Ryan Halsted

Ryan Halstead focused on the Medical Expense Ratio (MER) and oncology cost trends, asking about the swing factors for the portion of oncology risk Evolent controls, specifically regarding prescribing patterns of higher-cost therapeutics.

Answer

CEO Seth Blackley explained that approximately 80% of Evolent's managed risk in oncology relates to therapeutics, with 20% for other costs like radiation. He detailed that Evolent's value proposition lies in managing the average cost of therapeutics per case, including dosing, selection, and timing, while carving out new drugs or indications. He cited checkpoint inhibitors as an example of managing duration and therapy changes.

Ryan Halstead asked for more color on the headwinds experienced by the Nordion segment in Q4, particularly given lighter prior-year comps, and the specific drivers including the timing impact of Cobalt-60 harvest schedules. He also sought updated views on the potential impact of customer onshoring trends, driven by tariffs and government incentives, on Sotera Health's business.

Answer

Chairman and CEO Michael Petras clarified that Nordion's Q4 performance was driven by anticipated Cobalt-60 harvest schedules, which is a supply timing situation rather than a demand problem. He noted good visibility into these schedules, and the Q4 results were as expected or slightly better. On onshoring, Mr. Petras stated that the majority of Sotera Health's business is service-based and not significantly impacted by tariffs, with the Cobalt product being USMCA certified. He added that while discussions occur, no significant investment commitment for onshoring has been observed, but if it were to happen, Sotera Health is well-positioned in the United States.

Ryan Halstead asked for more color on the headwinds experienced by the Nordion segment in Q4 2025, particularly the impact of Cobalt-60 harvest timing, especially given lighter prior-year comps. He also sought updated views on the potential impact of customer onshoring trends, considering tariffs and government incentives for domestic manufacturing.

Answer

Chairman and CEO Michael Petras explained that Nordion's Q4 performance was driven by anticipated Cobalt-60 harvest schedules, which is a supply timing situation rather than a demand problem. He noted good visibility into these schedules and that the results were as expected or slightly better. Regarding onshoring, Mr. Petras stated that the majority of Sotera Health's business is service-based and not impacted by tariffs, and the Cobalt product is USMCA certified. He added that no significant onshoring movement has been observed, but if it occurs, Sotera Health is well-situated in the US.

Ryan Halsted asked about the competitive landscape for AI solutions, specifically if customers provide feedback on the ROI offered by other platforms or point solutions, and how Waystar's ROI compares.

Answer

Matthew Hawkins, CEO of Waystar, stated that while Waystar doesn't disclose exact ROI figures, they use a robust ROI calculator and a rich discovery process to present a compelling platform value proposition. He noted that clients often experience compounding benefits from using multiple Waystar solutions. He highlighted Waystar's robust win rates, which improved beyond the historical 80%, indicating strong client preference for their platform approach and compelling ROI against competitors.

Ryan Halsted asked about the competitive landscape for AI, specifically if Waystar is hearing customer feedback comparing its ROI to that offered by other platforms or point solutions.

Answer

Matthew Hawkins, Waystar's Chief Executive Officer, stated that Waystar has a robust ROI calculator and engages in a rich discovery process with clients, often highlighting compounding benefits from using multiple platform solutions. He noted strong and improving win rates, suggesting Waystar's ROI is compelling against competitors.

Ryan Halsted asked if Doximity is observing any changes in the cadence of pharma budgetary decisions, specifically whether the traditional seasonality of upfront and upsell seasons remains the norm or if there's a shift towards a more periodic review and decision-making process. He also inquired about the demand for multi-module integrated offerings.

Answer

Jeff Tangney, CEO and Co-Founder, characterized the late-year budget uncertainty as an 'anomaly,' not a new norm, emphasizing that buying at scale before December 31st typically offers the best economics. He referenced a similar Q4 dynamic two years prior where revenue growth normalized in Q1. Regarding multi-module integrated offerings, Jeff stated that DocDynamic accounted for approximately 45% of bookings this quarter, a significant increase from 18% a year ago, indicating continued strong interest despite its higher minimum cost.

Ryan Halsted followed up by asking about the demand for Doximity's multi-module integrated offerings, specifically DocDynamic.

Answer

Jeff Tangney, Co-founder and CEO, stated that DocDynamic accounted for about 45% of bookings this quarter, a significant increase from 18% a year ago. He noted that it remains an interesting product for many customers, despite its high minimum cost.