Accolade - Q4 2022

Transcript

Operator (participant)

Good day, and thank you for standing by. Welcome to the Accolade Q4 2022 Earnings Conference Call. At this time, all participants are on a listen only mode. After the speaker presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star one on your telephone. Please be advised that today's conference is being recorded. If you require any further assistance, please press star zero. I would now like to hand the conference over to your first speaker today, to Mr. Todd Friedman, Head of Investor Relations. Please go ahead.

Todd Friedman (SVP of Investor Relations)

Thanks, operator. Welcome everyone to our fiscal fourth quarter earnings call. With me on the call today are our Chief Executive Officer, Rajeev Singh, and our Chief Financial Officer, Steve Barnes. Shantanu Nundy, our Chief Medical Officer, will join us for the question-and-answer portion of the call. Before I turn the call over to Rajeev, please note that we will be discussing certain non-GAAP financial measures that we believe are important when evaluating Accolade's performance.

Details in the relationship between these non-GAAP measures to their most comparable GAAP measures and the reconciliations thereof can be found in the press release that's posted on our website. There are also slides that accompany this conference call that are available on the webcast. The slides will be available for download later following the call.

Also, please note that certain statements made during this call will be forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. Such forward-looking statements are subject to risks, uncertainties and other factors that could cause the actual results for Accolade to differ materially from those expressed or implied on this call. For additional information, please refer to our cautionary statement in our press release and our filings with the SEC, all of which are available on our website. With that, I would like to turn the call over to our CEO, Rajeev Singh.

Rajeev Singh (CEO)

Thanks, Todd, and thank you all for joining us today. Today's call marks an important inflection point for our company. We've delivered eight consecutive quarters of outperformance and a remarkable evolution of our business by being cognizant of the environment we're operating in and executing accordingly. Today, we're stepping back to acknowledge that the macro environment is. This has an impact on our business and no doubt every business in our sector and beyond.

This requires operating with even more discipline as it relates to profitability and growth. It is with this changing macro environment in mind that we're adjusting our go-forward forecast today. We make these adjustments having just completed a very strong fiscal year, where we dramatically expanded our footprint and exceeded our financial targets. We see a go-forward environment supported by the largest sales pipeline in the history of the company.

While there are tailwinds we're excited about, there are also headwinds. As you may have inferred from our press release, our relationship with Comcast will effectively end in December 2022. Given that timing, it is not a significant impact to FY 2023 revenues. However, combining that customer loss with a challenging macroeconomic environment is worthy of evaluation. Accordingly, we're moderating our annual revenue growth rate to 20% over the midterm while reducing our adjusted EBITDA loss on our path to profitability.

We're adjusting our spend to align with the revised growth rate and now expect to achieve full year positive adjusted EBITDA in fiscal 2025. This is not about being overly optimistic or unduly pessimistic. It is simply about being pragmatic and clear-eyed about the road ahead. Our updated forecasts are a reflection of that pragmatism. More on all of those points later.

For today's call, we'll follow the following agenda. I'll quickly highlight the Q4 and FY 2023 results, and then we'll talk about what we're seeing in the customer and competitive landscape and how the pipeline looks for the year. I'll give you a broad overview of the steps we're taking to position Accolade for both near term execution and long-term positioning to deliver against those growth and profitability goals.

Steve will then give you more information on the financial results. I'll talk in a minute about Comcast and how we plan to adapt to the dynamics at play in our industry. First, I'll recap the successes we achieved in fiscal 2022. First, I'd like to acknowledge the incredible efforts and commitments of our employees, who delivered four quarters of outperformance in the midst of an ongoing pandemic.

These teams brought together four organizations in Accolade, 2nd.MD, PlushCare, and HealthReveal, while maintaining exceptionally high satisfaction rates across all those customer bases. We went public two years ago with 1,000 employees, 50 customers, and $130 million in revenues. We exited fiscal 2022 with 2,300 employees, 600 customers, and $310 million in revenue, and $366 million in the bank.

Accolade today is more durable, diversified, and set up for long-term success than ever before. Before going any further, let's address the end of our Comcast relationship. First, let me express my appreciation to the team at Comcast for being our founding customer and for the visionary leadership that chose to reinvent the healthcare experience for their employees and their families by partnering with a company that, at the time, had no customers.

That was 12 years ago, and through multiple contract renewals and changes in their business, including me joining as CEO almost 7 years ago, Comcast has been a great collaborator. It's important to note that so much has changed over the years. In fiscal 2018, when we had fewer than 20 customers, Comcast represented 45% of our revenues. Today, we've got more than 600 customers, and Comcast represents less than 10% of revenues.

Next year, based on the economic structure of their current evaluation process, that percentage would have been materially smaller. Our roster of Fortune 500 clients is the envy of the industry. For good reason, customers of this nature oftentimes lead the way with innovation in healthcare because of their buying power and population size. Additionally, our customer retention rates have been north of 95% for many years.

While this isolated event is disappointing, it is just that, an isolated event. In many ways, the diversification of our revenue stream, offerings, and customer base were all in preparation for an event like this one. While we're always sad to say goodbye to an old friend, we wish Comcast the best of luck. With that, let's turn our attention to the future. Our conviction regarding our strategy, our offerings, and our company remains very strong.

First, we're in the midst of an exceptionally strong demand environment. We're participating in more RFPs across every market sector, including the middle market, enterprise and strategic, and government sector than ever before. Our performance early in the selling season has been strong. Building off that point, we're in the midst of renewing the TRICARE Select Navigator program for the third year of the pilot.

Year one of the pilot resulted in us achieving the majority of our performance incentives, and we expect our results in year two to be equally strong. Importantly, we're well-positioned to grow in other areas of the TRICARE program as well, such as our early success with the Autism Care Demonstration. Second, our offerings are differentiated and compelling. Accolade is a personalized healthcare company that combines the strength of an advocacy platform with clinical capabilities like primary care, mental health support, and expert medical opinion.

Those capabilities, increasingly tightly integrated, create the data-driven, personal, and value-based healthcare solutions that healthcare buyers need. Our customers and prospects agree as our new sales and cross-selling momentum remains strong. The utilization of primary care and mental health or expert medical opinion capabilities is exceptional when delivered in an integrated fashion.

Importantly, we've replaced our competition in those categories at a number of existing advocacy customers, where customers were keen to work with their proven front door to healthcare for services of this nature. Additionally, this broader portfolio is more interesting to health plan reseller partners who want to take Accolade's capabilities to their member base. This month, we announced a partnership with Priority Health in Michigan, who's incorporating advocacy, primary care, and mental health into their offerings.

Much as we already have in place for Accolade Expert MD, we see health plans as a key distribution partner for Accolade Care. Third, our ability to address the inequity in healthcare makes our solution essential for employers. Where healthcare has fallen dramatically short is in providing care to those who don't have easy access to it. Those impediments could be related to geography or social or economic factors.

We're leveraging our deep customer relationships, clinical depth, and expertise in machine learning to narrow those gaps. Finally, our disciplined approach to building our business will differentiate us in uneven economic times. Our cash position provides the foundation to execute on our strategy. Our commitment to delivering on our path to profitability is even further strengthened in our outlook today. I raise this point to address the challenge, the changing macroeconomic environment and competitive bid behavior that we believe is not sustainable for the long term.

Our success over the years has attracted our fair share of competition, and our win rate has remained very high. That said, more recently, we've seen some of our competition begin to lower prices to levels where we believe they must either sacrifice fiscal discipline or quality delivery to members.

In the end, strong businesses with a commitment to operating with discipline survive and thrive in environments like these, and we're positioning ourselves today to do exactly that. To that end, while the vast majority of our pipeline is made up of companies evaluating advocacy and personalized healthcare for the first time, we also have a meaningful number of prospects who previously chose a lower cost, lower engagement competitor years ago and have now reopened RFPs after coming to the realization that low-cost, low-engagement solutions do not produce the outcomes, experience and ROI desired.

Now, I want to revisit how our core principles shape our view on go-forward guidance. Our company has always been focused on creating a new category of healthcare solutions that put people at the center of the service. Today, our personalized healthcare solutions are doing just that for more than 10 million people.

We've been focused on growing our business on the top line while progressively improving profitability each year. That commitment has been unwavering since we went public in 2020. That said, as an operating team, we're also committed to confronting the facts in a changing market. We believe it's smart business to moderate our growth expectations for the year.

At the same time, we think fiscal discipline is important and are also reducing the adjusted EBITDA loss for FY 2023 and FY 2024 from our previous guidance. We expect to achieve positive adjusted EBITDA for the full year in FY 2025. Our guiding principle in challenging environments is to redouble our focus on execution and discipline. Our addressable market is growing, and our demand environment remains strong.

With our focus on discipline and execution, we expect to emerge from this challenging environment even further differentiated from the rest of the market. With that, let me turn the call over to Steve Barnes, our Chief Financial Officer.

Steve Barnes (CFO)

Thanks, Raj. First, I'm going to recap the results for the fourth quarter and full fiscal year 2022 before providing more color on the changes in our fiscal 2023 guidance. We generated $93.8 million in revenue in the fourth fiscal quarter, ahead of the top end of our guidance, representing 58% year-over-year growth on a GAAP basis over the prior year period.

Fiscal Q4 adjusted gross margin was 54.4% compared to 53.8% in the prior year period, which reflects the positive revenue beat as well as investments in staffing our frontline care teams to support growth and integration. Adjusted EBITDA in theQ4 of fiscal 2022 was $1.8 million, which compares to $2.7 million in the prior year fourth fiscal quarter.

This was significantly ahead of our guidance, primarily due to the revenue beat as well as lower spending than planned in the quarter in some areas such as hiring and personnel costs. For the full year, this rolls up to revenue of $310 million, an 82% increase over last year on a GAAP basis, and 30% on a pro forma basis, adjusting for the acquisitions.

Adjusted gross margin for the full year was 46.5%, compared to 45.6% in the prior year. Adjusted EBITDA for fiscal year 2022 was a loss of $42.4 million, or 13.7% of revenue, significantly better than our guidance and compared to a loss of $26.9 million or 15.8% of revenue in the prior year.

Turning to the balance sheet, cash and cash equivalents totaled $366 million at the end of the fiscal year, and accounts receivable DSOs were in line with prior quarters at about 20 days sales outstanding. Finally, we had approximately 67.3 million shares of common stock outstanding as of February 28, 2022. This does not include the approximately 3.4 million aggregate shares related to the 2nd.MD and PlushCare earn-outs, which will be issued in the near term, resulting in 70.7 million shares outstanding on a pro forma basis. Now turning to guidance. We're updating our guidance today for fiscal year 2023, as well as our midterm outlook.

We are now forecasting fiscal year 2023 revenue will be in the range of $350 million-$365 million, with an adjusted EBITDA loss between $35 million and $40 million. This represents revenue growth of approximately 15% at the midpoint and an adjusted EBITDA loss of negative 10%-11%. The change from the preliminary guidance we provided in January is primarily related to a few factors.

First is the Comcast contract, which will end in December and reduce revenue in the fourth quarter by roughly $5 million. Secondly, you'll recall in January, we expected revenue, excuse me, we expected between $50 million and $60 million of new business signed in fiscal 2022. The final result came in closer to the middle of that range, and we ended fiscal 2022 with annual contract value of approximately $286 million. We have also included some reservation on the lower end of our guidance related to the TRICARE pilot. As a government program, the pilot requires annual reauthorization.

While we fully expect the pilot to be renewed for the third year and we are bullish on other opportunities with the federal government, we haven't yet received the official authorization. The last factor relates to our comments about the macro and competitive environment. As we said, we're having a favorable start to the selling season and our pipeline is strong. With what we're seeing in the market, we have moderated our expectations and will give you ongoing color about the selling environment as the year progresses.

As it relates to our midterm outlook, we're now forecasting 20% growth excluding the loss of Comcast. As you look out beyond fiscal 2023, if you grow the business 20% ex Comcast, you will get to around $500 million in fiscal 2025 revenue. Importantly, we remain committed to our goal of consistent progress toward profitability. The loss of a more mature large customer like Comcast will impact gross margin.

While we won't try to recoup the entire gross margin loss at once, particularly in fiscal 2024 when the impact is greatest, we are adjusting our spend and now project positive adjusted EBITDA in fiscal 2025. One last note about spending in fiscal 2023. Like all of you, we see what is happening in the stock market, while at the same time are focused on employee recruiting and retention.

To that end, we are incorporating a stock component along with cash for our fiscal 2023 corporate bonus plan. Aside from providing a lever to manage cash, it also provides a clear incentive for the team to execute against our strategy and even further align with shareholders. This will result in a bump to stock-based compensation of approximately $14 million in fiscal 2023.

Now, before we take your questions, I want to align my comments today with the remarks we made in our January call regarding the revenue growth breakdown and modeling the path to profitability. The revenue impact I've just described primarily impacts the core advocacy growth rate. The one caveat I'd add is that PlushCare finished fiscal 2022 stronger than expected, but given the macroeconomic volatility, we haven't changed our internal estimate for that revenue in fiscal 2023.

Therefore, the implied growth rate is a bit lower than we said in January. While this updated framework results in a lower revenue target, we're adjusting our spend to improve our path towards positive adjusted EBITDA in fiscal 2025. Finally, allow me to take one more step back. While we had some difficult news to report today, this event has also given us the opportunity to take stock of Accolade from a broader perspective.

Two, three or four years ago, this kind of event would have had a much deeper impact on our business. We have built Accolade through internal innovation and M&A for growth and durability. Just compared to a year ago, our customer base is far more diversified, we have growth opportunities across multiple vectors, our revenue base is spread across different sources and structures, and we are solving more complex, meaningful healthcare challenges.

We went public to create the foundation for the business we are operating today. We continue to be confident about the future and the value we bring to our 600+ customers and 10 million members, even as we make adjustments to our spend to align our near-term business objectives with our path to profitability. With that, we'll open the call to questions.

Operator (participant)

Thank you, sir. As a reminder, to ask a question, you would need to press star one on your telephone. To withdraw your question, please press the pound key. We ask that you please limit yourselves to one question, and as time permits, we'll take follow-up questions. Please stand by while we compile the Q&A roster. Our first question comes from the line of Michael Wiederhorn from Bank of America. Please go ahead.

Michael Wiederhorn (Healthcare Services Analyst)

Good afternoon, and thanks for all the color. I think I want to dive in a bit on the differential in your commentary, Steve, a little bit further, and also make sure I heard correctly. If you think about that bridging and the 25% growth that you had estimated on the last earnings call, Comcast takes out a little more than 1% of that, or 1.5%, I guess, based on the timing. Seems like maybe 1% on bookings.

When you talk about the conservative nature of the rest of the business, how much of that is truly in year, business wins versus how much is some of the dynamics around performance-based fees that you may expect or expect not to get, versus how much is employment levels at your customers?

I know that's a lot of moving pieces, but I just want to make sure we can bridge a little bit better, and I just have one quick clarification after?

Steve Barnes (CFO)

Sure, Mike. Thanks for the question. You know, first, you're right. The Comcast and the softness in the ARR bookings in fiscal 2022 do come off the top for roughly a point each headwind on growth. The remainder of the guide is across the various vectors you mentioned. You know, we're softening the guidance across the board, to recognize the macro environment primarily, as it relates to being thoughtful around headcounts in a highly inflationary environment, for sure.

Being thoughtful around the timing of being able to book and launch new business in-year. You know, in part just recognizing that buying decisions last year pushed a bit towards the end, which is what resulted in the softer ARR. While our win rate remains strong when there is a decision, we're thoughtful about the fact that some of those decisions were slower.

One of the very important points to us, Mike, as we address all of that was in looking at the revenue softness, we look directly to our spend and profitability. You know, you see that we beat fiscal 2022 fourth quarter handsomely in terms of bottom line as well as top line, and we're rolling that forward to remain committed to the overall profitability structure from here through to fiscal 2025 positive EBITDA.

Michael Wiederhorn (Healthcare Services Analyst)

Got it. It's the one clarification. You talked about the 20% annual revenue growth, excluding Comcast. Just want to make sure that's completely out of the baseline in terms of how to think about 2024 and 2025. Want to make sure I get that, the math correct on how you think about that, given that the 2025 number came down by about $100 million overall.

Steve Barnes (CFO)

That's right, Mike. What we're effectively doing there is if you think about Comcast in fiscal 2022 having been about $28 million of revenue, you take about five out to get to your fiscal 2023 number. If you were to back that out and then put a 20% growth rate on top of that, compounding for the next two years, that's how you get to the approximately $500 million in fiscal 2025.

Michael Wiederhorn (Healthcare Services Analyst)

Got it. Thanks.

Operator (participant)

Thank you. As a reminder, we ask that you please limit yourself to one question. I show our next question comes from the line of Ryan Daniels from William Blair. Please go ahead.

Ryan Daniels (Equity Analyst and Group Head of Healthcare)

Yeah, guys, thanks for taking the question. I don't know how much detail you can go into this, but clearly a question we'll get is in regards to the Comcast relationship, especially as it was an anchor tenant for the organization. You know, clearly good relationship. You had 12 years with them, multiple renewals, so they like the service.

They got the ROI. What was it that led to the change on a go-forward basis to kind of end that relationship? Was it what you talked about with competitive pricing? You indicated the pricing would have made it much less than 10% going forward under newer terms. I just want to get a little more color on what you're referring to there and maybe what drove that loss? Thank you.

Rajeev Singh (CEO)

Yeah, appreciate the question, Ryan. It's Raj. A few thoughts. First and foremost, I appreciate you pointing out the fact that the Comcast relationship has been a really productive one over the course of 12 years in multiple contract renewals. We think over time that customers begin to evaluate different buying criterion in terms of what they're most interested in. I can't speak specifically to all the rationale for Comcast buying criterion, but I can say

We're really focused on servicing clients who are looking at improving healthcare outcomes while achieving that, the return on investment that's associated with achieving those healthcare outcomes. You know, in terms of that specific instance, I would say, we may have seen a divergence of those motive and mission there. For us, it's imperative to point out, we've had a customer retention rate, Ryan, of 95% on an ongoing basis for many years, first. Secondly, you know, we view this as an isolated event and not one that we expect to repeat itself with the customer base.

Operator (participant)

Thank you. I show our next question comes from the line of Jonathan Yong from Credit Suisse. Please go ahead.

Jonathan Yong (Assistant VP)

Hey, thanks for taking the question. I guess when you think about the 20% growth rate when adjusting for Comcast on a go-forward basis, how much conservatism are you kind of building into that? 'Cause obviously, the Comcast relationship was a bit of a surprise to you, to us, given how long that relationship has gone.

I'm just wondering how much conservatism is built into that top line. Commensurately with that, when you think about that bridge to breakeven to positive EBITDA in 2025, given the current inflationary environment and kind of what's going on, are there any pushes and pulls on any of the hiring that you'll need to do to achieve that 20% and achieve that EBITDA positive number that you're talking about? Thanks.

Rajeev Singh (CEO)

Jonathan, we're having a bit of a hard time hearing you. We'll try to recap your question, and I think that Steve will go you.

Steve Barnes (CFO)

Yeah.

Rajeev Singh (CEO)

We'll recap your question. Please catch us if we're missing it. I think you asked the question how much conservatism is baked into the 20% growth rate, excluding Comcast, and what impact, if any, would the inflationary pressures have on our hiring ability to achieve that 20% growth rate?

Jonathan Yong (Assistant VP)

Yep. Yep.

Rajeev Singh (CEO)

Okay. Steve?

Steve Barnes (CFO)

Yeah, sure. Happy to get that. Jonathan, first of all, on the level of conservatism in the 20%, it starts with our pipeline. As Raj mentioned in his comments, the pipeline is strong, and we're seeing a lot of interest, and particularly in terms of RFP volume from customers large and small, many of which have never purchased an advocacy offering. Based upon that, relative to ratios that we see in terms of deals closed, the size of pipeline, we feel like that's a good estimate to have. We're tempering it a bit, though, given the macroeconomic factors and the possibility that decisions will push.

The 20% we put together on that is based on really a pragmatic view in a clearly difficult environment. In terms of people and in an inflationary environment, this is top of mind for us. Obviously, a really an inflationary environment, it's important that we address that through a broad set of employee benefits, not just salary, but also compensating with stock and attracting great people to the mission and business that we have here. That comprehensive package, and I alluded to it in my comments of making sure we're aligning with employees across all of those vectors, is built into what we see. One last comment there.

You know, as we look at managing our spend and as we plan the growth, we look very hard at rigorous spending control opportunities that we have across the book. Remember, we're still barely a year into two significant acquisitions where we see more opportunities to lean into integration, et cetera. Finally, with a large customer transitioning, will we see opportunities there as far as reallocation of spend. Thank you.

Operator (participant)

Our next question comes from the line of Glen Santangelo from Jefferies. Please go ahead.

Glen Santangelo (Managing Director and Senior Equity Research Analyst)

Oh, yeah. Thanks for taking my questions. Raj and Steve, I wanna flesh out some of these comments on this revenue shortfall 'cause it seems like you took your revenue guidance down by, call it, roughly $35 million. If we know Comcast is, I don't know, a little more than $5 million of that for a couple months, it seems like the shortfall here is at least $25 million-$30 million.

Now, you said that you had some expectation of new business of about $50 million-$60 million and half of that, maybe didn't show up. I'm trying to figure out what happened from January tenth when you reported your last quarter when seemingly you had some visibility on all the January one starts to kind of now.

If you could just roll into that, your sort of comments about the competitive landscape and, you know, some competition lowering prices. I just want to make sure I understand the competitive dynamics. Also the last part. I'm done. Are PlushCare and 2nd.MD performing up to your expectations or is any of the, you know, that $30 million in weakness, you know, coming out of either of those two businesses? Thanks, and I'll stop there.

Rajeev Singh (CEO)

Sure. Thanks, Glenn. The bridge, you know, to the midpoint is about, it's about twenty-seven and a half million dollars to the midpoint. Let me just take that, break that down in pieces. You know, first of all, Comcast cost $5 million. On the ARR shortfall from prior year, we came in at the bottom end essentially of that $50-$60 million range of the booking of about 55 or so. When you adjust it for PGs, you end up at about 50.

There's another $5-$10 million there, all right? After that, you're talking about really a broad just softening, particularly around the advocacy side. The EMO business continues to perform along the lines of what we described in the last call, although we're certainly cautious about elective procedures as we've spoken about.

The virtual primary care business remains in line with what we talked about. The advocacy business is really where we see, because it tends to be a larger purchase for our broadest offering, where we are tempering our expectations around not just new business bookings, but also being super thoughtful around employment and other variables that go into the revenues associated with that book, given the inflationary and potentially recessionary environment we're heading into.

Operator (participant)

Thank you. Aisha, our next question comes from the line of Jeff Garro from Piper Sandler. Please go ahead.

Jeff Garro (VP and Senior Research Analyst)

Yeah, good afternoon. Thanks for taking the question. I want to dive a little deeper in the comments on the macro environment and pricing. I would ask if the predatory pricing or just aggressive pricing, is that on any particular offering or across all? How should we think about performance guarantees and your ability to offset lower base pricing from peers with the promise of stronger results?

Rajeev Singh (CEO)

Thanks, Jeff, for the question. I think in terms of when you think about pricing, I think, we're clearly, now having established a brand new category in personalized healthcare and establishing that the category is actually very interesting to customers. While we're looking at this year's revenues and moderating those expectations, we are continuing to see a really strong demand environment from customers looking at personalized healthcare.

Because of that, we've attracted a set, as you would in any space that's growing at this kind of clip, of competition, some of whom are approaching the space with materially lower price points, others who are looking at it from a materially lower service quality perspective. We think over time, those things iron themselves out.

Ultimately, as we noted in our prepared remarks, customers are seeking improved healthcare outcomes and return on investment. We traditionally see that in our full service advocacy offering. What we're beginning to see already is the early stages of customers who, having chosen in the past lower cost, lower engagement, lower outcome orientation solutions, are now coming back into our pipeline and revisiting Accolade solution as the chosen course or path.

I'd say, Jeff, to answer your question directly, we're really thinking more about the full service advocacy offerings as it relates to the pricing pressure. We expect over time that in the near term, that pricing pressure will alleviate itself as customers choose value over price.

Jeff, as it relates to performance guarantees and the thoughts we have in our guidance here, you know, always with performance guarantees for Accolade, take that into two pieces. First, you have the operational type performance guarantees that relate to engagement rates and customer satisfaction rates and you know, other kinds of engagement and operational rigor that we apply, and we continue to have very good visibility there and apply that same type of view towards fiscal 2023.

Savings-based revenues, similarly, although as you know, those can bounce around a little bit, particularly coming out of COVID, healthcare trend has been erratic over the last couple of years. We do apply some additional hedge in there to ensure that you know, our forecast represents a range where we feel confident in achieving.

Operator (participant)

Thank you. Aisha, our next question comes from the line of Ricky Goldwasser from Morgan Stanley. Please go ahead.

Ricky Goldwasser (Managing Director of Healthcare Services and Technology Research)

Yeah. Hi, good afternoon. It's a two-part question. The first one, when you think about your forecast, between now through 2025 and that CAGR of 20% top line growth, are you assuming any price pressure on that 20%, or are you assuming sort of steady state and to your point that your customers will ultimately kind of, like, understand the value? The second part of the question, as we think about your large employer book, can you just tell us what % of the book is up for renewal in the next couple of years?

Rajeev Singh (CEO)

Sure, Ricky. Thanks for the questions. In terms of the first point, one of the things that we take most to heart is both the incredible demand environment that exists, the number of evaluations that we're participating in today, given the long-term win rate of the business and the continuation of that win rate into this fiscal year.

The second part of that story from a pricing assumption perspective is we are receiving vendor of choice selections and new business wins right now at price points that are very similar to where we've operated in the past. Customers are aware, particularly in a space like healthcare, where we're talking about delivering healthcare services with doctors and nurses and frontline care teams, that there is a cost of delivering services like that.

Particularly customers who are focused on improving clinical outcomes, clinical quality and return on investment have continued to demonstrate the capacity and the wherewithal to choose solutions that may be higher priced than others. Our demonstrated value and a proven demonstrated value over the years.

That's part one in terms of our go-forward assumptions. In terms of customer renewals, we have customers that every year who are up for renewal. As we pointed out in the past, Ricky, we're because of the incredible value we've delivered for our customers, our renewal rates or our customer retention rates have been 95% for at least the last five years and probably longer than that.

We continue to see the vast majority of our customers renew their agreements with us because of the value we've provided and the relationships that we've built with their employees and their members.

Operator (participant)

Thank you. Our next question comes from the line of Cindy Motz from Goldman Sachs. Please go ahead.

Cindy Motz (VP of Equity Research)

Hi. Thanks for taking my question. Yeah, just following up because on the, you know, the revenue retention, I guess what I'm feeling like is you're expecting maybe that would continue that, you know, in the B2B market, it feels like some of this maybe competitive pricing, you know, does not fly, maybe it is more of a temporary thing, like as, you know, some players try to win,

you know, customers, but then in the end, you know, if you're running, you know, business and everything, you have to think about the sustainability of that, you know, whether they're going to be, you know, continue to be well-funded, and be around. I guess, would you sort of say that this is something it sounds like that you think is more temporary?

I also just did want to ask a second one just about the cadence of EBITDA because it looks like, obviously it's better than we would have expected full year, you're expecting. I guess not the next quarter, but it looks like it's going to be maybe positive through the third and fourth quarter. Anyway, if you could just give us something about the cadence there, and I'll stop and maybe ask one more follow-up.

Rajeev Singh (CEO)

Thanks, Cindy. Let me take the first question, and then I'll let Steve take the second question regarding EBITDA and the distribution of the EBITDA for the year. I think the answer to your question as it relates to the competitive landscape and customer retention is in line with the way you asked the question. Absolutely, we believe that this is an isolated event. We intend, you know, we've got great visibility in the customer retention on a year-over-year basis, and we expect that our retention rates remain on a midterm, long-term basis in that very high 90%+ range on an ongoing basis.

Over time, there will be in any market, particularly one growing this fast, the majority of our evaluations are for greenfield brand new customers who have never looked at advocacy or personalized healthcare before. That said, there is on occasion some customer trading. I referenced in my prepared remarks today that we've added customers from our competition where our customers are consolidating all of expert medical opinion, virtual primary care and advocacy into our relationship.

We've seen that in a number of different spots. That said, by and large, we're really focused on continuing to grow the organic space that's here, and we'd expect that will continue for the foreseeable future. Steve, you want to hit the EBITDA point? Sure.

Steve Barnes (CFO)

Cindy, on the cadence of EBITDA for fiscal 2023, the first fiscal quarter will be the low water mark, if you will, on the guidance we provided. Then, fiscal second and third quarter trend down, but still a negative and then a fourth quarter positive EBITDA to end that out to the $37.5 at the midpoint.

Cindy Motz (VP of Equity Research)

Okay. Yeah. No, that makes sense. I guess, I mean, if I could just add one more. As we project forward, I guess we see a similar sort of like seasonality. I mean, if you have any color there, it'd be helpful.

Rajeev Singh (CEO)

Sure. Yeah, that shape on a quarterly basis is a good one to use similarly in fiscal 2024. We provide in the presentation there. You would see that we expect that loss to be cut about in half by in fiscal 2024 with a positive EBITDA in fiscal 2025. Given the business seasonality, that shape persists as well.

Operator (participant)

Thank you. Our next question comes from the line of Ryan MacDonald from Needham. Please go ahead.

Ryan MacDonald (Managing Director and Senior Equity Research Analyst)

Hi. Thanks for taking my questions. Steve, I think you mentioned in the prepared remarks about gross margin impact from Comcast coming out of the model as it being a more mature customer being a bit accretive to gross margins. Can you sort of walk us through what sort of expectations for gross margins are or the magnitude of that impact in fiscal 2023? Then as we think about the bridge to the adjusted EBITDA, you know, maybe where some of those cost efficiencies can come into the model as we think about the OpEx lines. Thanks.

Rajeev Singh (CEO)

Sure. Ryan, so on more mature customers, you know, when we ramp up a new customer, there's a fair amount of investments to be made in both on the OpEx side and on the frontline care team side and in the customer service line. That is a little bit north of the corporate average gross margin that will come out in fiscal 2024. Fiscal 2024 gross margin, you could think of as roughly flat to a bit up off of fiscal 2023. We expect to take a little bit of a hit there.

Importantly, when we look across the business and look for opportunities around cost savings, you know, again, we just came off a year of beginning to integrate three businesses in which we see more opportunities to lean into those. In transitioning contracts off, particularly in the OpEx line, there are opportunities to, you know, reallocate that spend in other areas. Those are some of the target areas that we have for, you know, reducing some spend in some growth areas as we lower our top line growth rates.

Ryan MacDonald (Managing Director and Senior Equity Research Analyst)

Thank you.

Rajeev Singh (CEO)

Thank you.

Steve Barnes (CFO)

Thank you.

Operator (participant)

Our next question comes from the line of Sandy Draper from Guggenheim. Please go ahead.

Sandy Draper (Senior Managing Director and Research Analyst)

Thanks very much. Just first a quick housekeeping question, and apologies if I missed it. Did you guys give the actual revenue breakouts between advocacy, Expert MD, and then virtual primary care/plus care?

Steve Barnes (CFO)

Sandy, this is Steve. We haven't specifically. Though on the last call, we spoke to, you know, an expert medical opinion growth rate in the neighborhood of 20%, and the virtual primary care plus care business closer to 30%. What we're saying to you today is that that advocacy line is coming down to, based upon the factors that we gave today, and those are how you aggregate that down. You'll see in the 10-K filing, tomorrow the spread. You can think of the business as about 65% or so advocacy today with the balance across, expert medical opinion and, virtual primary care.

Sandy Draper (Senior Managing Director and Research Analyst)

Okay, great. I'll wait for that on the 10-K. I appreciate that. My broader question, and it's sort of been asked at a slightly different angle. Just trying to think in this macro environment, if I put myself in the shoes of an HR person, you know, there's a lot of challenges.

They're being pressured with retaining people, hiring people, you know, paying maybe higher bonuses, high signing bonuses, retention bonuses, et cetera. I can understand why they would maybe not want to commit to a new purchase or be hesitant to step up. I'm wondering, you know, have you seen signs of that or is that what you're factoring in?

Maybe as a follow-on to that, is this a situation where someone's less likely to do Accolade One and do the all in and say, "Yeah, that makes sense, but that's a much bigger ticket item. We're just going to do advocacy. We're not going to do all three." I'm just trying to think, not that the ROI isn't there and longer term this won't happen, but maybe those are the pressures that are at play. I'm just trying to get the additional commentary there. Thanks.

Steve Barnes (CFO)

Yeah. Thanks for the question. I think it's a really great one, Sandy, and I think here's the way we think about it. First, while we do see a really strong demand environment, and customers are really focused, to your point, they're focused on retaining their employees in a market that at least today is a very full employment market. They're also focused on addressing issues like healthcare equity, et cetera, that is, you know, in the last year, in fiscal 2022, we saw some defocusing of buyers' attention based on their focus on return to office and those things COVID and pandemic related. I think we're cautiously optimistic about the future this year.

Looking at the demand environment and the number of evaluations that we're participating in, we're clearly looking to see the number of opportunities that progress and actually make buying decisions. When customers make buying decisions, we have a very strong win rate. When prospects make buying decisions, we have a really strong win rate, to the degree those buying decisions actually occur, or versus customers choosing to kick the can down the road after an evaluation cycle, which leads to the second part of your question, which is what is there a likelihood that customers might be evaluating components of our solutions versus the entirety of our solutions in Accolade One? I think it's a very astute point.

I think customers will continue to want to buy in components, and it's really a significant driver of the way we've architected our strategy to be able to meet a customer where they'd like to be met, whether that's an expert medical opinion, virtual primary care and mental health or advocacy, or in those cases where it's all of the above. Yes, I think there may be a propensity for that type of buying to occur this year, and we'll have a lot more data as we come back to you in Q2 and the Q3 earnings calls.

Sandy Draper (Senior Managing Director and Research Analyst)

Great. Really helpful commentary. Thanks so much.

Operator (participant)

Thank you. Our next question comes from the line of Stephanie Davis from SVB Securities. Please go ahead.

Stephanie Davis (Senior Managing Director and Senior Research Analyst)

Hey, guys. Thank you for taking my question. I was hoping to talk a little bit more about the forward evolution of your pricing model. Just we're seeing some pushback in the employer market around PMPM solutions, and I know you've talked about going more risk on with some of your products. How should we think about maybe the mix of how you're selling and how you are looking at your forward pricing?

Rajeev Singh (CEO)

Thanks for the question, Stephanie. I think, look, we've consistently over the course of the last several years, call it over the last 5 years, we've delivered to customers a pricing solution that gave them an opportunity to put a percentage of our fees at risk. Typically, that number has been in the neighborhood of about 30% of our fees at risk. That's been consistent year-over-year and continues to be fairly consistent in terms of the outlook of the transactions that are occurring in fiscal 2023 and our view on those customer contracts that we're most interested in pursuing in fiscal 2023.

We believe that a percentage of our fees at risk associated with clinical outcomes, return on investment, and employee satisfaction are appropriate for most of our customers. There will be those customers who take advantage, and you've heard this before from us, Stephanie.

There'll be those customers who take advantage of all of our solutions, looking at advocacy, expert medical opinion, primary care and mental health, and a suite of our partner solutions where we've got the capacity to be more proactively managing all of their population health and the choices that they're making across the ecosystem. In those situations where we have a more pronounced control capacity, we're willing and able to take more of our fees at risk.

We don't think that's the preponderance of our customer base, but we expect that over the course of fiscal 2023, you're gonna see a customer breakdown that looks fairly similar or a new customer breakdown that looks fairly similar to the breakdown you saw in 2022 or 2021.

Operator (participant)

Thank you. I show our next question comes from the line of Richard Close from Canaccord Genuity. Please go ahead.

Richard Close (Managing Director Digital and Tech-Enabled Health Equity Research)

Yeah, obviously it's been a competitive business for some time, so I'm just curious your thoughts on the pricing environment and, you know, and maybe a timeline of when it deteriorated or, you know, is the pricing environment more competitive, as a follow-on to Stephanie's question in terms of other people coming in and going more at risk? Any thoughts there would be helpful.

Rajeev Singh (CEO)

Sure, Richard. I think we look at the competitive dynamic in the following ways. You can tier prospects who are looking at solutions in our category as those who are really focused on clinical outcomes, improving employee satisfaction, and delivering return on investment because they're improving outcomes. We think that's the preponderance of the marketplace. That marketplace is continuing to make buying decisions that are consistent with the way the market has always purchased, and we feel really great about our capacity to win the vast majority of those opportunities that actually transact.

There's another component of the buying cycle that's always existed, that's been more price conscious, that's been more focused on finding low-cost solutions that are either entirely digitally oriented or that offer less in terms of services or perhaps where the companies are more capable or willing to take lower profit margins. In those situations, you know, we think that those are deals that we have always in the past shown discipline around and haven't necessarily pursued and will continue to behave that way.

Operator (participant)

Thank you. I show our next question comes from the line of Stan Berenshteyn from Wells Fargo. Please go ahead.

Stan Berenshteyn (Senior Equity Research Analyst)

Hi, thanks for taking my questions. Maybe on the 20% intermediate growth guidance, how should we think about the different components of advocacy versus PlushCare versus expert opinion? Within advocacy, maybe as an add-on, is the expectation for PMPM to be flat and membership to be the growth engine there, or is the expectation for PMPM to be somewhat under pressure, given the competitive dynamics you cited earlier?

Steve Barnes (CFO)

Hey, Stan, this is Steve. On a long-term basis, think about that 20% as, of being pretty similar across the different business segments. You know, expert medical opinion and PlushCare are smaller in terms of lower base right now. Particularly PlushCare, we've called out, is growing a bit faster than that.

But think of it as not just membership within customers, but most or, you know, the majority of our business today is direct to employers, and therefore, you know, a lot of that growth is being projected upon new customer logos as well as, growth within those employer bases. In terms of PEPMs, you know, and where those are coming in, we've talked a little bit about, in the last call or two about case rate revenues on expert medical opinion.

You know, there's a bit of a dynamic there where some of that book is transitioned to a case rate off of a PMPM. You know, taking it all the way back to Raj's point, we think customers who are looking at these services, particularly advocacy and expert medical opinion as we bring them all together, they wanna understand ROI in a market that's extremely crowded with whether it be small point solutions or other customers that aren't able to warrant that ROI the way that we do consistently.

By putting a portion of our fees at risk and having had the ROI externally validated, we think that's ultimately the differentiator of why customers do buy and why they renew at such high rates. We weave all that together, and look at the growth of the breadth of the pipeline to tell us that we think that 20% growth rate makes sense across the different offerings and capabilities.

Rajeev Singh (CEO)

Maybe to the last part of that question, Stan, we believe over time that you know those customers and now those customers represent the preponderance of the marketplace are willing to pay for value and that value will represent consistent PEPM fees to what we've represented in the past.

Operator (participant)

Thank you. I show our next question comes from the line of Dev Veraswamy from Berenberg Capital Markets. Please go ahead.

Speaker 16

Hi, this is Brenda in for Dev. Thank you for taking my question. My question is, what particular types of clients are you seeing the most demand from for Accolade One? Is it more converting existing customer to VBC, or have you seen new client demand, and what are, like, the typical sales cycles on this? Thank you.

Rajeev Singh (CEO)

Thanks for the question. We continue to see great interest and traction from our existing customer base as it relates to looking at Accolade One, and that's really where the preponderance of our focus has been. We look at new prospects, and this goes to one of the earlier questions asked, as perhaps looking at either the platform of advocacy or some of the individual solutions, Accolade Care or Accolade Expert MD, as reasonable landing points for new prospects who are potentially just beginning to explore the opportunities in terms of healthcare reinvention. Because that market is growing so fast in each of those categories or demonstrating such demand, we wanna simplify those sales cycles and meet the customer where they'd like to be met.

Going all the way back to the beginning, Accolade One is really, we're seeing continued interest in the customer base where we're really focused.

Operator (participant)

Thank you. Our next question comes from the line of David Larsen from BTIG. Please go ahead.

Speaker 17

Hello. Thank you for taking my question. This is Aaron on for Dave. Few questions from my end. First, I guess, what do you see as the largest long-term opportunity from your TRICARE pilot in terms of revenue? My next question is, how much cross-selling are you seeing from Accolade Advocacy, Care and Expert MD, and how much cross-sell revenue are you factoring into your 2023 guidance? Thank you.

Rajeev Singh (CEO)

Guidance, I'll let Steve answer that question at the end. Let me first address the cross-sell, up-sell opportunities. Remind me of your first question besides cross-sell, up-sell.

Steve Barnes (CFO)

TRICARE.

Rajeev Singh (CEO)

The TRICARE opportunity. I'll start with TRICARE. We'll go to cross-sell, up-sells, and Steve, I'll let you answer the question on revenue guidance. As it relates to TRICARE, I appreciate the question. There's a couple of components to that story. There's first the renewal of the TRICARE Select Navigator program.

Additionally, just I think a quarter or two ago, we announced that we had actually expanded into a new pilot called the Autism Care Demonstration, capacity to deliver services to military families who are wrestling with children on the spectrum. That service is in pilot today to a small population in the mountains, in the mountain region, and we expect that has a significant opportunity to expand across the country and to a material population.

Incrementally, the government is today in the process of choosing a health plan for the T-5 contract. That selection will be happening this year. That selection should go into place on 1/1/2023 or perhaps 1/1/2024. We have teaming agreements with a number of the vendors who are bidding that T-5 agreement, and those teaming agreements give us an opportunity to deliver innovation as a subcontractor with those plans. Those are some of the vectors that we think are a part of a really exciting opportunity for growth.

Steve Barnes (CFO)

Aaron, to pick up on your question about cross-selling, here's how we think about that. You might remember on our last call, we talked about 40 customers, so 20 who had bought multiple offerings out of the gate from Accolade, and then about 20 that we had up-sold in one direction or the other, but primarily selling expert medical opinion into the advocacy base. If you think about that as representing, you know, in the neighborhood of 6 or 7% of the base right out of the gate, and this being our first full year on the selling season, we would expect that it'll break through in the 10% or so range of our total book and grow that over time.

You know, what we're seeing now when we go to market, we go to market with all of the offerings. Oftentimes we are either starting with advocacy and then displacing or adding on other of those offerings or selling a bundle right out of the gate.

Operator (participant)

Thank you. I show we have time for one last question. Our last question comes from the line of Cindy Motz from Goldman Sachs. Please go ahead.

Cindy Motz (VP of Equity Research)

Oh, hi. I just had one last one. Thanks for referring me to the presentation, too, 'cause I actually hadn't seen it. Where you break out all the expense items and the long-term EBITDA margins of 15%-20%. Long term, I mean, can I assume that's like in the 20s, you know, by 2029, 2030, or, I mean, is that what you're thinking? Like, is achievable and I appreciate the breakout for the expense items, lines as well. Any color there would be great.

Steve Barnes (CFO)

Sure. Cindy, first of all, you know, the growth rate of 20%, that's an adjustment to what we had seen in the past. The overall P&L construct and the EBITDA opportunity into that 15%-20%, yeah, I would think of that as the longer term profile. You know, kind of 5 years+ is the right way to think about that. Over the next 3 years is the outlook that we've provided today on getting to breakeven and then steady progression beyond that out, you know, several years out.

Rajeev Singh (CEO)

Yeah, I appreciate you calling that out, Cindy. I think it is imperative to note that with our updated guidance today, we've really tried to place a premium on the idea that we're evaluating our adjusted EBITDA loss and driving improved efficiency in the business to get to adjusted EBITDA positive in fiscal 2025.

Operator (participant)

Thank you. That concludes the Q&A session. At this time, I'd like to turn the call back over to management for closing remarks.

Steve Barnes (CFO)

We appreciate all of you being here today, and we look forward to catching up with you, down the road. Thank you.

Operator (participant)

Thank you. This concludes today's conference call. Thank you for participating. You may now disconnect.

Goodbye.