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    Ryan Langston

    Director and Senior Analyst for Healthcare Research at TD Cowen

    Ryan Langston is a Director and Senior Analyst for Healthcare Research at TD Cowen, specializing in coverage of major healthcare companies including Centene, UnitedHealth Group, agilon health, Acadia Healthcare, Universal Health Services, Elevance Health, Astrana Health, and Addus HomeCare. Known for a rigorous analytical approach, Langston has issued ratings with varied results, holding a career success rate of 16.67% and an average return of -16.44%, but boasting notable individual calls such as a +98.9% return on ALHC. Langston transitioned into equity research after supply chain and business strategy leadership roles at Aurubis Buffalo, Inc., and previously served as Vice President at Cowen Inc., joining TD Securities in late 2024. He holds active professional credentials, including FINRA registration (CRD# 5603483) and requisite securities licenses.

    Ryan Langston's questions to Astrana Health (ASTH) leadership

    Ryan Langston's questions to Astrana Health (ASTH) leadership • Q2 2025

    Question

    Ryan Langston asked for a geographic breakdown of the 4.5% medical cost trend, specifically comparing California to other markets. He also sought clarification on whether the 1.02 Medicare Advantage RAF score included Prospect and its expected future trend.

    Answer

    President & CEO Brandon Sim stated the company is not breaking out trend by geography but noted that ex-California markets are tracking toward profitability goals. He clarified the 1.02 RAF score was for the legacy Astrana business but that Prospect's scores are in line, and the company is not baking in future RAF increases.

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    Ryan Langston's questions to Astrana Health (ASTH) leadership • Q2 2025

    Question

    Ryan Langston asked for a geographic breakdown of the 4.5% blended utilization trend, specifically comparing California to non-California markets. He also questioned whether the reported 1.02 RAF score included the Prospect acquisition and how that score might trend into 2026.

    Answer

    President & CEO Brandon Sim stated that the company is not breaking out utilization trends by geography, as the vast majority of revenue comes from California, but noted that its Nevada and Texas markets are tracking toward profitability. He clarified that the 1.02 RAF score was for the legacy Astrana business in Q2 and did not include Prospect, whose RAF scores are in line. The company is not projecting RAF increases going forward.

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    Ryan Langston's questions to Astrana Health (ASTH) leadership • Q2 2025

    Question

    Ryan Langston asked for a geographic breakdown of the 4.5% blended utilization trend, specifically between California and non-California markets. He also questioned if the reported 1.02 RAF score included the Prospect acquisition and how that score is expected to trend into 2026.

    Answer

    President & CEO Brandon Sim stated that the company is not providing a geographic breakdown of medical cost trends at this time but noted that non-California markets are tracking toward their profitability goals. He clarified that the 1.02 RAF score was for the legacy Astrana business but that Prospect's scores are in line. Sim added that the company does not bake in future RAF increases and feels its model is insulated from risk model changes.

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    Ryan Langston's questions to Enhabit (EHAB) leadership

    Ryan Langston's questions to Enhabit (EHAB) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen asked if the hospice average daily census (ADC) grew each month during the second quarter and inquired about the company's long-term leverage targets and the potential timeline for pivoting to M&A.

    Answer

    CEO Barb Jacobsmeyer confirmed that hospice ADC did experience monthly sequential growth throughout the second quarter. CFO Ryan Solomon stated that deleveraging the balance sheet remains a key priority and that the company has not set a specific leverage target that would trigger a pivot to M&A, indicating the focus on debt reduction will continue.

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    Ryan Langston's questions to Enhabit (EHAB) leadership • Q1 2025

    Question

    Ryan Langston of TD Cowen questioned the remaining leverage in centralized hospice operations, the potential need for future step-investments to support growth, and the sustainability of the impressive ADC growth trend.

    Answer

    CFO Ryan Solomon indicated that while significant leverage has been achieved, future needs will likely require only minor incremental investments without materially altering the current margin profile. CEO Barbara Jacobsmeyer affirmed that capacity is managed locally and the growth trajectory is expected to continue. Solomon further noted that hospice RN capacity growth of 16% YoY has outpaced ADC growth of 12.3%, demonstrating their ability to stay ahead of volume demands.

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    Ryan Langston's questions to Enhabit (EHAB) leadership • Q4 2024

    Question

    Ryan Langston asked for clarification on how the 49 new payor innovation opportunities and 31 renegotiations factor into the 2025 guidance, and whether they represent potential upside. He also requested a breakdown of the strong hospice revenue per day, seeking to separate the impact of rate increases from hospice cap accrual benefits.

    Answer

    CFO Ryan Solomon clarified that the 2025 guidance already includes an anticipated $19 million to $21 million revenue improvement from pricing, which covers the CMS final rule and the new national agreement. He stated that the guidance does not assume any material incremental revenue from new payor innovation contracts, suggesting they could offer upside. Solomon also quantified the hospice cap accrual benefit at approximately $1.4 million, noting that when normalized, the remaining rate increase is consistent with Medicare's update.

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    Ryan Langston's questions to Enhabit (EHAB) leadership • Q3 2024

    Question

    Ryan Langston questioned the specific tactics driving the positive momentum in hospice business development and asked about Enhabit's capacity to retake UnitedHealthcare volume if a favorable agreement is reached.

    Answer

    CEO Barbara Jacobsmeyer attributed the hospice success to a combination of expanding the business development team, using data to target referral sources, diversifying referral types, and improving response times with centralized admission departments. Regarding UnitedHealthcare, she explained that resuming volume would be a 'slower turn,' with the immediate benefit of a new agreement being the ability to stop turning away referrals and return to a normal cadence of accepting patients.

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    Ryan Langston's questions to VIEMED HEALTHCARE (VMD) leadership

    Ryan Langston's questions to VIEMED HEALTHCARE (VMD) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen inquired about the financial and clinical benefits of the Philips ventilator exchange program and sought management's perspective on the new CMS leadership's potential stance on the Durable Medical Equipment (DME) industry.

    Answer

    COO & Director Todd Zehnder detailed the financial benefits of the vent exchange, noting cash back was generally higher than net book value, and the clinical advantages of receiving new, technologically advanced assets with lower maintenance needs. CEO & Director Casey Hoyt addressed the regulatory question, stating that while the new CMS head's specific views are unknown, the administration's focus on cost-cutting is driving competitive bidding pressure, and the industry is actively educating regulators for a more effective program.

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    Ryan Langston's questions to VIEMED HEALTHCARE (VMD) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen inquired about the financial and clinical benefits of the recent ventilator program upgrade with Philips and sought insights into the current administration's perspective on the Durable Medical Equipment (DME) sector, particularly regarding competitive bidding.

    Answer

    Todd Zehnder, COO & Director, detailed the financial benefits, noting cash back for exchanged vents was higher than book value, and the clinical value of receiving new, technologically advanced assets with lower maintenance needs. Casey Hoyt, CEO & Director, added that pressure for competitive bidding comes from the highest levels of the administration and that the industry is focused on providing feedback to ensure any new program is structured effectively.

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    Ryan Langston's questions to VIEMED HEALTHCARE (VMD) leadership • Q2 2025

    Question

    Ryan Langston from TD Cowen inquired about the financial and clinical benefits of Viemed's ventilator exchange program and asked for management's perspective on the new CMS leadership's potential stance on the DME industry.

    Answer

    COO & Director Todd Zehnder detailed the financial gains from the ventilator exchange, noting cash back was generally higher than net book value, and highlighted the clinical advantage of acquiring a newer, technologically superior fleet with lower maintenance needs. CEO & Director Casey Hoyt addressed the CMS question, stating that while the new leadership's specific views are unknown, the administration's cost-cutting focus is driving competitive bidding pressure, and the industry is actively educating regulators.

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    Ryan Langston's questions to VIEMED HEALTHCARE (VMD) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen inquired about the financial and clinical benefits of the ventilator exchange program and sought views on the new CMS leadership's perspective on DME and competitive bidding.

    Answer

    COO & Director Todd Zehnder detailed the financial benefits, noting cash back from Philips for old vents was often above book value, and the clinical value of receiving new, technologically advanced equipment with lower maintenance needs. CEO & Director Casey Hoyt addressed the regulatory question, stating that while the new CMS head's specific views are unknown, the administration's cost-cutting focus is driving competitive bidding discussions. He emphasized the industry's effort to educate regulators for a well-structured program.

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    Ryan Langston's questions to VIEMED HEALTHCARE (VMD) leadership • Q1 2025

    Question

    Ryan Langston asked for more details on the Lehan's acquisition, including its product mix beyond breast pumps and the key attractions of the asset. He also inquired about any new insights into the potential impact of the current administration and regulatory environment on the business.

    Answer

    CEO Casey Hoyt explained that Lehan's is a full-line DME with six locations, offering products like rehab equipment and wound care, which helps expand payer contract access. COO Todd Zehnder commented on the regulatory environment, stating it's still early but the administration has been receptive regarding the NCD. He noted no major impacts are expected in 2025 but sees potential long-term positives, while continuing to monitor discussions around Medicaid.

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    Ryan Langston's questions to Privia Health Group (PRVA) leadership

    Ryan Langston's questions to Privia Health Group (PRVA) leadership • Q2 2025

    Question

    Ryan Langston asked for an update on the IMS integration progress, its expected accretion this year, and whether to expect typical second-half seasonality.

    Answer

    CEO Parth Mehrotra reported that the IMS integration is proceeding well, with the group expected to be implemented on Privia's platform in Q3, leading to Care Margin and EBITDA contributions from Q4 onwards. He stated there is no reason to expect different seasonality this year. CFO David Mountcastle added that they still expect positive EBITDA from IMS in Q4.

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    Ryan Langston's questions to Privia Health Group (PRVA) leadership • Q4 2024

    Question

    Ryan Langston of TD Cowen noted a discrepancy in the 2025 guidance, where provider growth is expected to outpace attributed lives growth (10% vs 7.5%), a reversal from 2024, and asked for the reason.

    Answer

    CEO Parth Mehrotra pointed out that the guidance for lives has a wide range, with the high end representing 11.5% growth, closer to provider growth. He attributed the potential difference at the midpoint to the law of large numbers and the influence of provider mix, as the company builds multi-specialty groups and attribution is predominantly driven by primary care physicians.

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    Ryan Langston's questions to Privia Health Group (PRVA) leadership • Q3 2024

    Question

    Ryan Langston of TD Cowen asked about Medicare Advantage risk contracting for 2025, inquiring if Privia is seeing more willingness from payers to share risk or create more successful capitated contracts.

    Answer

    CEO Parth Mehrotra reiterated his differentiated view, stating that the significant MA headwinds will persist through 2025-2026. Consequently, Privia will not massively increase its full-risk capitated book. Instead, the strategy is to grow MA attributed lives through flexible shared-risk arrangements, which he believes is a more sustainable approach than the 'false view' that 100% capitation is necessary for value-based care in MA.

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    Ryan Langston's questions to Acadia Healthcare Company (ACHC) leadership

    Ryan Langston's questions to Acadia Healthcare Company (ACHC) leadership • Q2 2025

    Question

    Ryan Langston asked for an update on conversations with referral sources for underperforming facilities and for more detail on the 'local market pressure' affecting one specific facility.

    Answer

    CEO Christopher Hunter detailed the strategy for engaging referral sources, which includes facility tours and sharing data on quality investments, patient safety, and strong clinical outcomes. He clarified that the 'local market pressure' at the one specific facility was related to problematic local media coverage that has persisted for years.

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    Ryan Langston's questions to DAVITA (DVA) leadership

    Ryan Langston's questions to DAVITA (DVA) leadership • Q2 2025

    Question

    Ryan Langston asked for more specifics on the drivers behind the strong patient care cost performance and its sustainability into the next year. He also inquired about any long-term impact on spending from the recent cyber incident.

    Answer

    CEO Javier J. Rodriguez attributed the cost outperformance primarily to improved labor productivity, stemming from better teammate retention and more effective training. Regarding the cyber attack, he characterized any incremental long-term spending on security as a 'marginal cost,' stating that while prudent investments have been made, they are not material as the company must constantly innovate against evolving threats.

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    Ryan Langston's questions to DAVITA (DVA) leadership • Q1 2025

    Question

    Ryan Langston from TD Cowen asked how DaVita is maintaining its full-year guidance despite lower treatment volume forecasts, questioning if outperformance in phosphate binders was the primary offset. He also requested clarification on a decrease in professional fees and a gain mentioned within G&A.

    Answer

    CFO Joel Ackerman explained that the guidance is maintained because two headwinds (lower volume and cyber costs) are offset by two tailwinds (strong Q1 performance and increased profitability from phosphate binders). He clarified that the professional fee decrease and the gain within G&A were minimal, single-digit million-dollar items and not significant drivers.

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    Ryan Langston's questions to DAVITA (DVA) leadership • Q4 2024

    Question

    Ryan Langston of TD Cowen inquired about expected 2025 seasonality for both consolidated results and the IKC business. He also asked about the IKC patient count outlook and the timeline for that segment to reach breakeven.

    Answer

    CFO Joel Ackerman outlined typical seasonality, with Q1 being the low point for operating income (around 20% of full-year) due to RPT resets, and IKC results being back-half loaded. CEO Javier Rodriguez reaffirmed the company's expectation for the IKC business to reach breakeven in 2026, noting 2025 OI will be flattish to 2024 due to a timing pull-forward of revenue.

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    Ryan Langston's questions to DAVITA (DVA) leadership • Q3 2024

    Question

    Ryan Langston asked about the drivers behind increased Q3 advocacy costs and whether the elevated mistreatment rates from weather were expected to normalize.

    Answer

    CEO Javier Rodriguez attributed the rise in advocacy costs to initiatives in California, efforts in Washington D.C., and activities related to the inclusion of oral-only drugs in the Medicare bundle. CFO Joel Ackerman explained that mistreatment rates remain elevated versus pre-COVID levels and would be expected to increase seasonally in Q4, even without further storm activity.

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    Ryan Langston's questions to Addus HomeCare (ADUS) leadership

    Ryan Langston's questions to Addus HomeCare (ADUS) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen followed up on labor commentary, asking for the specific reasons why clinical hiring is considered more challenging than personal care hiring.

    Answer

    President & COO Bradley Bickham clarified that the primary driver of the challenge in clinical hiring is a systemic shortage of nurses, which creates a more competitive labor market. He characterized it as a long-term dynamic but stressed that it is not currently constraining the company's ability to accept patients or impacting volumes.

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    Ryan Langston's questions to Addus HomeCare (ADUS) leadership • Q1 2025

    Question

    Ryan Langston of TD Cowen requested details on employee turnover rates by service line and at Gentiva pre-acquisition. He also asked for an update on the integration and performance of the Tennessee Quality Care and Journey Care acquisitions.

    Answer

    W. Bickham, President and COO, stated that Personal Care turnover is currently between 50-55%, a significant improvement from the COVID era. He reported that Journey Care has performed better than expectations, and Tennessee Quality Care has seen strong traction from implementing the home health-to-hospice bridge program, with admission conversions improving significantly.

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    Ryan Langston's questions to Addus HomeCare (ADUS) leadership • Q4 2024

    Question

    Ryan Langston from TD Cowen asked for quantification of Q1 weather impacts, any effect from the flu season, and details on the Personal Care segment's caregiver turnover rate, including how Gentiva compares.

    Answer

    President and COO W. Bickham acknowledged a negative impact from January storms but did not quantify it, stating he felt good about the quarter overall. He noted no major impact from the flu season. He reported the legacy Addus turnover rate is around 50-55% and expects Gentiva's to be consistent, potentially lower due to its high concentration of preferred (family) caregivers.

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    Ryan Langston's questions to Addus HomeCare (ADUS) leadership • Q3 2024

    Question

    Ryan Langston of TD Cowen questioned if the strong personal care rate environment, like the 5.5% increase in Illinois, is a structural shift or if rates will revert to lower single-digit growth post-2025. He also asked about any unusual seasonality in the Gentiva business and the ability to deploy Addus technology before the full EMR integration.

    Answer

    CFO Brian Poff noted that while some rate increases are now aimed at improving access, the company's high-level expectation is for the overall rate environment to moderate back toward a historical norm, supporting a 3-5% total growth rate. He also confirmed there is no unusual seasonality in the Gentiva business and that Addus plans to quickly deploy its payroll system and caregiver support apps well ahead of the full EMR conversion.

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    Ryan Langston's questions to agilon health (AGL) leadership

    Ryan Langston's questions to agilon health (AGL) leadership • Q2 2025

    Question

    Ryan Langston from TD Cowen asked about the key qualifications agilon is looking for in its CEO search and whether the company is considering any partnership exits.

    Answer

    Executive Chairman Ron Williams detailed that the ideal CEO will have experience in multi-market management, strong relationships with primary care physicians, and a focus on operational rigor. CFO Jeff Schwaneke added that while there are no immediate plans for market exits, the company continuously evaluates the profitability of all its partnerships.

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    Ryan Langston's questions to agilon health (AGL) leadership • Q1 2025

    Question

    Ryan Langston asked if failure to carve out remaining Part D risk could lead to material membership reductions in 2026 and requested a reminder of the company's group Medicare Advantage membership proportion.

    Answer

    CEO Steven Sell stated that Part D risk could be managed through other means like risk corridors or higher premium percentages, so it would not necessarily cause membership reductions. He confirmed group MA penetration is about 18%, in line with the national average, and that trends within this population are consistent with the individual MA book.

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    Ryan Langston's questions to agilon health (AGL) leadership • Q4 2024

    Question

    Ryan Langston asked about the financial impact of an exiting ACO client and the reason for a 100 basis point lower cost trend assumption for a specific cohort.

    Answer

    CFO Jeffrey Schwaneke stated the exiting MSSP partnership was unprofitable but did not quantify the loss. CEO Steven Sell clarified the 100 bps cost trend reduction from 6.3% to 5.3% is not cohort-specific but reflects the net impact of 2025 payor bid changes, which are expected to lower both revenue and medical expenses.

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    Ryan Langston's questions to agilon health (AGL) leadership • Q3 2024

    Question

    Ryan Langston asked for the rationale behind exiting only two unprofitable partnerships when data suggests three others remain unprofitable, and if further actions on those partnerships would be considered.

    Answer

    CEO Steven Sell explained that the decision was based on the 'magnitude of loss' and the 'time frame' to achieve profitability. The two partnerships being exited faced a much longer and more challenging path back to profitability. In contrast, the other three unprofitable partnerships are much closer to breakeven, with several expected to become profitable in 2025.

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    Ryan Langston's questions to Alignment Healthcare (ALHC) leadership

    Ryan Langston's questions to Alignment Healthcare (ALHC) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen asked about the confidence in achieving 20%+ growth in 2026, the expected split between California and other markets, and whether the recent Arizona Star score upgrade allowed for bid adjustments.

    Answer

    CEO John Kao reiterated confidence in achieving at least 20% growth, viewing it as an opportunity in both California and ex-California markets, not an either/or choice. He emphasized the company's focus on balancing growth with margin expansion. Kao confirmed that following the successful appeal of their Arizona Star Rating, they were permitted by CMS to modify their 2026 bids to reflect the improved rating.

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    Ryan Langston's questions to Alignment Healthcare (ALHC) leadership • Q1 2025

    Question

    Ryan Langston of TD Cowen asked for clarification on the strong prior year development (PYD), noting a discrepancy in reported figures, and inquired about the drivers of this strength. He also requested Alignment's weighted average rate for 2026 to compare against the previously provided 2025 figure.

    Answer

    CFO Robert Freeman explained the difference in PYD figures is due to a standard margin pad (~7%) applied to IBNR reserves for compliance, which is not expected to be used. The key figure was a $6 million favorable release, a portion of which is shared with providers. He also stated that Alignment's weighted average effective growth rate for 2026 is approximately 8%, compared to about 5% for 2025.

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    Ryan Langston's questions to UNIVERSAL HEALTH SERVICES (UHS) leadership

    Ryan Langston's questions to UNIVERSAL HEALTH SERVICES (UHS) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen requested an update on the Nevada and Las Vegas markets, including volume trends and payer mix. He also asked about the company's capital deployment strategy, particularly regarding share repurchases, given the declining net leverage.

    Answer

    Executive VP & CFO Steve Filton noted a slight slowdown in Nevada volumes, reflecting some economic softness in the Las Vegas market, but described performance as still very solid. Regarding capital deployment, Filton indicated that the incremental free cash flow from the revised guidance would likely be dedicated to an elevated level of share repurchases beyond the initial $600-$700 million guidance.

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    Ryan Langston's questions to UNIVERSAL HEALTH SERVICES (UHS) leadership • Q4 2024

    Question

    Ryan Langston asked about the drivers of strong salary, wage, and benefits (SWB) performance in the behavioral segment and whether the 2025 share repurchase program might be front-loaded.

    Answer

    Executive Steve Filton attributed the strong behavioral labor performance to improved productivity, moderated wage inflation, and lower use of premium pay as the labor environment has improved post-pandemic. Regarding share repurchases, he stated that while the market is a consideration, UHS's approach is typically more programmatic and ratable throughout the year rather than attempting to time the market.

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    Ryan Langston's questions to UNIVERSAL HEALTH SERVICES (UHS) leadership • Q4 2024

    Question

    Ryan Langston of TD Cowen inquired about the drivers behind the strong performance in salaries, wages, and benefits (SW&B) in the behavioral segment. He also asked if the company might front-load its share repurchases in 2025 given market conditions.

    Answer

    Executive Steve Filton attributed the strong behavioral labor cost performance to a combination of improved productivity and moderation in both premium pay and wage inflation. Regarding share repurchases, he indicated that while market conditions are a consideration, UHS's approach is typically programmatic and ratable throughout the year rather than attempting to time the market.

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    Ryan Langston's questions to UNIVERSAL HEALTH SERVICES (UHS) leadership • Q3 2024

    Question

    Ryan Langston from TD Cowen asked if the D.C. supplemental payment benefit includes the new hospital and for thoughts on the increased frequency of legal headlines.

    Answer

    Steve Filton confirmed the new D.C. hospital will participate in the supplemental program, but the estimated benefit is based on the existing hospital's history, so the new facility represents potential upside. Regarding legal headlines, he noted that while UHS is increasing malpractice reserves due to rising severity, the two large disclosed verdicts are considered extraordinary and are subject to significant appeal activity.

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    Ryan Langston's questions to HCA Healthcare (HCA) leadership

    Ryan Langston's questions to HCA Healthcare (HCA) leadership • Q2 2025

    Question

    Ryan Langston from TD Cowen asked for an update on commercial contracting for the coming years and whether HCA might increase capital spending to gain share if non-profits become more cautious.

    Answer

    CEO Sam Hazen reported that HCA is ~80% contracted for 2026 and about one-third for 2027, meeting its targets. On capital expenditures, he noted high occupancy rates and a $5.5 billion project pipeline. While HCA continually evaluates opportunities to accelerate investment, he does not foresee a rapid acceleration of spending at this time but will proceed in the normal course.

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    Ryan Langston's questions to HCA Healthcare (HCA) leadership • Q1 2025

    Question

    Ryan Langston asked about current surgical scheduling trends and whether external factors like tariff risks or declining consumer confidence are affecting patient behavior for elective procedures.

    Answer

    CEO Sam Hazen stated that HCA does not aggregate forward-looking surgical scheduling data at the corporate level. However, he expressed confidence that the underlying demand for healthcare services remains robust. He expects surgical volumes to align with the company's market share gain expectations, supported by ongoing investments in medical staff, facilities, and technology, and sees no material impact from consumer behavior at this time.

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    Ryan Langston's questions to HCA Healthcare (HCA) leadership • Q4 2024

    Question

    Ryan Langston asked for details on the drivers of strong inpatient surgical growth and whether the decline in outpatient surgical volume was still attributable to Medicaid and uninsured categories.

    Answer

    CEO Sam Hazen confirmed that inpatient surgical growth was broad-based, with strong performance in neurosciences, orthopedics, general surgery, and vascular. He also affirmed that the outpatient surgery volume decline was driven by a 10% drop in Medicaid cases, while commercial and exchange volumes were up slightly. Consequently, revenue and profitability in outpatient surgery grew due to the favorable payer mix.

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    Ryan Langston's questions to HCA Healthcare (HCA) leadership • Q3 2024

    Question

    Ryan Langston of Northcoast Research asked if the recent severe hurricane activity would alter HCA's long-term capital allocation or M&A strategy, potentially causing a shift away from hurricane-prone regions.

    Answer

    CEO Sam Hazen responded with a definitive 'no,' stating that the company's portfolio is well-positioned for long-term growth. He provided examples of previously storm-damaged hospitals in Florida and Texas that have since recovered and are performing at higher levels than before the hurricanes, demonstrating the effectiveness of HCA's enterprise disaster response capabilities and investment strategy.

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    Ryan Langston's questions to MOLINA HEALTHCARE (MOH) leadership

    Ryan Langston's questions to MOLINA HEALTHCARE (MOH) leadership • Q2 2025

    Question

    Ryan Langston from TD Cowen asked for a 'same-store' comparison of utilization between renewing and new members on the ACA exchanges. He also questioned if achieving long-term targets now relies more heavily on accretive M&A given the pressures in core businesses.

    Answer

    CEO Joseph Zubretsky noted that, unusually, there was very little distinction in performance between member cohorts this year; all segments ran hotter than expected. He reaffirmed the 'small, silver, stable' strategy for the exchanges. CFO Mark Keim added that despite the pressures, the Marketplace business is still expected to achieve low single-digit pretax margins for the year.

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    Ryan Langston's questions to MOLINA HEALTHCARE (MOH) leadership • Q1 2025

    Question

    Ryan Langston asked if the uncertain political backdrop is impacting the M&A environment, particularly the willingness of potential targets to engage or the multiples on deals.

    Answer

    CEO Joseph Zubretsky stated that the challenging environment is actually increasing M&A deal flow, as smaller, single-state plans are struggling. He described the pipeline as "replete with opportunities" and noted the political uncertainty is not a deterrent but may even be a catalyst for consolidation. He expressed high confidence in meeting growth targets via M&A.

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    Ryan Langston's questions to MOLINA HEALTHCARE (MOH) leadership • Q4 2024

    Question

    Speaking for Ryan Langston of TD Cowen, Christian inquired about Molina's assumptions for Marketplace membership attrition if Advanced Premium Tax Credits (APTCs) are not extended and whether the newest cohort of members might be more or less sensitive to such a change.

    Answer

    CEO Joe Zubretsky stated that all factors, including potential policy changes, were incorporated into their membership forecast, which assumes a net 4% membership reduction over the course of the year. CFO Mark Keim added that they have high confidence in the quality and stability of their membership due to a high 70% renewal rate and improved program integrity from the agent of record lock, which should mitigate volatility.

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    Ryan Langston's questions to MOLINA HEALTHCARE (MOH) leadership • Q3 2024

    Question

    Ryan Langston from TD Cowen inquired if any service lines performed better than expected in Q3 to offset pressures. He also asked if the higher behavioral health utilization, previously highlighted in Kentucky, is now a more broad-based trend across other states.

    Answer

    President and CEO Joe Zubretsky explained that the higher behavioral health trend is indeed a national phenomenon, driven by reduced stigma and pent-up demand, though it was more pronounced in Kentucky due to a specific program change. CFO Mark Keim stated that while there are unique stories in each of their 21 states, he would not cite any specific service lines as having a 'good guy' trend on a national basis.

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    Ryan Langston's questions to TENET HEALTHCARE (THC) leadership

    Ryan Langston's questions to TENET HEALTHCARE (THC) leadership • Q2 2025

    Question

    Ryan Langston of TD Cowen asked about Salaries, Wages, and Benefits (SWB) performance, questioning if the current low levels represent a new baseline and what opportunities remain for further improvement.

    Answer

    Chairman & CEO Saum Sutaria explained that the strong performance is the result of sustainable strategies, including effective labor management, improved recruiting, strong nursing school partnerships, and better retention rates. He noted that real investments in nursing and hospital management have created a stable and effective workforce, driving these efficiencies.

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    Ryan Langston's questions to TENET HEALTHCARE (THC) leadership • Q1 2025

    Question

    Ryan Langston asked about the tight labor management in the first quarter, questioning how much more improvement is possible and what specific initiatives are in place to maintain this level of performance.

    Answer

    Saumya Sutaria, Chairman and CEO, clarified that further decreasing contract labor isn't necessarily an 'improvement,' as it can be used strategically to open capacity. He emphasized the long-term strategy has been to reduce reliance on contract labor by focusing on recruiting and retaining full-time staff, leveraging nursing school relationships, and returning to a focus on overall SWB inflation rather than just contract labor expense.

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    Ryan Langston's questions to Elevance Health (ELV) leadership

    Ryan Langston's questions to Elevance Health (ELV) leadership • Q2 2025

    Question

    Ryan Langston asked for clarification on Medicaid trends, noting the seeming contradiction of decelerating cost trend but increasing utilization, and inquired if benefit carve-ins were a factor.

    Answer

    CFO Mark Kaye clarified that cost trend deceleration was slower than expected due to higher-acuity members remaining after redeterminations. He identified LTSS, behavioral health, and inpatient care as utilization hotspots and updated the trend drivers to one-third acuity and two-thirds utilization/coding. CEO Gail Boudreaux added that benefit carve-ins are not a significant contributor, as rate alignment is typically a timing issue.

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    Ryan Langston's questions to Elevance Health (ELV) leadership • Q1 2025

    Question

    Ryan Langston asked for the specific impact of flu and respiratory illnesses on the first quarter MLR and whether these trends differed across the company's various service lines or patient populations.

    Answer

    Mark Kaye, CFO, stated that while the company had prudently modeled for a flu season similar to pre-COVID norms, Q1 flu-driven costs came in modestly above those expectations. He quantified the impact on the benefit expense ratio as being between 15 and 20 basis points for the quarter. He also noted that flu incidence rates have recently decreased, and no outsized impact is anticipated for Q2.

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    Ryan Langston's questions to Elevance Health (ELV) leadership • Q4 2024

    Question

    Ryan Langston of TD Securities asked if Elevance might revisit the acquisition of Blue Cross of Louisiana and inquired about the company's broader M&A priorities for 2025, following recent acquisitions like CareBridge.

    Answer

    CEO Gail Boudreaux declined to comment on specific M&A possibilities but noted the existing partnership with Blue Cross Blue Shield of Louisiana. Peter Haytaian, President of Carelon, outlined their M&A strategy, which is focused on acquiring capabilities for whole-person health, particularly in areas of specialty trend, pharmacy, and technology to solve healthcare complexity and enhance the patient experience.

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    Ryan Langston's questions to Elevance Health (ELV) leadership • Q3 2024

    Question

    Ryan Langston of Cowen asked about the margin profile for the Individual ACA exchange business and the overall Commercial segment, given the expected growth in exchanges for 2025.

    Answer

    Morgan Kendrick, President of Commercial Health Benefits, stated that the company feels very good about its Commercial business in aggregate. He noted a disciplined approach to ACA expansion over the last 36 months has positioned them well for continued growth and market share gains, with new market expansions expected to align with the company's economic expectations.

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    Ryan Langston's questions to P3 Health Partners (PIII) leadership

    Ryan Langston's questions to P3 Health Partners (PIII) leadership • Q1 2025

    Question

    Ryan Langston from TD Cowen questioned whether the company was observing the same accelerating negative utilization trends in Medicare Advantage that other public payers had recently highlighted. He also asked for details on the one market that was not yet at breakeven.

    Answer

    Executive Amir Bacchus responded that, contrary to broader reports, the company is seeing improving trends, with decreasing hospital census volumes and lower utilization. Executive Aric Coffman added that this positive trend is also evident in their ACO REACH business. Executive Leif Pedersen confirmed that the one underperforming market is where the single outlier payer is located. Aric Coffman noted that other payer partners in that same market are not exhibiting the same negative performance.

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    Ryan Langston's questions to P3 Health Partners (PIII) leadership • Q4 2024

    Question

    Ryan Langston from TD Cowen asked about the expected seasonality for 2025 given the changes in Part D risk, and requested elaboration on why the macro environment for Medicare is considered to be improving.

    Answer

    Chief Medical Officer Amir Bacchus noted that Q1 and Q4 are typically high-utilization quarters, making the early positive trends in Q1 2025 encouraging. He credited this to P3's care model and plan benefit changes like higher ER co-pays. Executive Aric Coffman added that the improving macro environment is primarily due to the rationalization of plan benefit designs from 2024 to 2025, including reductions in supplemental benefits, which is helping to lower utilization.

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    Ryan Langston's questions to CENTENE (CNC) leadership

    Ryan Langston's questions to CENTENE (CNC) leadership • Q1 2025

    Question

    Ryan Langston asked a bigger-picture question about the ability of states to fund necessary Medicaid rate improvements, given their current budget situations and the backdrop of potential federal funding cuts.

    Answer

    CEO Sarah London explained that states have budget savings from post-redetermination membership declines and are legally required to set actuarially sound rates. She added that state budget pressure has historically been a tailwind for managed care, as states look to move more populations into predictable, cost-saving models, creating growth opportunities for Centene, particularly in complex populations.

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    Ryan Langston's questions to HUMANA (HUM) leadership

    Ryan Langston's questions to HUMANA (HUM) leadership • Q4 2024

    Question

    Ryan Langston requested more detail on the margin pressure in the Group MA business, its specific drivers, and the expected slope of margin improvement compared to the Individual MA segment, as well as what is assumed for Group in 2025 guidance.

    Answer

    George Renaudin, President of the Insurance Segment, explained that the Group MA market is less mature and has been impacted by multi-year rate guarantees. While this is changing, it will take time to flow through financials. He stated that margin pressure in 2025 is built into guidance, with improvement expected in 2026 as long-term contracts come up for renewal.

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    Ryan Langston's questions to Surgery Partners (SGRY) leadership

    Ryan Langston's questions to Surgery Partners (SGRY) leadership • Q3 2024

    Question

    Will, on behalf of Ryan Langston from TD Cowen, asked about the long-term outlook for physician recruitment and if there are any new shifts in physician preferences for working in an ASC environment versus hospital employment.

    Answer

    CEO J. Evans stated that the recruitment environment remains very stable and strong. He explained that Surgery Partners offers physicians greater efficiency, consistent scheduling, and more control over their practice, which is a compelling alternative for surgeons frustrated with the traditional system. He affirmed that interest from independent physicians has not waned.

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    Ryan Langston's questions to Cigna (CI) leadership

    Ryan Langston's questions to Cigna (CI) leadership • Q3 2024

    Question

    Ryan Langston inquired about the drivers behind the rapid growth of the EnCircleRx program for GLP-1 drugs, which has grown to nearly 8 million lives in just a few months.

    Answer

    Evernorth CEO Eric Palmer and CEO David Cordani explained that the growth is driven by intense client interest in managing the affordability of GLP-1s. Cordani added that the program's value proposition resonates because it provides clinical and behavioral support wrappers to address the 'start and stop' dynamic often seen with these medications, aiming for more sustained and effective patient outcomes.

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