Jailendra Singh

Jailendra Singh asked for clarification on the fiscal 2027 revenue guidance, which implies an 8-10% core organic growth rate, and sought insights into the visibility for the Network Solutions selling season and the components contributing to this growth.

Answer

Balaji Gandhi (CFO, Phreesia) explained that the outlook involves assumptions about ongoing selling seasons, noting a similar situation to the previous year but with larger numbers. He indicated that Network Solutions is expected to be the fastest-growing segment organically, followed by Payment Processing and then Subscription, with increasing monetization of provider products within Network Solutions.

Jailendra Singh asked about Phreesia's thoughts on returning shareholder value via a share buyback program, considering current valuation levels and ongoing investment opportunities.

Answer

CFO Balaji Gandhi stated that a share buyback would absolutely be a consideration, noting prior approval for such a program. However, with the new debt facility for AccessOne, the current priority for free cash flow is to retire that debt, alongside other investment areas, but market dislocation remains a consideration for future buybacks.

Jailendra Singh asked how the Phreesia Voice AI product will drive opportunities in the Network Solutions business, given the substantial TAM increase and incumbent players.

Answer

CFO Balaji Gandhi explained that new products like Voice AI create more engagement opportunities for Network Solutions revenue, clarifying the TAM increase wasn't solely linked to Voice AI's timing. CEO Chaim Indig expressed excitement about the product's rapid growth and positive provider feedback.

Jailendra Singh inquired about how Phreesia's Voice AI product will drive opportunities in the network solutions business and the confidence in gaining traction amidst incumbent pharma marketing players.

Answer

Balaji Gandhi (CFO) noted that products benefiting providers and patients create engagement opportunities for network solutions. Chaim Indig (CEO & Board Member) expressed excitement, highlighting rapid growth and phenomenal provider feedback, expecting more Voice AI applications.

Jailendra Singh asked about the impact of the macro environment on the provider market, how conversations with provider clients have evolved, and if the company's outlook incorporates any incremental uncertainty.

Answer

CFO Balaji Gandhi stated that the core focus remains on delivering high-value products, which anchors client conversations. He noted that while the market is always competitive, Phreesia's ability to add new clients and grow revenue demonstrates the effectiveness of its value proposition, with no significant change in the market dynamics.

Jailendra Singh questioned the flat sequential growth in total revenue per AHSC, asking about the impact of business days and holidays. He also sought an update on the use of AI, specifically whether it's impacting internal productivity or driving Network Solutions business.

Answer

Executive Balaji Gandhi attributed the Q4 revenue per AHSC performance to tougher year-over-year comps due to calendar shifts and weather events. CEO Chaim Indig shared an anecdote about a new internal AI forecasting tool for the Network Solutions team that is already providing significant value and driving real financial impact.

Jailendra Singh asked about Phreesia's strategy for balancing the significant fiscal 2026 EBITDA margin expansion with the need for reinvestment to drive top-line growth.

Answer

Executive Balaji Gandhi explained that this balance is an ongoing effort rooted in over two years of expense discipline and a company culture of ownership. He noted that while efficiency gains contribute to profitability, a portion is consistently reinvested into areas that fuel future growth.

Jailendra Singh sought clarification on the fiscal 2026 guidance, asking if the message was that revenue per AHSC would be a stronger driver than previously modeled. He also asked about the drivers of the EBITDA guidance raise and the SDR count.

Answer

CEO Chaim Indig and Executive Balaji Gandhi confirmed the takeaway that total revenue per AHSC will be a more significant contributor to growth in fiscal 2026. Gandhi attributed the EBITDA outperformance to broad-based efficiency efforts across the company. He declined to provide a specific SDR count, instead pointing to the overall 500-person sales and marketing organization as the key input metric.

Jailendra Singh followed up on the macro environment, asking for elaboration on the improved visibility into Q4 driving the guidance raise (e.g., renewals, upsell, new logos), and if recent clarity for the pharma industry could lead to an uptick in client buying trends.

Answer

Brian Van Wagener (CFO) attributed the guidance raise to strong Q3 execution and earlier deal closures, noting broad strength across Crossix, SMB commercial, R&D, and services. He expressed satisfaction with the momentum entering Q4 and stated that future buying trends would be factored into next year's guidance.

Jailendra Singh asked for elaboration on the improved visibility into Q4, its drivers (renewals, upsell, new logos), and whether recent pharma industry clarity could lead to an uptick in client buying trends.

Answer

Brian Van Wagener (CFO) attributed improved Q4 visibility and guidance raise to strong Q3 execution, earlier deal closures, and broad strength across commercial (Crossix, SMB), R&D, and services. He noted that the company will factor this momentum into next year's guidance.

Jailendra Singh from Truist Securities requested more specific details on Crossix's performance, asking how trends compared to Q1 and whether its strength was driven by industry trends or market share gains.

Answer

CFO Brian Van Wagener confirmed continued strong performance from Crossix in Q2, with the Audiences business remaining the higher-growth segment. CEO Peter Gassner added that the success is driven by growth on two axes: gaining market share and expanding the product footprint into areas like HCP marketing. He attributed this to delivering solid ROI and customer success.

Jailendra Singh of Truist Securities asked about the conversion pace of top-20 pharma companies to Vault CRM compared to expectations from 18-24 months ago. He also inquired if conversations at the recent Commercial Summit revealed an increased customer focus on ROI compared to last year.

Answer

EVP, Strategy, Paul Shawah stated that progress with top-20 pharma is on track or slightly ahead of expectations, with most decisions expected in 2025 or 2026. CEO Peter Gassner noted the customer feeling at the summit was similar to last year, with a continued focus on execution and perhaps a slightly stronger lean into digital marketing, data, and analytics.

Jailendra Singh asked if the latest top-20 Vault CRM commitment was a new or existing customer and inquired about the typical migration timeline. He also asked about the drivers behind the accelerated headcount growth.

Answer

EVP of Strategy Paul Shawah confirmed the win was with an existing customer, Boehringer Ingelheim, and explained that migration times vary from weeks for small companies to nearly two years for a top-20 firm. CFO Brian Van Wagener stated that the headcount increase was broad-based, with a particular focus on investing in product teams for future growth.

On behalf of Jailendra Singh, Jenny Chou from Truist Securities asked about the continued weakness in professional services and whether previously delayed deals have begun to close.

Answer

Interim CFO Tim Cabral characterized professional services as a strength optimized for customer success, noting its performance can be lumpy and that customers have optionality. He also stated that while macro headwinds persist and can elongate deal cycles, Veeva is successfully executing through the environment and working closely with customers to close deals.

Jailendra Singh sought more color on the comparative pricing environment, asking if it has worsened, if it's widespread or segment-specific, and whether pressure is client-driven or competitor-driven.

Answer

CEO Barry Balfe stated that the pricing environment has not worsened but remains competitive compared to prior years. He noted that pressure often originates from large pharma due to relationship structures, but biotech customers also seek predictability. He attributed heightened competitive activity among competitors to upstream dynamics impacting customers, suggesting a smaller 'bowl' makes 'dogs hungrier.'

Jailendra Singh sought further color on the comparative pricing environment, asking if it has worsened, if it's widespread or segment-specific, and whether pressure is client-driven or competitor-driven.

Answer

CEO Barry Balfe stated that the pricing environment has not worsened but remains competitive compared to prior years. He noted that pressure often originates from large pharma relationships, though biotech clients also seek predictability. Balfe attributed heightened competitive activity to upstream dynamics impacting customers, suggesting that a smaller 'bowl' makes 'dogs hungrier.'

Jailendra Singh from Truist Securities asked for an update on the pricing environment for both large pharma and emerging biopharma clients, noting peer commentary about increased pricing concessions.

Answer

CEO Steve Cutler and COO Barry Balfe acknowledged that the competitive pricing environment has 'intensified a little bit.' Balfe explained that ICON's strategy is to create value by reducing the cost of clinical development through technology and superior execution. This allows them to offer a competitive price point to win volume and secure incumbency, particularly in large pharma partnerships.

Jailendra Singh from Truist Securities asked about any changes in the mix of full-service versus Functional Service Provider (FSP) RFPs from large pharma and whether FSP adoption is increasing among mid-pharma clients.

Answer

CEO Dr. Steve Cutler noted the mix is largely consistent, though the FSP business is growing slightly faster. COO Barry Balfe added that mastery of both models is crucial for strategic partnerships and that while some mid-sized clients are exploring FSP, adoption is not a rapid trend.

Jailendra Singh sought to reconcile ICON's description of a mixed biotech market with differing commentary from peers, asking if this was due to client mix and what specific factors are causing decision-making delays.

Answer

CEO Dr. Steve Cutler explained that the mixed environment stems from volatile biotech funding. While the overall capital raised in 2024 was good, it was concentrated in a select number of companies, leaving many others to be more cautious with their capital allocation, which contributes to delays. He characterized the situation as seeing 'green shoots' but noted it's too early to 'declare victory' on a full recovery.

Jailendra Singh asked for clarification on whether the 2025 low-to-mid-single-digit growth outlook was organic and questioned the drivers behind the sequential decline in the backlog burn rate.

Answer

CEO Dr. Steve Cutler confirmed the preliminary 2025 growth expectation is organic but stressed it was not formal guidance. Regarding the burn rate, he explained that significant vaccine work pushed into 2025 is expected to burn quickly, which should lead to a modest overall improvement in the burn rate, assuming the volatile projects proceed as planned.

Jailendra Singh sought confirmation that the 4.5% cost trend outlook for 2025 now incorporates the Prospect acquisition and asked if guidance accounts for a potential utilization surge from exchange members. He also requested details on levers for synergy upside beyond the stated $12-15M target.

Answer

President & CEO Brandon Sim clarified that a slightly higher blended cost trend is baked into the second-half guidance to account for Prospect. He identified synergy drivers as operational G&A improvements from technology integration and enhanced clinical coordination, which could lead to better payer relationships and potential upside to the initial target.

Jailendra Singh sought confirmation on whether the 4.5% cost trend outlook for 2025 includes the Prospect acquisition and asked about assumptions for a potential utilization rush in the health exchanges. He also requested details on the specific levers that could drive synergies from Prospect beyond the guided $12-15 million.

Answer

President & CEO Brandon Sim clarified that the 4.5% trend was for legacy Astrana, and a slightly higher blended trend including Prospect is already baked into guidance. He identified synergy drivers as G&A improvements from a unified data infrastructure, streamlined clinical processes, and enhanced care coordination, which are well-received by payer partners. He noted the in-house tech platform is a key enabler for these efficiencies.

Jailendra Singh sought confirmation on whether the 4.5% cost trend outlook for 2025 includes the Prospect acquisition and if the company anticipates a utilization rush from exchange members. He also asked for details on the specific levers that could drive upside to the guided $12-15 million in synergies from Prospect.

Answer

President & CEO Brandon Sim clarified that the 4.5% trend was for legacy Astrana and that a slightly higher blended trend including Prospect is already factored into the full-year guidance. He explained that synergy upside will be driven by G&A improvements from integrating Prospect onto Astrana's proprietary technology platform and by streamlining clinical processes to enhance care coordination, which provides greater value to payer partners.

Jailendra Singh from Truist Securities inquired about the 2026 selling season dynamics, asking if smaller clients were driving wins or if large employers were delaying decisions. He also questioned the slower H1 growth in Progyny Rx versus the fertility benefit.

Answer

CEO Peter Anevski clarified that the sales pipeline's timing, not client size, was the key factor, noting it was slower to build but has now caught up. He also attributed the Rx growth difference to timing, with more initial consults in Q1, and expects growth rates to align by year-end. President Michael Sturmer added that the next three months are the busiest for closing deals.

Jailendra Singh of Truist Securities inquired about the 2026 selling season, asking if there were any signs of delays in the RFP process and if the sales goal remained consistent with historical targets. He also asked about the trend for incremental adjusted EBITDA margins.

Answer

President Michael Sturmer confirmed the sales goal remains to add at least one million new lives annually. He noted that while the pipeline's dollar value is comparable to the prior year, the average lives per opportunity are currently lagging. CEO Peter Anevski explicitly stated they are not seeing any slowdowns or pauses in RFP processes. Anevski also explained that the near-term incremental margin is impacted by approximately $15 million in planned investments for platform and product expansion.

Jailendra Singh requested further insight into why consumption trends softened in Q3 and early Q4 before improving, and asked about the drivers behind the outperformance of the pharmacy benefits business in Q4.

Answer

CEO Peter Anevski reiterated that the company lacks specific insight into the personal timing of member journeys but emphasized the long-term cumulative revenue impact from such variability is minimal. He also explained that pharmacy revenue can outpace medical revenue in a given quarter due to timing differences, such as members ordering medications in advance of treatment.

Jailendra Singh from Truist Securities asked if the lower consumption in Q3 was a continuation of the Q2 trend or a worsening issue, and whether Progyny is considering new business models to reduce exposure to utilization volatility.

Answer

CEO Pete Anevski clarified that the Q3 trend was different and more stark: Q2 saw a slower rate of growth in ART cycles per utilizer, while Q3 experienced an actual decline, a pattern never seen before. He confirmed that the company is actively thinking about different models to mitigate utilization variability but has nothing to announce at this time.

Jailendra Singh of Truist Securities sought more detail on the ISP volume reduction at a specific PBM partner and questioned how GoodRx plans to compete in crowded direct-to-consumer (DTC) subscription markets like ED and weight loss.

Answer

CEO Wendy Barnes stated the ISP issue stems from the GoodRx price not always 'winning' in the PBM's system. The strategy to counter this involves adding more commercial lives, integrating brand drugs, and developing a direct-to-employer model. For DTC subscriptions, she highlighted GoodRx's competitive advantage in its large existing user base (2-3x larger than competitors), which allows for a lower customer acquisition cost.

Jailendra Singh of Truist Securities sought more detail on the ISP volume reduction, asking about its cause and the risk of it spreading. He also questioned the competitive strategy for new DTC subscription categories like ED and weight loss.

Answer

CEO Wendy Barnes explained the ISP headwind is a known issue where the GoodRx price isn't always selected within the PBM's system. She outlined a growth strategy based on adding more lives, integrating brand drugs, and a longer-term direct-to-employer push. On DTC competition, she highlighted GoodRx's advantage in having a large existing user base (2-3x competitors), which allows for a lower customer acquisition cost, though the company will still invest in marketing for these new services.

Jailendra Singh asked for more detail on the conviction in the lower half of the revenue guidance range and whether it was driven by the pharma business. He also inquired about the dynamic between declining MACs and rising revenue per MAC.

Answer

CFO Chris McGinnis clarified that the guidance reflects prudence early in the year rather than weakness in the pharma solutions pipeline, which he still expects to be a 20% growth business. He explained that the decline in MACs was in line with their expectations, resulting from strategic pricing adjustments to improve pharmacy partner profitability. This, in turn, drives higher revenue per MAC, and he believes there is still headroom to improve this metric.

Jailendra Singh asked for more detail on the company's conviction in the lower half of its revenue guidance and inquired about the dynamics between the decline in Monthly Active Consumers (MACs) and the increase in revenue per MAC.

Answer

CFO Chris McGinnis clarified that the guidance commentary reflects prudence given the pharma solutions sales cycle builds throughout the year, not a sign of weakness, and reaffirmed confidence in 20% growth for that segment. He explained the MAC decline was in line with expectations and resulted from strategic pricing adjustments to ensure retail pharmacy profitability. This, in turn, drives higher revenue per MAC, and he noted there is still headroom to optimize this metric.

Jailendra Singh of Truist Securities inquired about momentum in the Pharma Manufacturer Solutions business, pharma's willingness to spend amid macro caution, and if Q4 guidance assumes a year-end "budget flush."

Answer

Interim CEO Scott Wagner highlighted strong consumer intent on GoodRx, pointing to the growth in point-of-sale cash programs from around 20 to 72 as a key success metric. CFO Karsten Voermann added that the Q4 guidance does not rely on any potential year-end budget flush from pharma clients.

Jailendra Singh asked about the momentum in the provider pipeline, considering the struggles of peers and macro uncertainties, and whether Privia is becoming more aggressive.

Answer

CEO Parth Mehrotra confirmed strong momentum, noting a record first half for provider signings that builds on a strong 2024. He attributed this to the company's resonating value proposition across all practice business lines and affirmed that Privia continues to be 'very aggressive' due to persistent market tailwinds.

Asked for details about the recent IMS transaction in Arizona, including what made it unique and its expected financial contribution to the company's guidance.

Answer

The executive explained that Arizona is a strategic market and IMS is a large, culturally aligned practice. While specific financial contributions are not disclosed, the acquisition is embedded in the raised guidance, is expected to be EBITDA positive in Q4 2025, and will contribute significantly in 2026, supporting the company's 20% EBITDA growth target.

Jailendra Singh from Truist Securities asked for more color on the timing of cash payments that led to the high EBITDA-to-cash-flow conversion in 2024, and if this was the reason for the lower 80% conversion guidance for 2025.

Answer

CFO David Mountcastle clarified that the high 2024 conversion was due to the timing of certain payments and working capital management. He explained the 2025 guidance of at least 80% conversion is primarily driven by the company beginning to pay cash taxes as its Net Operating Loss (NOL) carryforwards are nearly exhausted.

Jailendra Singh from Truist Securities inquired about the new Indiana partnership, asking about implementation timing, monetary considerations, and how Privia's approach to this new market might differ from past entries given recent industry changes.

Answer

CEO Parth Mehrotra confirmed Privia acquired the tax ID and will own 100% of the medical group, ACO, and MSO in Indiana for an immaterial consideration. He expects implementation in Q1 of the next year. He stated that the company's core strategy remains unchanged despite industry shifts or political changes, and Privia will remain aggressive in business development, leveraging its strong balance sheet to capitalize on disruption.

Jailendra Singh of Truist Securities requested more color on the biotech market environment, such as competition and RFP timelines, beyond the CEO transition impact. He also asked CEO Anshul Thakral for his high-level perspective on the CRO industry's current headwinds and tailwinds.

Answer

CFO Jill McConnell acknowledged the competitive landscape but reiterated that win rates with existing biotech clients are consistent. CEO Anshul Thakral shared his long-term positive outlook on the CRO industry, stating that despite macro headwinds, the fundamentals remain solid because 'good science continues to get funded,' which was a core reason for his decision to join Fortrea.

Jailendra Singh from Truist Securities requested an update on customer churn and demand trends amid macro uncertainty and asked about the R&D expense outlook for the upcoming year.

Answer

CEO Dr. Ido Schoenberg highlighted a strategic win with Florida Blue and noted that the market's focus on cost savings is a tailwind for Amwell's efficient, integrated platform. CFO & COO Mark Hirschhorn reiterated that R&D expense is on track to decrease by over 10% in 2025 and that cost discipline will continue into 2026 to support profitability goals.

Jailendra Singh questioned the impact of macroeconomic uncertainty and potential tariffs on health system IT budgets and sales timelines, and also asked about Amwell's direct exposure to tariffs.

Answer

CEO Ido Schoenberg acknowledged the financial pressures customers face but asserted that Amwell is viewed as part of the solution. He emphasized that the platform's strong ROI in driving efficiency, savings, and revenue growth is accelerating sales conversations, despite broader market headwinds.

Jailendra Singh asked about expectations for Annual Contract Value (ACV) growth in 2025 and sought commentary on the company's longer-term top-line growth prospects, given recent performance.

Answer

CEO Dr. Ido Schoenberg noted that excluding the divested APC business, the company is guiding for significant growth in 2025. He expressed long-term optimism based on a much larger and higher-quality sales pipeline that heavily favors subscription revenue, strong client retention and expansion, and the ability to monetize third-party clinical programs on the Amwell platform.

Jailendra Singh of Truist Securities inquired about potential opportunities for Amwell in the GLP-1 and weight management space, given the high interest from payers and employers.

Answer

CEO Ido Schoenberg responded that while Amwell does not offer GLP-1 solutions directly, its core value is serving as the integration and orchestration platform. Amwell enables clients to easily embed and manage various third-party weight management programs, providing a single point of access and ROI reporting.

Jailendra Singh asked about emerging trends in the 2026 selling season regarding client preferences for bundled offerings and pricing, and requested an update on win rates. His follow-up focused on the drivers of yield improvement and the impact of Hinge Connect.

Answer

President Jim Pursley noted that while it's early in the sales season, demand is strong because MSK is a top cost driver, and clients' actual behavior shows a preference for best-in-class solutions over bundles. Co-Founder & CEO Daniel Perez added that yield improvements are consistent across new and legacy clients, driven by better member targeting. He explained that Hinge Select expands the brand's appeal, while Hinge Connect's data integration helps target ROI-rich members, both contributing to higher yield.

Jailendra Singh asked for provider feedback on the health plans' pledge to reduce prior authorizations and whether this could inadvertently lead to more post-service denials.

Answer

CEO Matt Hawkins clarified that the industry initiative is focused on streamlining processes with modern technology, not eliminating necessary checks. He explained that manual authorizations delay patient care and that Waystar's platform, which already automates 90% of these transactions, is positioned to lead the industry toward more efficient, real-time approvals, which benefits both providers and patients.

Jailendra Singh requested an update on the 30% of former Change Healthcare customers who were pursuing cross-sell opportunities and asked if Waystar is seeing providers re-evaluate vendors as their initial post-disruption contracts come up for renewal.

Answer

CEO Matt Hawkins confirmed that the competitive environment is active and that conversations with the cohort of clients who joined last year are ongoing. He noted that Waystar saw nice adoption of additional software modules from this group in Q1, reflecting strong demand. Without giving specific numbers, he characterized the company's go-to-market efforts as very active in helping both existing clients and new prospects evaluate their options, leveraging ROI calculators and client references.

Jailendra Singh from Truist Securities asked if management believes Teladoc now has all the necessary components in place to return to and accelerate growth, or if further product expansion or restructuring is needed.

Answer

CEO Charles Divita stated that while considerable progress has been made in technology and clinical capabilities, the company will never be "done" in a dynamic market. He emphasized that they will continue to invest organically and consider strategic acquisitions, like Catapult, to accelerate progress. He also noted that the BetterHelp insurance initiative is critical to returning that segment to a growth trajectory.

On behalf of Jailendra Singh, an analyst asked about the current trends in customer acquisition costs (CAC) for the BetterHelp business and whether there were notable differences between domestic and international markets.

Answer

CFO Mala Murthy described BetterHelp's CAC trends as stable and even slightly more favorable due to strong conversion from the new weekly offer. She noted no significant differences between U.S. and international CAC. Murthy also mentioned that the company's wide guidance range for BetterHelp is intended to account for potential volatility in the ad market and uncertain consumer sentiment.

Jailendra Singh of Truist Securities requested more details on the previously mentioned client that plans to transition a portion of its business in Q2, asking about the drivers and Teladoc's confidence in retaining the remaining relationship.

Answer

CEO Chuck Divita confirmed the client was in the health plan channel and attributed the decision to broad macro pressures impacting the payer industry. He declined to comment on specifics but expressed confidence in Teladoc's strong offering and its ongoing business relationships and strategic conversations with other health plans.

Jailendra Singh sought to clarify the 2025 Integrated Care growth outlook of 'flat to up 2.5%'. He asked if this forecast assumes the current negative trend in the selling season continues, and whether offsetting factors like pricing or product mix were considered in the guidance.

Answer

Chief Financial Officer Mala Murthy confirmed that the preliminary 2025 outlook factors in the current booking challenges, which reflect a year-over-year decline at this point in the selling season. She also affirmed that the outlook includes positive contributions from robust visit revenue growth, fueled by strong membership gains. Both the headwinds from bookings and the tailwinds from visit volume are incorporated into the flat to 2.5% growth projection for next year.

Jailendra Singh sought to clarify if the 2025 Integrated Care growth forecast assumes the current weak selling season trend continues or if it builds in an acceleration. He also asked about potential offsets from product mix or pricing headwinds.

Answer

CFO Mala Murthy confirmed the outlook reflects the current year-over-year decline in bookings seen to date, while noting time remains in the selling season. She clarified that the forecast already factors in both the bookings challenges and the offsetting robust growth in visit revenue, which is fueled by strong membership gains.

Jailendra Singh of Truist Securities asked about intra-quarter demand trends in Q2 and whether the scope of work for new or reactivated trials has changed, along with any related margin implications.

Answer

CEO August Troendle responded that the business environment was consistently strong throughout the quarter, with the primary positive driver being a significant reduction in cancellations. He confirmed that some projects have been down-scoped or delayed by clients to manage funding, which negatively impacts profitability as faster-running projects are most profitable for Medpace.

Jailendra Singh of Truist asked about the stability of the projected $1.6 billion in backlog conversion over the next 12 months and how that supports the full-year revenue guidance despite weaker bookings. He also inquired how Medpace is responding to what appears to be a more aggressive competitive landscape for biotech clients.

Answer

CFO Kevin Brady affirmed the company's confidence in its 2025 revenue guidance, explaining that it is supported by programs already in the backlog and assumes a normal level of cancellations. CEO August Troendle commented on the competitive environment by stating that he has not seen any material change in competitive dynamics recently.

Jailendra Singh of Truist Securities inquired about the key catalysts biotech clients are waiting for before proceeding with projects and whether sponsors are pressuring them to deploy capital. He also asked for more detail on the quality of RFPs and the company's business mix across clinical trial phases.

Answer

CEO August Troendle stated that for Medpace's clients, funding remains the primary issue, and he does not see clients with available cash holding back on projects. He clarified that while Q4 RFP dollar volume was fine, his qualitative assessment was that opportunities were less promising. He noted the business is concentrated in Phase II and III, with very little in Phase I or late-phase trials.

Jailendra Singh asked for details on the intra-quarter trend for cancellations in Q3, questioning if conditions worsened after an initial stabilization in July. He also inquired about the competitive landscape, particularly if Medpace is facing increased competition from peers targeting the biotech space.

Answer

CEO August Troendle noted that while July initially looked fine, cancellations occurred throughout the quarter, pushing them outside the normal range. However, he emphasized the low 1.0x book-to-bill was primarily driven by the depleted pipeline from prior quarters' cancellations, not just Q3's activity. President Jesse Geiger responded that while the environment is competitive, they have not seen any irrational behavior or aggressive pricing from competitors, and win rates remain good.

Jailendra Singh of Truist Securities asked for a deeper look into the TAS segment, specifically the consulting business, inquiring when it might return to its historical high-single-digit growth and what leading indicators are being watched.

Answer

CEO & Chairman Ari Bousbib stated that based on pipeline reviews and coverage, the company is confident the consulting business will return to high-single-digit growth in the future. He noted the project mix is changing, partly due to the transition to AI-driven offerings. He projected this recovery would likely occur towards the end of the current year or into the next year.

Jailendra Singh asked about any changes in the mix between full-service and FSP models in RFPs and bookings, and also requested an update on the status of two previously delayed mega trials.

Answer

Chairman and CEO Ari Bousbib noted a potential reversal in the trend towards FSP. While FSP grew to nearly 20% of bookings in 2024, it was less than 10% in Q1, with pipeline indicators also showing a decline. Regarding the mega trials, he confirmed one is expected to start in H2 2025 as planned, but the second has been pushed out of the year due to client-specific reasons. An executive added this was factored into guidance, which could now see R&DS revenue trend toward the lower end of the range.

Jailendra Singh asked if Doximity is monetizing its AI-powered offerings, the adoption rate among clients, and for an updated view on the 10:1 ROI metric. He also inquired about proactive steps being taken to position Doximity as a strategic partner for optimizing spend.

Answer

CEO Jeff Tangney and CFO Anna Bryson confirmed that AI optimization is a monetized upsell purchased by a minority of clients, but those brands are growing more than twice as fast as others. Jeff Tangney added that the client portal is the key proactive step, enabling more frequent ROI studies and providing daily performance insights, which increases trust, transparency, and strategic partnership with clients.

Jailendra Singh asked if returning to high-teens growth requires market acceleration or if Doximity's pipeline is sufficient, and requested more data on the impact of the client portal.

Answer

CFO Anna Bryson stated that while they have the tools to outgrow the market, they expect to return to a more normal 2x market growth rate, rather than the 3x seen this year. CEO Jeff Tangney clarified the portal is not purely 'self-serve,' as Doximity vets all programs to protect the user experience, and noted that rolling it out to all clients is a gradual training process.

Jailendra Singh inquired about the role of large customers in driving growth, the impact of client M&A on revenue, and the current pricing environment.

Answer

CFO Anna Bryson confirmed that large customers lead growth, citing a 124% net revenue retention rate for the top 20 clients. CSO Dr. Nate Gross explained that client M&A can be beneficial, acting as a 'cultural trojan horse' to introduce digital-first strategies into larger pharma companies. Regarding pricing, Ms. Bryson noted that while prices increase steadily, it is not the company's primary growth lever.

Jailendra Singh questioned how the favorable 2026 Medicare Advantage final rate notice would flow through to agilon's financials and when the company would have clarity on its 2026 rates.

Answer

CEO Steven Sell explained that since 40% of membership was repriced for 2025 on a percentage-of-premium basis, the rate increase will directly benefit them. For 2026, 50% of membership is up for renewal, with negotiations focused on reducing Part D exposure, expanding quality incentives, and improving Part C terms. He noted progress would be shared on subsequent calls.

Jailendra Singh requested more visibility into the $50 million of 2025 initiatives and asked for agilon's perspective on the 2026 MA advance notice.

Answer

CEO Steven Sell explained that about half of the $50M initiative is tied to quality performance incentives (achieving 4+ stars) in renewed payor contracts, with the rest from clinical programs like palliative care. Regarding the 2026 advance notice, he called it an encouraging signal but emphasized the need for final rates to fully catch up with recent utilization trends.

Jailendra Singh inquired about the 12% oncology trend assumption for 2025, recent trends, and the rationale for not renegotiating the entire Performance Suite portfolio.

Answer

CFO John Johnson clarified that the 12% trend is an annual forecast and that early 2025 leading indicators are consistent with this outlook. CEO Seth Blackley explained that the renegotiations focused on contracts with the most urgent need, and for others, the risk/reward of reopening them did not make sense at the time due to their existing structure or performance.

Jailendra Singh of Truist Securities, Inc. sought clarification on the $100 million rate adjustment, questioning its retroactivity and asking about efforts to make future contract adjustments more automatic.

Answer

John Johnson clarified that the $100 million rate increase is entirely prospective for 2025. He detailed that $45 million is from automatic, mechanical contractual adjustments, while the remaining $55 million is subject to negotiation. Johnson also confirmed that Evolent is increasing the use of mechanical contract protections, which now cover about 50% of Performance Suite revenue.

Jailendra Singh requested more specific details on the GLP-1 revenue contribution to better understand the strong sequential growth in average order value. He also asked about the renewal behavior and subscription duration of GLP-1 users who remain after the first month.

Answer

CFO Yemi Okupe acknowledged accelerating GLP-1 adoption but emphasized strong growth in the core business. He suggested analysts could estimate the contribution by using public subscriber counts and average revenue figures. He noted that the platform becomes very sticky for users who continue past the 12-week mark and reiterated that the typical duration for weight loss subscribers is around five months, reflecting high consumer confidence and satisfaction.

Sought clarification on whether the core 2024 EBITDA outlook remains unchanged and if the growth trajectory for 2025 is unaffected. Also asked if the Change Healthcare disruption or the strategic review process has impacted RFP flow or client contract rollouts.

Answer

Executives clarified that some KPI impact from the Change outage, particularly related to denials, is expected to carry over into the first half of 2025. However, the core business remains fundamentally sound. There was no long-term impact on the sales pipeline, only a brief 3-4 week delay, and the outage has actually increased demand for AR and denials solutions.

Inquired about customer health, specifically the two customers behind the Q4 credit loss allowance and their 2024 outlook. Also asked for the executive's general views on creating shareholder value as a public company versus other options, referencing a recent filing.

Answer

Executives stated that overall customer metrics stabilized in 2023 but work remains. The Q4 allowance relates to one small and one midsize customer who are restructuring; their impact is factored into 2024 guidance. Regarding the potential of going private, the CEO expressed confidence in the business in any context and stated the board is evaluating the proposal in the best interest of shareholders.

Asked about the relationship between performance guarantees (PGs) and platform-connected revenues, how PG trends compared to expectations in Q4, and if PG design is changing to focus more on partner engagement.

Answer

Executives stated that driving downstream utilization of partners has always been a core value proposition and part of PGs, so it's not a material change. This utilization helps achieve cost savings goals, increasing confidence in hitting PG targets. Q4 PG performance was consistent with prior years, and this contract structure remains critical as customers are highly sensitive to the current elevated cost environment.

Asked about the strong bookings, questioning if they were delayed deals, if the sales cycle was impacted by GLP-1s, and if there's a strong pipeline from previously deferred accounts.

Answer

Management clarified that the strong selling season reflects consistent sales cycles and strong demand, not delayed deals. They are seeing the pipeline for the next calendar year develop early, which gives them confidence in continued demand for their differentiated advocacy solutions, especially in a cost-conscious environment.