Option Care Health, Inc.

Good day, and thank you for standing by. Welcome to the Option Care Health 2022 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during that session, you will need to press star 1-1 on your telephone. Please be advised that today's conference is being recorded. I would now like to hand the call over to our speaker today, Mr. Mike Shapiro. Go ahead.

Good morning. Before we begin, please note that today's discussion will include certain forward-looking statements that reflect our current assumptions and expectations, including those related to our future financial performance and industry and market conditions. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our expectations. We encourage you to review the information in today's press release, as well as in our Form 10-K filed with the SEC, regarding the specific risks and uncertainties. We do not undertake any duty to update any forward-looking statements except as required by law. During the call, we will use non-GAAP financial measures when talking about the company's performance and financial condition. You can find additional information on these non-GAAP measures in this morning's press release posted on the investor relations portion of our website. With that, I'll turn the call over to John Rademacher, Chief Executive Officer.

Thanks, Mike, and good morning, everyone. Overall, we are very pleased with the progress we have made in the second quarter and the financial results we delivered as reported this morning. Despite operating in a very dynamic environment, our team continues to execute our plans to realize our purpose of providing extraordinary care that changes lives. In the quarter, we increased the number of patients we serve and who entrust us with their care in the home or one of our alternate infusion sites. Throughout the second quarter, we also made strong progress on several fronts of our focus strategy. As Mike will outline in a few minutes, we delivered low-teens revenue growth and mid-teens EBITDA growth and translated that into strong cash flow. We continue to navigate a very difficult labor market and inflationary dynamics, which presents challenges on a daily basis. Yet we were able to leverage our strong infrastructure and continue our track record of delivering strong EBITDA growth and expanding EBITDA margins. And at the same time, we invested for the future growth, having closed on our acquisition of Specialty Pharmacy Nursing Network, or SPIN, early in the second quarter and opened six new infusion centers in key markets across the country. With respect to our results in the second quarter, we saw balanced growth across our portfolio of therapies, including low single-digit growth in our acute portfolio and mid-teens growth in our chronic portfolio. Despite modest hospital discharge volume growth at acute care facilities across the country and continued supply shortages in vital nutrition support products, we saw solid referral trends throughout the quarter. Given recent repositioning by some other market participants, we are confident that we are executing well relative to the broader market, and we remain well positioned to support market demand for the portfolio of acute therapies. I've spoken before about our commercial focus to ensure we have the appropriate market coverage through reach and frequency, and we are seeing the value of this disciplined approach. The investments we have made and continue to make into our care management center infrastructure to help ensure we are responsive to our acute care channel partners and referral sources have resulted in a more reliable and timely collaboration across our national network of 97 highly connected and efficient pharmacies. We have created an increasingly effective digitally enabled platform for complex pharmacy administration and point-of-care services across the country. Our chronic portfolio continues to grow in the mid-teens, and our results are quite balanced across established chronic therapies as well as newer products that have rounded out our portfolio. With our comprehensive nursing network, we are well-positioned to help payers meet the immediate needs of their members and move beyond the infusion event to help better support the whole patient and reduce the total cost of care. As we have discussed previously, we continue to operate in a challenging market backdrop with continued labor and cost pressures. Our focus on recruiting our existing team members every single day and recruiting new members to the team helps ensure that we have capacity and vital skills necessary to provide advanced care to our patients. The teams in the field are executing well to help ensure we have the right staff and the right therapies to provide extraordinary care. The inflationary cost pressures continue to present challenges, but we remain very focused on offsetting those pressures where possible, primarily through leveraging our technology to drive productivity and operating efficiencies. We continue to see widespread cost pressures across a broad array of inputs, including fuel and transportation, packaging and medical supplies, and a variety of other categories. And we do not expect those pressures to subside anytime soon. As I mentioned earlier, we are thrilled to welcome the SPIN team to the broader option care health enterprise. And with the acquisition, we continue to make progress on creating a unique skilled infusion nursing platform. Combined with our internal nursing organization, as well as our acquisition of Infinity Infusion Nursing last fall, we have now established a leading clinical organization of more than 3,000 qualified infusion nurses. to provide exceptional infusion services at the point of care to patients across the country. While we are in the early innings of integrating those organizations, we are more confident than ever that the SPIN and Infinity teams will be instrumental in our growth strategy going forward. Finally, we are investing for future growth through our expansion of infusion centers nationwide. In the second quarter, we opened six new infusion centers and now expect to open more than 25 in 2022. As a reminder, center expansion is a vital growth strategy as it enables us to provide more choice for our patients, drive clinical labor efficiency, while also expanding our ability to collaborate with referral sources to increase our patient census. Through our consistent investment in site capacity, we now have more than 140 infusion centers across the country. And I expect this to be an area of continued investment beyond the current year. Our disciplined investment strategy focuses on improving access to care across geographies and therapies and improving the patient experience. Given our investment in infusion centers and technology over the past several years, we continue to cast a wider shadow, so to speak, into new therapies, more rural geographies, and a broader base of referral sources. It's about providing consistent, high-quality care, whether you're in New York City, Kansas City, or Carson City. So overall, the second quarter was very productive, and we continue to make solid progress on executing our growth strategy, focused on providing extraordinary patient care in the post-acute setting. We delivered strong revenue and EBITDA growth in this quarter, and we increased our cash balances while making significant investments into our future, allowing us to tighten and raise our full year guidance. Before I hand it over to Mike to go into the results in more detail, I must recognize and highlight the incredible collaboration and focus of our teams across the country as they rise up to meet every challenge and maintain our focus of placing the patients and their families at the center of everything that we do. And with that, I'll turn the call over to Mike to review the results in a bit more detail. Mike?

Thanks, John. Overall, Q2 is a very solid quarter with double-digit revenue growth that translated into leveraged growth at the bottom line and modestly better EBITDA margins despite the cost headwinds that John articulated. Additionally, our balance sheet has never been stronger, and with our relentless focus on translating revenue into cash flow, we are reporting record levels of cash and new lows in terms of our leverage profile, which are critical as we navigate the challenging environment. Revenue grew 14% and was consistent with our expectations, and as expected, growth was a bit more tempered relative to the first quarter due to higher prior year comps. Nonetheless, our chronic portfolio continues to perform quite well and represented most of our revenue growth. Acute revenue was up in the low single digits despite mixed acute volumes reported by our health system partners, and we attribute our relative performance in our acute portfolio to the investments John alluded to and our strategic focus on this portfolio of therapies. Gross margin of 22.1% declined versus the prior year as expected due to the mixed shift towards chronic therapies and higher costs to deliver care. Despite the gross margin decline, we drove 9% growth in gross margin dollars based on higher volumes. And SG&A grew considerably slower than gross margin as we fought to offset inflationary pressures, which allowed us to expand EBITDA margin despite the mixed headwinds. While we continue to focus on efficiency and cost savings to mitigate inflationary cost pressures, which as John mentioned, we do not expect to subside anytime soon. Adjusted EBITDA of $85.2 million grew 17% over the prior year and represented 8.7% of revenue. So despite the mixed shift towards chronic and unprecedented cost pressures, we continue to expand profit margins and demonstrate the scalability of the platform. Additionally, as we discussed earlier in the year, we have reversed our valuation reserves on our tax net operating losses, and as expected, our effective tax rate has migrated upward to 28.8% in the quarter, as we now anticipate fully utilizing all NOLs. We generated over $104 million in cash flow from operations in Q2, and we increased cash balances by $58 million in the quarter, despite paying approximately $60 million in the quarter to acquire spin. At the end of Q2, our net leverage ratio has declined to 2.7 times, which is extraordinary given where we started this journey three years ago. As I mentioned earlier, our capital structure is quite strong, and with no maturities until 2028 and modest interest rate exposure, we believe we are in a strong position going forward. And based on the momentum exiting the second quarter, we are increasing our outlook for the full year accordingly. We now expect to generate revenue of $3.85 billion to $3.95 billion and adjusted EBITDA of $330 million to $342 million. Based on our higher earnings, we now expect to generate cash flow from operations of at least $250 million. So overall, we're quite pleased with the momentum halfway through the year and continue to anticipate a productive full year. And with that, we will open the call for Q&A. Operator?

Certainly. As a reminder, to ask a question, you will need to press star 1-1 on your telephone. Please stand by while we compile the Q&A roster. And our first question comes from Lisa Gill of JP Morgan. Your line is open.

Thanks very much and good morning. Congratulations on a great quarter. Just really want to start with referral patterns. So you talked about, you know, acute versus chronic. Just curious what you're seeing today, really in two areas. One, as we continue, I hate to even talk about COVID at this point, but as we continue to see COVID ebb and flow, has that had any impact on referral patterns? And then Secondly, John, as we think about site of care, it's become so important to manage care, really keeping patients in sites of care like option care. Can you maybe just talk about what you're seeing in the environment today? And do the payers have any interest in moving more towards narrow networks as they've seen the benefit of this benefit from change in site of care?

Yeah, good morning, Lisa, and, yeah, thanks for the question. So, on referral patterns, as you outlined, look, it still is very local as communities are dealing with the BA-5 strain and, you know, that kind of putting a little bit of disruption in, you know, patients visiting doctors or receiving elective surgeries or other aspects of that. So it truly is localized. We're not seeing kind of national patterns. And as we called out, you know, it was, although moving in a forward direction around hospital admissions and discharges, as you see in others as they report, It was modest growth. A lot of our focus is really on making certain that we are well prepared as an organization, as a partner of choice for those referral sources, that we focus around reach and frequency of our teams, that we've got the right, you know, therapies on the shelf and staffing models in order to do that. We expect that it's going to remain a little bit choppy market by market as we continue to deal with different variants of the COVID strain, but feel like we're well positioned to be a partner of choice. And the investments that we've made into our core infrastructure and the 97 pharmacies that are operating effectively and efficiently, we feel well positioned from that side. On the second part of your question on site of care, look, we continue to have really productive conversations with the payer community around their thoughts around not only thinking about site of care initiatives and making certain that they get that balance of cost quality aligned with member choice. And we're working closely to help support those efforts. you know, across the board. A lot of the investments that we're making not only into the nursing community but also into the infusion centers, you know, across the country really dovetail and fit well within that overall strategy of moving more of the care closer to the home or into these dedicated site of care to align with the payers' initiatives. And we feel as if, you know, the progress that we're making opening, you know, over 25 this year and six in the quarter just continues to position as well as a partner of choice as they're thinking about their network design and the partners that they want in network moving forward. Along that with kind of the back part of that question is we are seeing interest in narrowing of networks or the qualifications that the payers are looking for as that moves ahead. And we've done everything as part of our strategic moves to make certain that we are on the right side of any of those narrowing. given that fact that we can provide high-quality care consistently and effectively. And as I said in my prepared remarks, whether in New York City, Kansas City, or Carson City, we've got a national network that really drives that consistent high-quality care in a setting in which patients want to receive it.

Great. Thanks for the comment.

Yeah. Thanks, Lisa. Thanks, Lisa.

Thank you. And our next question will come from David McDonald of Truist. And David, your line is open.

Good morning, guys. So just a couple of quick questions. I'm curious, just conversations with your payers in terms of, you know, as contracts start to roll forward and renewals, just conversations around potential escalators, just acknowledgement out of the payer community when you talk to them about the inflationary environment. And then, Mike, you know, is the $10 million to $12 million per quarter Is that kind of still the right number, any acceleration or deceleration in that is my first question.

Hey, Dave, it's John. I'll start on just the conversations with the payer community. Yes, I mean, look, there is recognition of some of the pressures that are out there. I think as we've explained before, you know, we really have three legs of our reimbursement stool. Certainly, you know, the cost of the drugs. our clinical per diems, and then the nursing. And, you know, we look at it across all of those dimensions as we're moving and negotiating our reimbursement rates with the payer community. We're always looking for the appropriate balance across those three dimensions. I think it's been well publicized and people know clearly that there are pressures from an inflationary and labor perspective, especially in the areas of nursing and some of the inputs that I highlighted on that. We're very balanced in the way that we look at it, knowing that we've got to make certain that as an organization, we're working across all three of those dimensions. And no one's knocking on our door telling us that they want to give us more money, as you fully understand. But I think there's good recognition of some of the inflationary pressures, and we're going to continue to be focused on that as an organization as we're looking at renewal cycles and the way that we're contracting as we move ahead.

And, Dave, the only thing I would say on the inflationary pressures is we estimated, you know, $40 million to $50 million of annualized or call it $10 million to $12 million a quarter. Again, you know, this is a broad estimate, I'd say, as we think about the inflationary pressures. you know, nothing has materially deviated from how we thought about the cost pressures when we connected, you know, 90 days ago on the first quarter call. And again, one of the things we're proud of is we continue to drive leverage in the P&L with gross margin dollars growing 9% and SG&A growing slower. Part of it is just our relentless focus on efficiencies and searching for coins between the cushions on the couch, so to speak. So, so far, you know, continuing to report modest EBITDA margin expansion and what is unprecedented inflationary pressures is it's energizing for the team. But, you know, make no mistake, it's still challenging across several cost categories, as John mentioned.

Okay. Just wanted to dig into labor a little bit further. Given the strength of the top line, I assume the answer to this is yes, but were you guys able to staff all the demand that you saw in the quarter? And then secondly, can you just talk about the leverage from continuing to put up these ambulatory infusion suites? And also, is there an opportunity to maybe replace or alleviate some labor pressure through you know, further automating some jobs that maybe some, you know, people are actually doing right now?

Yeah, so I'll start on just the capacity models and the way that we operate from that perspective. As you, you know, as you said, Dave, you know, we certainly were really strong in the quarter of being able to staff uh appropriately on that look at a market by market level there may be some um you know uh some challenges that uh on a day basis or on uh on a weekly basis on that but for the most part the team has worked extremely well and collaborative uh in order to do that part of the investments into the nursing community uh with infinity and spin as well as the um What we've done with the infusion centers is to help to expand and make certain that we've got that capacity, especially in the nursing area, in order to move that ahead. So we feel really good about the position we are in. You know, I called out, look, we spend a lot of time on making certain that we are recruiting our team members every single day. We have been adding staff. in markets in which we have the opportunity to continue to expand and grow. And, you know, we'll work aggressively to make certain that we have that capacity both in staffing as well as all of the products that are necessary for us to be able to move that ahead. So all in all, feel good about that.

Okay.

Yeah, the only thing I'll say, you know, I'm sorry, go ahead. No, go ahead, Mike.

No, John made the point. Go ahead, John.

Okay, just last question, guys. And John, I think you touched on this a touch in your prepared comments, but our checks suggest, you know, there are some competitor pharmacy closures. Does this create an opportunity in acute? And is there the potential for that to become, you know, somewhat non-trivial over time?

Yeah, look, you know, the market is dynamic and continues to change, and certainly as organizations, you know, reevaluate, reposition on that, we feel really good about the investments that we've made into our pharmacy infrastructure and our ability to support the acute therapies broadly within that standpoint. you know it's early to tell kind of what the the long-term implications are and look there's it's a competitive environment um you know across the board there we have many competitors in most of those markets as we move ahead but the platform that we've created um the consistency and quality that we've invested in the ability to drive that leverage growth and scalability within our infrastructure, all of that we feel like we're well positioned to be a partner of choice for those referral sources and also to capture, you know, our fair share or more than our fair share of demand based on the reach and frequency and really just the expertise of our commercial as well as our clinical team. Okay. Thanks very much, guys. Yep. Thanks, Amy.

One moment. And our next question will come from Matt LaRue of J.P. Morgan. And your line is open, Matt.

Okay. I switched firms. Not bad. I'm Matt LaRue from William Blair. I'm curious, Mike, if you could maybe break out the growth for us between – you know, the M&A, whether it's Spin Infinity, new centers, and organic. You know, I think there's maybe more so than previous quarters, just a lot going on here. So, maybe that'd be helpful.

Absolutely, Matt. So, in the quarter, again, you know, last year in the first quarter, we did have the BioCure results, which was admittedly one of the smaller acquisitions we've made. So, in the second quarter, we did have the full results of Infinity, and Wasatch as well as virtually a full quarter. That top line contributed a little over two points of the growth. So, about two and a quarter of our reported growth. From a new center perspective, that's not really how we think about it because, again, we simply view that as a point of care. So, that's really, you know, I'd say the gains in our center penetration was up modestly in the quarter. But again, that's just part of our overall organic growth strategy. You've heard us talk about how, you know, around 20% of our nursing events were occurring in one of our centers. It's a couple points higher than that in the quarter. We're probably around 21, 22. So nice momentum there. Not only are our nursing events obviously growing, but the penetration in the centers has crept up a bit as well.

Okay. And then just on gross margins, you know, obviously over the last couple of years, as this shift towards chronic has been occurring, gross margins still have been kind of modestly expanding. Just curious, you know, this year on a year-over-year basis, could you maybe break out for us some of the more inflationary pressures, you referenced gas and travel, I think packaging relative to, you know, sort of that portfolio shift, just so we could maybe better model future periods?

Yeah, so, you know, look, as I mentioned in the prepared remarks, and again, we've been talking about this consistently, with that chronic acceleration relative to acute, we, you know, it is inevitable that we will be facing mixed pressure at the gross margin rate line. Not to sound defeatist, because as you know, we fight for every darn basis point. In our gross margin, there are what we would refer to as the direct cost to administering care. So the compounding pharmacy technicians, the oversight of the clinical pharmacists at our pharmacies, all of the medical supplies, the direct nursing labor for administration of the therapy, as well as the transportation and distribution. Again, all of the therapies that leave our pharmacies are delivered directly to the patient's homes through UPS, FedEx, or a courier. And so some of the categories, no surprise, that have been hit harder from an inflationary perspective. Obviously, the clinical labor we continue to, as John has mentioned, keep our ears to the rails at the local level to make sure we're competitive. So the clinical labor has seen some inflationary pressure upwards. Transportation, packaging materials, medical supplies, which are petroleum-based plastics, those we have seen considerable inflationary pressure, especially around a lot of the transportation and medical costs.

Okay, and then the last one, you referenced mixed volumes from health system partners, and I guess just curious maybe how much of that relates to some of the COVID dynamics around referral patterns that Lisa alluded to versus health systems coming back and maybe reengaging more with their own internal insurance offerings.

Yeah, Matt, it's John. Look, we have We continue to look at kind of those referral patterns. We have not seen major changes in the referral patterns that hospital systems are holding on in HOPVs or other places. I mean, where we have competition, competition has been strong on that. You know, so, you know, the team is working aggressively to make certain that we are well positioned as a partner of choice, that we're doing everything we can around the patient registration and administration aspects to make it a smooth and efficient transition of care out of the inpatient or on to service for our chronic patients. So we haven't seen anything, you know, substantial, but it's competitive. And, you know, it's always been competitive, whether it's you know, a in-kind competitor or a hospital-owned competitor, you know, the dynamics continue to be, you know, as competitive as it's ever been.

All righty. Thank you.

Yeah.

Thanks, Matt.

One moment. And our next question comes from Joanna Gajuk of Bank of America. Your line's open.

Good morning. Thanks for taking the question. So I guess first, actually, I'll follow up on something you mentioned in your preparatory remarks. You mentioned a repositioning of other players. So can you tell us, you know, what you're actually referring to? And are you talking about your competitors, I guess, scaling down their footprint? We saw some of the changes at the site of care from... you know, employees being let go in some of these locations. Are you referring to this or just something else you're talking about when you refer to repositioning of other players?

Yeah, Joanna, it's John. Look, the market is dynamic, as I've said before, and we have, you know, there are certain markets in which several of our competitors are retreating from certain therapies really in the acute area as they're kind of thinking about what their longer-term goals could be. We see this kind of market by market. There's always interesting dynamics on that as competition ebbs and flows on that. As an organization, we've invested in a national network and a platform of highly connected and efficient pharmacies to make certain that we are a partner of choice across all of the therapy sets that we're able to provide services, whether it's coming out of an acute facility or whether it's a patient that has chronic conditions. And so, you know, our focus remains steadfast in the investments that we're making, the partnerships that we're developing, our ability to collaborate closely with hospital discharge planners, case managers as they're thinking about safe and effective transition of patients out of the hospital into the home or into an infusion suite. And so we feel like we're well positioned on that. You know, the focus and the discipline that we've had in kind of our investment thesis remains solid. And, you know, our expectations are that as demand is in the marketplace, that we are, you know, a – a partner of choice as they're making their decisions around where to send patients and how to participate from that standpoint.

Okay, thank you. And I guess another, I guess, follow-up here before my real question, but when I was thinking about other players and also you commented about the hospital systems and HOPDs, but I've also been hearing about hospitals also interested in sending out their own home infusion business in Portugal. I think Mary Sarsberg can talk about like a program that they offer to help hospitals. I mean, it sounds like they might be using third parties. So I don't know if this is something you're also seeing where hospitals coming to you directly to kind of have some sort of, you know, more closer, you know, relationship or some sort of, you know, structure that kind of will bring more volume. or can you just talk about those .

Thank you.

Yeah, Joanna, look, we have always had fusion pharmacies as part of the competitive dynamics of the marketplace. And again, we have partnerships with some hospital systems in which we work very closely on that. And we continue to look at that as just the competitive dynamics in the marketplace. Yeah, you know, there are different organizations that align around supporting hospitals in that process. and helping support their needs as they're looking at where they want to deploy their capital and how they're looking at their overall healthcare ecosystem. As an organization, look, we take all competitive threats seriously, and we really work hard to make certain that we are well positioned on that. I can say that in certain circumstances where hospitals do have their own hospital-owned infusion pharmacies, we still have strong partnerships. When you think about the ability that they have in the catchment area that they can provide for their patients, in today's healthcare system where there is a lot of travel associated with going to centers of excellence and other aspects, given the national network we have, given the ability that we have to take a patient that may receive service in City A, but they live in a rural setting, you know, a state or two states over, we can still be their partner of choice and help with that transition, given that they don't have the catchment area to be able to provide that consistent high-quality service outside of their local geography. We're always looking at the competitive dynamics. We're always keeping our ear to the rail. We believe that the investments that we've made into our national network, we think that the outcomes that we drive from a clinical standpoint, and we think that the partnerships that we've developed with our commercial team just position us to be a partner of choice.

um as they're making those decisions um and um and uh looking for uh ways to support their patients in the local community and outside of that thank you thanks for this caller and i guess my question on the cash flow so uh you've raised your operating cash flow outlook and sounds like uh you're expecting to use the nos so i just want to uh i guess two-part question on the cash flow so one is uh are you expecting to start paying cash taxes this year? And a second question, you know, in spite of that, I guess, you've raised the cash flow, so should we expect, you know, more M&As? There's pressure on the smaller operators, so you're expecting to kind of spend more on deals. How should we think about the use of this increased cash flow? Thank you.

Yeah, Joanna. So from a cash tax perspective, what we said is we don't expect to be a material cash taxpayer this year. We'll obviously update our thoughts around 2023, but... the overwhelming majority of the NOLs will be used this year. And so there could be a very modest cash tax position in Q4, but nothing of note. Look, we're thrilled. And as you know, our mantra around here is that EBITDA only counts if it converts the cash in the bank. And given the dynamic market we're in, carrying a little bit higher cash balances, we think is a prudent strategy. However, our thinking around deploying that capital, it's not our cash, it's the shareholders' cash. And we think the best way to create value for the shareholders is through deploying that in an M&A strategy. So simply because we're generating more cash doesn't lower the bar on our expectations around the strategic and economic merits of any opportunities. And to the extent that we think that there's excessive cash, we'll obviously look at alternative avenues through which we can return to the shareholders. However, at this point, our conviction remains that M&A is the primary strategy for us to optimize value.

Thank you. You bet.

Thank you. And our next question comes from Brooks O'Neill of Lake Street Capital Markets. Your line is open.

Hey, good morning guys. This is Charlie Montagnon for Brooks O'Neill. Just one quick question for me. Could you please talk about how the shift to value-based care might impact option care and where might you see advantages in the new paradigm?

Hey Charlie, it's John. Look, we continue to have very constructive conversations with the payer community as things continue to evolve down that path. Those, you know, very constructive discussions Our focus has always been around creating favorable clinical outcomes, and we believe that the ability for us to continue to be well positioned to provide high quality care at an appropriate cost in a setting in which patients want to receive that care makes us part of that longer term solution that is being looked for. The platform that we've created and the ability for us to really be focused around that patient experience, member experience, and that high-quality care, we think is something that allows us to continue to be in those robust conversations and part of the solve. I think as we're looking at value-based, it's hard to define at this point. Each organization is looking at it a little bit differently on that. But total cost of care is something that they're beginning to really focus on, looking at the overall outcomes associated with therapy sets and care delivery. And, you know, we're doing a lot within our organization to make certain that we're well prepared, not only to clearly articulate the outcomes that we can deliver, but more importantly, the experience from a patient standpoint. and the quality of the care that they're receiving.

Okay. Thank you very much. That was very helpful, and that's it for me.

Yep. Thanks, Charlie. Operator, are you there? Yes. Our next question will come from Pito Chickering of Deutsche Bank. Your line is open.

Good morning, guys. Thanks for fitting me in here. A follow-up four-part question about why some of your competitors are exiting the markets. I guess, number one, why do you think they exited? Is it because they didn't have enough scale? Number two, does this give you more leverage to the payers who are less providers but still want home infusion savings? Number three, can you quantify how much of the market share you've captured at this point? And number four, does this bring down multiples for tuck-in deals going forward?

Only four parts, Peter. That's good.

Yes, let me start. Look, we're not going to hazard a guess around why people do what they do. Our focus is around our strategy and our execution. What I can tell you is all along we've looked at the strength of the platform that we've created and our ability to be a partner of choice at the local level, right? Healthcare is local. As much as we do to use our scale and the technology to create a highly reliable and interconnected network, it still is local. And, you know, the investments that we've made into our care management centers, our staff, The quality of our services is something that we believe really meets the needs of the marketplace and meets the needs of our referral sources on that. And so we're going to be steadfast in our strategy, in our execution. And we have said time and time again, we love the balance. of the portfolio across the acute and chronic and our ability to use that to drive leveraged growth and scale as a competitive advantage. You know, we have invested a lot within our commercial resources to make certain that we had that reach and frequency, that we were well positioned in the relationships that we were developing in those local markets, in the ability to identify opportunities to partner more deeply with them. And, you know, again, we'll look at any opportunity to continue to push that forward, to continue to deepen those relationships and continue to find ways to serve more patients. because we truly believe that a patient that's served by Option Care Health receives the best care available in the home or in one of our infusion suites. You know, on the overall look, it's early to tell around what this will be. I can also, though, just continue to reinforce, every market is competitive. There's multiple competitors in every single one. And so, look, we like our positioning, and we like the investments that we've made, and we think that the disciplined approach that we've brought puts us in a really strong position to seize on any opportunities that come to us, but way too early to tell around what any repositioning may do. And it's, you know, it's incumbent on us and our team to make certain that we're deepening the relationships and that we're capturing demand as it is available in the marketplace.

Hey, Peter, it's Mike. The only thing I would add is, look, as you know, as we talk about kind of the market participants and relative shares, these are all estimates. We don't have real-time market share metrics from IMS. And as John said, look, we're focused on being responsive to our referral partners in certain markets, and it's early days, but Um, and again, back to John's comments, it's about being dependable and reliable when the call comes in at four o'clock on a Friday afternoon, can we be responsive? And that's something we pride ourselves in. And if that, if that continues, we're confident in, in the momentum on the acute side from a MNA perspective. Um, look, I mean, we're, we're not seeing meaningful moves in, in multiples and valuation yet. Again, we're not, um, we're going to be very thoughtful looking at what are those strategic opportunities, and we're going to be disciplined in how we value those, but we're not seeing any seismic move in valuation expectations.

Okay, fair enough. And then on the supply chain, in the script you talked about shortages in nutrition. I guess looking at your broad portfolio, are there any other areas that you're seeing or worry about seeing shortages in And on the shortages, are these more revenue impacts or gross margin impacts or no impact at all you're just monitoring? Thanks so much.

Yeah, Peter, look, on what we called out, certainly in nutrition support, I mean, it's well publicized around some of the challenges that have existed in the marketplace with plant closures and other aspects. And so our team has done a tremendous job of helping to navigate through that and make certain that we can support not only our existing patient census, but where we can take on new patients and looking at formulary alignment. And we have dedicated... and really expert dieticians that are part of our team that work tirelessly to make certain that all of our patients receive the nutrition support necessary as they're executing around the therapy plans. Look, there's always going to be some of those spot outages. You know, we've got other situations where electrolytes and trace elements for our principal nutritional are under constraint. There's also, you know, some, you know, modest constraints around some of the other products as things ebb and flow from a supply chain standpoint or you know, plant closures or repair aspects. And so we've got a dedicated team in our trade relations strategic sourcing who are just adept at kind of beating the bushes and making certain that our teams in the field have the products that they need to make certain that we can meet, you know, the demand that's in the marketplace. So we work, you know, extremely hard and I believe extremely effectively to try to minimize, mitigate, or adjust around that. Mike, I mean, if you want to, on the, you know, impact the revenue or margin.

Yeah, look, I mean, obviously, you know, a lot of our therapies are orchestrating and compounding complex therapies for a patient-specific prescription. And so as we think about like parenteral or enteral nutrition, if you don't have that one trace element, that one electrolyte that's critical, you know, it's a real clear orchestration, not only of the therapy input, Pito, but it's also making sure we have the right infusion pump, the right infusion set that, again, is a PVC derivative, all orchestrated. And so, look, our team makes it look easy, but it's anything but. And so I would say from your perspective, Whether it's, you know, certain medical plastics, certain infusion pumps with semiconductors and chips, whether it's, you know, nutritional compounds that our pharmacy techs compound under a hood. It does have an impact on the top line and margin. But again, thus far, you know, knock on wood, our procurement team manages this 24-7 and we've fared relatively well.

Great. Thanks so much, guys. Thanks, Peter.

Thank you. And I'm showing no further questions at this time. I would now like to turn the call back to John Redemaker for closing remarks.

Yeah, thank you for joining us this morning and participating in our second quarter earnings call. To sum it up, we are very pleased with the performance of our team, the progress we are making against our strategic initiatives, and the continued strengthening of our balance sheets. We expect that there will continue to be challenges and know we have to work ahead of us to achieve our goals. However, we are focused on execution and we look forward to making continuous progress. Take care and be well.

This concludes today's conference call. Thank you for participating. You may now disconnect.