Josh Raskin

Josh Raskin inquired about Privia Health's technology investments, including AI advancements for physicians, new capabilities implemented, and efficiencies observed in administrative and revenue cycle operations, as well as athenahealth's impact on the provider base.

Answer

Parth Mehrotra (CEO, Privia Health Group) detailed Privia's data-rich environment and five buckets of AI investments across corporate functions, fee-for-service, value-based, and patient engagement workflows, and care delivery, emphasizing potential for margin enhancement and productivity. He noted that these investments aim to push EBITDA margin towards the high end of the 30-35% long-term range. David Mountcastle (EVP and CFO, Privia Health Group) did not add specific details to this question.

Josh Raskin asked about Privia Health's tech investments, including AI advancements for physicians, new capabilities implemented, and efficiencies observed in administrative and revenue cycle functions, as well as the impact of athenahealth's rollouts on the provider base.

Answer

Parth Mehrotra, CEO of Privia Health Group, detailed the company's data-rich position for AI applications, outlining investments across corporate functions, fee-for-service, value-based, patient engagement, and care delivery workflows. He mentioned implementing Gemini on Google Cloud, working with partners like athenahealth, and investing in Navina for clinical decision support, anticipating significant productivity enhancement and margin improvement towards or exceeding the 30%-35% EBITDA margin target.

Josh Raskin asked for more details on Community Health Systems' technology agenda, specifically regarding the ERP system changes, how the implementation has progressed, and where the company is targeting additional efficiencies and savings in light of divestitures. He followed up by asking about any new efforts or initiatives focused on revenue optimization from a technology perspective.

Answer

CEO Kevin Hammons stated the ERP implementation was successful, completed on time, and fully live across the portfolio by January 1, 2025. It saved approximately $50M in the past year by reducing duplicative systems, improving decision support, and standardizing data, with expectations for further savings as the system matures and new AI functionality is rolled out. He mentioned continued use of AI in appeals processes and autonomous coding, with plans to expand these products, and noted that revenue cycle software vendors are integrating AI technology to help with charge capture and prior authorization.

Josh Raskin asked for more details on Community Health Systems' technology agenda, specifically the ERP system changes, how the implementation progressed, and where additional efficiencies and savings are targeted in light of divestitures. He also inquired about any new efforts or technological advancements focused on revenue optimization.

Answer

Kevin Hammons, CEO, reported that the ERP implementation was completed on time by January 1, 2025, and has already saved approximately $50 million by replacing multiple systems, improving decision support, and leveraging scale. He expects further savings as the system matures and new AI functionality from Oracle is integrated. On the revenue side, he mentioned continued use of AI in appeals and autonomous coding, with plans to expand these applications and leverage AI components from revenue cycle software vendors to enhance charge capture and prior authorization.

Josh Raskin asked about Brookdale's progress in transitioning to an operating company, seeking specific examples of changes in workflows, budgeting, and guidance approach. He also inquired about the expected progress of the Health Plus platform, including 2026 rollout targets, and any data on rent increases or resident retention in communities where Health Plus has been implemented.

Answer

CEO Nick Stengle detailed the operational shift, highlighting the new COO role, the regional operating structure, and the creation of a Senior Vice President of Strategic Operations to consolidate pricing, labor management, and capital expenditure decisions. COO Mary Sue Patchett expressed enthusiasm for these specialized functions supporting regional efforts. Regarding Health Plus, Nick Stengle noted its expansion to 58 additional communities in 2025, emphasizing a strategy of 'winning markets' to drive performance. He reported improved resident retention due to reduced hospital and emergency room visits, which prevents 'leakage.' Mary Sue Patchett added that Health Plus also positively impacts associate turnover rates and aids move-ins by showcasing program benefits.

Josh Raskin inquired about Brookdale Senior Living's progress in transitioning to an operating company, seeking specific examples of changes in workflows, budgeting, and their approach to guidance. He also asked for an update on the HealthPlus platform, including 2026 rollout targets and data on rent increases or resident retention in communities where HealthPlus has been implemented.

Answer

CEO Nick Stengle emphasized the company's focus on being an operating company, highlighting the new COO Mary Sue Patchett and the regional operating model with dedicated teams. He also detailed the new Senior Vice President of Strategic Operations role, which centralizes pricing strategy, labor management, and capital investment decisions. Mary Sue Patchett added that these changes support regional teams in local market success. Stengle further explained that HealthPlus expanded to 58 additional communities in 2025, with future plans to fill gaps in key markets to drive performance. He noted a definite improvement in resident retention due to care coordination and reduced hospitalizations, which helps occupancy growth. Patchett added that HealthPlus also positively impacts associate turnover rates and aids move-ins by showcasing program benefits.

Josh Raskin inquired about the potential for continued step-function improvements in margins, given past performance and the new focus on expense management, specifically asking for the company's view on the broader technology agenda, including AI and revenue cycle management.

Answer

Saum Sutaria, Chairman and Chief Executive Officer, affirmed belief in continued margin expansion opportunities, noting that the urgency for current initiatives is heightened by the exchange marketplace situation. He explained that new technologies like AI and automation, combined with established standard processes, enable the next level of business improvement.

Josh Raskin asked about Tenet Healthcare's broader technology agenda, including AI and revenue cycle management, and whether the company anticipates additional 'step function improvements' in margins similar to those seen in the past.

Answer

CEO Saum Sutaria affirmed that Tenet Healthcare continues to see margin expansion opportunities in the hospital segment, even with current headwinds. He noted that the urgency for these initiatives is heightened by the situation in the Exchange Marketplace. Mr. Sutaria explained that the organization has significantly improved reliability, accountability, and efficiencies, standardizing processes and workflows. With the advent of new technologies like AI and automation, Tenet is now better positioned to deploy these tools to drive the 'next level of improvement' in margins.

Josh Raskin sought clarification on the exchange contribution to revenue versus adjusted admissions and asked about changes in the ASC M&A environment, including competitive landscape, valuations, and physicians' perspectives on opportunities.

Answer

CEO Saum Sutaria clarified that USPI's exposure to exchanges, both in volumes and revenue, is proportionally less than the hospital business. Regarding ASCs, he highlighted USPI's multi-dimensional growth platform (de novo, MSO partnerships, diverse service lines) and its position as a partner of choice in the acquisition market. Physicians seek consistent track records, growth ability, and support for diversification and multi-specialty center development. CFO Sun Park reiterated that exchange business represented 8.4% of admissions and 7% of consolidated revenues in Q3 2025, with admissions slightly higher than revenue.

Josh Raskin sought clarification on the contribution of exchanges to revenue versus admissions and asked about changes in the competitive landscape and valuations in the ASC M&A environment, as well as physicians' perspectives on ASC opportunities.

Answer

Chairman and CEO Saum Sutaria clarified that USPI's exposure to exchanges (volumes or revenue) is proportionally less than in the hospital business. He emphasized USPI's strong position as a partner of choice in the ASC market due to its consistent track record, growth capabilities, and ability to help physicians diversify and grow centers into multi-specialty facilities. Executive Vice President and CFO Sun Park reiterated that HICS represented 8.4% of admissions and 7% of consolidated revenues in Q3 2025.

Josh Raskin asked for specific segment margins implied in the 2026 guidance, Centene's long-term margin targets by segment, and whether the absence of a Premium Deficiency Reserve (PDR) in Medicare Advantage indicates an earlier path to break-even in 2026.

Answer

CEO Sarah London noted it's premature for long-term targets due to policy volatility but sees significant enterprise-wide margin improvement. CFO Drew Asher detailed 2026 assumptions: stable Medicaid HBR, Commercial (Marketplace) pre-tax margin around 4% (vs. -1% in 2025), Medicare PDP target around 2% pre-tax (vs. 3%+ in 2025). For Medicare Advantage, no PDR means it's not losing money on the margin, but it's still operating at a slight loss on a fully allocated basis for 2026.

Josh Raskin requested specific segment margins implied in 2026 guidance, long-term margin targets, and whether the absence of a Medicare Advantage PDR in 2026 indicates an earlier path to break-even.

Answer

CEO Sarah London noted long-term targets are premature due to policy volatility but confirmed margin improvement opportunities. CFO Drew Asher detailed 2026 segment specifics: stable Medicaid HBR, Commercial (Marketplace) around 4% pre-tax (from -1% in 2025), PDP around 2% pre-tax (from 3%+ in 2025), and Medicare Advantage not quite break-even but not losing money on the margin (no PDR), though still a slight loss on a fully allocated basis.

Josh Raskin asked about Centene's confidence in getting ahead of Marketplace trend, the potential impact of competitor exits on 2026 risk pool stability, and if adverse selection could lead to rethinking certain markets or the segment entirely.

Answer

CEO Sarah London explained that Centene's Q4 2025 Marketplace medical expense forecast includes an additional $75 million provision due to an uptick in September utilization. For 2026, revised rates, averaging in the mid-30%, account for adjusted 2025 baseline morbidity, year-over-year trend, EAPTC expiration, and program integrity measures, aiming for meaningful margin recovery. London expressed confidence that Advanced Premium Tax Credits (APTCs) prevent a 'death spiral' and that peers were thoughtful in 2026 pricing.

Josh Raskin asked about Centene's confidence in managing Marketplace trends, the impact of competitor exits on 2026 risk pool stability, and whether adverse selection could lead to rethinking certain markets or the entire segment.

Answer

Sarah London, Chief Executive Officer, explained that Centene saw an uptick in Marketplace utilization in September, leading to a prudent $75 million additional provision for Q4. For 2026, she detailed that revised rates, averaging in the mid-30%, account for 2025 baseline morbidity, forecasted trend, program integrity rules, and the sunset of eAPTCs, reinforcing confidence in margin recovery. She also noted that advanced premium tax credits prevent a 'death spiral' in the market.

Josh Raskin asked about the confidence in confirming the long-term EPS growth target of 12%+ starting in 2027, inquiring if specific opportunities in Medicare, Medicaid, commercial markets, or Carelon are driving this, and if the view includes 2027 MA rates post the preliminary notice.

Answer

Gail Boudreaux, President and CEO, Elevance Health, expressed confidence in the 12%+ adjusted EPS growth for 2027, building off the 2026 baseline of at least $25.50. This confidence stems from actions taken in 2025 to strengthen the foundation (pricing discipline, execution, affordability through Carelon) and ongoing execution in 2026. The path is not predicated on a single assumption but on multiple independent levers and disciplined execution across commercial, Medicare, Carelon, and Medicaid, leveraging the diversified platform.

Josh Raskin asked for more details on the confidence in Elevance Health's long-term EPS growth target of 12%+ starting in 2027, given recent trends, and whether this includes the view of 2027 MA rates post the preliminary notice.

Answer

Gail Boudreaux, President and CEO, expressed confidence in the 12%+ adjusted EPS growth for 2027, building off the 2026 guidance of at least $25.50. She highlighted that 2025 focused on strengthening the foundation (pricing discipline, execution, affordability), and 2026 is about execution. The 2027 outlook is driven by specific portfolio decisions, hardened pricing, and operating decisions designed to protect earnings and leverage the diversified platform, not predicated on a single assumption. She did not explicitly confirm inclusion of 2027 MA rates post-prelim notice but implied it's part of the forward view.

Josh Raskin inquired about HCA's technology agenda, identifying the greatest opportunities, and specifically how AI can contribute to both administrative cost reduction and revenue enhancement.

Answer

CEO Sam Hazen detailed significant investments in HCA's tech agenda, including an EHR transition to standardize data for leveraging big data. He outlined three domains for AI application: administrative (revenue cycle, HR, IT, supply chain for efficiencies and better interactions), operational (throughput, asset productivity, scheduling, staffing, OR management for consistency and effectiveness), and clinical (using proprietary data patterns to provide insights for physicians and tools for nurses to improve care and safety). Hazen expressed strong confidence in AI's potential to merge with human intelligence for value creation across quality, efficiency, and management effectiveness.

Josh Raskin inquired about the Medicare Advantage (MA) cycle, specifically if the industry is at the bottom given the projected mid-teens decline in traditional MA lives for 2026 and the potentially negative 2027 proposed rates. He also asked if MA margins are expected to improve beyond 2026 and the strategic importance of the core MA book to other enterprise segments, particularly Optum Health.

Answer

Stephen Hemsley, Chairman and CEO of UnitedHealth Group, affirmed MA's importance to Optum Health and Optum Rx, highlighting the complementary nature of Optum businesses to UnitedHealthcare. Tim Noel, CEO of UnitedHealthcare Medicare & Retirement, explained that the 2026 strategy prioritized margin recovery, expecting approximately 50 basis points improvement in MA margins, with membership losses within internal planning. He noted the 2027 Advance Notice was disappointing, reflecting $130 billion in funding reductions over three years, which will necessitate a hard look at geographic and product footprints, potentially leading to meaningful benefit reductions across the sector. While too early for 2027 estimates, he emphasized the long-term importance of value-based care models.

Josh Raskin inquired about the future of the Medicare Advantage (MA) cycle, asking if the industry is at the bottom, and whether MA margins are expected to improve in 2026 and 2027. He also asked about the importance of the core MA book to other enterprise segments, particularly Optum Health.

Answer

Stephen Hemsley, Chairman and CEO, highlighted the importance of MA to Optum Health and Optum Rx, emphasizing the complementary nature of Optum businesses to UnitedHealthcare. Tim Noel, CEO of UnitedHealthcare, explained that the 2026 strategy prioritized margin recovery, expecting a 50 basis point improvement in MA margins despite membership losses. He expressed disappointment with the 2027 Advance Notice, anticipating significant benefit reductions and potential changes to plan footprint and benefits, but noted the long-term importance of value-based care.

Josh Raskin asked for an updated and more specific view on Optum Health's sub-businesses, inquiring about the revenue base from capitated premiums (including the split between UnitedHealthcare and other payers), fee-for-service billings from employed physicians, and directional membership details for 2026.

Answer

Stephen Hemsley, Chairman and CEO, directed the question to Patrick Conway, CEO of Optum, and Krista Nelson, COO of Optum Health. Patrick Conway detailed that Optum Health's revenue is 65% value-based care (VBC), 15% care delivery fee-for-service, and 20% payer employer services. He noted that two-thirds of the VBC business serves UnitedHealthcare. Krista Nelson reaffirmed commitment to the 6%-8% long-term margin target, with 5% for VBC, expressing optimism for long-term positioning.

Josh Raskin asked for an updated and more specific view on the sub-businesses within Optum Health, particularly the revenue breakdown from capitated premiums (including the portion from UnitedHealthcare) and fee-for-service billings from employed physicians, along with directional membership details for 2026.

Answer

Stephen Hemsley (Chairman and CEO, UnitedHealth Group) directed the question to Patrick Conway (CEO of Optum) and Krista Nelson (COO of Optum Health). Patrick Conway stated that Optum Health's revenue breakdown is 65% value-based care (VBC), 15% care delivery fee-for-service, and 20% payer employer services. He noted that approximately two-thirds of the VBC business serves UnitedHealthcare. Krista Nelson reiterated the commitment to a long-term margin of 6-8% for Optum Health, with 5% for VBC, expressing optimism for 2026 positioning.

Josh Raskin asked about the motivations for payers to cede margin in their Medicare Advantage books during renegotiation efforts for 2026, and whether the benefit design changes made by plans were consistent with prior recontracting discussions. He also inquired if P3 Health Partners attempts to have plans participate in potential surpluses or if all 2026 contracts are full capitation.

Answer

Aric Coffman (CEO, P3 Health Partners) confirmed that benefit design changes across geographies met expectations. He explained that payers are motivated by P3's investment in their membership, especially for high-risk patients, medical expense reduction, and STARS/quality performance. Coffman clarified that P3 takes the risk from payers, receiving a percentage of premium, and that the partnership involves bilateral accountability for outcomes, with increased meeting cadence and visibility.

Josh Raskin asked about the motivations for payers to cede margin in their Medicare Advantage books during renegotiation efforts, especially given their own goals to increase margins for 2026, and whether the benefit changes for 2026 aligned with P3 Health Partners' recontracting discussions. He also inquired if P3's 2026 contracts are all full capitation and how incentives are aligned for medical management to prevent prior period adjustments.

Answer

CEO Aric Coffman explained that benefit designs varied by geography but met P3's expectations. He noted that payers are motivated by P3's investment in their membership, particularly for high-risk patients, medical expense reduction, and STARS/quality performance. Coffman confirmed that P3's model involves taking full risk (100% capitation), with payers retaining administrative margin and P3 using a percentage of premium to run its business. He emphasized that payer 'skin in the game' relates to their execution outside P3's direct business and hitting plan-related STARS performance. He also mentioned increased cadence of Joint Operating Committee meetings and clearer expectations with payers to improve bilateral accountability and reduce miscommunications.

Josh Raskin from Nathron Research inquired about the specific causes of the prior period adjustments, the data exchange processes with health plans to prevent future issues, and the company's confidence in its partners' Medicare Advantage bids for 2026.

Answer

CEO Eric Hoffman attributed the prior period issues to a payer's claims system migration and a data delay from another, noting that improved joint operating committee processes are now in place. CFO Leif detailed the $9 million Q2 adjustment, breaking it down into a 2024 RAF receivable adjustment, a missed quality measure, and a favorable payment integrity program pickup. Leif also confirmed P3 uses its own data alongside plan data for reserves. Regarding 2026, Eric Hoffman expressed confidence based on directional discussions with plans about benefit design and network structure, despite not having final bid information.

Josh Raskin inquired whether Molina Healthcare's early 2026 outlook, similar to the $14 EPS guidance for 2025, represents a new baseline for future growth and embedded earnings realization, or if it's still considered abnormally depressed, implying above-average growth for margins to return to target levels.

Answer

CEO Joseph Zubretsky and CFO Mark Keim clarified that while they expect rates to eventually balance with medical cost trend, they are not forecasting the exact timing. For 2026, they assume rates will be modestly in excess of trend. They emphasized that their long-term margin outlook for Medicaid (4.5%) remains unchanged, and the company's better performance relative to the industry means it needs a smaller rate catch-up. The 2026 outlook implies reduced margins (2% consolidated, 2.5% Medicaid pre-tax) compared to long-term targets, suggesting significant growth potential as the rate cycle normalizes.

Josh Raskin asked if the early 2026 outlook of $14 EPS is considered a new baseline for future growth or if it's abnormally depressed, implying above-average growth for a couple of years to reach target margins across all segments.

Answer

CEO Joseph Zubretsky stated that while the $14 EPS outlook is a jumping-off point, Molina has not changed its long-term outlook on target margins (e.g., 4.5% for Medicaid). He believes rates will rebalance with trend over time, and Molina, needing only a fraction of the rate increase the market needs, will return to target margins. CFO Mark Keim added that the implied 2% pre-tax margin for the company and 2.5% for Medicaid in 2026 are significantly below longer-term targets (4-5% for company, 4.5% for Medicaid), suggesting reduced margins with significant growth potential as the rate cycle normalizes.