AdaptHealth - Q2 2023
August 8, 2023
Transcript
Operator (participant)
Good day, everyone, and welcome to today's AdaptHealth second quarter 2023 earnings release. At this time, all participants are on a listen-only mode. Later, you will have the opportunity to ask questions during the question and answer session. You may register to ask a question by pressing star 1 on your telephone keypad. Today's speakers will be Richard Barasch, Chairman and Interim CEO of AdaptHealth, and Jason Clemens, Chief Financial Officer of AdaptHealth. Josh Parnes, President of AdaptHealth, will join Richard and Jason for the question and answer portion of this call. Before we begin, I'd like to remind everyone that statements included in this conference call and in the press release issued today may constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act.
These statements include, but are not limited to, comments regarding financial results for 2023 and beyond. Actual results could differ materially from those projected in forward-looking statements because of a number of risks and factors and uncertainties, which are discussed at length in the company's annual and quarterly SEC filings. AdaptHealth Corp. should have no obligation to update the information provided on this call to reflect such subsequent events. Additionally, on this morning's call, the company will reference certain financial measures such as EBITDA, adjusted EBITDA, and free cash flow, all of which are non-GAAP financial measures. This morning's call is being recorded, and a replay of the call will be available later today. I'm now pleased to introduce the Chairman and Interim CEO of AdaptHealth, Richard Barasch. Sir?
Richard Barasch (Chairman and Interim CEO)
Good morning, everyone. Thank you for joining us today to discuss AdaptHealth's second quarter performance. To start our call today, I'd like to take a moment to welcome Crispin Teufel, who will be joining AdaptHealth on September first as our new Chief Executive Officer. Crispin brings many years of industry experience and a deep understanding of the markets in which we operate. His expertise and proven track record will be key to this organization's future success. We're excited to get him on board and look forward to you getting the chance to meet with him in the coming months. AdaptHealth is a full-service, nationwide provider of products and services that enable our patients to live their healthiest lives at home and in the community.
We have nearly 11,000 employees, including nearly 1,000 healthcare professionals, who work to bring these needed products for approximately 4 million patients. We know that we are crucial in the healthcare continuum, especially for post-acute care and management of chronic diseases like diabetes, OSA, and COPD. Most of our devices are connected and generate lots of useful data to help manage these chronic conditions and reduce downstream costs. We are now in the process of figuring out how best to use that connectivity for the benefit of our patients and our payer partners. Turning now to the details of the quarter, I'm pleased to report solid second quarter results, driven by strength in our core sleep and respiratory businesses, coupled with sequential improvement in our diabetes business and successful execution of cost savings initiatives.
Most notably, our non-acquired revenue grew 8.7%, and our adjusted EBITDA increased 14% year-over-year. We're also quite pleased with our improved cash flow generation in the first half of the year. The highlight of the quarter was continued growth in our sleep and respiratory product lines, which represent more than half of our total revenue. Building on the robust first quarter, these products grew a combined 15% year-over-year in the second quarter. Drilling down, the performance in our sleep business was driven by strong market demand, both new starts and resupply, as well as our improved ability to service this demand more efficiently. The investments we've made in this business line over the past year are now paying off.
We have enough equipment on hand to satisfy demand, and we've improved our processes in new starts, especially in resupply, an area of great strength for AdaptHealth. Industry data shows that we are the clear leader in sleep and have gained market share over the past year. Our respiratory line of business had its strongest patient acquisition quarter since the fourth quarter of 2021. We hit our set up expectations and we're starting to see stabilization in the length of time patients are on oxygen and vents, which had decreased during the pandemic. Turning to diabetes. After a very disappointing first quarter, we saw a modest rebound in our diabetes business in the second quarter. We acknowledge that we did not react swiftly enough to changing market dynamics and are committed to resuming growth in this crucial market.
Over the past three months, we've done a deep dive into all aspects of our diabetes business and have emerged with a solid plan to achieve results that reflect a growing market for diabetes supplies, especially CGMs and pumps. This plan, building on our existing patient census, which is the highest in our history, gives us a solid foundation upon which to grow. I'm going to highlight two specific areas of focus in our plan to regain our momentum. First, we are going to be even more intentional to focus on our government business, where the market for CGMs and pumps is large and growing. We're encouraged by recent decisions by Medicare and other government payers to widen their coverage of CGMs as a result of the emphasis on the medical benefits of compliance.
The government market is growing rapidly. We are generally able to achieve pricing that takes into account inflationary pressures. We've emphasized to our vibrant sales force the importance of government business and have already seen meaningful impact. Government-sponsored payers now represent 77% of our CGM census, an increase of 900 basis points compared to last year and up 200 basis points from the first quarter. We anticipate this trend will continue over the course of the year. As to the commercial business, we plan to update contracts to enable us to increase access to our current and new CGM patients, including through the pharmacy channel. We see this as an essential part of the strategy to offer full and creative solutions for our payer partners and patients.
We are employing the scale and capability of the entire AdaptHealth team to rapidly improve the operations of our diabetes business. One example is creating synergy between the HME and diabetes sales forces to take advantage of HME's national reach. Another is to use our world-class HME resupply operation to make it easier and more efficient for our diabetes patients to get their supplies, including through digital reordering. The diabetes line of business is crucial to the growth and strategic success of AdaptHealth. Sadly, diabetes continues to grow rapidly in our population, and we intend to expand our reach and services to help our patients manage this chronic disease. More to come on this important topic in future reports.
Subsequent to our earnings call in May, we announced a relationship with Humana to become the value-based provider of home medical equipment and supplies to their Medicare Advantage HMO members in 33 states, plus the District of Columbia. The program began on July 1, 2023. We are working hard on the implementation of this transformative arrangement. Based on our patient-focused culture, we've committed to high levels of customer service, which is a sign of the alignment that we've established with Humana. This value-based contract marks a significant step toward highlighting our essential role in keeping our patients healthy in their homes. We think this is an important new area of focus for AdaptHealth. We intend to pursue other similar arrangements. Like most businesses, we've been affected by increased labor and other costs. We are actively mitigating inflationary factors in several ways.
First, as we have done in the past, we are continuing to add and refine technology that reduces the costly administrative friction between our prescribers, patients, and payers. Among the most important KPIs we review each week is the percentage of e-prescribed orders that we process, which has grown meaningfully over the past year. Another tangible result of technology and process improvement is in our RCM function, which, as Jason will describe, has led to significantly reduced DSOs and better collections. Building on these technology improvements, we are also focused on additional cost-saving opportunities. As you know, we were an active acquirer in prior years and are now focused on achieving the scale of a much larger business.
As a result of this effort, we are confident that we will achieve the previously announced target of $25 million in cost savings, and we're continuing to examine our operations for areas of further improvement. I'll now turn the call over to Jason Clemens, our CFO, to review the second quarter financials and full-year guidance. Jason?
Jason Clemens (CFO)
Thank you, Richard. Thanks to all for joining our call today. I want to reiterate Richard's sentiment about the strength in our core product lines and the opportunities ahead of us in diabetes. Let me begin by reviewing our second quarter results. Our revenue of $793.3 million increased 9.0%. Our non-acquired revenue increased 8.7% year-over-year. Our second quarter results were led by strength in our sleep and respiratory product categories, both of which were up double digits. Taking a closer look at each of these product categories, our total sleep revenue of $303 million increased 16% compared to a year ago, driven by PAP equipment setups and consistent resupply operations. Our PAP equipment patient census grew 41% year-on-year. Our resupply orders are up 11%.
Respiratory delivered another strong quarter, with revenue of $154 million, an increase of 13% year-over-year. As mentioned, this was the strongest quarter of net patient census since the fourth quarter of 2021. Our diabetes revenue was up 2% over the prior year. The 13% year-over-year increase in CGM patient census was just enough to offset the expected decline in pump and pump supply orders. The strength in our government census helped offset the channel mix pressures in our commercial business, which strengthens our foundation for future growth. As we look forward to the second half of the year, we anticipate third quarter year-over-year growth to be in line with the second quarter and the fourth quarter to be somewhat higher.
Our adjusted EBITDA was $171 million in the quarter, an increase of 14% compared to a year ago. This reflects an adjusted EBITDA margin of 21.6%, a full point increase year-over-year, primarily attributed to execution of our cost management program. Cash flow from operations in the second quarter was $86.3 million. As expected, Q2 CapEx was 10.4% of revenue, compared to 10.6% a year ago, and 12% in Q1. For the first half, we generated free cash flow of $54.8 million, which gives us confidence in achieving our full year goal of between 3% and 4% of revenue. Turning to the balance sheet. We ended the second quarter with $45.1 million in cash.
DSOs of 41.2 days are trending in the right direction compared to 45.4 days a year ago and 42.7 days last quarter. We expect DSOs to remain at this level in the second half as we fully realize the benefits of refining our revenue cycle process and investments we've made in our technology and workflow. Our net leverage ratio at the end of the quarter was 3.54 times, down from 3.63 times at the end of the first quarter. We were very pleased with Q2 results, but there is still a gap to make up from Q1 expectations, so we are updating full year revenue and adjusted EBITDA guidance as follows: revenue of $3.16 billion-$3.20 billion, adjusted EBITDA of $650 million-$680 million.
We are maintaining our expectations for total CapEx between 10% and 12% of revenue and free cash flow between 3% and 4% of revenue. I would like to provide a little insight into the assumptions that support our guidance. We expect Q3 revenue to increase just over 5.0% year-over-year. Keep in mind that Q3 2022 is a tougher comparable period, as the top equipment supply chain eased considerably in the second half of 2022. We expect Q3 adjusted EBITDA margin to be in line with Q2. In terms of free cash flow, we continue to expect the third quarter to contribute modestly, and the rest of our projected free cash flow will come in the fourth quarter. We are making steady progress, and we're pleased with where we stand today.
We look forward to providing updates on our operational improvements and our Humana agreement as it ramps up in the second half of the year. With that, we will open the call for questions. Operator?
Operator (participant)
Thank you. At this time, if you would like to ask a question, please press the star and 1 key on your telephone keypad. You may remove yourself from the queue at any time by pressing star two. Once again, that is star 1 to ask a question. Our first question will come from Brian Tanquilut with Jefferies. Your line is open.
Brian Tanquilut (Equity Research Analyst)
Hey, good morning, guys. Congrats on the quarter. Jason, thank you for all the color and the guidance. Maybe as we look past, you know, kind of like the normalization trend that we're, we're hopefully seeing through the rest of the year, how are you guys thinking about, you know, what the normalized growth rate should be for the diabetes business as all the moving parts click, you know, with the shift to government and the, what do you call it, the channel shift within commercial as well?
Jason Clemens (CFO)
Sure, Brian, good morning. You know, I'll offer a few points of contact. First, if you look back to our Capital Markets Day, last September, you know, our, our view was that by 2025, our diabetes product line would be delivering mid to upper single-digit growth, and we still think that's true. Now, the path that we estimated back then versus today is, is a different one. You know, we saw growth gliding down from mid-teens to low-teens to, to kind of that final resting place, if you will. In fact, what we're seeing is trends and headwinds face us just sooner than we expected.
I mean, you know, pumps has been a continued pressure point, also a big opportunity, we think, going forward, but a big pressure point with the OP5 release, with their tubeless technology. You know, we estimated that this would be a $9 million-$10 million a quarter headwind over the course of 2023 as compared to prior year. We saw that in Q1. We again saw that in Q2. You know, spot on at, at, at that level, and we believe that'll continue for the course of the year. What we're guiding is our view that we will grow through that, you know, with modest, low single-digit growth on each quarter for the balance of the year.
You know, we think we'll add a couple of points in 2024, and, and then move back to that, that longer term growth rate as, as the opportunities in front of us, you know, that we, we capitalize on them.
Brian Tanquilut (Equity Research Analyst)
All right, got it. As we think about the, you know, likely return of Philips potentially in the market in the next, you know, few months or so, how are you thinking about, you know, what that could do as I think about maybe 2024 in terms of potential margins and just incremental growth for the industry or even specifically for Adapt?
Jason Clemens (CFO)
Sure, Brian Tanquilut. You know, I'll take the second part first. You know, the, the, the re-entry of Philips, you know, to the marketplace, I, I, I think would be welcomed by all market participants, I, I think by providers, by, by, by, by distributors, by, by patients. You know, if, if when they come back, we believe they will, but we, you know, we continue to think it's, it's up to six months after the estimates that are out there in the street. In other words, we're not counting on it. In terms of margins or growth, you know, we're at a point today that, that our supply chain is healthy.
I mean, we're getting the product we need when we need it to get on our patients with the consistent demand that we've seen in the sleep business. You know, we don't think that more product really changes that. Now, you know, you can get into price and will that, will that drive change within price? I mean, we think it's logical to think so, but, you know, we'll have to let that play out, you know, once there's more availability on the market, and we'll enter those negotiations with the PAP manufacturers that we want to enter with.
Brian Tanquilut (Equity Research Analyst)
Got it. Jason, if I may squeeze one last quick question. Just any way we should be thinking about the Humana contract? Obviously, big headline, big, big contract, big client, but how should we be thinking about the benefit of that? I know you said it'll be in the P&L beginning in the back half of the year, but just as a whole, you know, just to put some context around the contract. Thanks.
Jason Clemens (CFO)
Sure, sure. You know, we're very excited to be already rolling in our new Humana relationship. You know, again, it's over 1 million patients that have come online that, that we're managing their DME need, their DME needs across the product lines of sleep, respiratory, and HME. It excludes the diabetes product line and the supplies to the home product line. We think there's opportunity there in the future, but, but this contract excludes those lines. You know, when we report Q3, you know, we should expect to see sequential growth in those three categories. I mean, that, that's where the growth will come from for these, for these Humana patients.
It's early, we're working through conversions, just, you know, a heavy lift that we're, we're integrating at the moment. We're being very cautious on specific number expectations for the contract, but it is all fully baked inside of our, our guidance that we, we refreshed this morning.
Brian Tanquilut (Equity Research Analyst)
Awesome. Thank you.
Operator (participant)
Thank you. Our next question will come from Eric Coldwell with Baird. Your line is open.
Eric Coldwell (Senior Research Analyst)
Thanks very much. good morning. Just one quick one on Humana, and then I have a, another, set of questions. On, on the, equipment, buy-ins, if you will, what, what is the thought process? You, you maintained your cash flow, so I'm assuming it's not a big deal, but, what is the outlook for, needing to go out and, acquire equipment for the, onboarding of the Humana patients? Then, I have a follow-up. Thanks.
Jason Clemens (CFO)
Sure. Good, good, good question, Eric. Yeah, I'd first note that, you know, our, our CapEx, as a percent of revenue for the quarter, was within our expectations. You know, we reported 10.4% of revenue. That's actually down a couple of bits over the second quarter of last year, as expected, it's down considerably from Q1, when we had reported, you know, our intention to load up on PAP, on respiratory, on, on other patient equipment. You know, some of that was invested to go after what we see as a very large and growing sleep market and to continue winning share, we believe we had, as, as, as Richard mentioned. Then secondly, was in preparation for this agreement.
you know, we're, we're confident that the revenue that will come online with Humana, that it won't, you know. The profile of that, in terms of the CapEx need, will be consistent with the rest of the business. you know, in other words, we believe that our 11% midpoint for CapEx, that we feel very good hitting at or below that number for the year.
Eric Coldwell (Senior Research Analyst)
Got it. Thank you. My other question was about another initiative that, Jason, you've had internally, which is, as you've gone through system upgrades and consolidation of various activities in the company over the last couple of years. One area that I believe was still a bit behind was the processes, people, paper, manual activities going on in your warehouses. I know you had an initiative to upgrade systems and invest in digitization and technology in those warehouses to improve your automation and process. I'm curious if you can give us a status check on where you are with that and what's left to come. Thanks.
Jason Clemens (CFO)
Sure, Eric. We're happy to report we went live last Tuesday. This is a full integration with Oracle Cloud and the, you know, the hardware and the tech in the warehouses that, that comes with it to create a full, you know, warehouse management system. We've had great success. Of course, you know, running the, you know, daily issues, logs, and everything else you'd expect that, that come with these implementations. What's really exciting is, you know, the data that we've now got at our fingertips on for each warehouse worker, you know, the number of picks they're running per hour and per day. We know specifically what they're picking. We know specifically what's, you know, patient returns, what's coming back, you know, across our entire diabetes platform.
It's only been a week, but it's been a good week. You know, we are targeting a handful of important, of, of important sites within the HME portfolio in Texas, that we're aiming to go live early Q4. That work is underway. You, you know, the way to think about this from an efficiency standpoint, the, the, you know, the AI embedded in Oracle on mins and maxes and, you know, ordering thresholds based on your demand plan, you know, that is all in process of getting turned on. Eliminating a more than a fair amount of cost there, as well as squeezing the inventory that's on the balance sheet. You'll note a tick down in our inventory.
You know, we, we are charging our, our teams to continue to focus on running turns faster and getting, getting cash out of the balance sheet. You know, we'll report more to come on that. Finally, you know, the ability to, to fully integrate and consolidate these sites is now unlocked. You know, we've taken out a lot of locations as part of our cost management program, that I'm sure we'll talk about later, over the course of 2023. This really gives us an ability to unlock that value, now that, now that we've got, we've got the technology, turned on. You know, in terms of returns or more cash, you know, changes to our free cash flow estimates, you know, think of this as 2024 money, if you will.
You know, we're spending the money this year to get the technology installed, we do believe that our, you know, our free cash, generating power is going to increase, as, as, as part of these efforts.
Eric Coldwell (Senior Research Analyst)
Thank you very much. Appreciate the answers.
Operator (participant)
Thank you. Our next question will come from Matthew Blackman with Stifel. Your line is open.
Matthew Blackman (Analyst)
Good morning, everybody. Thanks for, for taking my questions. I've got 2 maybe to start on, on diabetes. Jason, just hoping for any insight you may have, specifically on CGM volume trends, in particular with basal coverage now. Have you seen any step up in, in patient adoption, post reimbursement? I guess a follow-up there, I think I heard you say 77% government payer mix in CGM. What's the reasonable ceiling for that metric? I've got 1 guidance follow-up.
Jason Clemens (CFO)
Sure, Mathew. Reasonable ceiling? I don't know, probably halfway from 0 to 100, could be reasonable. I'd say, in, in terms of, in, in, in terms of CGMs, in general, you know, I'd say that, that we're very happy with the census growth. You know, in this quarter, we, we hit a record census volume for diabetes and, and for CGM. Of course, you know, our, our government book is, is growing faster. That's quite intentional, as Richard described in the opening remarks. You know, harnessing the power of our, you know, 700 person strong sales force across the country, to, to sell all products. I mean, that, that sounds easier than it is in terms of training, enabling, equipping.
You know, it's a, it's a different sale, different sales cycle. You know, our teams are continuing to grow the cross-sell, and, and again, that cross-sell is, is pointed directly at the government business, which we think is, for us, is, it's good business, it's strong, it's healthy, and it's... Your basal comment, it is growing. You know, I think like DexCom, it's early. We, we won't put numbers on that. You know, it's, it's just very, very early. You know, we do think that TAM is somewhere between 3 million-4 million patients of basal, basal patients. You know, we agree Medicare is open for it, and, you know, the commercials are, are, are well over 50% adoption there.
It's, it's really early innings, and, you know, we haven't, nor will we include any expectations on basal or, you know, in our guide, for, for 2023.
Matthew Blackman (Analyst)
All right. I appreciate that. Then just as we reflect the, the new revenue guidance in our models, how should we think about which segments revenues should move lower in? Is it isolated to any in particular, or is it sort of broad-based? Just any help on, on sort of segments.
Jason Clemens (CFO)
Yeah, sure. Sure, Matt. Across the product categories, you know, I'd say firstly in diabetes, you know, very modest growth in Q2 at 2%. We think that's about in line in Q3. You know, we're hopeful it's up a touch. Could it be a point? Could it be 2? Maybe. In Q4, that's, you know, that's what we're thinking. If you look at supplies to the home, you know, you'll see that year-over-year growth has been, you know, low to mid-teens, each quarter now for 4 quarters. The reason for that was the, you know, value-based arrangements that Josh, you know, executed and spoke about a year ago.
You know, now, you know, as we enter Q3, we are lapping those arrangements, and so expect supplies to the home to come back down to, you know, a very low single digit growth rate. Could it be 2? Could it be 3 in that, in that ballpark? Thirdly, you know, I'd, I'd note on the HME book of business, as we've reported previously, we, we have changed sales incentive to focus on ePrescribe. You know, ordering, that is absolutely working, as our ePrescribe is up pretty considerably in DME. With that comes just cleaner orders, you know, cleaner claims, you know, better margins in terms of processing and servicing.
You know, so that'll give you a perspective on, you know, some of the lower growers, if you will, and then, you know, rounded out by, you know, continued, performance, we think, in sleep and respiratory to round out the rest.
Matthew Blackman (Analyst)
Really helpful. Thank you so much.
Operator (participant)
Thank you. Our next question will come from Peter Chickering with Deutsche Bank. Your line is open.
Kieran Ryan (Analyst)
... Hi there, guys. You've got Kieran Ryan on for Peter. Thanks for taking the question. Another, another solid quarter on, on the sleep side. I was just wondering, are you still seeing any of those issues on kind of the new start logistics side, that it's kind of limited the new starts despite record backlog, or, or is that starting to, to work itself out at this point?
Jason Clemens (CFO)
Yeah, good, good question. It has, it has not just started to work itself out, but we're feeling, we're feeling very good about, about the movement of product. You know, I tell you, in the summertime, I mean, as usual, setups are a bit soft. You know, folks on vacation, providers on vacation, holidays, things like that. You know, nothing out of the ordinary, other than what we'd expect over, over the summertime here.
Kieran Ryan (Analyst)
Got it. Thanks. Then, and then on the, on the Q2 margins, obviously came in nicely ahead of your expectations. I, I think in 1Q, when you, when you kind of guided to that just under 20%, you'd said that that did include the benefits from the cost savings program. Should we just read the upside as being pretty much purely related to the rebound in diabetes there?
Jason Clemens (CFO)
I, I, I wouldn't say that the margin improvement is due to the pure diabetes rebound. I mean, keep in mind, the diabetes product lines come at, come at, you know, the, the, the lowest margins across the product catalog, you know, as we've reported, several times. Y- you know, really what we're seeing is the strength in sleep and respiratory. y- you know, I mean, tho- those products together, I mean, represent almost, almost 2/3 of our business, and they're, they're performing well, they're healthy. y- you know, it's, it's all systems go, and, and, and that's really helping, helping the margin improvement with the addition of the, you know, the cost management programs that, that, that we discussed.
Kieran Ryan (Analyst)
Thank you.
Operator (participant)
Thank you. Our next question comes from Joanna Gajuk with Bank of America. Your line is open.
Joanna Gajuk (VP, US Equity Research)
Good morning. Thanks so much for taking the question here. I'll get first on the, on the Humana contract. I know it's early, right? It just started, a little bit more than a month ago, July first. Can you talk about, you know, how progress has been in terms of the transitions and of the 1 million patients you're talking about, are these, the vast majority are new? Also with that, do you need additional infrastructure to support this contract? You know, trying to get a sense of, you know, the margin profile of, of that business versus your kind of, you know, legacy business.
Jason Clemens (CFO)
Sure, Joanna. You know, a couple of infrastructure investments that we've made. You know, it, it was important to us, upon entering this, this, this new arrangement, you know, this, this new relationship with Humana, to, to really overcloud it and, and invest in, the customer service aspect. You know, we've, we've done that. We've, we've stood up a dedicated, you know, onshore call center, specific for, for these Humana patients. We have, you know, doubled down within our, within our sales force. I mean, the, the number of referral points that, you know, this arrangement opens up is considerable. You know, lots of new referral points that frankly, we haven't heard, a referral from, in some cases, ever, or, or in other cases, in, in a very long time.
You know, that's, that's taking resource to, you know, to crack open those doors and to, and to start, you know, to start taking care of the patients in those provider groups. So that's really on the, on the, in terms of the, the, the infrastructure side. I'd say again, on CapEx, we, we discussed earlier, I think with Eric, that, you know, we're comfortable with our CapEx projections, with our utilization projections, in terms of servicing the contract. You know, really it's all about, you know, again, that, that high touch, taking care of patients, you know, reporting, you know, new SLAs to Humana around operational metrics, turnaround times, and the such. You know, patient satisfaction is, is just paramount here.
Of course, that helps, y- you know, the, the MA payers, as you know, with, with a variety of things, including reimbursement, to, to get those, those patient satisfaction scores, up. You know, that's what we're focused on doing.
Joanna Gajuk (VP, US Equity Research)
Again, if I may, I guess a related question on the diabetes, right? You're talking about the shift to the government business, and it, it is a lower rate in commercial. I, I assume a, a, a lower margin right there. You know, how do you think about this business going forward in terms of the margin profile? You just said it's, you know, traditionally been below the, you know, other products in your portfolio. Then, will you adjust cost structure for the change, or I guess, if that's part of the program that you had already announced in terms of the cost savings and, you know, in response to those changes in the diabetes business?
Jason Clemens (CFO)
Yeah, that, that's right, Joanna. There are some, y- you know, intermediate term, you know, less than 12 months, you know, cost management focuses that, that the technology is enabling. Of course, we'll be, you know, we'll be happy to, you know, to execute on that and, and, and increase margin profile. You know, I'd say in general, the, y- you know, the government book of business has been large at Adapt, since we started in, in diabetes. Some of that was just the, the nature of the businesses we bought and their profiles, you know, heavily within the type 2 diabetes space. I'm sorry, the type 1, I'm, I'm mixing up. The type 1 diabetes space, which, which we all know is, you know, is, is very heavily concentrated with, with DexCom products.
You know, the type two space, we are growing, you know, again, through our primary care sales force, you know, the DME sales people that we've retrained and, and enabled to go after new business. You know, we, we do expect to continue growth of, you know, what's already a very large government book of business, and, and we're, we're, we're thrilled to take that business. You know, we're, we're, we're very pleased with the money, and particularly with the free cash flow that those that those businesses generate for us. You know, margins and margins are in very good shape. You know, this is more about growing through the pump headwinds that we've reported, as well as growing through the payer mix trends that, that again, we've, we've reported.
I mean, this, this is our plan to, to, to again, grow, grow through these things, and, and if we execute, you know, margin will be just fine.
Joanna Gajuk (VP, US Equity Research)
Thank you. If I may, just the last follow-up, since you mentioned the government business and you've been, I guess, exposed to that in other, in other parts of the portfolio. Just quickly, outlook for Medicare rates and specifically competitive bidding, and where the expectations are there. I mean, clearly, CMS put the program on pause when it comes to competitive bidding. You expecting any announcement later this year for a 2025 competitive bidding? Any kind of views in terms of new categories that will be included in there? Thank you.
Jason Clemens (CFO)
Yep, good question, Joanna. You know, as, as you said, you know, the CMS formally postponed competitive bidding. You know, we don't, we don't believe that competitive bid will go away forever. You know, frankly, Adapt has, has benefited from these programs over the year. We think, you know, patients and providers and, and certainly the taxpayers have benefited from these programs. You know, we don't think that it, it, you know, will go away. Timing is very hard to predict on this. I mean, you know, some context might be just the complexity in running the program. When you've got, you know, hundreds and hundreds of MSAs all over the country with thousands and thousands of products.
You know, what we believe is, is, is between 5 and 6,000 remaining providers in the space, the DME companies in the space. You know, they'll accept, you know, essentially 10 bids, you know, many more will bid, and so it's a big, you know, big calculator down at CMS, I guess, that, that runs all the data through. You know, that administrative side is, is, is not, is not a fast or easy process. You know, in order to meet a 2025, you know, go live, if you will, for, for another competitive bid program, you know, things, things need to get rolling, you know, in terms of the bidding process and everything else. That's more context.
I mean, we won't speculate on, you know, what, what will happen next, but, you know, we think we position our business well, you know, regardless.
Operator (participant)
Thank you. As a reminder, that is star one to ask a question. Our next question will come from Kevin Caliendo with UBS. Your line is open.
Kevin Caliendo (Managing Director, Senior Equity Research Analyst)
Thanks. Thanks for taking my question. Richard, I want to ask, you know, we're 1 month away from Crispin coming in and taking over as CEO. Maybe give us a little bit on, on the process and, and Crispin's background and sort of what you expect him to bring to the table when he starts in 1 month.
Richard Barasch (Chairman and Interim CEO)
Kevin, thanks. You know, obviously from Crispin's background, he brings a great deal of experience in the businesses that we are in, and we felt that it was very important to bring someone in who could hit the ground running to, you know, to just help us get to be a better company. Blocking, tackling, administrative, we're, we're doing a lot of great things. He can help us further those. He's financially oriented. He came up through finance in his prior organization, and we expect that he will tighten down or even greatly improve financial processes over the next several months. It's really, it's really a hire to make us a better company.
Kevin Caliendo (Managing Director, Senior Equity Research Analyst)
Do you think there's an opportunity with him in place to take share? Obviously, he was running one of your competitors. Yeah, a lot of those relationships are, you know, at the personal level. Is that an opportunity set? Is that something we should be contemplating, or is this coming in and this is more about executing X's and O's and the like?
Richard Barasch (Chairman and Interim CEO)
It's, it's about executing the X's and O's in our business. you know, we, you know, we are very respectful of Crispin's prior, prior employment and will not do anything to jeopardize anything that he has ever done in that company from a confidentiality perspective. we have to be, you know, on, on the, on the greater side of, of caution there. what we do expect is for him to help us be a better company.
Kevin Caliendo (Managing Director, Senior Equity Research Analyst)
Fair enough. That's super helpful. Thank you.
Operator (participant)
Thank you. At this time, there are no further questions in the queue, I'd like to turn it back over to management for any additional or closing remarks.
Richard Barasch (Chairman and Interim CEO)
Thanks, everyone, for joining the call this morning. We look forward to talking to many of you to give you even some more detail on what was a very, very positive and encouraging quarter for AdaptHealth. Thank you very much.
Operator (participant)
Thank you, ladies and gentlemen. This does conclude today's program, and we appreciate your participation. You may disconnect at any time.