well and present well together. So that's been really exciting and fun. Usually we're taking out competitors in the market that have aging technology, and we've got this emerging new good paradigm, great user interface with ShiftWizard. So organizations like UKG and API where we compete, we generally are replacing something. And so I hope that answers your questions. And in general, we're trying to expand the capabilities at ShiftWizard to handle ever larger and larger systems. We do have some large systems as customers, and we just need a more robust, basically reporting and data analytics suite, which we have in learning, which is great. So we're going to use a lot of that infrastructure to launch better class of data analytics and learning around scheduling, which we think will meet the needs of even the larger health systems. So we're excited about that. And that should be a this year event. We're making good progress on that as well. Again, as I mentioned, with monthly releases of ShiftWizard, very exciting. We'll have a webinar and hundreds of people will attend for each monthly release to see what's coming on ShiftWizard. And it's just gaining traction and momentum and excitement as we add enterprise class features so we can go after even larger customers.
spk09: great and then um just a follow-up i guess to richard's question around metrics have you um or can you talk about just how many uh hstream ids have been claimed at this point is that something you can provide it's it's interesting it's over a million but we got a lot of work to do there's a lot of and we've been building tools for a long time now deduping tools uh we've been building tools to let people
spk06: know if they're if they're if they worked at one health system they could claim their records another and combine them so they have this unified transcript as an individual so it is really exciting but it's kind of still nascent uh i mean there's several steps in the process first we have to wire the application we have dozens of applications to the htrem architecture using so it uses the htrem id and then we have to get the professionals to kind of claim any other uses like we call it putting keys on keychains so once you have an hstream id you're able to then go and say oh well i also use this application and so kind of merge that information uh almost the way you do at google where you get universal access to all their apps but for us it's a limited set of apps now so we have over a million uh what i'll call reconciled ids and there's going to be millions more over time but that is going to take time and that's you know until we can get to that pure subscriber count You know, historically, you think of us as a B2B software, you know, three separate tech stacks. But increasingly, the tech stacks are interrelated through the HStream platform and the HStream ID. And we're kind of, you know, mid-stages maybe deploying both the technology and the reconciliation of IDs. So over a million unique HStream IDs have been issued, which is really exciting. But there's millions more to go. And we expect steady, quarterly progress on that. And, of course, when we get to some place where we're excited, where we have enough momentum, that can become a metric. And that could be the basis for some kind of ARPU. But there are two things that have to happen. One, more of our applications have to connect to it, and then more of the users have to reconcile. And we've been building – this is a very complex topic, and we've been working on it for years – You have to have the reconciliation tools, the account joining tools, the keys on keychains, the management tool sets. And we're actually getting very good at those. And the LTMID deployment models, we're getting very good at all that. And so we expect it to kind of continue to spool up.
spk09: And I guess just last question along those lines, where do you think you are in the journey, Bobby, you know, whether it's in baseball terms or some other language? But just, you know, having all the apps on the platform. common architecture, you know, making them all interoperable and seamless. Just how far along do you think you are?
spk06: Oh, and well, in the baseball analog, and I'm not a huge baseball person, but I'd say third inning, you know, it's, but it's going faster. So it's one of those things. It's not linear. Like each, each inning isn't the same length. I think it's the kind of thing that can kind of be maybe geometric or maybe, maybe, maybe exponential, but, but definitely geometric where, it should go faster than linear. And so while we're in maybe three out of nine innings, the fourth should be faster than the third and so on. So I think it can continue to spool up. Thank you.
spk22: Thank you. Our next question comes from Vincent Colicchio with Barrington Research. Your line is open.
spk30: Yeah, good morning, Bobbie. Most of my questions have been answered. Just curious on the credential stream side, With the success you're having, has there been any competitive response in terms of trying to match your differentiation there?
spk06: We have lots of things to do in our roadmap to continue to differentiate, but right now, I think we've got a really exciting product. In fact, to the point where, as I mentioned, organizations like Workday are thinking of us as the best of breed and bringing us into their deals. you know, I'm excited about where it is. Now, where it's short is, and we've talked about this, is some of its enterprise feature sets, particularly around data management reporting. Like if you're a large organization with 50, 60, 70 hospitals, you have different demands on how you distribute information and you're solving labor issues across markets and across, you know, regional deployments. And so we're going to get more sophisticated on that this year. But those are the advances that we have. Now, The true differentiators are still yet to come. So we're beginning to incorporate some of the technologies of our platform, for example, the license service. I hope that by the end of the year, for example, we'll be using the license service that was built in Credential Stream to verify a nurse's license before we schedule them. And so we have that capability, as you know, in our platform to check licenses. And so it'll be a further differentiation as we connect shift wizards to services like the license verification service that is a function of our H-stream platform. So that's an example of a differentiation yet to come that I hope is this year that will continue to distinguish us from our competitors. And there, of course, is a roadmap full of those ideas as well.
spk19: Hey, Vince, were you asking about credential stream on your question?
spk06: I think he was, actually, because I just got a note from someone. So I guess the same holds true for credential stream as it takes advantage of connectivity to the learning center, for example. We're in the middle of going back to customers that have both our learning system and our credentialing system and showing them the interoperability of the early stages of interoperability between those. For example, how logical is it, but if you earn a credential in the learning network, it should auto-populate as a credential into your credentialing system. And so the same kind of answer holds is that there are plenty of differentiations to come this year that show interoperability and several that are in place now that we're beginning to market actively.
spk30: So, Bobby, will you still respond to my question because I got cut off?
spk06: I think in both cases, I try to give examples of both shift wizard and credential stream that are going to be increasingly competitively differentiated by how they access services of the H-DREAM platform, whether it's the H-DREAM ID to create interoperability, for example, your data following you from one system into the other. The example I just gave was a learning credential earned in the learning system following you into the credentialing system and maintaining its primary source verification status, or a scheduling system that relies on the platform technology to check a license before you're scheduled. And so to verify your license is active, before we schedule you. And so those are two examples of interoperability that are, one is actively being marketed and the other is to come this year. But increasingly, the differentiation will come from how these applications interoperate or operate together and how data moves between them and how services built in the platform power up distinguished features in the application. This is true in learning, scheduling, and credentialing. In all cases, We hope to further differentiate it. I think there's also kind of a broader value proposition of getting these applications interoperable. I think it's more appealing to a COO, a CTO, a CFO when they see a suite of software working together instead of individual separately implemented tech stacks. And so we're looking for operational synergy, implementation synergy over the coming months and years.
spk30: And one last one. How would you characterize pricing in the acquisition market? Is it rich? Is it improved? What would you say?
spk06: Well, let's see. We didn't do a deal in the last 13 months. And during that, I guess I would say in the last quarter or two, I think a little bit of softening and some excitement, maybe deal pipelines can pick back up. But, you know, the private companies always hold on as long as they can to the past. And so, you know, Maybe one of the contributing factors was that in the first half of the year. But I don't know how to say it. If you have a hot company that's a SaaS model and it's emerging and growing fast, you're going to be able to demand a premium for your business when you sell it. And so I think that is almost always true. Maybe fewer companies meet that criterion, and they're also burning cash. So I think those companies, there's going to be some deals out there, I think, as companies try to recap at lower market caps in the next year or so. Nice. Thank you.
spk22: Thank you. There are no further questions at this time. I'd like to turn the call back over to Robert Frist, CEO, for any closing remarks.
spk06: Thank you to our analysts for following our story and helping us tell it. Thank you to our 1,100 employees for making all this happen. We'll look forward to our continued reporting and growth as a company. Thanks for going along the journey, all you shareholders. We'll see you on the next earnings call.
spk22: Thank you for your participation. This does conclude the program. You may now disconnect. Everyone have a great day.
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