American Well - Q3 2023

Transcript

Operator (participant)

Good morning, good afternoon, and good evening. My name is Aaron, and I will be your conference operator for today. At this time, I would like to welcome everyone to the Amwell Q3 2023 earnings call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question-and-answer session. If you would like to ask a question during this time, simply press star followed by the number one on your telephone keypad. If you would like to withdraw your question, press the pound key. We do ask that you please limit yourself to one question per time. Thank you. I would now like to hand the call over to Sue Dooley, Head of Investor Relations with Amwell. Sue, you may begin.

Sue Dooley (Head of Investor Relations)

Hello, everyone, and welcome to Amwell's conference call to discuss our third quarter of 2023. This is Sue Dooley of Amwell Investor Relations. Joining me today are our Chairman and CEO, Dr. Ido Schoenberg, and Bob Shepardson, our CFO. Earlier today, we distributed a press release detailing our announcement. The release is posted on our website at investors.amwell.com, and is also available from normal news sources. This conference call is being webcast live on the Investor Relations page of our website, where a replay will be archived. Before we begin our prepared remarks, I'd like to take this opportunity to remind you that during the course of this call, we'll make forward-looking statements regarding projected operating results and anticipated market opportunities. This forward-looking information is subject to the risks and uncertainties described in our filings with the SEC, and actual results or events may differ materially.

Except as required by law, we undertake no obligation to update or revise these forward-looking statements. On the call, we'll refer to both GAAP and non-GAAP financial measures. A reconciliation of GAAP to non-GAAP financial measures is provided on our posted earnings release. With that, I would like to turn the call over to Ido.

Ido Schoenberg (Chairman and CEO)

Thank you, Sue, and hello, everyone. In Q3, our business moved forward in three important ways. We won a striking new opportunity supporting the United States federal government, specifically the Defense Health Agency's Digital-First Initiative across the Military Health System. We are excited by this important validation of our new Converge platform and the expanded opportunity it awards us. We also accomplished our goal for client migrations and reached our metric of 50% of visits on Converge, a quarter ahead of schedule. In addition, we made significant progress in transforming our growth organization to maximize the commercial impact of our solution. Finally, we demonstrated the value and benefits of our approach through compelling customer testimonials. I'd like to take some time to go into each of these highlights.

The standout event of Q3 was the previously announced $180 million task order awarded to the Leidos Partnership for Defense Health, which includes Amwell. Together, we aim to modernize and provide digital health enablement to DHA providers and patients. Let me jump right into some details I can share. With the Leidos Partnership, Amwell was selected to power a multi-year transformation as part of DHA's Digital-First Initiative. This award followed a rigorous, data-driven evaluation process, and our Converge solution emerged as uniquely qualified. The award demonstrates our market leadership position as an enabling digital transformation partner. It also extends our TAM, expanding our reach into the government and public sectors. This is a major event in our company's history that increases our revenue visibility and fortifies our path to profitability.

After the initial phase next year, the enterprise rollout outlined in the task order would place the U.S. government among our largest customers, with a very substantial weighting in recurring software revenue. Work has already begun. Roy, myself, and our entire team are so proud of this exceptional opportunity to serve this very special group of people. Bob will provide you with more on this in a moment. Continuing with highlights of Q3, we drove a steady pace of client migrations. Over 50% of our visits were completed on Converge in Q3, up from 43% last quarter. We achieved this milestone a quarter earlier than our plan, propelled in part by our strategic payer client that went live late in Q2 and continued to scale rapidly and drive healthy volumes in Q3.

With over half of our volume now on Converge, the data is confirming that our new platform is a game changer. Migrated clients consistently scale rapidly and report high provider and patient satisfaction metrics. Continuing with the theme of solid execution, we are deep into our efforts toward the payer migrations that will start to go-live early next year. Q3 was a very active quarter for us. Here are a few additional examples of our success. We also announced a partnership with Nestlé Health Science. The partnership leverages our automated patient journeys with Nestlé's expertise in nutrition. The first of several programs is for patients undergoing major surgery. On Converge, providers will be able to deliver Nestlé content to better prepare patients for surgery, aiming to improve outcomes while minimizing length of hospital stays, lowering risk of surgical complications, and reducing costs.

In yet another notable booking, we had a strategic win with a new Medicare Advantage program in Georgia. This client is looking to add differentiation in the market and fuel their growth initiatives by building out their hybrid care offering to include behavioral health. Turning now to our growth transformation, we are taking swift action, and these efforts are well underway. Here are some of the initiatives we have in place to expand pipeline and drive deal velocity, as well as overall efficiency. We completed the summer of learning, and we are hiring and upskilling with precision, assigning proven leaders to key growth teams, including strategic accounts, sales, and sales operations. We are putting in place the data and rigor that enables our team to focus our sales initiatives on the key segments where we see high subscription software content, high profitability, and right to win.

We realigned our product solution leaders within our commercial organization to enable faster go-to-market for new products. Finally, we also streamlined and rationalized our commercial headcount, supplementing our ongoing corporate cost reduction initiatives. I'm proud of our teams. We believe these changes are already fueling the sales discussions that will provide the foundation for long-term partnerships, high customer value, and retention. In that spirit, we were active at Becker's and Oracle Health conferences during Q3. We also held two of our own virtual forum meetings targeting the provider and payer markets. These are important demand generation events for sharing our vision and the benefits of our approach. Here are some of the customer testimonials we shared.

With our hybrid care programs, AU Health's Candler County Hospital drove a 35% increase in net revenues and a 50% reduction in transfers, resulting in a positive operating margin in fiscal year 2022. Northwell Health continues to provide a shining example of focusing on engaging patients to improve outcomes. Northwell's expanding use of our automated programs now extend to 35 specialties, addressing many operational challenges with powerful results. For example, with our automated programs, Northwell reduced colonoscopy no-show rates by 48%, capturing 800 more procedures and $1 million in additional annual revenue. They reduced readmissions by 32%, closed gaps in care in 69% of the interactions, and identified high-risk pregnancies in 16% of routine automated monitoring interactions. And importantly, by leveraging automation, Northwell is aligning providers to focus more on patient care, boosting staff satisfaction and retention while increasing productivity.

Finally, our virtual nursing discharge solution is delivering for clients. In the first months of deployment, University of Pittsburgh Medical Center successfully completed over 1,300 virtual discharges, saving about 40 12-hour nurse shifts while registering high patient satisfaction scores. We are rapidly documenting and sharing these client success stories through case studies, webinars, and events. We believe these proof points will inspire other clients and prospects to view our Converge solution as a must-have. I would like to close my remarks with a brief comment. Today, we have a front-row seat as we partner with the most strategic players in healthcare as they strive to own and optimize the patient and provider experience. After years of internal investing and struggling with fragmented IT assets, healthcare organizations are increasingly turning to us.

They recognize the value of a partner who can speed the path to the right hybrid care modalities to achieve their goals. And with our DHA win, we added yet another name to the strategic clients that are choosing Amwell as their partner. As I think about our company, I believe we are at a turning point, leaving behind us many of the risks of replatforming and rapidly putting in place the strategies to pursue our market opportunity and realize profitable growth. We have shared many green shoots with you tonight. As we emerge from this time of transformation, it is clear from our vantage point, the market is moving to us. With that as context, I would like to turn the call over to Bob to review some of the DHA specifics, our Q3 financials, and key metrics, plus our guidance. Bob?

Bob Shepardson (CFO)

Thanks, Ido, and hello, everybody. I would like to walk you through a few operating metrics and financial results from the third quarter, as well as our guidance. Then I'm eager to provide you with some more context regarding our DHA win, building on our press release issued last month. While our financials continue to reflect our transition to Converge, our business moved meaningfully ahead this quarter in terms of client migrations, our growth transformation, normalizing, rationalizing costs, and of course, the DHA win. To review, we ended the third quarter with 104,000 active providers, flat compared to a year ago. This represents a slight decline from last quarter, as during replatforming efforts, temporary declines can occur.

We continue to view active providers as an important indicator of the sustained value our clients see in our platform, and we anticipate that our number of active providers will increase as we migrate existing and implement new clients onto Converge. Total visits were approximately 1.4 million in the third quarter, about equal to last year. Scheduled visits represent, represented 65% of the total, in line with our experience over the last few years. As it relates to visit volume patterns, we continue to believe that we are returning to more typical seasonality, with second and third quarters lower than the first and fourth, which was less apparent during the pandemic. We continue to make good progress, successfully migrating our clients to the new platform.

In Q3, successful migrations drove visits on Converge for the quarter to 50%, up from 43% in the second quarter, and crossed the 50% threshold one quarter earlier than our target. As Ido said, payer migrations have begun. Given payer visits are tied to the enrollment cycle at year-end, we expect to see payer-related visits transition to Converge beginning early next year. Total revenue was $62 million for the quarter, about flat to last quarter and down 11% from a year ago. Approximately 50% of that decline in revenue versus last year was subscription-related, driven primarily by legacy platform declines, with the balance split between lower visit and services and Carepoint's revenue. Subscription revenue was $28.4 million in the third quarter, up slightly from Q2.

AMG visit revenue trended 7% lower than last year and was $26.7 million. AMG visits were 8% lower versus the third quarter of 2022, reflecting a return to normal seasonality, with last year elevated due to COVID-influenced volume. Average revenue per visit was slightly higher than last year at $77, driven by better urgent care pricing. Our services and Carepoint's revenue was $6.8 million for the quarter, which represents an increase of 8% from last quarter, driven primarily by growth in marketing services. These revenues are lumpy from quarter to quarter due to customer buying patterns for our marketing programs and for Carepoints, as well as the timing of professional services that precede deployments.

Turning to profitability, our third quarter gross profit margin was 35%, down from 39% last quarter and 40% last year, largely on a revenue mix shift away from higher margin implementation services to marketing services, which are strategic to our clients, but lower margin. Turning to operating expenses, we are applying ongoing cost discipline across our company. We are tracking well on our path to R&D normalization. While GAAP R&D expense was 7% higher versus last quarter at $27.7 million, it was 16% lower after adjusting for $7.1 million of capitalized software costs in the second quarter. This was 24% lower than the third quarter of last year.

As we have discussed, we believe that the fourth quarter of 2022 represented our peak R&D spend, and that we will exit 2023 with an R&D spend down mid 20% from this level. Sales and marketing spend declined 5%, and G&A expense was 19% lower this quarter compared to last quarter. We continue to expect SG&A to decline approximately 10% overall for the second half versus the first half of 2023, primarily due to lower stock-based compensation expense. As Ido outlined, we are streamlining and rationalizing our commercial headcount in keeping with the growth changes. We do not need to spend more in SG&A to achieve our growth goals, and there is healthy operating leverage as we scale. Adjusted EBITDA for the quarter was -$38.5 million, a 15% improvement on last quarter.

Also, we recorded a non-cash goodwill impairment as a result of the decline in our market capitalization as compared to the carrying value of our equity as of September 30. In arriving at this amount, we estimated the fair value of our equity based on our market capitalization and a related control premium. As a result of this interim quantitative impairment assessment, we recorded a $79 million non-cash goodwill impairment charge. Transitioning to the balance sheet, we ended the third quarter with $418 million of cash in marketable securities. We have a substantial cash position, which provides us ample resources to complete the transformation of our company with Converge and take us to profitability with a substantial remaining balance.

Concluding my review of our financials and turning to our outlook, we continue to believe that revenues for 2023 will be within our guidance as shared on our second quarter call. I would like to speak for a moment on how we are thinking about our EBITDA in the fourth quarter. Regarding the DHA, we have a rapid deployment timeline for this critical work, and our work is underway. This spend is incremental to our prior assumptions for the fourth quarter, underlying our adjusted EBITDA guide for the year....

We expect this investment will be in the area of $2 million in the fourth quarter, and as such, we are adjusting our prior 2023 adjusted EBITDA guidance by $2 million to a loss of -$162 million to -$167 million from a loss of -$160 million to -$165 million. We view this incremental spend as a high priority as we undertake the important development and deployment work with our Leidos partners and the DHA to build and deploy Converge for the Military Health System. With my financial review and guidance complete, here is some additional detail on Amwell's important role in the DHA's digital-first initiatives and the powerful catalyst this win represents. We are honored to have been selected to support a multi-year transformation of DHA's care delivery model.

The task order awarded to the Leidos partnership has a 22-month period of performance and is valued at up to $180 million. It includes several parties in addition to Amwell. Under the agreement, the partnership in Amwell will deploy multiple automated care and digital behavioral health solutions and replace the legacy Military Health System Video Connect capability with Amwell Converge, starting with an initial phase during 2024, followed by a full enterprise rollout. Amwell represents a meaningful portion of the task order allocation, but we are not in a position to disclose specific amounts related to Amwell or any other partner. However, I can share today that Amwell's total allocation of the task order is sizable and includes predominantly software revenue. In the initial phase, it also has professional services component related to deployment.

This win meaningfully adds to our total addressable market, extending our reach into the U.S. government, healthcare, and public sectors. To provide some additional context, our subcontract with Leidos was finalized quite recently, and so there will be no revenue impact on Q4. But the initial five-site deployment does add to our visibility as we consider next year's guidance, which we will share in February. There are a few important things to keep in mind regarding scope and timing. The initial phase of deployment, standalone, fortifies our long-term model and positively impacts our cash position. The enterprise rollout outlined in the award would involve a meaningful expansion comprised of nearly all recurring subscription software revenue. As Ido mentioned earlier, this would place the U.S. government among our largest customers as early as 2025.

Regarding the enterprise-wide potential, DHA has a beneficiary population of roughly 9.6 million service members, retirees, and family members, and manages authority, direction, and control of nine medical centers, 36 hospitals, and 525 clinics across their global enterprise. I would like to take a moment to share what we can about the investment associated with this effort, which further supports our commitment to the government sector. Together with a partnership, we will build and deploy a secure, comprehensive, and integrated platform that will be configured for operation in the accredited government cloud infrastructure. Upon go-live of the initial phase of deployment, the platform will be fully scalable and ready to deliver complete hybrid care across the entire enterprise without additional future development required. The investments associated with the initial phase will continue through 2024 and are incremental to our planned R&D spend.

Importantly, the initial phase of deployment is cash flow accretive on its own over the 22-month period. As we proceed into the enterprise rollout, we will try to provide updates as specific milestones are behind us. Wrapping up, we are honored and privileged to have been selected to serve this important community. Building on the validation we have from other major players in the healthcare industry, like Elevance, CVS, and others, the DHA can be a powerful catalyst for us as we exit our time of transformation to Converge. To briefly summarize, we are encouraged by progress in our business. We have strong validation of our approach, success migrating clients, and we believe we have the right initiatives in place to enable our growth organization.

As we enter the fourth quarter, bolstered by the potential that our DHA win represents, we are confident that our broader growth initiatives will advance us along our path to profitability. Thank you for listening. With that, I'd like to turn the call back to Ido for some closing remarks. Ido?

Ido Schoenberg (Chairman and CEO)

Thank you, Bob. With Q3 behind us, we are focused on three key areas of execution as we look to close out the year in a strong position, setting up for 2024. First, we are finalizing our growth transformation. Second, we will continue migrating clients on to Converge. And finally, working with our LPDH partners, we are beginning the important deployment work supporting the DHA's Digital-First Initiative. Before we take your questions, I'd like to share an insight from our time spent with clients in the market this quarter. Healthcare remains one of the final frontiers for optimizing through technology. It's still early days for our industry as we evolve towards Hybrid Care delivery, but we believe the industry is ready for this change. At Amwell, we are driven every day to inspire and enable our clients to evolve their approach to Hybrid Care.

... As we pursue our mission and drive toward profitable growth. With that, we are ready to conclude our formal remarks. Thank you for listening today. Operator, please open the line for questions. Thank you.

Operator (participant)

Thank you, Dr. Schoenberg. Ladies and gentlemen, at this time, I would like to remind everyone that in order to ask a question, please press star and then the number one on your telephone keypad. We'll pause for just a moment to compile the Q&A roster, and as a reminder, we please ask that you limit yourself to one question per time. We will go ahead with our first question from Craig Hettenbach from Morgan Stanley. Your line is open.

Craig Hettenbach (Executive Director)

Thank you. Congrats on the DHA win. You know, in particular, in terms of the rigor of the evaluation, is there anything else you can share in terms of any, the amount of solutions besides Amwell that they evaluated, and what you think gave you the biggest edge to clinch that deal?

Ido Schoenberg (Chairman and CEO)

Hi, Craig. Sure, I'll try to give more color. This was. We've known the DHA for a long time. We started to serve the U.S. Navy five years ago, and we participated in numerous pilots. This effort was relatively short, but very, very deep evaluation, very robust. The nature of the way that the prime contractor works is such that we are not privy to other options and the vendors, and we are not able, even if we known, to share that. But I can share with you that they did look at every detail, and the plan for deployment is there.

What they did share with us during the award process and the selection process is that they were very impressed with our maturity and track record. We serve very, very large clients and strategics in their size and even bigger. I think they liked a lot of the elements of the technology. Of course, this call is way too short to describe the list. It's pretty long. I can give you just one example maybe. We are able to have a dynamic scheduling for a provider.

We call it a dynamic provider queuing, and that allows, when this system is deployed, globally, for a sailor in Hawaii, to seek care, very close, if it's available, but if not, based on multiple fairly complex rules, we can expand the reach really anywhere around the globe and make sure that they have a much better access, to care. In addition to that, the DHA and MHS were very vocal, including the Secretary of Defense, Lloyd Austin, and the director of the DHA, Telita Crosland, about the importance of taking care of people. They call it, TCOP. And they talked much about the crisis in access to behavioral health services, to chronic care, to wellness, and we have all that.

So the comprehensiveness of the offering in the Converge matched very well the need of the clients. I would add maybe one more element. This is really a partnership that includes many really good participants, including our longtime partner, Oracle Cerner. The fact that we've worked and integrated with Oracle Cerner for many years I think was also helpful for the client to feel that the risk in this deployment is lower, and we can all work really well together.

Craig Hettenbach (Executive Director)

Great. Thanks for sharing that.

Operator (participant)

Thank you for your question. Our next question is from Stan Berenshteyn with Wells Fargo Securities. Your line is open.

Stan Berenshteyn (Senior Equity Research Analyst)

Hi, thanks for taking my questions. Maybe on the guidance, you have a pretty wide implied range on the fourth quarter. Can you just walk us through what, what's driving the upside and downside of that range? Thanks.

Bob Shepardson (CFO)

Hey, Stan, it's Bob here. So, I think we left the guidance in place, primarily because, you know, the fourth quarter can have some pretty large swings on visit volumes. We saw that last year, when we had an early and severe flu season drive some pretty meaningful volumes. So we opted to leave that in place. That would really be the factor that might move things around within the range. And as you saw, we also widened out a little bit on the cost side associated with the DHA.

Stan Berenshteyn (Senior Equity Research Analyst)

Got it. And maybe just a quick follow-up on that. How should we think about the incremental impact of the R&D spend as we model 2024?

Bob Shepardson (CFO)

Yeah, I would say on that, we've done, I think, a real good job in delivering on the cost savings associated with R&D as we progress through the year. And I think we'll continue to see those types of declines through the end of the year.

... next year, away from the spend associated with the DHA contract and customizing and implementing and integrating there, we would continue to be on a path towards normalization, you know, in that 25%-30% of subscription revenue over the next couple of years. So, that's proceeding as planned. As we kinda get into the budgeting, you know, come to the end of the budgeting process and are working very closely with our LPDH partners here on the deployment, I think we'll be in a much better position to guide on spending for next year, incremental to what, you know, what we've had out there.

Craig Hettenbach (Executive Director)

Great.

Operator (participant)

Thanks for your question. Our next question is from Jailendra Singh with Truist Securities. Your line is open.

Jailendra Singh (Managing Director)

Thank you, and thanks for taking my questions. And congrats on the DHA contract, and I appreciate all the color there. My question is around the, your kind of core business where, you know, you talked about in the past, like a strain on your provider clients business as they're trying to deal with some, you know, staffing shortage and improving patient experience. And you guys have called out, you know, sales process getting elongated. Just curious if you can provide any update there. Have you seen any improvement in trends? And a little bit more color on capital spending from your provider clients in particular.

Ido Schoenberg (Chairman and CEO)

Hi, Jailendra, this is Ido. Essentially, there is obvious pressure in the market, cost pressure that is apparent to anyone that is there. With the Converge especially, we have lots of proof points around critical pathways that are relevant both in times of prosperity, but even more relevant in time where the budget is tight. I gave a few examples in my prepared remarks. So in high level, we are able to prove that we are helpful in improving things like staff retention and member retention. We have long list of ways to impact the efficiency, and I gave a few examples for that as well.

And we have ways to expand the scope of products or services that our clients can offer and drive the top line for our customers. So as more of those proof points are becoming available in the market, our reposition growth organization is having an easier and easier time to articulate the rationale behind those investments, even in time of cost pressure. I would also add that we see quite a bit of consolidation in the market, especially in provider market, and Converge serves as a really effective electronic glue between those organizations.

So it's a very good way to integrate a lot of your digital assets, and that allows you to do many things, including some serious IT cost savings and an ability to create immediate integration of data and services that seems to be very high priority for these type of organizations. I would also add, lastly, that the staff pressure is really significant. Nurse shortages, especially, the digital discharge that we have and many other programs are hitting home with many of those customers and allow them to basically expand the reach of the staff that is in such a short supply during this period.

Overall, this is not a luxury product, an add-on innovation type thing like telehealth used to be a few years ago. This is a necessary day-to-day infrastructure that is now proven to improve financial performance for customers. Again, we have the actual proof points, and some of them were shared with you today.

Jailendra Singh (Managing Director)

Very helpful. Thank you.

Operator (participant)

Thank you for your question. Our next question is with from Jack Wallace of Guggenheim Securities. Your line is live.

Jack Wallace (VP of Equity Reseacrh)

Thank you. I got a follow-up on the MHS, yeah, award. And just thinking about some of the upfront spend, you know, particularly on the customization, it sounds like, yeah, Bob, you mentioned that there's an element of that that was gonna be cash flow accretive, and then I just wanted to confirm that, whether that was, you know, from an upfront spend standpoint or if there was a margin on the professional services component. And then, you know, second, to that would be, you know, how much of the upfront build here would be transferable in the instance for, say, the VA would also have a similar type of award, and this would make, you know, for an easier plug-and-play opportunity there. Thank you.

Ido Schoenberg (Chairman and CEO)

Hi, Jack. I'll take the second part of your question and let Bob do the first part. So in the initial phase, we will do a lot of work to integrate into the GovCloud, the government cloud, the EHR Genesis, and comply with many rules and regulations for this unique environment, including cybersecurity and other elements. Nothing in this work is risky in our opinion. The work is very clear. We know what to do, and we are very comforted by the enormous experience of other partners like Leidos and Oracle Cerner that they are very familiar with the environment and are going to do the work together with us.

This work is directly relevant for clients who are potential clients, who are not included in this task order. First and foremost, the VA. As I'm sure you know, the MHS Video Connect, the one that we are replacing and modernizing for the DHA, is really a derivative of the VA Video Connect. And the EHR, the VistA, is very similar to the one we are integrating with. Very much like the DHA, the VA is also very, very large. It's actually larger than the DHA. There are 172 medical centers, over 1,000 clinics and about 9 million enrollees. So, there is another really important point, which is the system is built for a continuity of care.

I mean, essentially, there is movement between those two, population that is important, and that's why, in many ways, these organizations typically choose similar solutions. So we believe that that initial effort will position us very well to compete for the business of the VA and other public entities. Bob, maybe you'll take the first question.

Bob Shepardson (CFO)

Yeah. So thanks, Ido. So Jack, the, you know, thank you for the question. The initial th- this is... Think about it in, in two phases. There's an initial deployment phase and then a, a full enterprise rollout. If we just think about the initial deployment phase, that in and of itself is cash flow accretive to Amwell. So, so that's a positive, you know, positive cash generator for us over the 22-month period of performance.

To go from the initial deployment to the full enterprise deployment, that's to the full 9.6 million people that the DHA provides care to, you know, and across the 47 or so hospital and medical centers and the 525 clinics, there's no incremental investment required to go from that initial deployment to the full enterprise rollout. So you'll see, you know, all of that come on without any incremental spending to bring that on. It's basically to bring the first medical center on, we're gonna spend just about everything we need to spend. So that's how you should think about it.

Craig Hettenbach (Executive Director)

That's helpful. Thank you.

Operator (participant)

Thank you for your question. Our next question is from the line of Ryan MacDonald of Needham and Company. Your line is live.

Matt Shea (Equity Research Analyst)

Hey, thanks for the question, and congrats on the DHA win. This is Matt Shea on for Ryan. Wanted to touch on the active providers, so was surprised to see client providers tick down again in the quarter. Just curious, was there any churn within that to call out or just re-platforming? And with 50% of visits now on Converge, should we expect to see that number start to increase sequentially now? And then on the AMG side also, was just curious what drove that decline and if there's any gross margin benefit from less AMG providers.

Ido Schoenberg (Chairman and CEO)

Hi, Matt. I'll take the first part and let Bob continue with the second. So, we talked a lot in previous calls about what re-platforming means. You have some of your clients in a legacy, some of them are migrating. There is an element of churn, but we talked about it, and it's very much growingly in the rearview mirror where we stand right now with more than half of our volume already on a Converge. Per design, when you move from one environment to another, and you lose people quite quickly, but you gain them a little more slower. So the answer to your question is that we certainly plan and expect to see continued growth in our active providers.

I think Bob actually said that in his prepared remarks. As you may remember, there are big deployments also this year, but certainly early next year that are all going to increasingly contribute to raise this number. Bob, why don't you take the second part?

Bob Shepardson (CFO)

Yeah. And on the AMG side, I wouldn't read too much into the number of active providers. They're 1099. And you know, there is some impact you know, from a gross margin perspective as we think about ramping up panels for our APC business. We you know, we need to have we have SLAs there. We need to have availability for you know subject to those SLAs. So that can actually have you know, having too much capacity there can be negative from a gross margin perspective. But you know, in the you know, away from that, on the urgent care side, I wouldn't read too much into it.

You know, we can be adding, you know, at some of our customers, we're building platforms to activate their doctors. And so we can be growing on that side of the business and, you know, you wouldn't see that on the AMG side. So, you know, I think that addresses your question, but if it didn't, let me know.

Operator (participant)

Matt, thank you for your question. Our next question is from the line of Charles Rhyee with TD Cowen. Your line is live.

Charles Rhyee (Managing Director and Senior Equity Research Analyst)

Yeah, thanks for taking the questions. Maybe I know you touched on it kind of tangentially, but just wanted to get an update, sort of how, you know, bookings for next year are trending here through the third quarter, particularly as you've kind of changed sort of your go-to-market strategy. Maybe any update on the progress of, you know, sort of this implementation of the new Salesforce focus on ROI?

Ido Schoenberg (Chairman and CEO)

Hi, Charles, this is Ido. Thank you for your questions. So, where we stand today, we have very good stats on Converge and very happy customers, so that's a really good starting point. We have a healthy pipeline, but very importantly, in the same way that we transformed our platform, we really transformed our growth organization to grow it methodically and meaningfully over the next few years. So to give you more details as you requested, the first thing we did is upskilling of the team and the people.

We did some research and thinking and are now focused on market segments and subsegments where we have very strong right to win and to maximize really the value and impact on profitability. I think a good example is our very encouraging hit rate with very large strategic customers. People tend to forget that we completed Converge only this summer, and we won not one, not two, not three, but actually four. Four very large strategic customers on a platform that just emerged into the market. So that definitely a very good sign. We improved our methodology, the way that we operate in sales operation.

We did a lot of work there, and we really optimized and increased the clarity of our communication. What we sell today is very different than what we sold with the legacy, and I think we're able to communicate it much more clearly today. Very importantly, we built an infrastructure that allows us to capture and report truth points. You're one of the beneficiaries on these calls, but we have lots of other places, and especially with clients, where we can really show the value of the different utilities in the new platform.

As you asked in the question, we built a whole new solution organization that allows us to really have a dialogue with customers to understand their issues and build solutions that are right for them. It's really not a slogan. We are not viewed as just a vendor, we are viewed as a partner, and we are helping to transform those organizations, and they do need help, as they need to do a lot of important things. Lastly, we shared that we brought some very capable leaders, very mature and experienced leaders across all organizations, but especially growth, led by Kathy Weiler from United. We improved the way that the different units of the company, between product, delivery, and growth, are working together as one team.

Overall, all those efforts translate, in our opinion, to very good level of readiness to begin to grow our pipeline and convert it faster, much faster than we did before.

Operator (participant)

Thank you for your question. Our next question is from Glen Santangelo with Jefferies. Your line is live.

Glen Santangelo (Managing Director)

Oh, yeah. Thanks for taking my question. Hey, Ido, I just wanna come back to some of the comments you made in your prepared remarks. I mean, now with 50% of the visits now migrated to Converge, you know, you seem to suggest in your prepared remarks that these migrated clients are scaling very rapidly, and you sort of talked about, you know, all these proof points. But when I sort of take that back to subscription revenues, it seems like the total subscription revenue number has been stubbornly stuck in that high 20s number for a good number of quarters. And so I'm trying to, you know, get a better understanding for these already migrated clients, like what the upsell opportunity looks like into these converted customers, or is that not the right way to think about it?

Should we think about it more that, you know, this just strengthens those relationships, and it's really about sort of winning new business?

Ido Schoenberg (Chairman and CEO)

... Well, Glen, hi. There are multiple things here. One is we still have legacy in the rearview mirror, and legacy comes with a number of pain points. And it's drawing expenses, and it's not developing the way it should because it's basically a platform that is going to be sunset. At the same time, you have a new platform that is looking fantastically well, but it's being implemented. And normally, especially with larger clients, there is a whole process here that takes some time. You integrate, you train, you grow, and you don't grow overnight. I mentioned the timeline. We finished Converge this summer, so we fully expect that to scale very nicely.

But we have a lot of upside ahead of us with our existing clients in same store and also with the new ones, but it's going to accelerate as a new platform. So there is some time for it to take a full momentum of the opportunity. And what you see is the combination in a number, and that may be a little bit confusing, but these are the two conflicting trends that we see where we stand. We fully expect that to be a thing of the past as we finish next year.

Operator (participant)

Glenn, thanks for your call and your question. Our next question is from the line of David Larsen with BTIG. Your line is live.

David Larsen (Managing Director)

Hi. Congratulations on these large enterprise wins. It shows that Converge is obviously the right strategy. You've talked, Ido, about sunsetting the legacy platform. Can you describe a little more like what exactly does that mean? Is that FTEs? Is that bodies? And, and how much money are you gonna save, you know, once that platform is sunset? And then with a decline in R&D costs, can you describe the nature of that? Are you? Is there an external vendor who is building Converge for you, and then once you're at, call it 60% or 80% or 100% migrated, the vendor kinda disappears? Just thanks very much.

Ido Schoenberg (Chairman and CEO)

Sure. So a few things. When we talk about our legacy platform sunsetting is a goal, when that happens, a lot of good things happen for the company. Keeping clients are on legacy for various reasons. They're not ready to migrate. Some of the functionality wasn't ready on time when they wanted to because we were building it and things of that nature. So about half a volume, a little less now, is still there. Supporting an older platform and not investing it is expensive and it's uncomfortable for us and for our customers.

So there's no question that once you have a single modern, a very capable, code base that is very high quality, it's, it's less costly, and very importantly, the customer sentiment is much, much better. The Converge heavy lifting really finished this summer, and we are, as Bob mentioned, we are really scaling down R&D very significantly. Our R&D include a core of engineers that are full-time employees in Amwell, and we did work with quite a few contractors as we built the Converge, and what you see right now is the reverse of that. So as we finish components of Converge, we're able to reduce and normalize our R&D, which is really a potential to save a significant amount of equity.

We are going to continue and invest in the platform, but it's a normal proportion of our budget and not the extraordinary sums that you've seen in the past few years to really build this transformational platform. Bob, I don't know if you have anything to add.

Bob Shepardson (CFO)

Yeah, I would say a couple of things to add on. One is, you know, the amount of money that we estimate that we'll save once we're able to sunset those platforms is between $5 million and $10 million. And, you know, some of that is, you know, cost to vendors, and things like hosting and other... And I would say the other piece of this is we have a lot of resources dedicated right now to migration. And obviously, once we're at a point where we can sunset those platforms, those resources can be redeployed elsewhere.

So, you know, I think that's another part of how to think about what happens with, you know, the sunsetting of those platforms and the ending of the migration effort, which, you know, we're really targeting the end of next year for.

Operator (participant)

Thank you for your question. Our next question is from the line of Jessica Tassan with Piper Sandler. Your line is live.

Jessica Tassan (VP and Senior Research Analyst)

Hi, guys. Thank you for squeezing me in, and congratulations on the DHA. So I think we just wanted to understand the kind of positioning into the payer replatforming for 2024. I know we had two large strategic payers plus the DHA commit so far in 2023. So I guess-

...At this point, does Amwell have complete visibility or complete commitment from payer customers heading into 2024? And can we think of 3Q 2023 as kind of the low point for quarterly subscription revenue from here, with new strategic hospital cross-sells and payer migrations kind of layering in from this point forward? Thanks.

Ido Schoenberg (Chairman and CEO)

Hi, Jess, good to hear your voice. We have four strategics. Three are named, one is not. All of them are fully committed to Converge at this point in various degrees. Two are live, one will be live early next year, and the other one shortly thereafter. So that's the headline. Bob, why don't you take the second part of the question?

Bob Shepardson (CFO)

Yeah, I don't really have an answer for you, Jess, on, you know, does 3Q represent the low point in subscription revenue? It could very well. I think the... You know, as we think about, you know, the rollout here going forward, you know, the DHA, obviously there's nothing in this year for the DHA. That, we will start to see revenues from them, you know, at go-live next year. And that will build because there are several go-lives associated with that contract.

I think the other important thing to note is, you know, once the government, the DHA, makes the election to go to the full enterprise rollout, which, you know, we estimate for planning purposes to be towards the end of the year here, there's a step function in our financials from 2024 to 2025. That's really important to understand. And as I think I said earlier, that step function doesn't bring with it any incremental investment.

So the, you know, the initial deployments here, which is cash flow accretive over the, you know, just on the initial deployment, over the initial, the 22-month period of performance, is all the spending that's loaded in for that full enterprise deployment. So, you know, we, I'm sure we're around the low point here of where subscription revenues should be. But the upside, you know, associated with the growth initiatives that Ido has talked about, as well as, you know, just looking myopically at this DHA contract, that brings with it the potential for, you know, a dramatic expansion in subscription revenue.

Operator (participant)

Thank you for your question. We just have time for one final question. That will be from the line of Diana Lee with Bank of America. Your line is live.

Hanna Lee (Equity Research Associate)

Hi, this is Hanna Lee. I'm on for Allen Lutz. Thanks for taking my question. Just wanted to know if there's been any updates on how you're thinking about the $400 million profitability targets, and if you can frame what you're thinking about in terms of gross margin expectations or any OpEx assumptions related to those targets?

Bob Shepardson (CFO)

Yeah, sure. So, yeah, no real new thinking on it other than, you know, I would say, getting there has been meaningfully de-risked over, you know, with what we've accomplished here over the last quarter. And that brings with it, getting to that, you know, area of $400 million over 1,000 basis points of gross margin expansion, as the lion's share of that growth is really gonna be driven by subscription software revenue.

So you combine that, you know, over 1,000 basis points of improvement with probably about 25% declines in operating expenses, driven primarily by declines in R&D spending over that period of time, but also pretty meaningful operating leverage in SG&A. And that all kind of comes together to deliver a break-even at a, at in and around that 400 level.

Operator (participant)

Thank you for the question. We are just at time, so I'd like to turn it back over to Dr. Schoenberg for any final comments.

Ido Schoenberg (Chairman and CEO)

Thank you, Aaron, and thank you, everyone. Thank you. We really appreciate you joining us this evening, and wish you a great night.

Operator (participant)

Thank you, and ladies and gentlemen, this does conclude today's conference call. You may now disconnect. Have a great evening. Take care.