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spk01: Good morning, ladies and gentlemen, and welcome to the Q3 2021 Tabula Rasa Healthcare Incorporated Earnings Conference Call. At this time, all participants are on their listen-only mode. Later, we will conduct a question and answer session, and instructions will follow at that time. If anyone should require any assistance during the call, please press star, then zero on your touch-tone phone. As a reminder, this conference call is being recorded. I will now like to turn the conference over to your host, Mr. Kevin Dill, General Counsel. Sir, please proceed.
spk06: Thank you and good morning. I'm Kevin Dill, Corporate Counsel for Tabula Rasa Healthcare. The company intends to avail itself of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Certain statements made during this call will be forward-looking statements within the meaning of that law. These forward-looking statements are subject to risks, uncertainties, and other factors that could cause Tabula Rasa Healthcare's actual results to differ materially from those expressed or implied by the forward-looking statements. These risks and uncertainties include the developing nature of the market for technology-enabled healthcare products and services, and potential changes to laws and regulations that may impact our clients. For additional information on the risks facing tabular asset healthcare, please refer to our filings with the SEC, including the risk factors section of our 10-K filed on February 26, 2021. The recording of this call is accessible through a link on the investor relations page of our website, and it will be available for 90 days. I'll turn the call over to Dr. Calvin Knowlton CEO, chairman, and founder of Taglerasa Healthcare.
spk08: Thank you, Kevin. I want to open the call with a summary of our third quarter results, including the key theme, which is our organic revenue growth is improving. Three points. Third quarter revenue grew 23% year over year to 86.6 million. This compares to 4% revenue growth last year and 6% revenue growth in the first half of 2021. This trajectory bodes well for us as we get close to 2022. Second, third quarter organic revenue growth of 17% compares with 1% during the first half of 2021. MedWise Healthcare software subscription revenue of $11.8 million increased 16% year-over-year and 17% on a sequential basis as compared to the second quarter of 2021. The focus in our board meeting earlier this week on Monday and Tuesday was maximizing long-term value for our shareholders. In the near term, We are doing three things. First, organizational leadership changes to better align strategy, product, and sales. And this will go into effect next week. Second, evaluating options to unlock value in non-core assets. And third, exploring new strategic and transformational relationships. We will provide greater detail in the coming weeks and months as our strategy execution progresses. At this time, I will turn it over to Ursula to discuss our Carevention Division, which houses five offerings in PACE, after which Kevin will discuss our MedWise Division, and then Brian will discuss the financials. Ursula?
spk05: Thank you. During the third quarter, Our net census growth for the program of all care for the elderly remained at the range of 1% monthly sequential growth. The pace population has benefited from the high level of vaccinations administered to seniors across us with the vaccinations rates among the 65 and older at 84.5%. As per October 21 per the CDC. In short, we feel good about the future trajectory of PACE enrollment and our care mentioned healthcare business. As part of our normal annual reporting, we will provide detailed PACE metrics in conjunction with our fourth quarter earnings call, but I wanted to highlight a few trends. First, our average per member per month, or PMPM revenue, continued to grow at a healthy rate during the third quarter, up 4% versus the second quarter, and up 9% versus the first quarter. as we benefit from a growing base of care kinesis clients or pharmacy services and medication risk mitigation utilizing, in fact, the number of PACE participants served by care kinesis is up 15% at the end of the third quarter versus a year ago. Second, PACE cross-sell revenue recognized through the first nine months of 2021 is 12% higher versus the same period a year ago and exceeds the total revenue recognized for the full year of 2020. High-growth new startups and expansion activity are encouraging with existing states, including Florida, Massachusetts, North Carolina, New York, Louisiana, Ohio, and Maryland. Expanding pace in new states include Washington, D.C., Kentucky, and Illinois, and those looking to add pace. Startup organizations are relying on the expertise of CareVention Healthcare, helping them enter the market with confidence. As of September 30th of 2021, our PACE implementation backlog stands at 47, with 17 projected to go live during the final quarter of 2021, and the remaining 30 scheduled for 2022 and 2023. During the third quarter of 2021, we completed four implementations, bringing the total as of September 30th We continue to be pleased with the growing support for PACE, which remains the gold standard for value-based care. In September, HHS published a report titled, Comparing Outcomes for Dual Eligible Beneficiaries in Integrated Care, which concludes the PACE program stands out from our analysis as a consistently high performer. The report found that dual eligible beneficiaries in PACE have better outcomes compared to regular Medicare Advantage enrollees. And this study evaluated dual eligible beneficiaries enrolled in three mutually exclusive plan types, comparing them to PACE. I'd like to turn the call over to Kevin Boesen, our Chief Scientific Officer.
spk11: Kevin Boesen, Chief Scientific Officer Thank you, Ursula. And this is Kevin Boesen, Chief Sales Officer. Thanks, Ursula. Appreciate the promotion. As part of our effort to provide greater transparency into our financial model, I'll start reporting on our actual bookings figures. Excluding sales related to COVID testing in 2020, overall, CareVention Healthcare and MedWise Healthcare, Q3 bookings increased 87% compared to a year ago and totaled a record $15 million, led by our MedWise segments. Notable third quarter deals included two Blues organizations, self-insured employer groups, several health plans serving Medicare and Medicaid, and an exciting partnership with eHealth. eHealth is one of the leading private online marketplaces for health insurance and a key driver in our Q3 record results. In August, we went live with our eHealth-sponsored Medicare Plan Finder solution, and this relationship has increased our retail pharmacy footprint significantly. by almost 1,000 new community pharmacy rooftops during the third quarter. This is the largest growth in new community pharmacy customers in a single quarter since the 2019 acquisition of Prescribe Wellness. At the end of Q3, our retail pharmacy footprint is close to one out of every four rooftops across the country. Our Prescribe Wellness network represents an incredibly valuable asset as pharmacists play a more integral role in overall medical care. growth in our pharmacy network is an important part of our payer sales strategy. The larger our network, the more opportunity to enhance payer engagement for payers through the local pharmacist-patient relationship. I'm also excited about our collaboration with McKesson Health Mart, which officially launched in October to 5,000 community pharmacies and will begin contributing meaningful revenue during the fourth quarter of 2021. Health Mart's digital portfolio includes is a new solution powered by the prescribed wellness platform and provides pharmacies with a suite of digital tools and services, including a consumer web portal, a mobile app with the goal of strengthening critical interactions between a pharmacist and patient. We also have a subscription-based premium offering with a number of important features and functions for 2022 and beyond. Turning to our year-to-date performance through the first nine months of 2021, our overall bookings across both the CareVention and MedWise Healthcare segments total $25.5 million, an 8% decline as compared to the same period in 2020. This bookings figure is a good proxy for annual recurring revenue, or ARR, as less than 2% of the $25 million represents one-time or non-recurring revenue. As of today, we estimate 54%, or $13.7 million, of our 2021 bookings year-to-date will be recognized as revenue in 2021. Our in-year revenue target as part of our 2021 guidance was 21 million or 7 percentage points of growth. Given that we have less than two months of selling remaining in the current fiscal year and our ability to convert bookings into recognized revenue decreases every month as we get closer to December 31st, we will not be able to close the remaining $7 million gap. The lower sales and lower conversion rate of bookings to recognize revenue are key factors in our Q4 guidance. The shortfall is due to several factors. One, contract delays that pushed key wins to later Q4 starts, and two, short-term hiring challenges, which our peers have also commented on. The pandemic has elevated the role of retail pharmacies and created strong demand for pharmacists and pharmacy technicians. As we headed to 2022, we are in a better position than we were a year ago. First, our sales team continued to expand during the third quarter, and as of September 30th, we are close to our target of 50 individuals across divisions with the largest headcount supporting our community pharmacy and payer markets, the MedWise healthcare segment. Second, we feel good about the overall sales pipeline and the level of late-stage activity as we head into 2022. Our payer pipeline has continued to grow as a direct result of the increased headcount and a key return of live trade shows in recent weeks, including Health, Assembia, Academy of Managed Care Pharmacy, and LeadingAge, to name a few. In short, we remain confident in the long-term growth for MedWise in our payer division, leveraging the proven outcomes from our recent MedWise publications, as well as our proven results around star ratings. In early October, CMS released its 2022 star ratings, and our clients continue to outperform. Among our existing Medicare Advantage clients, Seven contracts improved from a four- to a five-star plan, bringing the total number of five-star contracts to 38, or effectively one out of every four contracts we serve. This compares favorably to 16% of total Medicare Advantage contracts that attained a five-star rating. I'll now turn it over to Brian Adams.
spk03: Thanks, Kevin. As Cal mentioned earlier, although we continue to see a healthy acceleration of our growth rate from the first half of the year, we're not satisfied with the progress. and we're taking actions to further enhance our growth. Before commenting on guidance, I want to dig into our MedWise results. As expected, we saw the benefit of a large new contract go live during Q3 with the leading private online health insurance marketplace, which led to 16% software subscription revenue growth and 7% revenue growth for the MedWise healthcare segment. Unfortunately, medication safety services fell short of our internal projections, declining by 4%, with the primary factor being hiring challenges within our telepharmacy call centers, leading to a lower number of comprehensive medication reviews, or CMRs, being completed compared to our target during the quarter. As of today, we are adequately staffed to deliver on our fourth quarter medication safety services revenue projections. And at the end of September, our call center headcount excluding interns was 19% higher as compared to June 30, with strong hiring in both August and September. It's important to note that the one large client loss in 2021 and the reduced fees for our EMTM program this year accounted for 14% of revenue last year. And this headwind offset strong growth from new clients in 2021. ClearSpring Health is one example. and continued gains at two major health plans where 2021 third quarter revenue more than tripled versus a year ago, and now accounting for 18% of total medication safety services revenue in the quarter. Now turning to Q4 and the full year outlook. When we provided our initial 2021 guidance back in February, we highlighted five key assumptions bridging our actual 2020 results to our projected 2021 results. I want to revisit each of these and provide you with an update. First, our PACE Census growth is tracking to plan. Our October 21 monthly sequential Census growth for care kinesis was in the range of 1% and enrollment is up 9% versus a year ago. As a reference point, the latest PACE data from CMS showed October enrollment up 5% versus a year ago. So we continue to grow well above the overall market. Personica is right on target, contributing five percentage points of inorganic growth. Third, new client contracts were expected to add three percentage points of growth during 2021, and we are behind, primarily due to the delayed launch of McKesson Health Mart, which has now gone live, as Kevin mentioned. Fourth is new business, and as Kevin discussed, we're behind our sales plan, and the weaker revenue outlook for the fourth quarter and full year is entirely related to the MedWise Medication Safety Services line. Unfortunately, we've experienced contracting delays, expanding a relationship with a material existing customer for a program that was expected to be implemented during the fourth quarter, and that is a major factor leading to the weakness in our medication safety services revenue at the end of the year. Lastly, revenue attrition is as expected. The reduced revenue outlook is having a disproportionate impact on our adjusted EBITDA guidance given the ongoing investment in the business. albeit these investments are at a more measured level heading into 2022. Our fourth quarter 2021 revenue guidance reflects growth of 9% to 12%, all organic, as compared to a year ago. We expect CareVention Healthcare to increase at a faster rate than the overall growth range of 9% to 12%, as we benefit from the growing participant base. We expect MedWise Healthcare revenue to increase in the low to mid single-digit range with continued strength in software subscriptions. Last, we plan to provide formal 2022 guidance in connection with our fourth quarter 2021 earnings release, but wanted to offer some preliminary thoughts for next year. For some history, I'll remind you that in 2020, we experienced organic revenue growth of 3%. In 2021, we are projecting 7% and are exiting the year in the range of 9% to 12% for the fourth quarter. We expect organic revenue growth to continue to trend positively in 2022, and we feel comfortable we can generate 12 to 14% organic revenue growth in 2022, which includes two to four percentage points of growth from future unsigned contracts that we expect will be converted into revenue next year. If you exclude the revenue loss attributable to the planned end of the EMTM pilot program of 3%, our growth rate next year would be 15 to 17%. Regarding adjusted EBITDA, we are committed to driving margin expansion in the range of 100 basis points as compared to 2021. Current guidance reflects a range of 5.8 to 6.1%. With that, I'll turn it back over to Cal for closing comments.
spk08: Thanks, Brian. To close, this management team and all of our team members are working incredibly hard to create value for our clients and our shareholders. The three initiatives that we launched I mentioned earlier the organizational leadership changes, the evaluation of options to unlock value and non-core assets, and the exploring of new strategic and transformational relationships all bode well for increasing performance and shareholder value. As you heard, our Care Venture Division is back on track for a wholesome 2022, and our MedWise Division is headed in the right direction. Operator, would you kindly open the call for Q&A, please?
spk01: Yes, ladies and gentlemen, if you have a question at this time, please press the star and then the number one key on your touchtone telephone. If your question has been answered or you wish to remove yourself from the queue, please press the pound key. Your first question will come from the line of Ryan Daniels with William Blair. Please go ahead with your question.
spk12: Yeah, good morning. Thanks for taking the questions. This is Jared Haasen for Ryan. So, you know, Certainly one of the themes here for the quarter is the hiring challenges and the way that that has sort of impacted the results in Q3. So, you know, I just wanted to kind of stick on that theme for a minute. I mean, I guess my question is, you know, can you sort of talk about what specifically the hiring challenges were? You know, was it sort of just falling short of, you know, some of your hiring goals? Did you see an increase in sort of attrition or hypertension issues in the call centers? You know, I'm just sort of curious. What gives you comfort that at this point, you know, those issues are kind of alleviated as we go into Q4 and then into FY22?
spk08: Yeah, this is Cal. We had a number of different issues with hiring, as many people did. But the one thing that really hurt us was we usually have a few hundred student pharmacists working with us from the different schools of pharmacy. And I think because they're not in class but they're remote, It's really cut down and less than half of what we normally have every year signed up. We were well under 150. We do have a new initiative that we launched then with a new liaison, a full-time liaison to the schools and colleges of pharmacy in the country that we work with to try and bolster that. So that was a big hit on the MedWise side for us.
spk03: Yeah, I'd just add on to that, Jared. Under Kelly Kovach's new leadership, You know, we've adjusted our staffing model and are going to continue to evolve that going into 2022 with more full-time individuals. And so, you can see just based on the headcount change from the end of the second quarter to the end of the third quarter that we've made progress against that. We feel like we're very well positioned to staff to satisfy any of the future contracts. But, you know, as Cal described, the students and recruiting those, which, happen typically twice a year, and there's heavy churn there, what was challenging this past quarter. And so we've made some adjustments to the model, and so we're excited to continue to promote that.
spk12: Got it. Thanks for that, Collar. And then I guess just maybe a quick follow-up. So in terms of some of the sort of contract delays or the timing issues with closing contracts that's impacted the outlook, I think that's been a theme that's cropped up maybe a couple times you know, of late. So I guess I'm just sort of curious, you know, what specifically with this large renewal, you know, what specifically delayed that? Is any of it related to COVID where it's just harder to kind of get people's attention on certain projects or maybe harder to travel, things like that? You know, I'm just sort of curious to what extent this might be an issue that crops up in the future.
spk11: Yeah, thanks. I appreciate that question. This is Kevin Bowes, and I'll take that. The contract issues and where we were confident in being able to close these earlier, do closer starts, are existing contracts where we're looking to add more of simple amendments. But what we found is that even simple amendments are difficult. And one of our largest customers is a retail community pharmacy that really struggled with bandwidth with COVID testing. the employer mandates for COVID vaccines, and we just found that we were definitely over-optimistic in our ability to get some of the share time for legal teams to get things done as quick as we thought we could get them done.
spk12: Okay. Thanks for that, and I'll hop back in the queue.
spk01: Your next question will come from the line of Sean Dodge with RBC Capital Markets. Please go ahead with your question.
spk09: Yeah, thanks. Good morning. I wanted to go back to the comments, Kel, you made at the beginning of the call on the strategic focuses for 2022. One of the things you mentioned was evaluating options for non-core assets. Can you just give us a little bit more detail there, maybe some sense of what you'd consider to be non-core right now? And then you also mentioned some leadership changes to come. I was wondering if there's anything more you could share on that. on that as well.
spk08: Yeah, they're not, well, to be very honest, I can't really share the non-clear assets yet because, you know, we have employees that don't know about what we're doing. So I don't want to, I don't think I can do anything on that right now. But you will hear about that shortly. On the leadership changes, we've added Kelly. She's been here 90 days, very experienced on MedWise, and we're going to make a couple other leadership changes there to help us bolster our MedWise team. And you'll hear about that next week, actually.
spk05: And that's Kelly Kovach.
spk08: Yeah, I'm sorry, Kelly Kovach. We brought her in. She's been here almost 90 days, but we're going to make one more fairly substantial, very senior leadership change.
spk03: And, Sean, I just echo, you know, Cal's comments on Kelly. I mean, she's been here for 90 days, has some really exciting observations related to the business and changes that she wants to implement that I think are going to be really meaningful going into next year. So, very pleased to have her on board.
spk09: Is there, so I guess I appreciate not naming non-core assets specifically. Is there anything more you can give on kind of what evaluating options means? Are these units that you're looking at like vaccine or shutting down or doing something else with?
spk03: Sean, unfortunately, I don't think we can share more at this point.
spk09: Okay, fair enough. Okay, maybe then I guess the third leg of the stool you mentioned was looking at maybe potential partnerships. Is there any examples or some ideas you can give us of what you're thinking there?
spk03: I think what I would say on that front, Sean, at this point is we've been looking at a couple partnerships that, you know, would really put us in a position to align our growth strategy with some other businesses that are in certain markets that we're targeting. And, you know, hopefully we'll be able to hear about those in the coming months. But they've been underway for some time now.
spk08: We've just expanded. Okay. Yeah, we've expanded on that, but. Yeah, I'm sorry we can't get in the weeds on that too much, Sean, at this point.
spk09: All right, I understand. Thanks again. Thank you, Sean.
spk01: Your next question will come from the line of Sean Whelan with Piper Semler. Please go ahead with your question.
spk10: Hi, thanks very much. Good morning. So going back to the guidance that you gave in February, my notes say that Guidance is conservative. We need to do about $20 million in new business to hit it. You know, compare and contrast the $20 million you needed to hit your guidance in February to the $20 million cut that you made today.
spk03: Yeah, Sean. So, you know, a big piece of it is, you know, the new contract that we had hoped to win, but not hoped to win, but is currently closed. In contracting with an existing customer, that is a material piece of the adjustment. As Kevin referenced, I think I did as well, we did have some delays implementing contracts that were secured last year, specifically the Health Mart contract that was delayed until really the fourth quarter. And that had a meaningful impact this year. We did have some delays with a couple of the contracts that did not come online as we had hoped. Most of that happening in the second half of the year. And then, you know, we had a couple million dollar miss in Q3 related to some of those hiring challenges. So a lot of this is back in weighted. And, you know, the most material is this contract with a very large chain pharmacy that we have an existing relationship with that was looking to expand clinical programs. And we have that contract underway, but it has not been executed yet. And so that's the most meaningful piece, heading into the end of the year.
spk10: This contract that the expansion is delayed, first, can you quantify the impact of that? And second, was that contract expansion in part of the $20 million of revenue that you needed to win, or was that part of what you thought you had visibility into?
spk03: No, that was in the 20 that we needed to win. And it was a pretty meaningful piece of that. I think that's what I could say at this point. I don't know, Kevin, if you would expand on that at all.
spk11: Yeah, it is meaningful. It is something that we anticipated. It was part of what was a new win, something that we expected would have launched sooner. But I think what we've learned over the course of this year is that while we've been able to shorten many aspects of the sales cycle by some of the folks that we've brought in, the back-end aspects of the sales cycle continue to be a challenge, and we need to be much more conservative in terms of some of those timelines.
spk10: So it just looks like – You know, comparing the original guidance to where we are today, it looks like you didn't win any business throughout the year, and I just don't see how that – is that right?
spk11: No, we had – as we reported from a transparency standpoint, is we do have $25 million in new business wins and almost 14 of that contributed to 20-21 revenue. So there are some of the other factors that Brian mentioned relative to staffing challenges that we faced in Q3 that caused us to miss a little bit, and then the slowness of the Health Mart launch, which we're very excited that it launched, but it was much later in the year than we anticipated.
spk10: Okay, thanks very much.
spk01: Thank you, Sean. Your next question will come from the line of Stephanie Davis with SBB Lyric. Please go ahead with your question.
spk04: Hey, team. Thank you for taking my question. I do appreciate that it takes a lot to own some of these shortfalls and take a hard look at the business. So happy you're doing that. So I've got two questions, one of them very broad strokes of financials and one of them pretty granular. First up, Brian. Just in light of how the year has progressed, how do you think your guidance philosophy has changed, and how are you approaching guidance on a go-forward basis, maybe looking even beyond 2022?
spk03: Yeah, thanks, Stephanie, for the question, because I think that this is important to address. You know, coming into this year, I think we clearly were aggressive with our targets. And while we've been in the process of building out the sales team, as Kevin mentioned, the sales cycles continue to be a lot longer than were originally assumed in our guidance. And so going into next year, it's probably noted, you know, we're looking at a contribution of really two to four percent of top line contributed from new contracts versus And that's the equivalent of six to 12 million versus the 20 plus that we were focused on this year. So coming off of a bigger base, we've got a much lower target in order to get to the numbers that we're forecasting. As Cal mentioned, we've got fantastic growth across the majority of the business and there's one area that we're working to correct that growth rate. We want to take a more conservative approach to our expectations related to new sales at this point. We're going to continue to update you as we make progress against those targets, but we've got a significant reduction in that assumption for next year. I think that's going to continue to be our philosophy going forward.
spk08: How much time? philosophy of the philosophy of the board has changed to on this on this matter. So I think we're pretty coherent now, throughout the company and the board that how we're going to forecast and it's, as Brian said, it was a little, we were a little aggressive. But we were we got that back.
spk04: Good, good to hear. Now on a very granular question has been complete opposite of philosophy. How should we think about your debt covenants and cash flow needs in light of the past few quarters?
spk03: Great question. We've been getting this from a few investors. To be honest, you know, from a covenant perspective, no concerns on that front based on current business performance and what we forecasted. What I will note for you, Stephanie, is that we have been taking actions even during this year to improve the cash burn and I'll give you an example, and to lower our operating expenses. And I'll give you an example. We recently outsourced a significant portion of our IT infrastructure to Accenture. That is savings for 2022. The transition is happening right now, but that is an action we did take earlier this year. We expect to continue to evaluate all areas of our operating expenses to see where we can do things more efficiently. Even thinking about our footprint from a rent perspective, there are areas where we're really looking across the board to drive that down. Also, as Cal mentioned, we are exploring ways to unlock value in some non-core assets that I think could meaningfully contribute to our cash position in the coming months. So I think that's the way I'd comment for this point.
spk04: Given all these moving pieces in the near term, is there a time where you would recommend we start retaking a temperature check for when you guys should be wrapping all these changes up?
spk03: So I would say, you know, you're going to continue to hear from us on progress over the next three months or so, you know, as it relates to a lot of this activity.
spk04: Helpful. Thank you, guys.
spk03: Thanks, Stephanie. Thank you.
spk01: Your next question comes online of David Grossman with Stifel. Please go ahead with your question.
spk02: Good morning. Thank you. I'm wondering if we could just go back to the 2022, you know, guidance or preliminary guidance, and perhaps you could just help us better understand how much visibility you have today based on the 2021 bookings and things that you plan starting up in the fourth quarter so that we can get a better sense of, you know, on that guide of 12 to 14, just how much visibility we have today, you know, providing some caveats for risks around hiring and any other items that, you know, are important.
spk03: Yeah, so that's a good question, David. And so we're sitting here today with about 10% that we've got very clear visibility into for next year. And then, you know, factoring another 2% to 4% related to new sales. And so there's a lot of activity in the pipeline right now, and as Kevin mentioned, we've got some deals that are late stage that we would expect to convert for that 2 to 4% of incremental revenue for next year. So we're, you know, that, yeah, so over 80% of that number is currently accounted for.
spk02: Got it. And how much of that, you know, 80% is, or maybe ask differently, how much of the 20% is medication safety specifically, I guess?
spk03: So it's a mix. Maybe I'll defer to Kevin in terms of the pipeline and how you spread the wins that we have projected for next year.
spk11: Yeah, thanks, Brian. The majority of the headcount that we have in place is on that MedWise division side. So it's the community pharmacy growth as well as the payer growth. So I would say what we expect in new sales continues to be on that MedWise side. On the pay side of the business, there are, as Ursula has mentioned, we do have a really strong pipeline there. We continue to grow in that business. In terms of the wins there, there's a mix between some of the new startups that give us gradual growth along with transitioning some of the larger-paced programs to our care kinesis pharmacy, which drives some of the larger wins. We are really conservative on some of those large-paced wins as far as forecasting and really putting our energy into the MedWise division. So that's how I would balance it, is I would expect to see much more growth and wins on the payer side of the business.
spk02: Yeah, Kevin, maybe I could just rephrase that. I didn't do a very good job the first time. Is that of the 20% that you don't have visibility on for 2022, how much of that are you expecting to come from medication safety? Yeah.
spk11: I mean, I would say in terms of what we're shooting for, probably north of 50% of that, so maybe in the 75 percentile. So it's really our focus is to continue that payer growth.
spk02: Got it. And just you, Brian, you gave several metrics for 2022. And sorry, can you just repeat them? I got the 12% to 14% growth with 3%. headwind from the EMTM, but I think he gave a couple of other metrics for 2022, and I'm hoping you can just repeat those really quickly.
spk03: Sure. No problem. So, you know, just as kind of a little bit of history, as I was mentioning before, you know, just organic revenue growth in 2020 was 3%. We're projecting 7% this year, exiting at 9% to 12% for the fourth quarter. As you mentioned, 12% to 14% organic growth for 2022, which includes two to four points of growth from future unsigned contracts. That's the piece that we were just discussing that Kevin was giving you the breakdown on. The EMTM pilot program contributed 3%. to revenue this year. And so that's a headwind going into next year. And if you excluded that, it would be 15% to 17% growth. And then on adjusted EBITDA, we are expecting to drive at least 100 basis points of expansion, which the current guidance is 5.8% to 6.1%. Got it.
spk02: And then just one last question. You mentioned Kelly Kovacs' name a couple times and some of the changes that she's, in a very short period of time, been able to identify. Perhaps you could just highlight the most important things that she's done and the potential impact those may have.
spk03: David, I think I want to just clarify a point because I'm not sure that we're all speaking the same language here, just in terms of what we have visibility into for next year. I think we're saying it's very small. It's over 95% in terms of total revenue that we have visibility into. I'm not sure if we were discussing earlier just the go-get, but I want to make sure that we're clear that our overall you know, target for next year where, you know, we still need to sign some businesses, you know, it's 2% to 3% of total revenue. So we've got visibility into north of 95% sitting here today.
spk02: All right, great. Thank you for that.
spk03: Okay. Sorry, I just wanted to make sure that we're all clear on that point.
spk02: And just the second question was really around Kelly Kovac. I think you've mentioned her name several times and some of the changes she's making. I was wondering if you could just kind of highlight the most important ones and the impact it may have on the business.
spk03: I would say that there's a couple areas of focus for her right now. One is on, obviously, the staffing model. and making sure that we've got a scalable solution and she's made and implemented some changes already as we were talking about. The second is really a full review of contractual relationships and focusing on existing customers to make sure that we're meeting all of their expectations. And, you know, the third is really on growth and making sure that we've got models that are, you know, being well received by customers. And, Cal, would you add anything to that?
spk08: Well, I think she's pushing big time on enhancing the relationship partners we have with current clients. She felt that... Account management. Account management, yeah, I'm sorry, yeah. She felt that we were under the norm there, and so she's already... boosted that to start with anyway, but that was an important observation. We had a meeting with her 30, 60 to 90 days after, and the board did too this week, just to get opinions from what she sees on that division. And she was very insightful, and she's working on it. I think it's going to make a big difference.
spk02: Okay, great. Thanks very much. Good luck.
spk07: Thanks, David.
spk01: I am sure no further questions at this time. I would now like to turn the conference back over to our host for today. Do you have any closing remarks?
spk08: No, but thank you very much. Thank you for everyone who attended.
spk01: Ladies and gentlemen, this concludes today's conference. Thank you for your participation and have a wonderful day. You may all disconnect.
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