Premier, Inc.

Hello and welcome to the Premier, Inc. Fiscal 2022 Third Quarter Results and Conference Call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then 1 on your touchtone phone. To withdraw your question, please press star then 2. Please note, today's event is being recorded. And now I'd like to turn the conference over to Angie McCabe. Ms. McCabe, please go ahead.

Thank you, and welcome to Premier's fiscal 2022 third quarter call. Our speakers this morning are Mike Alkire, Premier's President and CEO, and Craig McCaffin, our Chief Administrative and Financial Officer. Before we get started, I would like to remind you that our earnings release and the supplemental slides accompanying this conference call are available in the investor relations section of our website at investors.premiereinc.com. Our remarks today contain certain forward-looking statements and actual results could differ materially from those discussed today. These forward-looking statements speak only as of today, and we undertake no obligation to update them. Factors that might affect future results are discussed in our filings with the SEC, including our most recent Form 10-K, and our Form 10-Q for the quarter, which we expect to file soon. We encourage you to review these filings, including our detailed safe harbor and risk factor disclosures. Also, where appropriate, we refer to adjusted or other non-GAAP financial measures, such as free cash flow, to evaluate our business. Reconciliations of non-GAAP financial measures to GAAP financial measures are included in our earnings release, in the appendix of the supplemental slides accompanying this presentation and in our earnings form 8K, which we expect to furnish to the SEC soon. I will now turn the call over to Mike Alkire. Mike?

Thanks, Angie. Good morning, everyone, and thank you for joining us today. As we expected, our third quarter results reflect the continued normalization of our direct sourcing revenue within our supply chain services segment toward a pre-COVID-19 pandemic level. Our performance services segment results were affected by the timing of revenue associated with enterprise analytics license agreements in the quarter as compared with the prior year quarter. Notably, our adjacent markets and consulting businesses are expected to continue to grow this fiscal year and we believe our adjacent markets businesses collectively are on track to exceed 25% growth on a year-over-year basis. So aside from a couple of transitory items, our core underlining businesses continue to deliver steady growth, and we are making progress in further positioning our business to achieve our longer-term growth objectives. Importantly, as we begin to wrap up our fiscal 2022, Based on our results for the first nine months of the year and our expectations for the fourth quarter, we are increasing our full year adjusted earnings per share guidance to a range of $2.48 to $2.58. This morning, I'll provide some brief comments on the macro environment as well as highlights on the progress we are making toward achieving our longer term objectives. Craig will then review our operational and financial results, as well as our updated fiscal 2022 guidance in more detail. From a macro perspective, we continue to operate in an environment affected by rising inflation, labor shortages, supply chain disruption, and increased raw material costs. While the COVID-19 pandemic appears to be abating in the United States, we are closely monitoring the spread of COVID cases and lockdowns in China. Ports are operating at lower levels of productivity due to a lack of dock workers, and trucking capacity has also been reduced. In an effort to mitigate disruptions, some shippers are switching their cargo to nearby ports. Over the coming weeks, we anticipate further transportation delays resulting from lockdowns and increased COVID testing across China. While we have contracted suppliers that manufacture and export goods from this region, including our own direct sourcing company, S2S Global, we have been diversifying our business to reduce dependence on China for a number of years. We are also keeping a close eye on any potential impact from the Russia-Ukraine war. which could further stress an already constrained global supply chain as access to certain critical supplies used in the manufacturing process are sourced from these two countries. We remain in close contact with our supplier base to monitor all the overall supply of semiconductors, which are used in medical supplies, such as IVs, MRI machines, pacemakers, and blood pressure monitors, among other items. We are not currently seeing direct shortages of semiconductors in healthcare, and we're not aware of any direct impacts to patient safety thus far. However, we believe a proactive approach is warranted to avoid supply shortages and the potential for patient harm. Therefore, we'll continue to take a leadership position in working closely with our suppliers, the government, and industry partners in an effort to stay ahead and informed of any potential disruptions. In addition to the availability of medical supplies, we continue to focus on proactively addressing drug shortages. In fact, during the pandemic, we have maintained a steady supply of drugs for our members despite demand spikes of 150% and shifts in manufacturing prioritization due to vaccine production. Moreover, our pharmacy programs have been instrumental in the delisting of 14 drugs from the Food and Drug Administration's shortage list. We also created opportunities that incentivized nearly 30 generic injectable suppliers to enter the market over the past decade. In addition, we and 11 of our leading member health systems invested in Accela Pharma Sciences to secure and support US-based drug manufacturing and further reduce drugs on the shortage list. Finally, we have led in advancing policy solutions to increase supply chain security domestic manufacturing, and the FDA's capabilities to address shortages. Also, we've communicated over the past several years an over-reliance on any one geography for raw materials. Pharmaceuticals and the production of medical supplies is one of the biggest disruption risks to the healthcare supply chain. We will continue to focus on creating a more resilient and geographically diverse supply chain. Lastly, as we discussed on last quarter's earnings call, high labor costs are impacting our members. To help address this, we convened an advisory committee of more than 30 of our member health system CEOs and CFOs who resoundingly cited labor shortages as the greatest challenge. We believe, and this group confirmed, that our consulting services and technology platform are well positioned to help our members address these labor shortages. From our workflow automation technology that saves time and money to our consulting services solutions that enable real-time demand and capacity planning, we are delivering critically needed solutions to help mitigate this issue. I'll now review some highlights from the quarter and provide some insights into our adjacent markets businesses with the focus on Remitra, Pink AI Applied Sciences, and Pink AI's technology capabilities. particularly for clinical decision support and prior authorization. First, in Remitra, our digital payments and financial solutions platform, we are on track with the roadmap we shared at our investor day last November to expand our capabilities from automating invoicing to automating payments for providers and suppliers. We continue to evolve our entire supply chain services business into an end-to-end technology-enabled supply chain solution that can help create efficiencies across the entire supply chain process from the sourcing of products and services to settlement of payments. This is critically important now since our members are feeling pressure from labor shortages. We are seeing growing interest in Remetra from our member healthcare providers and suppliers. We believe our strategy is a key market differentiator and that ReMentor remains on track to achieve $50 million to $100 million in annual revenue in the next three to five years, as previously communicated. Second, in our Pink AI Applied Sciences business, we have a strong pipeline and continue to partner with market-leading life sciences companies to leverage Pink AI's artificial intelligence, machine learning, and natural language processing technology to help close the gap in cancer diagnosis and care. In partnership with AstraZeneca and through our relationship with HealthX, which is the largest public health information exchange in the U.S., we are collaborating to identify patients with idiopathic pulmonary nodules, or IPNs, to bring them back into the health system so that potential underlying conditions, including lung cancer, which is the leading cause of cancer's death globally, can be addressed. Early results from this work have yielded approximately 140,000 patients with IPMs that would have otherwise been missed. With regard to Pink AI, this scalable technology and services platform is the engine behind our innovative solutions designed to meet the many needs of providers, life sciences companies, employers, and payers. Pink AI's clinical decision support has natural language processing and machine learning capabilities that our data science experts are leveraging to automate the prior authorization process. A labor, workflow, and administrative burden for both payers and providers, current prior authorization processes can delay the delivery of care to patients. Our foundational capabilities and advanced imaging are being used by several payers today, and we continue to explore partnership opportunities that we believe will help accelerate our ability to technologically automate every aspect of this process from the time a clinician enters an order to the moment it is approved by a payer, consolidating the timeline from days to minutes. In summary, we have positive momentum as we begin to wrap up our fiscal 2022 with some exciting and innovative opportunities to continue to evolve our business. We believe we remain on track to achieve our short- and long-term goals as we continue to enhance our capabilities in new ways and advance our strategies to deliver greater value to our members and other customers. I will now turn the call over to Craig McCasin for a discussion on our operational and financial performance.

Thanks, Mike. As we expected, our supply chain services segment and total net revenue declined from the third quarter of last year, as we continue to return to a more normalized pre-COVID-19 pandemic level in our direct sourcing products business. While our performance services segment performance was affected by the timing of revenue in the quarter, we believe we remain on track to achieve and for some metrics exceed our previously communicated fiscal 2022 financial guidance. I'll provide more detail on our revised fiscal 2022 guidance after reviewing our third quarter performance. For the third quarter of 2022, and as compared with the year-ago third quarter, total net revenue was $347.8 million, a decrease of 26%. Supply chain services segment revenue was $250.9 million, a decrease of 32%. And performance services segment revenue was $96.9 million, a decrease of 2%. In our supply chain services segment, net administrative fees revenue increased 1% from the year-ago quarter, primarily due to further penetration of member spend, which was partially offset by the impact from a small number of members that did not amend and extend their GPO agreements as part of our August 2020 restructure, as previously communicated. We are pleased that our non-acute business is performing well. Compared with the prior year quarter, this business grew more than 10%, and as we communicated at our 2021 Investor Day, we believe it's on track with our expectations to grow faster than the acute business over the next few years. Within our GPO portfolio, certain categories continue to generate strong year-over-year growth. These categories include our food program, which continues to return to pre-pandemic levels, and workforce staffing where we continue to see high demand due to the ongoing labor challenges in the market. Within the diagnostics category, we saw less demand for COVID-19 testing supplies compared with the year-ago third quarter. And notably, we continue to manage price increases for supplies for our healthcare providers, and inflation did not have a material impact on our performance during the quarter. Products revenue declined 57% from the prior year quarter and was primarily the result of the normalization of demand and pricing of personal protective equipment, or PPE, and other supplies as a result of the state of the COVID-19 pandemic relative to the prior year quarter. This decrease was partially offset by ongoing demand for commodity products as we continue to expand our product portfolio and drive increased member adoption. In our performance services segment, revenue declined in the third quarter as compared with the third quarter of fiscal 2021, primarily due to the timing of enterprise analytics license revenue in the current year compared with prior year. This is similar to what we experienced in the first quarter of this fiscal year and is consistent with our general expectation that we may experience periodic variability across quarters in our performance services segment, given that revenue recognition on enterprise license agreements typically results in a significant percentage of the total contract value being recognized in the quarter in which the agreement is signed and the technology is delivered. Notably, Both our consulting services and our adjacent markets businesses continued to grow in the third quarter compared with the same period last year. In our consulting services business, our recent focus on strengthening our capabilities and enhancing our sales efforts are producing results. We have significantly enhanced our talent and capabilities in this business, and we now deliver a clinically focused, technology-enabled business model that delivers larger scale, more integrated solutions to help drive performance improvement for our customers. Mike discussed a few of our adjacent markets businesses in his remarks, and I would like to highlight Contigo Health, which is our direct-to-employer adjacent markets business. We're very pleased with Contigo Health's performance year-to-date. As consistent with our expectations, it continues to ramp nicely gaining further traction in its third-party health plan administration services. In addition, as the pandemic abates and travel resumes, our employer customers are increasingly accessing Contigo Health's Centers of Excellence services for their associates. As Mike said earlier in his remarks, we believe our adjacent markets businesses are on track to exceed our expectation of 25% year-over-year growth. in fiscal 2022. With respect to profitability, GAAP net income was $39.1 million for the quarter. Adjusted EBITDA of $112.2 million in the third quarter decreased 7% from the same quarter a year ago as a result of the following. Supply chain services adjusted EBITDA of $118 million was relatively flat quarter over quarter primarily due to a slight increase in net administrative fees revenue that was partially offset by increased freight costs in our direct sourcing business. And performance services segment adjusted EBITDA of $26.6 million decreased from the prior year quarter primarily due to two factors. First, the aforementioned decrease in revenue, and second, higher selling general and administrative expense mainly related to a decrease in capitalized labor, primarily as a result of initiatives to offshore certain software development efforts, as well as additional headcount to support growth in our Contigo Health and Remitra adjacent markets businesses. Compared with the year-ago quarter, adjusted net income decreased 13% to $68.1 million, and adjusted earnings per share decreased 11% to $0.57 due to adjusted EBITDA performance and the increase in our effective tax rate in the third quarter of this year compared with the prior year quarter. From a liquidity and balance sheet perspective, cash flows from operations for the nine months ended March 31, 2022 was $334.8 million, compared with 192.4 million for the prior year. The increase was mainly due to a decrease in cash outlays in the current year period, resulting from the prior year buildup in inventory to meet demand for PPE and other supplies associated with the COVID-19 pandemic. This was partially offset by a decrease in cash received as a result of lower normalized revenue in our direct sourcing business, The impact of higher administrative fee share payments to members in the current year compared with the prior year and an increase in cash outflows for payments related to operational investments to support growth in our adjacent markets businesses. Free cash flow for the nine months ended March 31, 2022 was 201.9 million or approximately 54% of adjusted EBITDA. compared with 71 million for the same period a year ago. The increase was primarily due to the same factors that affected cash flows from operations, lower purchases of property and equipment, and changes resulting from our August 2020 restructure. For fiscal 2022, we now expect free cash flow to approximate 45 to 55% of adjusted EBITDA. Cash and cash equivalents totaled $179.5 million at March 31, 2022, compared with $129.1 million at June 30, 2021. We ended the quarter with an outstanding balance of $250 million on our five-year, $1 billion revolving credit facility, $75 million of which we subsequently repaid in April. With regard to capital deployment, We continue to focus on taking a balanced approach by investing in organic growth and targeting acquisitions to strengthen, enhance, or complement our existing capabilities and differentiate our offerings in the marketplace. We also continue to return capital to our stockholders. During the nine months ended March 31, 2022, we repurchased approximately 6.4 million shares of our common stock for a total of $250 million, thereby completing our fiscal 2022 stock repurchase program. We also paid dividends to stockholders totaling $72.9 million. Recently, our board of directors declared a dividend of 20 cents per share payable on June 15, 2022 to stockholders of record as of June 1st. Turning to our full year fiscal 2022 guidance. Based on our performance for the nine months year to date and outlook for the remainder of this year, we are raising guidance for the following metrics. For supply chain services segment revenue, we are increasing our guidance to a range of $1.02 billion to $1.03 billion. This increase primarily reflects higher products revenue than we previously expected. Therefore, we are increasing our total net revenue guidance to a range of $1.41 billion to $1.45 billion. With respect to adjusted EBITDA, we are raising the low end of and tightening our guidance range to $490 to $500 million, and we are increasing our adjusted earnings per share guidance to a range of $2.48 to $2.58. In summary, as we begin to wrap up this fiscal year, we continue to execute our strategy, generate strong free cash flow, and maintain a flexible balance sheet. As we look beyond fiscal 2022 and adjusted for the impact of the COVID-19 pandemic, we remain committed to and believe we are on track for achieving our targeted multi-year compound annual growth rates of mid to high single digits, for total net revenue, adjusted EBITDA, and adjusted earnings per share. Thank you for your time this morning. We'll now open the call up for questions.

Yes, thank you. At this time, we will begin the question and answer session. To ask a question, you may press star, then 1 on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. To try your question, please press star, then 2. At this time, we will pause momentarily to assemble the roster. And the first question comes from Eric Percher with Nefron Research.

Thank you. I appreciate you mentioning the long-term guidance at the end, and I know you mentioned you're getting fairly far into fiscal year 22. Craig, could you speak to kind of the known headwinds and tailwinds? And my thought here is really a couple of items, including the product normalization, the admin fee, weighing on first half of next year or second half of this year, and then maybe some of the timing fluctuations, how much of those factors will continue on?

Sure, Eric. This is Craig. Thanks for the question. I'll start kind of and move down. From a GPO standpoint, we've talked about the fact that the contract reset, for the most part, is behind us now, and that really where we are in the back half of this year is the baseline to grow from again. So we'll see that as we move into fiscal 2023 and when we establish guidance on our next quarterly earnings call. From a direct sourcing perspective, we've continued to normalize down. We do believe, for the most part, we should be back to kind of pre- on a go-forward basis. And then performance services will have the periodic variability that we've talked about, but we haven't really seen as much of an impact directly tied to the pandemic. The only sort of potential headwind or thing we have to keep an eye on is the impact of the labor shortages. And while in the long run, we believe that that will create more need for our services to help them automate and technology enable some of their processes

Thank you, and once again, please press star then 1 if you would like to ask a question. Again, pressing star and then 1 will allow you to ask a question. And our next question comes from AJ Rice with Credit Suisse.

Hi, everybody, and I apologize if there's background noise. One of the things that was mentioned last quarter was, you know, you were seeing some deferrals, obviously, with the surges we saw late in the year. Obviously, we had a surge in January that continued. And you might see that as a potential source of upside as some of that volume came back later in the year, but you were still sort of monitoring it. Do you have any sense of update? Do you think there's deferred activity that may provide some short-term boost to to the next few quarters for you.

This is Craig. I'll be happy to take that. Mike, you can add some color if you'd like. So, you know, clearly the impact of the pandemic and labor is affecting utilization, although we do continue to see utilization returning for the most part, to normalized levels. Depending on regional areas, there can be some pent-up demand that's coming back. But overall, I would say that we're getting back to sort of historical levels. It does ebb and flow a little bit across various months. But what I would say for the most part is that as we've talked with our healthcare executives, they're continuing to try and get all of the acute episodes, surgeries, things of that nature done. scheduled and taking place. If there are deferrals due to some of the challenges that are out there, it would be in the lower acuity things that can continue to be pushed out. I wouldn't expect a big ramp up of pent-up demand, but I think over time you'll continue to see that coming through broader healthcare utilization.

And this is Mike. So over the last number of weeks or a couple of months, Craig and I have been obviously meeting with our board and meeting with our board advisory committee and having one-on-one conversations with the members. I'll tell you, I do think that obviously our health systems are looking forward to the potential of some of the procedures that may have not happened over the last number of months because of COVID. The balance to that really is labor. So I think that to the degree that our health systems, you know, are, don't have the staff to, you know, do a lot of those, uh, uh, procedures and those kinds of things, that's gonna be sort of the headwind a little bit, uh, in terms of, you know, the, the, the growth and, and, um, uh, you know, would, would potentially, uh, sort of mute that growth, uh, going forward, but we'll, it's really early and, and there's a lot of dynamics here at play and, uh, We'll have a better understanding over the next number of weeks.

Okay, great. Maybe just one other one. Obviously, diversifying the supply chain has been a topic of discussion for a little while now, moving to some domestic sourcing in certain areas near shore sourcing. I guess the thing that's hard to understand is how much has actually changed versus where your key sourcing was pre-pandemic. as it stands today, and where do you hope to take it, you know, looking a couple years out?

Yeah, great question. So I'll tell you, prior to the pandemic, and even in the pandemic, we had been diversifying our sourcing out of China, just because there was such an overdependence on the one country, and into other Southeast Asian countries. We literally just broke ground. on some PPE manufacturing in a Southeast Asian country just recently. We're really, really excited about that. We think it will provide a really nice bolus of supplies at obviously reasonable cost. So we want to continue to create that resiliency on a regional level. So we'll continue to do that. As far as domestic goes, Obviously, you know, we've made the investments in our face masks with Prestige Ameritech, the investments we've made with Isolation Gowns, with DeRoyal, the investments that we've made in Accela for generic drugs and the partnerships for gloves that we have with Honeywell. I'll tell you, I think for the foreseeable future, we want to build those capabilities out. We will be looking for additional capabilities that we see as opportunities to diversify into our domestic market to produce those products. As I have spoken about in the past, it's really going to be an eye towards products and pharmaceuticals that you know, are highly automated where, you know, the labor cost isn't a profound impact on the manufacturing of the product. So strategically, the way we like to describe it is we want to balance supply chain depending on the category. We'd like to try as much as possible to do a third, a third, a third. So a third in low labor cost countries, a third in near shore, and a third domestically. And we think with that, we'll create the right level of of resiliency as well as the best prices for our members.

Okay, great. Thanks a lot. Thank you.

And the next question comes from Richard Close with Canaccord Genuity.

Excuse me. Yeah, thanks for the question. Mike or Craig, can you go over the labor pressures a little bit? Obviously, that's a major issue right now. And I'm just curious if you could go into a little bit more detail with respect to what you're doing to help clients there on the labor issues. And then, you know, you just mentioned mentioned it a little bit, that it could factor into growth for some of your customers. But how would you gauge labor issues as a potential risk to growing your business as we think about fiscal 23?

Thanks, Richard. And I'll hit this, Craig, please add any color. So, you know, just from a, if we just stood back a little bit and looked at the broader issue from a labor standpoint. I think COVID, as we've been talking about, resulted in significant burnout among many of our clinicians of our healthcare systems. What that really led to was that we had a number of, you know, clinicians either retiring early, or in some cases, clinicians that were working full time are now doing either travel work and maybe working just, you know, a couple of days a week, which obviously exacerbates the shortage. Richard, to put it into perspective, for every one clinician that's hired, there's approximately 2.6 job openings. And so we know that we've got a huge gap to fill. Also, we know that the wages for traveling staff had almost tripled. Now, that has come down a little bit. I would still tell you it's more than doubled. But, you know, we were seeing, you know, the tripling of an hourly, you know, rate for a traveling clinician. So, you know, those are significant issues that are impacting, obviously, the margins of the healthcare systems. And so... You know, we're obviously trying to create a number of capabilities to help them really manage their staff or work with their staff to manage their work more effectively. And so in the short term, you know, obviously it's really about how can we help them close gaps and, you know, get access to the labor and those kinds of things. In the short and middle term, I'll tell you, it's really about leveraging our technology. And you asked this very, very specifically. We think we've designed some of our technology with the intent to drive incredible efficiencies around labor. So if you think about our products that do the technology enablement of prior authorization, oftentimes you have clinical staff that are looking at the notes and they're looking at the charts, and they're determining, you know, what can either be pre-approved or authorized for a procedure, and that we have technologically automated that, and at least, you know, in our early cases, we're seeing incredible accuracy to that, to our ability to automate that. You know, we think that's going to be a huge opportunity for us to work with our healthcare systems to redeploy that staff into more clinical line opportunities. So that's number one. Number two, we've been launching and rolling out our HCC codes, coding capability as well, which is obviously all using machine learning, looking at the unstructured data. Again, another area where you have people doing chart reviews and those kinds of things. We believe that our technology there is going to be able to really offset the need for a lot of labor to do a lot of that work. And then finally, and I spoke a little bit about this in my opening comments, but Remetra, our e-invoicing and e-payables platform, you know, it's really interesting, you know, if there's an invoice that has an error, and it doesn't matter if that error is, you know, $500 or, you know, $50,000, it takes the same amount of time to do the work, to track down why there's an error and how to fix that error. And so we believe by totally automating that whole process that we're going to bring a lot of efficiencies to our healthcare systems and allow that labor to also be redeployed. So that's kind of how we're thinking about it. The last thing is, and obviously you're well aware of this, Richard, we have an advisory services business that's been out working with our healthcare systems and building out plans and performance improvement engagements to really help them optimize the later labor to ensure that that labor is being utilized the most efficiently. So those are the areas we're focused on. Craig, I'm not sure if you have any additional color.

Yeah, the only color I would add, Mike, thanks, is on the supply chain side of our business, Mike really focused on the performance services side. But on the supply chain side in the GPO, we have temporary staffing contracts. element of growth as I mentioned in my comments. And then we also have supply chain co-management capabilities where we actually augment staff in the supply chain in our health systems. And that is an area that we're focused on and are seeing growth as some of our healthcare providers need some assistance given what's happening in the marketplace.

Okay, thank you. If I could ask a follow-up, on the enterprise timing, Craig. Is there any way that you guys can transition to a SAS model at all from the license with that? I know you do offer SAS models, but I was just curious if there's any way you could do that and take sort of that lumpiness out of the equation.

Yeah, it's a good question, Richard. What I'll tell you is the vast majority of our performance services technology revenue continues to be SaaS-based. It really gets to the structuring of the contract agreement with the healthcare provider, how they want to host or hold that technology. In some cases, they actually want it to be more of a license basis so they can capitalize their acquisition costs versus having ongoing expense. So we evaluate when we're going through the sales process the most effective way, and we really do try to meet the customer where they are. But we'll continue to think about ways to, you know, clearly we'd prefer to have a more seamless consistency, but at times it's just difficult to have things close exactly on the timeline that you would like.

Yep.

Thank you.

Thank you, Richard.

Thank you. And the next question comes from Stephen Valiquette with Barclays.

All right, great. Thanks. Good morning, everybody. So a couple things here. First, your comments on the pharmaceutical supply channel were helpful. I guess I just have two interrelated questions around that. First, just to the extent that there are some elevated levels of supply shortages for injectable drugs used in the hospital setting, I'm curious, is it more on the brand side or the generic side? And then secondarily, are you seeing any notable signs of generic drug price inflation either due to those supply shortages or perhaps maybe just due to higher generic manufacturing costs, if you're getting any feedback from manufacturers on that variable.

Thanks. Thanks, Stephen. Real quick, on the national drug shortages, you know this is something we've been incredibly passionate about for a number of years. And so primarily what we focus on, Stephen, is the, we focus obviously across the entire portfolio, but where we have an acute focus is really on the generic drugs that are chronically in short supply. So obviously that's the market that when a product goes generic, there's huge savings, but we always have to balance and ensure that we have healthy supply markets because we know that if there's suppliers that are eliminated, then you potentially have that imbalance, and then you have a generic drug that obviously goes up in price. And so the net of all of it is we've got sort of a three-pronged approach, if you will, to really work through those drug shortages. So one, we have our Provide GX program, which really the focus there was to create partnerships and deploy capital working with generic drug manufacturers to expand production or to expand pharmaceutical companies to getting into the market. And so that's something that we want to continue to double down on. We believe that that will create healthier markets, which is really, really critical for us to help our health systems manage their generic drug supply. Secondly, our investment there in Accela. and what we're attempting to do with our health systems. They're a great platform, very strong capability to produce products. We want to expand those products to hit more of the generic drugs that are in short supply or to manufacture more of those drugs. And then we want to vertically integrate those processes as well and make sure that we have the ability where it makes sense to actually produce the APIs or the active pharmaceutical ingredients as well, because we do think that's part and parcel to the whole solution. And then finally, we want to continue to drive standardization of buying on behalf of our members, because that gives us the most amount of flexibility in terms of how to deploy that standard buying to the organizations that You know, we either, you know, want to continue to work with and support or to help build up new ones, or it just gives us a lot more flexibility to keep healthier supply markets. So, you know, that's going to be, you know, the continued focus. As far as inflation, it's one of those things that, you know, we continue to manage and we've been keeping in check. But, you know, again, we'll just keep building our resiliency strategies and keep building out our capabilities to, as much as possible, keep that inflation abated.

The only quick follow-up is, has there been any inflection in, like, the trends maybe over the past couple of months? where either shortages have either accelerated or generic price deflation has maybe swung back towards inflation. If there's none, that's fine, too. It just helps to hear that kind of one way or the other.

Thanks. Yeah, no, I appreciate it. We saw some, obviously, some pretty significant utilization of drugs that were needed for folks to be intubated. And so, obviously, there was a huge increase in a lot of those product lines you know, during COVID. But, you know, I would tell you that the way I would describe it is, you know, fairly normal with the exception of the drugs needed to treat, you know, COVID patients. And so far, we've been able to manage through that. Okay, great. Thanks.

Thank you. And the next question comes from Michael Cherney with Bank of America. Merrill Lynch.

Good morning. Thanks for all the details so far. I want to go back to a question I think Richard asked. relative to the dynamics of your performance services business broadly. Obviously, you're building a number of interesting strategic platforms that are garnering various degrees of share and my share already. As you think about what's built into the views of your long-term trajectory, how do you think about that conversion of in-year, in-period sales relative to revenue growth and how much of it will evolve over time based on Some of the, you know, Remitra, Contigo, et cetera, some of the other platforms are being built out versus what you've traditionally sold to market.

Yeah, so this is Mike. I'll start, Craig. Please, you know, add any color. But it's a balance, right? You know, our focus really is to really leverage our SaaS-based technology and our enterprise license deals to help our healthcare systems grow. you know, drive performance improvement. And so we're continuing to do that. We have a strong pipeline. Obviously, everything I've been talking about in terms of focusing on labor, you know, one area I did not focus on is clinical standardization. I'll tell you, our healthcare systems are, you know, very much focused on, you know, standardizing the way care is being provided. They're looking for new ways to generate revenue and those kinds of things through you know, new models and oftentimes, you know, looking at ways to, you know, partner with payers or become payers in the market. So we want to make sure that we're building out all those capabilities, which is absolutely core to who we are in terms of meeting their needs from a performance improvement standpoint. And then along the way, we have to leverage that, you know, that profit, you know, that the revenue, you know, from those businesses to grow those other businesses, because we know long-term the technology enablement of these processes. We know the technology from the processes around prior authorization and HCC scoring and those kinds of things. We know that that will be the most efficient way to actually, you know, perform those functions. And then, obviously, we see a huge opportunity in what's happening, as Craig described in his opening comments on Contigo, supporting our members as they're thinking about moving into new care delivery models. And then, finally, as I spoke a little bit about, in life sciences, we think we have some really, really unique capabilities, not only doing real-world evidence in terms of helping our healthcare systems, I'm sorry, in terms of supporting life sciences organizations and our health care systems. But we also think the opportunity to identify patients using our, you know, our advanced technology, our machine learning and our natural language processing at the point of care is going to be something that's going to be, you know, we think really differentiating for our life sciences segments or subsegments. So we're really excited about all of it. But to me, it's all about balance.

Yeah, and the only color I would add, Michael, is that, and we talked about this at our Investor Day last November, but it really is the balance Mike's talking about, the core provider business in performance services growing at sort of a mid-single-digit kind of growth rate, but then leveraging those capabilities to drive the much higher 30% to 40% growth in those adjacent markets that Mike talked about, clinical decision support, applied sciences, working with payers, and then employers through Contigoil.

Got it. And then if I could just do a follow-up on the GPO business, especially now as you're almost two years past the announcement of the change in operating structure. How should we think about the ongoing period of renewals, of retention? Is there a different cadence that we should expect versus where you've been previously on when your various different previous member owners and large customers will come up? And along those lines, Will we get to a point where we essentially have all of those member owners that reset after the change all renewing at the same time?

Yeah, so – and Craig, I'll – go ahead, Craig.

No, I was just going to – sorry, Mike, you can jump in. But so all of the historical member owners are now – contracts have been renewed as we talked about at the time of the restructuring those were five six seven year agreements so the majority of all of our business is contracted and will come up in our fiscal the beginning of our fiscal 2026 um so we have a number of years under contract remaining um we we over time we'll continue to look at creating more of a waterfall um we did a little bit of that through the restructuring and then as you would expect, have other customers that are across both our acute and non-acute portfolio that, you know, renew at regular times throughout various contract periods. Got it. Thank you.

Thank you. And the next question comes from Jessica Tassin with Piper Sandler.

Hi. Thank you for taking the question. So just interested to know if you could help us understand how many of your GPO members are currently using Remitra, or maybe just what percent, and then just how is that solution billed, and when these are enterprise contracts or enterprise licenses, kind of how long do the contracts tend to be for? Thanks.

And by the way, Jessica, congratulations. So I'll hit... I'll hit Remitra first. So one of the reasons that we were so interested in the underlying platform of IDS is that it was already embedded in a number of our very, very large healthcare systems. And so I think the important way that we look at that is if you look at our most significant health systems, boy, I'll tell you, a high percentage of them had been using that technology now. We are obviously and have been adding functionality to that program and that platform. And so, you know, we're in the process of building out more capabilities to do that. So it was one of the key reasons why we actually acquired IDS is because of the penetration that they already had in our health system. So, you know, obviously we're really excited about where that goes. And our comfort, it gives us comfort, obviously, with our interest to continue to expand that platform. And you know, our goal there is to build out that network of healthcare systems and network of suppliers to more easily transact using advanced technologies, but more easily transact doing invoicing and payments. So We're really, again, excited about that. And Jessica, I forgot the last question. Craig, if you remember, you can answer it.

Yeah, the second question was the kind of time, the length of our enterprise analytics license agreements and performance services. And generally, those are five-year contracts.

Got it. That's helpful. Thank you. And then just maybe a follow up. I think CMS invited comment on how to incentivize hospitals to purchase domestically manufactured N95 starting in 2023. So just do you have any views on a potential payment adjustment starting next year? And could that potentially be a meaningful tailwind to reaccelerate the direct sourcing business? Thank you.

Yeah, obviously, we're well aware of that. We have been in conversations with that. Right now, I think it's too early to tell whether or not we think there's going to be a significant tailwind or not.

Got it. Thank you.

Thank you. Thank you. And the next question comes from Jack Wallace with Guggenheim.

Hey, thanks for taking the question. Really a good job, particularly on the supply chain side of the business this quarter, managing through some of the roll-offs as well as the kind of the global disruption going on. Question for you on the guidance for the year. There's still a pretty wide range, about $20 million. It looks like the net admin fee has been pretty stable throughout the year. Can you just give us a little color on some of the puts and takes that go on to the fourth quarter of the implied guide and what can cause this to end up with a higher or lower end of the ranges? Thanks.

Yeah, thanks for the question, Jack. This is Craig. You know, I think as you've seen throughout the year, the thing that's a little difficult to precisely predict is this normalization that's been happening on the direct sourcing side of the business and then the utilization impacts due to either labor challenges or kind of what's been happening from overall resumption of services and hospitals, as we talked about earlier. And so, We're confident in the updated guidance that we've provided to the extent that we, you know, see some of that demand come through in the fourth quarter. That could help us both in direct sourcing and the GPO to push us to the upper end of that range. If there was for any reason, you know, one of the things we're kind of keeping an eye on, while at this point it's not affecting hospitalizations too much, but with the country sort of broadly moving away from mask mandates, people flying without masks, all those things. We're sort of just keeping an eye on that. And so to the extent that there was any sort of mini surge that would affect utilization across healthcare providers, that's what could kind of cause us to be at the lower end. So we're trying to be prudent in terms of the confidence of the business continuing to perform in a stable way that it is. But that's sort of the puts and takes that can cause

Got it. That's helpful. All for me. Thank you so much.

Thank you. Thank you. And the next question comes from Stephanie Davis with SEB Securities.

Hey, guys. Thank you for fitting in. I just had a quick question on hospital demand environment given the whole macro backdrop. How should we think about the shifting appetite for large contracts just given what's going on with utilization, labor, and the broader macro? Are you seeing any areas of incremental demand versus areas that are being deprioritized?

Okay, Stephanie, this is Mike. So it's a great question. I will tell you, I think that health systems right now obviously are really struggling with labor costs and thereby their margins. And I think, you know, us being able to have a – quiver, if you will, of products and services that we can take in there to help them be more efficient. I think they're really, even with all the pressure happening from a labor standpoint and those kinds of things, I think they're very open, obviously, to engaging with us and having that dialogue around what are those things they need to be potentially doing differently. And again, I've been spending a lot of time talking about how to ensure that we're as efficiently as possible utilizing, you know, clinicians and standardizing care and those kinds of things. I will also say, you know, I think health systems are, you know, looking for ways to balance and create more variable costs as opposed to fixed costs. And so there's just a lot of that kind of opportunity that we're discussing with them, given that, you know, there is this sort of new normal that everybody's dealing with, with these labor, these labor issues.

Now, the follow-up to that, if this backdrop continues of labor and supply chain disruption and whatnot, would you think of the next year as seeing greater demand for your supply chain business or your performance services business?

That's our hope. Craig hit the nail on the head in terms of where we think there's the opportunity to do co-management with our health systems. And so, As the pressure increases and as there's issues associated with potentially getting access to the labor, we believe we could potentially step in there and provide some services. I will tell you, it is also the reason that we did our partnership with GABS and created our joint venture called Long 80, which is really, from a technology side, helping what we believe is going to get, you know, helping our healthcare systems get access to healthcare technology labor more easily than if we didn't have that partnership. So we're also, you know, looking forward to, you know, deploying that capability over the next couple of years as well.

Awesome. Thank you.

Thank you.

Thank you. And that concludes both the question and answer session as well as the call itself. Thank you so much for attending today's presentation.