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Heather Dixon, an executive, detailed the EBITDA phasing, noting Q1 had the highest startup costs. She identified the timing of the Tennessee DPP as the largest variable and confirmed the full-year outlook for supplemental payments remains positive despite a Q1 decline. Executive Christopher Hunter added that the company's conservative rate outlook is due to general policy uncertainty, not specific negative trends, and that underlying rate growth remains stable.

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CFO Heather Dixon attributed the conservative 2025 rate guidance to a smaller anticipated tailwind from supplemental payments and a prudent approach amid policy uncertainty, while noting commercial rates are assumed stable. For margins, she explained Q4 compression was due to a professional liability reserve and a facility closure. For 2025, she stated that while start-up costs and other headwinds are factored in, the underlying margin of the core business is considered stable and consistent with historical performance.

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CFO Heather Dixon confirmed the volume decline was a step-down at the start of October that then stabilized, rather than deteriorating further. CEO Christopher Hunter added that the joint venture pipeline remains robust and that there has been no material impact on talent recruitment, citing ongoing investments in technology and employee engagement.

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CEO Javier Rodriguez stated the Brazil acquisition is nearing completion, pending some required divestitures, and that the M&A pipeline remains focused on international opportunities and smaller domestic deals. CFO Joel Ackerman explained the IT product was moved to another segment because its utility expanded beyond IKC to the broader DaVita enterprise, and this does not materially impact IKC's path to profitability. He attributed the G&A per treatment change primarily to lower treatment volume in Q1.

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CFO Joel Ackerman detailed that of the 6.5% midpoint growth in patient care costs, 3.75% is from historical cost inflation for labor and other expenses, which is the comparable figure to prior years. He reiterated the capital allocation strategy of targeting 3-3.5x leverage and returning excess capital via buybacks, noting that while M&A could involve 'hundreds of millions,' it would not significantly alter the repurchase program.

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CFO Joel Ackerman confirmed the Q4 hurricane impact would be felt almost entirely on EBITDA. He stated that new patient admissions are consistent with prior commentary and that storms added about 10 basis points to the mistreatment rate. Regarding mortality, Ackerman noted that while no new negative trends emerged in the quarter, the persistence of elevated rates informs their cautious outlook for 2025.

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CFO David Doherty reiterated the annual M&A target of around $200 million, which is supportable by internal cash flow while deleveraging towards a sub-3x target leverage ratio. He explained that acquisitions enter the same-store calculation after a full year, and since last year's deals were weighted towards higher-acuity orthopedics, they should provide a positive lift to the rate metric when they are included starting in Q3 2025.

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CEO J. Evans stated he could not comment on the timing of the special committee's process. Regarding 2025 guidance, Evans emphasized looking at the full year rather than quarterly metrics. CFO David Doherty added that for the full year, they expect a relatively balanced contribution from case and rate growth, though mathematical effects from prior acquisitions might continue to mute rate growth in the first half of 2025 before balancing out.

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CFO and COO Brian Scott clarified that the travel nurse bill rate stabilization metrics explicitly exclude the more variable rates from labor disruption events. President and CEO Cary Grace noted that while Spanish remains the top language, there has been a modest downturn in its share of the total mix, though overall client demand remains strong. Scott attributed the locum tenens spread pressure to competition and a mix shift toward lower-margin CRNA business, but mentioned that spreads are now stabilizing and momentum is building in higher-margin specialties.

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CEO Caroline Grace noted a return to more normal pre-COVID seasonality in demand. CFO and COO Brian Scott detailed the Q1 outlook, highlighting growth in locums and language services offsetting some headwinds. Grace quantified the international revenue headwind at approximately $100 million over 2024-2025, with the remainder impacting H1 2025. She clarified that large clients reducing spend are rebalancing their permanent-to-contingent staff mix, not changing vendors.

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President and CEO Cary Grace confirmed the competitive landscape is intense across all service models, not just MSPs. For Locums, she cited bill-pay spread pressure as the primary margin factor. She noted 2025 growth drivers include potential labor disruption revenue and seasonal growth in PLS and language services. Executive Randle Reece clarified the normalized Q4 run rate, suggesting a midpoint revenue of $650 million and an adjusted EBITDA margin of about 8.3%.

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Executive Mark Ordan explained that the guidance remains conservative due to broad uncertainty in healthcare and the economy, not specific legislative or demographic concerns. He stated the full-year range was raised simply to reflect the significant outperformance already achieved in the first quarter.

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CFO Kasandra Rossi explained that the 2025 outlook assumes flat volume and flat pricing, as the significant payer mix tailwind from 2024 is expected to level off. CEO Mark Ordan added that while discussions with hospital partners are continuous, the forecast does not bake in any increase in subsidies or contract economics.

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Executive Charles Lynch provided a historical baseline, suggesting a 60% to 66% conversion of EBITDA to operating cash flow is a good forward-looking guardrail. CFO Kasandra Rossi stated that for 2025, the company will have 'optimal flexibility' to deploy excess cash across M&A, share repurchases, or debt paydown. She clarified the $30 million EBITDA improvement is an estimate with potential upside, as it is intended to cover all costs of exiting practices, and the company will continue to seek further efficiencies.

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CEO Jon Rousseau stated that the impact from Quorum's market exit is largely baked in at this point. He expressed positive thoughts on the overall infusion market and confirmed the business is on track to hit its internal budget for the year. Regarding M&A, he reiterated that the potential deal is a unique situation that fits their philosophy but is separate from their typical tuck-in M&A mode, and he looks forward to sharing more details later.

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Executive Jon Rousseau attributed the LDD success to a long-standing focus on operational excellence and high service levels, resulting in top-tier Net Promoter Scores, rather than a material shift in the market. He noted a trend toward narrower networks for niche therapies, where BrightSpring is a chosen partner. For the Infusion business, Rousseau highlighted that a new team and process standardization have led to best-in-class turnaround times, positioning the segment for a return to growth, with a target of over 20% for the year.

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CEO Jon Rousseau confirmed the successful onboarding of a major customer across over 200 facilities, which is expected to contribute approximately $1 million in monthly EBITDA once start-up costs normalize. He noted that discussions with payers for home-based primary care are progressing well. Regarding the Haven acquisition, Rousseau projected it would contribute $1-2 million in EBITDA in the current year, with the potential to become a $15 million opportunity over several years.

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President and COO Brian Evanko characterized the selling season as active, with PBM retention tracking toward the mid-90s. He noted affordability and personalized solutions are key client themes. He attributed the strong 9% customer growth in the Select segment to Cigna's funding-agnostic approach and improved affordability, rather than a direct correlation with economic uncertainty.

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CFO Brian Evanko confirmed the 2025 outlook reflects the Medicare sale, with the majority of proceeds earmarked for share repurchase. He provided a normalized 2024 Cigna Healthcare earnings base of slightly below $4 billion to aid comparison. He also stated that the maturation of large client contracts is already factored into Evernorth's 2025 guidance, which aligns with the long-term growth targets on a normalized basis.

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CFO Brian Evanko stated that Cigna expects cost trends to remain elevated in 2025 and is pricing for rate increases greater than 2024. CEO David Cordani addressed the VillageMD situation, calling the timing of the investment poor due to market disruption. He noted that while Evernorth's accountable care relationships will continue, the company will take a 'paced path' given the current environment and focus on capabilities like CuraScript.

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CEO Thomas Ryan explained that the transition to an insurance model, particularly for SCI Direct, is temporarily slowing sales but will ultimately increase general agency revenue and significantly boost the average revenue per service as contracts mature. CFO Eric Tanzberger stated that capital deployment is opportunistic, with share repurchases being attractive in Q1. He affirmed the M&A pipeline is strong and the company expects to meet its annual acquisition spending target.

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Chairman and CEO Tom Ryan attributed volume volatility to the diminishing ripple effects of COVID and a normalization of mortality trends, leading to a 'flat to slightly down' volume outlook for 2025. He clarified the preneed insurance transition is occurring differently in the SCI Direct and core channels, aiming for more stable, underwritten products. Executive Eric Tanzberger described the M&A pipeline as robust and expressed optimism for exceeding the $75-$125 million guidance, similar to the prior year, contingent on deal timing.

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Chairman and CEO Thomas Ryan explained that the primary driver for the volume outlook is the diminishing pull-forward effect from the pandemic, combined with population growth and a strong preneed backlog. He noted that the recent strong acquisitions will contribute to growth targets, as they are high-quality, tuck-in businesses in major markets offering synergy potential. Regarding management changes, Ryan stated they were part of a long-term succession plan triggered by an executive's approaching retirement, and the company is excited about the elevated responsibilities for the named executives.

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Chief Investment Officer Chad Keetch responded that competition for deals remains consistent, but Ensign often wins due to its operational reputation and closing track record. He expressed confidence in achieving strong economics in new markets by relying on local leaders' expertise. CEO Barry Port addressed the state-level question, stating that states are not proactively planning for federal policy changes due to the uncertainty in Washington. He noted Ensign has good visibility on rates for the current year. CFO Suzanne Snapper added that the company is in continuous discussion with states about rate setting, educating them on local market conditions.

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COO Spencer Burton noted a gradual improvement in the labor market and highlighted the company's relentless focus on attracting and retaining talent through local leadership development. CFO Suzanne Snapper confirmed that the costs associated with the California Workforce Standards program are fully baked into the 2025 guidance. Regarding M&A, Executive Chad Keetch described the deal flow as very strong, with more opportunities than they can pursue, allowing them to be highly selective. He reiterated their disciplined approach, focusing on having local leaders in place and adhering to strict valuation criteria, such as using trailing-12-month performance for rent calculations and maintaining a focus on price per bed.

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CEO Jim Rechtin responded that, excluding the unknown Stars outcome, the company feels good about the underlying progress of the business. He acknowledged the various external puts and takes but stressed that management's focus is on controllable elements like medical costs, G&A, and Stars performance, with more detail to come at the June investor conference.

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CEO James Rechtin clarified that the 2026 litigation is separate from 2027 performance. He reiterated that while operational progress in Q4 2024 was strong, uncertainty around 2027 thresholds remains, consistent with prior commentary. For 2028, he expressed more confidence due to having a full year of runway to implement changes. George Renaudin, President of the Insurance Segment, added that new Q4 initiatives were successful, but the cautious tone reflects prudent planning.

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CEO Jim Rechtin clarified that the investment need is driven by the broad trend of rising Stars thresholds, separate from the specific appeal. On the strategic trade-off, he stated it's too early to provide a definitive answer but the company's intent is to balance long-term earnings potential with near-term progression, without harming the business long-term.

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CFO Mike Marks explained that the revenue growth was driven by a favorable payer mix and higher acuity in outpatient services. He noted that contracting is well-advanced for 2025, 2026, and 2027 at rates consistent with targets. CEO Sam Hazen added that HCA has improved its overall managed care positioning, citing new, broad participation agreements with Kaiser in Denver and an advanced position with a Blue Cross product in Chattanooga.

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CFO Mike Marks stated that HCA is 80% contracted for 2025 and 60% for 2026, with pricing on target. He noted that while there is a lot of activity around denials and underpayments, HCA's enhanced capabilities have prevented it from becoming a material impact for the company in 2024.

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CFO Mike Marks clarified that the preliminary 2025 outlook, which anticipates growth near or slightly above the high end of their long-term range, already accounts for manageable, lingering hurricane effects. CEO Sam Hazen added that volume strength is broad-based, with emergency room and cardiac services being particularly strong performers.

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CEO Sarah London stated that the $1 per share headwind estimate for APTC expiration remains valid, with further analysis pending on the interplay with new Marketplace rules. Regarding work requirements, she noted Centene's past experience, explaining that the impact would vary by state and that the company sees an opportunity to work with state partners on implementation to ensure member access to care.

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CEO Sarah London confirmed that underlying Medicaid trends remain stable with no new developments to report. CFO Andrew Asher clarified that the outperformance in the Medicare segment was largely driven by a very strong performance in the Part D (PDP) business, which provides confidence heading into 2025 amid further IRA changes.

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CEO Sarah London responded that rate needs are state-specific and that work on sufficiency continues. CFO Andrew Asher added that Centene has secured high-single-digit rate increases in smaller states, demonstrating that states are responsive to data. He emphasized that the company continues to work on future rate cycles.

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CFO Douglas Coltharp explained that benefit expense is about 10-11% of total SWB and that while they proactively manage plan design, they expect the growth rate to moderate in the second half of the year as they anniversary the increase. On audits, he noted that TPE activity from Palmetto was low in Q1 but can be 'lumpy,' and the company has factored this potential into its full-year bad debt assumption, while also noting a high success rate on claims that are reviewed.

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CEO Mark Tarr asserted that Florida is not overbedded due to strong demographics and that Encompass Health's first-mover strategy secured a leading position. CFO Douglas Coltharp added that the market had a significant supply deficit before the CON law change. On the regulatory front, Tarr sees no specific near-term threats, while Coltharp noted their advocacy focuses on improving MA pre-authorization and network adequacy rules.

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CEO Joseph Zubretsky stated definitively that the Washington political backdrop is not impacting state-level discussions. He explained that rate negotiations are purely actuarial, focusing on specific cost trends, and the RFP cycle is currently at a low point and proceeding without influence from federal budget debates.

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CFO Mark Keim projected a very evenly distributed 50-50 earnings split between the first and second halves of 2025, a departure from the typical front-loaded year. This is due to front-loaded G&A for new contract implementations offsetting other seasonal factors. On the political landscape, CEO Joe Zubretsky argued that any major federal funding cuts are unlikely to result in significant program changes, as the necessary actions—cutting enrollment, benefits, or provider payments—are politically untenable for both parties at the state level.

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President and CEO Joe Zubretsky expressed confidence, citing significant on-cycle and off-cycle rate increases in the second half of 2024, with Q4 on-cycle rates averaging 9%. He stated the model of using risk corridors as a buffer while rates catch up to trend is working as expected. Zubretsky also affirmed Molina's proven ability to manage medical costs effectively, noting the company's history of operating deep within risk corridors, which provides a financial buffer regardless of gross trend.

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Theodore Wahl (executive) clarified that the court ruling primarily removed a future overhang rather than changing current operator behavior. He attributed strong Q1 margins to solid service execution and strategic investments in SG&A that improve compliance and customer experience. Matthew McKee (executive) added that while food inflation saw a sequential increase, the overall labor market for healthcare is showing strong recovery, with HCSG's wage growth remaining stable and job applications high.

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Executive Theodore Wahl stated that there is no significant seasonal pattern to new business wins. He attributed the Q1 revenue outlook to momentum from new business added throughout Q4, a client retention rate greater than 90%, and a strong pipeline. Executive Matthew McKee detailed that while food inflation is ticking up, wage inflation has moderated. He stressed that HCSG's modified contracts provide the right to pass through inflation for food, supplies, and wages, ensuring the durability of the business model.

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Executive Matthew McKee described the labor market as stabilizing, with the industry workforce on track to recover to pre-pandemic levels by late 2026, though challenges persist in rural markets. He noted food inflation was 40 basis points for the quarter. Executive Theodore Wahl explained that capital allocation is holistic, with share repurchases viewed as opportunistic. He also confirmed the company is always evaluating complementary inorganic growth opportunities and sees potential for more activity in the year ahead.

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Timothy Noel, CEO of UnitedHealthcare Medicare & Retirement, responded. He confirmed the care pressure was focused on the community and group MA books, not D-SNP or C-SNP. He specified the trend was slightly more pronounced in the group business but that underlying drivers were likely affecting the individual book as well. He also stated that Part D and other previously discussed pressures like upcoding were tracking as planned.

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CEO Andrew Witty affirmed that nothing seen in Q4 changed their positive view for 2025, citing a better membership mix. Executive John Rex elaborated that Q4 MLR was impacted by normal seasonality, non-run rate revenue effects like group MA refunds (80-90 bps), and seasonal flu/RSV (50-60 bps). He noted that trends in hospital coding intensity and specialty drug prescribing had stabilized at previously elevated levels and were incorporated into the 2025 outlook.

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Andrew Witty, CEO, explained that the 2025 outlook is a responsible plan that balances significant external pressures, like government funding cuts, with the critical need to continue investing in long-term growth drivers. He emphasized that the company will not pull back on investments in value-based care and technology modernization to meet a short-term target, framing the plan as one that ensures long-term value creation.

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CEO Parth Mehrotra noted the narrow guidance range reflects the business's predictability. The primary variable is the performance of the value-based care book versus accruals. Regarding Washington, he sees no specific threats to Privia's model, citing broad support for the programs they participate in and does not anticipate disruptive changes.

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CEO Parth Mehrotra stated that while it's too early for 2025 guidance, the business is highly predictable, with 90-95% of financial metrics visible by year-end. He highlighted the diversified model across over 100 value-based care programs as the key mitigator of variability. He reiterated the company's long-term target of 20%+ EBITDA growth, supported by a strong balance sheet and record sales year.

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Executive Steve Filton reiterated that the ACA subsidy impact is a high-level estimate, assuming about half of the company's exchange-covered patients would lose coverage. Regarding new hospitals, he stated they are expected to be EBITDA-positive combined in 2025 and, while they will likely depress same-store volume metrics via cannibalization, they should not be a drag on consolidated earnings.

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Steve Filton stated that labor trends have stabilized, with wage inflation lower and premium pay usage diminishing. For capital deployment, he indicated a continued focus on capital expenditures, including restarting bed additions in the behavioral business, and share repurchases. He noted that while M&A opportunities are reviewed, few have been compelling recently.

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Chairman and CEO Dr. Saum Sutaria explained that the USPI volume pattern was anticipated due to difficult 2023 comparisons and that the focus on higher acuity continues. Regarding capital, he emphasized that accelerating investment in USPI is the most value-accretive action. He noted that while debt paydown is a priority, the company's strong cash position provides flexibility to be more proactive on both M&A and share repurchases.

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