Ryan Daniels

Ryan Daniels inquired how HealthStream's strategy of data origination as a competitive advantage influences its capital deployment for internal product development and M&A. He also asked about any market hesitation observed by the sales team regarding longer-term contracts, elevated pricing, or buying pauses due to potential AI solutions.

Answer

Robert A. Frist Jr., CEO and Chairman, confirmed increased capital allocation towards AI development as a core element of the hStream platform, focusing on data management, classification, and rights management. He characterized Q4 as 'exceptionally strong' with significant wins, including the American Red Cross Resuscitation Suite and Competency Suite. Frist noted that CIOs are looking to consolidate point solutions into platforms, and HealthStream focuses on solving core business problems like nursing shortages and efficient onboarding, where AI can facilitate workflows.

Ryan Daniels asked if HealthStream's focus on data origination as a competitive advantage influences its capital deployment strategy, particularly for internal product development or M&A, to generate more proprietary data. He also questioned whether the sales team observes any market hesitation due to AI, such as longer contract negotiations, resistance to elevated pricing, or a pause in buying decisions from CTOs evaluating AI solutions.

Answer

Robert A. Frist Jr., CEO and Chairman of HealthStream, confirmed that capital is increasingly flowing into AI development, data management, classification, and data rights management across the network, with AI being one of the 10 core elements of the hStream Platform. He characterized Q4 as 'exceptionally strong' for sales, with significant wins in unique product sets like the American Red Cross Resuscitation Suite and Competency Suite. He acknowledged that CIOs are seeking to consolidate point solutions and that HealthStream is positioning itself as a core consolidation platform, focusing sales dialogues on solving fundamental business problems like nursing shortages and efficient onboarding, rather than just AI budgets.

Ryan Daniels from William Blair questioned the timeline for the full commercial launch of the new HealthStream Learning Experience (HLX) and whether the increasing interoperability between core application suites is driving more cross-sell opportunities and improving customer satisfaction.

Answer

CEO Robert Frist stated that the HLX product is live, priced, and available for sale, with the sales team now trained. He anticipates initial sales in the first half of 2025, with an acceleration in the second half following successful pilots. Regarding interoperability, Frist noted that while cross-selling is already a strength, the technology-enabled benefits are expected to manifest more significantly in the second half of the year as they work with key customers to adopt the full 'suite of suites'.

Ryan Daniels inquired about the strategic advantage of Waystar's AI improvements, especially with Iodine, for contracting, asking if there are thoughts on risk-based contracts or tying to KPIs for greater revenue enhancement.

Answer

Matthew Hawkins, Waystar's Chief Executive Officer, acknowledged that building an autonomous revenue cycle platform that delivers a 'perfect, undeniable claim' is on Waystar's roadmap. He confirmed a willingness to explore performance-based pricing opportunities internally, aligning with the value delivered to clients.

Ryan Daniels inquired about the strategic implications of AI and Waystar's platform improvements, particularly with Iodine, for achieving a 'perfect claim.' He asked if this could lead to a contracting advantage, including risk-based contracts or sharing savings, to enhance revenue and accelerate adoption.

Answer

Matthew Hawkins, CEO of Waystar, discussed Waystar's vision for an autonomous revenue cycle delivering the 'perfect, undeniable claim' with minimal intervention, learning from proprietary data. He confirmed Waystar's willingness to explore performance-based pricing opportunities, contemplating internally how to price to the value delivered to clients, aligning with the goal of creating real financial results.

Ryan Daniels inquired about the competitive landscape, particularly in light of a competitor acknowledging technological shortcomings, and asked for color on Waystar's recent win rates and sales pipeline.

Answer

CEO Matt Hawkins stated that Waystar's win rates remain strong and consistent with previously disclosed figures. He noted a level of unrest in the competitor's client base, which, combined with Waystar's strong pipeline and bookings, presents an opportunity for the company to be a significant share gainer.

Ryan Daniels asked about the trend of providers insourcing previously outsourced RCM functions, driven by AI, and whether this could be a long-term tailwind for Waystar's software sales.

Answer

CEO Matt Hawkins agreed this is a beneficial trend that Waystar is beginning to see. He explained that generative AI allows for the automation of high-volume, low-complexity tasks, enabling providers to bring functions back in-house that they previously had to outsource. He cited examples like denial prevention and automated appeal letter generation, which reduce staff time and improve outcomes. Hawkins believes this trend will expand Waystar's addressable market by replacing expensive outsourced services with efficient software and AI.

Ryan Daniels inquired if the increasing complexity of RFPs is extending sales cycles and asked about key client pain points identified at the True North conference that could influence future R&D or M&A strategy.

Answer

CEO Matthew Hawkins responded that while RFPs are more complex, particularly regarding cybersecurity, sales cycles are not extending beyond normal timeframes. He identified claim denials and managing higher patient volume with limited staff as key pain points from the conference, which directly inform R&D priorities, like generative AI, and the company's disciplined M&A approach.

Ryan Daniels inquired about the new HCP marketing initiative, specifically if it has started selling for the 2026 season, the reception from pharma clients, and whether the dollars are incremental or a shift from D2C budgets.

Answer

CEO Chaim Indig confirmed that selling has begun for select clients to pilot the offering in the new year, with significant demand. He believes these are incremental dollars, as DTC and HCP budgets are generally very different, and expects programs to turn on in the new fiscal year.

Ryan Daniels inquired about the new HCP marketing initiative, specifically if it has begun selling for the 2026 season, the reception from pharma clients, and whether the revenue generated will be incremental or a shift from existing DTC budgets.

Answer

Chaim Indig (CEO, Phreesia) confirmed that Phreesia has started piloting the HCP offering for select clients and has seen significant demand, with programs expected to launch in the new fiscal year. He believes these are incremental dollars, as DTC and HCP budgets are generally distinct.

Ryan Daniels asked if newer products like 'appointment readiness' need to reach a critical mass before being monetized via Network Solutions. He also inquired about the competitive landscape, particularly regarding AI agents from larger tech firms.

Answer

CEO Chaim Indig stated that scale is a key requirement from the early stages of product development, so products are typically scalable upon public discussion. He added that the entry of larger players has been a net positive, as it raises market awareness and Phreesia's close rates have improved.

Ryan Daniels asked about the sustainability of the recent downward trend in sales and marketing expenses and sought details on the new MEDITECH alliance, including reseller status and integration timelines.

Answer

Executive Balaji Gandhi stated that the company expects to continue gaining leverage from its sales and marketing spend, which has been stable for around 11 quarters. CEO Chaim Indig clarified that MEDITECH is a reseller for a small piece of Phreesia's technology, but the alliance primarily facilitates direct sales of a broader product suite to MEDITECH clients, with integration rolling out over the coming years.

Ryan Daniels asked about the 100% year-over-year growth in the small-medium business (SMB) segment and how Doximity targets agency partners to bring in these smaller clients. He also sought clarification on the 40% of bookings from integrated offerings, asking if they start in the calendar year 2026 and if this increases Doximity's visibility despite market uncertainty.

Answer

VP of Investor Relations Perry Gold confirmed the agency partnership program is going well, with over a dozen partners contributing to SMB growth and bringing in high seven figures in business. He noted the program provides significant value to smaller customers with lesser budgets. CFO Anna Bryson clarified that the 40% of bookings refers to Q2 upsell sales impacting Q2 and Q3 revenue, not calendar 2026. She added that integrated offerings are expected to represent a similar portion of the upfront cycle, which does provide better visibility due to their typical January start, 12-month duration, and ease of add-ons.

Ryan Daniels asked Anna Bryson about Doximity's strategy for targeting agency partners to bring in smaller clients, given the reported 100% year-over-year growth in the small-medium business (SMB) segment. He also sought clarification regarding the integrated offerings, which accounted for 40% of Q2 bookings versus 5% last year, and if their typical January start date for calendar year programs increases Doximity's visibility for the upcoming year.

Answer

Perry Gold, VP of Investor Relations, confirmed the agency partnership program is successful, with over a dozen partners driving SMB growth and bringing in new clients. He noted the program has generated high seven figures in business and provides significant value to smaller customers. Anna Bryson, CFO, clarified that the 40% of bookings referred to Q2 upsell sales impacting Q2 and Q3 revenue, not calendar 2026. However, she confirmed that integrated offerings are expected to lead upfront sales for 2026, providing better visibility due to their 12-month, single-line-item nature.

Ryan Daniels from William Blair & Company asked if Doximity's new AI suite would eventually be monetized as a standalone enterprise product, similar to the strategy used for the Doximity Dialer.

Answer

CEO Jeff Tangney confirmed that the company plans to follow a similar "freemium" to enterprise model as it did with the Dialer. He noted that they have already been approached by clients about Scribe and that the Pathway acquisition demonstrated a proven model of physicians paying for premium clinical tools, signaling a clear long-term opportunity for enterprise subscription revenue.

Ryan Daniels inquired about how earlier launches of large, multi-module programs might alter revenue seasonality and asked about the company's strategy for targeting Nurse Practitioners (NPs) and Physician Assistants (PAs).

Answer

CFO Anna Bryson explained that the integrated programs, which start in January with the first available module, could lead to a more consistent year-over-year revenue curve. CEO Jeff Tangney added that Doximity has over 60% of all NPs as members and that they are highly engaged with workflow tools like AI-powered letter writing and faxing, representing a key growth area.

Ryan Daniels asked if the current stress on payers and the shrinking number of full-risk enablers is creating more opportunities for Privia to negotiate favorable, balanced contracts.

Answer

CEO Parth Mehrotra confirmed this is a good observation, stating their track record and multifaceted value proposition are leading to more 'forward leaning' conversations with payers. He emphasized that Privia's model of sharing risk with both doctors and payers, rather than pursuing unsustainable full-risk models, is proving to be a stable and attractive alternative for payers seeking reliable partners to manage their MLR.

Ryan Daniels asked for color on the Q3 operating margin guidance, which implies a sequential decrease, and inquired about the development of the new partnership with Cigna and its early momentum.

Answer

CFO James Budge explained that the Q3 margin guidance reflects a deliberate decision to reinvest first-half outperformance into sales and marketing for the peak selling season and into the development of Hinge Select. Co-Founder & CEO Daniel Perez added they are hiring more sales heads to capture the large TAM. Regarding Cigna, President Jim Pursley confirmed the partnership has launched successfully, with millions of Cigna lives entering the pipeline and early client wins already materializing for 2025 and 2026 launches.

Ryan Daniels of William Blair & Company, L.L.C. asked for more detail on the planned sales force investments, particularly the expansion in the U.S. and three international markets. He also requested further feedback on the CancerDx launch, including usage patterns and any surprises in its adoption.

Answer

President and CEO Jay Mazelsky explained the international investments aim to increase commercial density, as higher call frequency drives diagnostic usage. The modest U.S. expansion supports the growing product portfolio. Regarding CancerDx, he noted strong enthusiasm, with usage initially weighted toward "aid in diagnosis" as vets test its performance. He was pleased that 15% of submissions are from competitive lab customers.

Ryan Daniels requested more detail on the planned sales force investments in the U.S. and three international markets. He also asked for early feedback on CancerDx, particularly regarding how it's being used—as part of a broader panel or as a standalone diagnostic.

Answer

CEO Jay Mazelsky explained that international investments aim to increase commercial density, as coverage per rep is much higher than in the U.S. The modest U.S. expansion is to support a growing product portfolio. On CancerDx, he reported strong enthusiasm, with initial usage weighted more toward 'aid in diagnosis' as veterinarians validate the test's performance. He noted that a growing number of practices are incorporating it into wellness screens and that 15% of submissions are from competitive lab customers.

Matthew Mardula, on behalf of Ryan Daniels from William Blair, asked about the progress and outlook for cross-selling Dining Services into the existing Environmental Services client base. He also inquired about the company's view on the smaller but growing education segment for the second half of the year.

Answer

Chief Communications Officer Matthew McKee explained that the new business pipeline is evenly split between EVS and dietary, but the preference remains to lead with EVS and then cross-sell dining, a strategy with significant runway as dining penetration is still under 50% of the EVS base. He added that the education segment, while less than 5% of revenue, continues to show positive returns and remains a commitment for future growth, complementing the core business strategy.

Ryan Daniels asked about the impact of market noise, such as tariffs and price negotiations, on customer behavior and whether the company is seeing any hesitation from clients. He also inquired about how the shift to a subscription-based model affects revenue recognition and margins, and sought clarity on the future gross margin profile given some dilution from direct-to-consumer (DTC) managed services.

Answer

CEO Stephen Silvestro stated that the company has not seen any pullback from clients, who are instead 'leaning in' on cost-effective digital channels. CFO Edward Stelmakh explained that subscription revenue is spread over a 12-month period and is accretive to margins due to low costs of sale. Both executives confirmed that the gross margin target remains in the high 50% to mid-60% range, with the current product mix keeping it within that band.

Ryan Daniels inquired about go-to-market changes for the recently acquired Medicx (DTC) business, whether sales focus is shifting to the core DAAP offering, and the nature of the four large client deals expected to exceed $10 million each in 2025. He also asked for clarification on why average revenue per top manufacturer was growing faster than overall revenue.

Answer

CEO William Febbo and executive Stephen Silvestro explained that the go-to-market strategy for the DTC business involves an enhanced sales team focused on the market shift to self-service models. They highlighted that integrating the DAAP platform's real-time data capabilities into DTC audience creation is a key differentiator. Mr. Febbo confirmed the four large clients represent over $40 million in expected 2025 in-year revenue, providing unprecedented visibility. He attributed the strong growth in top client spend to their increasing buy-in to the company's integrated HCP and DTC precision marketing platform.

Ryan Daniels from William Blair asked for more detail on the new oncology navigation solution, including how it integrates with existing products, its potential value multiplier, and how it might be incorporated into Performance Suite contracts.

Answer

Executive Seth Blackley described the navigation solution as a key differentiator in a strong selling environment. He estimated it could increase the total savings opportunity by 10-20% by engaging patients and addressing Part A medical costs, which complements the traditional focus on Part B. He believes this will enhance sales conversions and drive value.

Ryan Daniels asked about the rationale for narrowing the scope of some solutions, the quantifiable impact of new risk protections, and the net financial swing from 2025 tech investments to 2026 savings.

Answer

CFO John Johnson stated the narrowing was driven by a focus on core operations. He quantified the risk reduction by noting a 200 basis point trend uptick that now impacts EBITDA by $9 million would have been a $20-$25 million impact previously. He also confirmed that the $10 million investment in 2025 followed by a $20 million benefit in 2026, creating a $30 million net swing, was 'approximately correct' but not official guidance.

Ryan Daniels of William Blair & Company sought to confirm the mechanics of the $100 million rate increase and asked for context on a reported 50% year-over-year spike in cancer prevalence in some markets.

Answer

John Johnson confirmed the analyst's understanding of the rate increase mechanics was correct. He clarified that the 50% cancer prevalence increase was an extreme example from one market in August compared to the prior year's average, but noted that a broader, significant increase in prevalence is being observed across the business.

Ryan Daniels inquired about the details of the revived EHR project, including its potential timeline, cost, and benefits, and also asked how the new digital intake platform is improving patient collections.

Answer

CEO Dave Bourdon stated it is too early to comment on the EHR project's cost or timeline but noted its goal is to enhance clinician and patient experiences and drive efficiency. He described the digital patient check-in tool as a 'game changer' for automating collections for virtual visits, which has been a primary driver of the improved DSO of 38 days.

Ryan Daniels asked about the partnership pipeline and growth outlook for 2026-2027, and also inquired about a negative $1.2 million charge related to new geography implementation costs.

Answer

CEO Steven Sell projected 30,000 to 45,000 new members for 2026, with a focus on existing geographies, but noted the main focus is on a rich pipeline for the 2027 class. CFO Jeffrey Schwaneke explained the negative charge was a true-up and reversal of an accrual for annual wellness visits.

Ryan Daniels requested details on the new care management fee model, including who pays it, if there is upside potential, and how it transitions to full risk.

Answer

CEO Steven Sell clarified the fee is paid by the payor directly to the 50-50 partnership agilon operates with its physicians. He confirmed there is upside potential through performance incentives, particularly for quality. The model is a 'glide path' where the transition to full risk is discussed toward the end of year one, with the expectation to move to full risk over time.

Ryan Daniels of William Blair & Company asked about leveraging positive Medicare clinical data for marketing, the marketing budget allocation for the Medicare segment, and the rollout status of the new 'Easy button' for converting EAP members to insurance plans.

Answer

CEO Dr. Jon Cohen stated that while Medicare Advantage plans are showing significant interest, they are currently viewed as standard Medicare, with potential for deeper, value-based relationships in the future. He also confirmed the 'Easy button' is being rolled out on a plan-by-plan basis and is having a positive impact. CFO Ian Harris explained that the marketing budget uses a data-driven portfolio approach, with a willingness to invest more in new cohorts like Medicare, and noted that the Military segment has exceeded expectations, warranting increased investment.

Ryan Daniels of William Blair & Company inquired about Alignment's strategy for managing dual-eligible and chronic condition populations, asking if it involves new tech platforms or an expansion of strategic partnerships. He also questioned if 2026 is the target year for significant new market expansion or M&A activity, given the company's recent profitability and operational leverage.

Answer

CEO John Kao clarified that the focus is on leveraging their proven, differentiated care management capabilities for complex populations, which is performing well both in and out of California. He confirmed that the company is actively planning for new market entries in 2026 and initiating processes for 2027 launches, all funded by operating cash. While a services business is a future possibility, the approach remains disciplined and thoughtful.

Ryan Daniels asked about Alignment Healthcare's future innovation initiatives and the primary drivers behind its significant membership growth acceleration.

Answer

CEO John Kao explained that the company is deepening its "ground game" by investing in provider operations and scaling its Care Anywhere clinical model to improve visibility and control. He attributed the strong membership growth to a disciplined bid strategy that leveraged advantages in Star ratings and the V28 risk model, combined with prior investments in the member experience to boost retention.

Ryan Daniels of William Blair & Company questioned if TransMedics' high DCD penetration makes it more susceptible to market fluctuations. He also asked if the long-term gross margin target of mid-to-upper 60s is still achievable given new investments in maintenance and logistics hubs.

Answer

CEO Waleed Hassanein agreed that high penetration can lead to short-term susceptibility, as seen in Q3, but emphasized the company is 'just getting started' and stands by its 10,000 transplants by 2028 goal. CFO Stephen Gordon reaffirmed that a mid-60s long-term gross margin is still the goal, contingent on gaining service efficiencies by maximizing the use of their owned aircraft.

Asked what the organization can do to actively drive usage-based platform connected revenues, including marketing efforts and the use of internal analytics to promote services.

Answer

The company's entire business is focused on driving these revenues. They use a data-informed platform to guide members to the right service at the right time. This includes using analytics to identify members in need and running specific outreach campaigns (e.g., to members who haven't seen a primary care physician) to improve clinical outcomes, lower costs for customers, and drive revenue for Accolade.