Privia Health Group - Q4 2025

Transcript

Operator (participant)

Good morning, ladies and gentlemen, thank you for standing by. My name is Kelvin, and I will be your conference operator today. At this time, I would like to welcome everyone to the Privia Health Q4 Conference Call. All lines have been placed on mute to prevent any background noise. After the speakers' 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, please press star one again. Thank you. I would now like to turn the call over to Robert Borchert, SVP, Investor and Corporate Communications. Please go ahead.

Robert Borchert (SVP of Investor and Corporate Communications)

Thank you, Kelvin, good morning, everyone. Joining me are Parth Mehrotra, our Chief Executive Officer, and David Mountcastle, our Chief Financial Officer. This call is being webcast and can be accessed in the Investor Relations section of priviahealth.com, along with today's financial press release and slide presentation. Following our prepared comments, we will open the line for questions. Please limit yourself to one question only and return to the queue if you have a follow-up, so we can get to as many questions as possible. The financial results reported today are preliminary and are not final until our Form 10-K for the year ended December 31, 2025, is filed with the Securities and Exchange Commission. Some of the statements we'll make today are forward-looking in nature based on our current expectations and view of the business as of February 26, 2026.

Such statements, including those related to our future financial and operating performance and future business plans and objectives, are subject to risks and uncertainties that may cause actual results to differ materially. As a result, these statements should be considered along with the cautionary statements in today's press release and the risk factors described in our company's most recent SEC filings. Finally, we may refer to certain non-GAAP financial measures on the call. Reconciliation of these measures to comparable GAAP measures are included in our press release and the accompanying slide presentation on our website. Now I'd like to hand the call over to our CEO, Parth Mehrotra.

Parth Mehrotra (CEO)

Thank you, Robert. Good morning, everyone. Privia Health delivered a very strong 2025 as we continue to execute extremely well and drive growth across our markets. This morning, I'll summarize our performance and business highlights. David will discuss our 2025 financial results and our 2026 guidance before we take your questions. Privia Health's outstanding operational execution and the strength of our diversified business model clearly demonstrate our ability to perform in all types of market and healthcare regulatory environments. We are proud to deliver on our mission to achieve the Quadruple Aim, better outcomes, lower costs, improved patient experience, and happier and more engaged providers. New provider signings and implementations remain strong across all markets, which provides great visibility through 2026.

We added 591 providers, a 12.3% increase year-over-year. We ended the year with 1.54 million value-based attributed lives, up 22.7%. The combination of implemented provider growth and very strong value-based performance helped increase practice collections 16.9% in 2025. We continue to show strong operating leverage on cost of platform and G&A expenses. Adjusted EBITDA for the year increased 38.8% to $125.5 million, with EBITDA margin as a percentage of Care Margin expanding 480 basis points to reach 27.2%. On December 5, we completed the acquisition of Evolent Health's ACO business. This added over 120,000 value-based attributed lives across existing and new states.

We also entered Arizona in April with our anchor partner, IMS. IMS was implemented on the Privia platform at the end of Q3, and we are seeing strong sales momentum in the state. We deployed $180 million for these transactions, and our cash balance ended the year at 480 million. This was only $11 million below a year ago due to the tremendous cash flow generation of our business as we converted 130% of EBITDA to free cash flow. Our 2025 performance and momentum positions our business extremely well. We expect to drive EBITDA growth of approximately 20% at the midpoint of our 2026 guidance and convert 80% of EBITDA to free cash flow.

This positions Privia Health to end 2026 with approximately $600 million in cash, assuming no new business development. Our 2025 results and 2026 guidance further demonstrate our ability to continue to compound EBITDA and free cash flow in a very difficult healthcare services environment. Privia Health's national footprint now includes a presence in 24 states and the District of Columbia, including the Evolent Health ACO business. At year-end 2025, we had 5,380 implemented providers caring for over 5.8 million patients. We continue to demonstrate very high gross provider retention of 98% and patient NPS of 87 across our footprint. Privia Health's diversified value-based platform serves over 1.5 million patients through more than 130 commercial and government programs. Our total attributed lives increased 23% from a year ago.

This was driven by new provider growth across our markets, the addition of Evolent ACO, and our entry into Arizona. Commercial attributed lives increased more than 16% from last year to reach 910,000. Lives attributed to the CMS Medicaid programs were up 52%. Medicare Advantage and Medicaid attribution increased 15% and 23%, respectively, from a year ago. We remain highly focused on generating positive contribution margin in our value-based book. We have proven that we can build scale and manage risk without depending on any one particular contract, while we continue to implement clinical and operational enhancements in our medical groups. Our performance over the past few years is a testament of our approach to value-based care and the strength of our actuarial underwriting, clinical operations, and physician-led governance structure.

Now I'll ask David to review our financial results and 2026 guidance in more detail.

David Mountcastle (EVP and CFO)

Thank you, Parth. Privia Health's strong operational performance continued through the Q4. Implemented providers grew 130 sequentially from Q3 to reach 5,380 at December 31, an increase of 12.3% year-over-year. Implemented provider growth, along with solid value-based performance and ambulatory utilization trends, led to practice collections increasing 9.6% from Q4 a year ago to reach $868.7 million. Adjusted EBITDA, which is reconciled to GAAP net income in the appendix, increased 26.4% over the Q4 last year to reach $31.5 million, representing 27% of Care Margin. This is a 390 basis point margin improvement year-over-year, as we continue to generate significant operating leverage.

For the year, we exceeded the high end of our updated 2025 guidance provided in November for all key operating and financial metrics, with Practice Collections and Platform Contribution coming in at the high end. Practice Collections increased 16.9% to reach $3.47 billion. Care Margin was up 14.4%, and Adjusted EBITDA grew an exceptionally strong 38.8% to reach $125.5 million. All metrics were substantially higher than our initial guidance that we provided at the beginning of 2025, reflecting our strong execution amidst a very challenging environment. Our business continues to generate very strong financial leverage as conversion from EBITDA to free cash flow was 130% in 2025. We ended the year with $479.7 million in cash, with no debt.

Given our outstanding cash generation with minimum capital expenditures, we expect to end 2026 with approximately $600 million in cash, assuming no capital deployment for new business development. This positions us with significant financial flexibility to take advantage of opportunities as they present themselves in the current market. Our outstanding 2025 performance positions us well to continue our momentum through 2026. Using the midpoints of our new 2026 guidance, implemented providers are expected to increase 10.6% year-over-year to reach 5,950 by year-end. Attribute lives are expected to be approximately 1.58 million. We expect practice collections to grow 6.6% and Care Margin 13% at their respective midpoints.

We are guiding to Adjusted EBITDA growth of 19.5% at the $150 million midpoint and expect 80% of full year 2026 Adjusted EBITDA to convert to free cash flow as we become a full cash taxpayer this year. While our guidance for 2026 assumes no acquisitions, we will remain disciplined and strategic in our capital deployment. We expect to continue to actively seek business development deals, both in new and existing markets, to continue to grow the business and compound our EBITDA and free cash flow. Over the last two years, our EBITDA growth rate has averaged 32%, far exceeding our target growth rate of 20%. The midpoint of our 2026 guidance will result in more than a doubling of EBITDA in the past three years.

Privia's consistent growth and our ability to compound EBITDA and free cash flow across economic, healthcare, and regulatory cycles over the past nine years validates the strength of our business model. Privia's business momentum, powered by the consistent execution by our provider partners and our employees, has positioned us well to continue to drive growth and profitability as we build our national footprint. I would like to take this opportunity to thank each one of them for their continued hard work. Operator, we are now ready to take questions.

Operator (participant)

Your first question comes from the line of Josh Raskin of Nephron Research. Please go ahead.

Josh Raskin (Research Analyst)

Hi. Thanks, and good morning. Can you speak to tech investments, including AI and maybe advancements that you're making on your model for physicians? I'm interested in any new capabilities that you've implemented, maybe efficiencies you're seeing on both the administrative side and the revenue cycle side. Lastly, anything athenahealth's rolled out that you think is making an impact on your, you know, implemented provider base?

David Mountcastle (EVP and CFO)

Yeah, thanks for the question, Josh. I think it's very timely, and I'd like to just step back maybe. I think, just to structure our thoughts, there are three components when we think about AI-related investments, and I'll go into a little bit deeper. The first is, I think, it's important to understand, in our business model, we are very uniquely positioned with our medical group structure, with the single TIN medical groups, with the ACO entity, and then with the full tech and services platform, where we are deeply embedded in the workflow, that we have access and ownership of a lot of data across every single patient, 5+ million, every single specialty, every single practice across the whole care continuum. The medical groups have access to every single patient encounter, the clinical records.

Our MSO has access to every single claim that goes through the RCM engine. Then we have every single patient interaction with the doctor, with our service lines, with after-hours. Everything's documented. This leads us to be, you know, a real perfect model where it's a very data-rich environment, and we are really excited on all potential applications of AI. With that being true, the second key point is what buckets of investments we can make to enable us to benefit from all of this innovation that's going to happen now and into the next two, three years, you know, that'll lead us to enhance margins and then ultimately shareholder returns. We look at these in five broad buckets effectively. One is every single corporate function at Privia, on the corporate side.

We're on Google Cloud, Google Workspace, as an example. We are implementing Gemini in every single thing that we do in a HIPAA-compliant manner. As an example, we are working with our existing technology partners. You mentioned athenahealth. There's also Salesforce, there's Workday, on every single corporate function. And then there are new innovators that are innovating across the spectrum that we are continuously piloting.

That's on the corporate side. Then on the physician practice side, I think there are three buckets. The entire fee-for-service workflow, the entire value-based workflow, and then the patient engagement workflow, where we are looking at different applications of AI with both existing vendors that we work with, like athenahealth, but then also new companies. We invested in Navina last year, as we talked about, helping us with clinical decision support, with suspect medical conditions, with better documentation of patients. We are looking at everything that's happening on the revenue cycle side, you know, all the innovations coming through, scribing, as an example.

Parth Mehrotra (CEO)

I think this will be a balance between what existing partners can do and what new innovations will happen over the next few years. Balance between how much we can implement sooner versus a little bit of delayed gratification, as these models are becoming better and faster, as we are reading about. The last bucket is actual care delivery. How our doctors interact with patients in a capacity-constrained manner. There's a shortage of PCPs, shortage of nurse practitioners and APPs. I think the productivity enhancement that we can get across our whole organization is massive. Ultimately, the last bucket is: How does all that lead to tangible ROI and margin improvement as we grow and then also scale this company?

I think if you look at slide 11 on our investor presentation this morning, you know, we've gotten the business to, if you look at the midpoint of our guidance for 2026, at 29% EBITDA margin as a percentage of Care Margin. That's very close to what we thought at IPO as our long-term range, you know, 30%-35%. I think with all that we see from what we can do with AI, I think we can get to the high end of the range or even exceed it over the next many years. There's no reason why a company like ours, with this much opportunity, should not be able to do that. I think that's gonna lead to really good results for the shareholders as the margin improves.

Operator (participant)

Next question comes from the line of Jailendra Singh of Truist Securities. Please go ahead.

Jailendra Singh (Managing Director)

Thank you. Good morning, and congrats on a strong quarter. I was wondering if you can provide some color on Practice Collection trends for both Q4 and 2026 guidance. Q4 results and 2026 guidance are both pretty solid, but that's the one metric where some variability versus consensus and what you have typically seen. We also noticed in your slide that the care center locations declined slightly, like 40 from Q3 to Q4. Not sure if that's the primary driver for Practice Collections not growing in 2026 at the rate you have historically grown.

Parth Mehrotra (CEO)

Yeah, thanks for the question, Jailendra. On practice collection, there are two or three things. One is Q3 to Q4. In Q3, as you recall, we recognized there's a lot of prior period true-up on our value-based book from 2024. That's obviously led to the great outperformance on EBITDA. That's, we, you know, I think we talked about this last quarter, where Q3, we had some prior period adjustments, so the quarter-over-quarter, you know, the comps get a little bit tougher. Annually, there are two or three variables.

One is, if you look at page 10 of our press release, where we break out revenue by source, you'll see the capitated revenue line went up by close to $100 million, and that was a result of increase in lives, in capitation, as well as the percentage of premium we are recognizing. That's not gonna carry forward in 2026. I mean, we're pretty prudent with our guidance. I don't think you're gonna see. We're not assuming the guidance does not assume that will repeat itself. Then also on the Evolent ACO business, it's important to highlight, like, we are not recognizing any premium revenue in practice collections on our value-based book other than this capitated line. you know, that makes the comps tougher.

I think the right way to look and compare is at the Care Margin line. That's what we are focused on what Privia can get from a shared savings perspective, and our shareholders can, and that's growing pretty consistently. At the midpoint, Care Margin is growing, you know, low double digits, which is very consistent with how we looked at the business. Hopefully that clarifies on the collections. Overall, it's pretty strong trends, just some year-over-year nuances. On the care centers, I think it's just rounding. Instead of being precise, it's 1,300 plus care centers. You know, the provider growth speaks for itself. The implemented providers is super, really strong. We had one of our best sales year, best implementation years. You can see the year-over-year growth.

You can see the guidance for this year, for 2026. That's the key metric there.

Operator (participant)

Your next question comes from the line of Lisa Gill of JP Morgan. Please go ahead.

Lisa Gill (Managing Director)

Good morning. Thanks for taking my question. Just have a question around utilization trends. Obviously, it's been a really strong utilization environment the last few years. What are your thoughts around some of the changes around ACA and Medicaid enrollment, and any potential impact that it could have?

Parth Mehrotra (CEO)

Yeah, thanks for the question, Lisa. Look, I think as we've said previously, we really have to bifurcate the utilization into ambulatory, physician, community-based physician practice, you know, primary care and OB/GYNs, you know, the community-based care utilization versus the inpatient that you see more in the post-acute or acute facilities. We've consistently said, and that holds true, that post-COVID, as the trends normalized, the ambulatory utilization continues to stay elevated, and we expect it to remain elevated, and that's actually a good thing. That's the lowest cost setting. You want patients to interact with their primary care providers, and we don't see that utilization coming down.

I do think, like you pointed out, with what's happening with the ACA population, with Medicaid, all the changes, either enforced by the government or otherwise, payers reacting to it, you're gonna see a lot of churn. We expect that to happen. I think our diversified model across commercial, MA, MSSP, Medicaid, exchange, you know, positions us really well. I mean, it's reflected in our results. We don't have a big Medicaid population, don't have a big exchange population. Whatever we have tends to get normalized. You know, people tend to see their primary care provider, you know, children tend to see their pediatrician, even if they lose coverage or move on. We see a lot of, uninsured or self-insured folks show up.

We don't see any trends abating for us, so I think that bodes well for our business. Overall, I do think for the acute and post-acute care, I mean, there's gonna be nuances as all of this normalizes over the next couple of years.

Operator (participant)

Question comes from the line of Jeff Garro of Stephens. Please go ahead.

Jeff Garro (Managing Director and Equity Research Analyst)

Yeah, good morning, and thanks for taking the question. Wanna ask about EBITDA to free cash flow conversion. You know, conversion guidance was 90% a couple years ago, and 80% last year, and now here in 2026. It, you know, so materially outperformed on that metric ultimately in 2025, and I know there's a couple moving pieces with taxes and folding in ECP. I was hoping you could help us bridge between those historical expectations, 2025 outperformance, and the FY 2026 guidance on EBITDA free cash flow conversion.

Parth Mehrotra (CEO)

Yeah, absolutely. I'll start, and then David will give some of the specifics. Look, I think you've highlighted one of the strongest elements of our business model. You again, look at slide 11, you look at the. This is nine years of data, including this year's guidance. I mean, we've averaged over 100% conversion. We love free cash flow. You can quote me on it. It's the cleanest, purest metric. You can't adjust it. It's either in the bank or it's not. I think we manage a negative float in this business, and we've tried to do that. Obviously, whether, you know, at some point we're gonna start paying taxes here, real cash taxes, as we run down the NOLs, and David will walk through some of the nuances.

I think we really focused on how we better can manage that negative float, focus on collections, get money to our providers. It's a strength of our business model relative to others in the space. I think, you know, enterprise value to free cash flow is a key metric here that normalizes across companies and across business models in the physician enablement or even, you know, clinic-based models, where you can see the strength, where we have no CapEx, and everything's expensed on the P&L, and it's a very clean metric. I think we're gonna manage that as the best we can. Obviously, our guidance always assumes more normalization, and then if things turn out better, that's what we hope benefits the shareholders.

We expect to pay taxes in cash taxes in 2026, so that's reflected in the 80%. I'll let David Mountcastle answer any specifics on that one.

David Mountcastle (EVP and CFO)

Yeah, I mean, outside of that, I mean, I would just say we had a really good collection year. You know, we had a few timing issues at the year-end that I think we were originally expecting them to come in beginning of January, and they came in at the end of the year. We did have a little bit of timing there at the end, but we are definitely confident in our 80% or more for 2026, and we will become a full cash-paying taxpayer in 2026. That is gonna put a little hit in our number for 2026.

Operator (participant)

Your next question comes from the line of Whit Mayo of Leerink Partners. Please go ahead.

Whit Mayo (Senior Managing Director and Senior Research Analyst)

Hey, thanks. Good morning. Parth, you're gonna have $600 million of cash at the end of the year. You don't have any debt. Not very efficient to have this much cash sitting on the balance sheet. Just maybe any updated thoughts around capital deployment and if the priorities have changed at all?

Parth Mehrotra (CEO)

Yeah, appreciate the question, Whit. I think, first of all, we really love our position in this space. The strength of the model, the cash flow generation, the balance sheet strength, relative to others, private or public companies. I think our answer is consistent to that question. You know, our priority will be to continue to deploy capital to keep compounding the business. You saw us deploy $180 million last year. You know, we've doubled EBITDA, 2023 to 2025. On a rolling basis, we're gonna double it again, 2024 to 2026, in probably the toughest healthcare MA regulatory environment.

I think our ability to use cash to acquire assets across this ecosystem and keep compounding our units, whether it's entering new states, adding implemented providers, adding lives, we can acquire medical group tax IDs, ACO entities, MSO entities. It's such a diversified business model, and I think there are a lot of companies that are challenged, public and private. I think a lot of medical groups, hopefully, as all of this disruption goes through, as venture capital dollars, private equity dollars, stop chasing the space that happened in the last five years, I think it hopefully, given our track record, you know, gives us the ability to be the partner of choice, from a long-term perspective for a lot of the physician groups out there. I think our priority is to keep compounding the business.

Obviously, as we've stated before, we like to keep a sufficient cash balance for a rainy day. We don't like leverage on businesses that could potentially have variability in shared savings. As we all know, pandemics happens, hurricanes happen. We're supporting our medical groups, so there's a rainy day fund. Then also, if, again, we have the flexibility to return capital as a last resort, if, you know, our stock price continue, you know, if it deviates meaningfully from what we think is intrinsic value, we have that option too. I think the priority is gonna be continue to deploy capital and keep compounding the business the way we've been doing.

Operator (participant)

Your next question comes from the line of Matthew Gilmore of KeyBanc. Please go ahead.

Matthew Gilmore (Equity Research Analyst)

Hey, thanks for the question. I wanted to ask about the Evolent acquisition. Now that you've owned the asset for a few months.

David Mountcastle (EVP and CFO)

I was curious if you had any updated perspective about the business or the synergy within the acquisition. I was particularly curious about the cross-sale discussions with Privia platform into that physician base, whether that's new or existing states. Thanks.

Parth Mehrotra (CEO)

Yeah, I appreciate the question, Matt. You know, we just closed this in December. I think we're really excited to have the team join us, and be part of the Privia family. I think the provider groups that they focused on, are really solid. I think you see their MSSP results. It's publicly available. Our hope is we can increase that savings rate, pretty meaningfully this year into, you know, the next few years. You can compare the savings rate on that book relative to our overall savings rate, and, you know, I think there's a lot of opportunity there just on the core business that they run.

I also think it allows us to have an offering, you know, in this Care Partners model, where providers are not on our technology stack, that we can go out and reach out to a lot more providers that may have partnered with other companies, that may not be doing that well, to get them at least have a relationship with Privia in an ACO entity, and then, obviously, cross-sell into our full medical group business model. I think that'll happen over time, both on the existing Evolent providers. There'll be opportunities in some of the existing states where we have the medical group presence, and then obviously in new states as we enter over time. I think that'll materialize itself over the next few years.

We are really excited, really excited to have that business be part of our offering, and, I think, we're gonna realize as many synergies as we can going forward.

Operator (participant)

Your next question comes from the line of Sean Dodge of BMO Capital Markets. Please go ahead.

Sean Dodge (Managing Director and Equity Research Analyst)

Yeah, thanks. Maybe just staying on the Evolent ACO acquisition. Parth, you mentioned increasing their savings rate up to the levels of the other Privia ACOs, maybe as quickly as this year. Well, just mechanically, how do you do that? What are the first couple of levers you can pull there to drive that? Initially, you said it would contribute positively to EBITDA in 2026. Any quantification you can share on how much you've embedded into guidance for 2026 from the Evolent acquisition?

Parth Mehrotra (CEO)

Yeah, I appreciate it, Sean. Just to be clear, I didn't say it happened this year. I think it'll happen over time. These things take time. We just got the business. I think rule number one is don't do anything stupid and disrupt it, and get to know these provider practices and implement, you know, how Privia does things, hopefully a little bit better, given MSSP has been a core part of our business model, as you've known for many years. I think it's the same block in tackling. I mean, you know, we've been in that program for the last, you know, eight, nine years. We have a playbook that we run. You have all the quality metrics that you wanna improve. There's some basic block and tackling.

I think it's a little bit nuanced, given that these providers are not on our platform, we are focused on making sure we have the right level of engagement with the practices, right level of data that comes through, the technology stack that's implemented on top of their existing infrastructure. You know, getting the patients to see their doctors, you know, making sure we prevent the ED rates and patient rates, all of those things. You know, they are like basic stuff that obviously every ACO does, and then all the nuances as we stratify the population, look at where, you know, you have some high acuity patients, manage those, things like that. I think we're gonna run our playbook.

This will happen over time, so please don't expect that this will be like a one-year thing, but we do feel really good about the business. On your second part of the question, you know, the acquisitions are creative. You saw their savings rate. It makes money. There are synergies to be had. We didn't break out the EBITDA. It's all included in our guidance. I mean, that's why, I mean, we grew EBITDA 39% last year. We're growing another 20% this year. Part of that is from the acquisitions that we did, and, you know, that's a core part of the strategy. I mean, our growth algorithm is gonna be based on same store provider growth, same store care center growth, adding new providers, adding lives into value-based arrangement, and then doing deals that are accretive.

I think we're gonna keep doing all of those four things and hopefully keep compounding EBITDA here.

Operator (participant)

Your next question comes from the line of Andrew Mok of Barclays. Please go ahead.

Andrew Mok (Director of Equity Research)

Hi, good morning. The corporate G&A expense dropped sharply in the quarter. Was there anything to call out driving the beat, and is this the right run rate to think about for 2026, even with the moderation in practice collections growth for next year? Thanks.

David Mountcastle (EVP and CFO)

Yeah, no, there's not really anything to call out. We definitely had some sequential, I would say, decreases in things like legal and some of our consulting. You know, I would look at our 2026 guidance as maybe a better way to look at all of our expenses. We do expect to continue to gain leverage in the G&A space. You know, I would say nothing other than sort of normal decreases around sort of the operating business flow.

Operator (participant)

Your next question comes from the line of Matthew Shea of Needham & Company. Please go ahead.

Matthew Shea (VP of Equity Research)

Hey, good morning, thanks for taking the question. you know, one of the things that's impressed us is the continued provider growth in existing markets, so it's good to hear you're already seeing strong sales momentum in Arizona. I guess it would be great if you could expand on that comment and what you're seeing in Arizona, in particular, as well as any other noteworthy markets. As we look across the broader network, and you touched on this a bit, but do you expect your sales or growth efforts to be different in the value-based care or ACO-only states versus the implemented provider states, or is it the same playbook and resources sort of across markets? Thanks.

Parth Mehrotra (CEO)

Yeah, appreciate the question, Matt. Look, our playbook in the core you know, medical group business is the same across all our markets. Our objective is to really dense delivery systems with a very low-cost provider base, with community-based providers at the forefront. You know, that that, you know, materializes differently in every state. We establish presence, work with a great anchor group, if we can get a pretty sizable anchor partner, like we did with IMS. Doctors know doctors the best. You know, before we show up in a state, this model pretty much does not exist on how physicians can be autonomous, independent, and yet be part of something bigger, like Privia. I think our objective is to, you know, then showcase what we've done in other states. The payers know us.

They know the playbook that we run, offer that delivery network to the payers of healthcare. This is where costs can really be taken out, quality can be improved, independent practices can stay alive. There's a win-win here, given all the cost pressures and everything that we hear, that's wrong with the healthcare ecosystem. I think, you know, how that materializes to your question, I mean, we got a great anchor group, great set of physicians with IMS. I think they're super excited to be part of Privia. They see what we've done elsewhere. I think, it leads us to then reaching out to and running full steam ahead in a state like that.

It's a great state in terms of population growth, percentage of Medicare Advantage lives, as a percentage of total, the networks around these patients and the opportunity that's there with independent providers, given the health system dynamics and the payer dynamics in the state. That's our playbook there. I think, again, that's kind of, generally speaking, the case in all our markets. There are some nuances in particular markets. Some hit up in some year than others. It's an ebb and flow that happens as a portfolio approach, you know, you've seen us, again, on Slide 11, just speaks for itself. That implemented provider growth hopefully just continues to tick up.

I think, you know, the way we sell just the ACO only versus the full stack, I think it just depends by state. I think there are obviously nuances to both. We have a very ROI-driven value prop in each. There's a separate sales team for each, but there'll be cross-sell opportunities, we just try to optimize that. The medical group value prop obviously, is a much more deeper discussion versus an ACO only. Some of the competitors that we deal with are also different in both of those. I think, you know, our overall story should resonate with physician practices. I mean, they're looking for a full solution. Whether we get them in one or the other, we're kinda indifferent as long as we get them.

I think, we'll just continue to go full steam ahead on both.

Operator (participant)

Your next question comes from the line of Jack Slevin of Jefferies. Please go ahead.

Jack Slevin (VP and Healthcare Services Equity Research Analyst)

Hey, good morning. Thanks for taking the question, congrats on the really strong results. I wanted to touch on a little bit of the MA contracting environment, acknowledging, you know, you've got less full risk in your book and sort of have been on the front end of getting ahead of utilization swings. What we're seeing right now, I think, is a lot of sort of concessions that are being given by payers to value-based players that are driving value. I'd just be curious to hear your take on how that might develop for your business as you look at 2026 and then beyond to 2027, with some of the payers looking to claw back margin, but also sort of acknowledging the value that's being brought from PCP-led provider groups in the space. Thanks.

Parth Mehrotra (CEO)

Yeah, thanks for the question. I mean, it's, it's pretty nuanced. Just to take a step back, look, I think us foresighting what might would have happened in the MA environment and that transpiring over the last few years, given all the headwinds that all of you have written on this call, I think it was similar to like a call on shorting mortgage-backed securities before 2008. I just think the dynamics were so challenged that I think whether by luck or by foresight or by execution, we kinda avoided some of the traps. Look, we've continued to have a belief that shared risk is the right model, where the doctor, an entity like Privia, and the payer all have skin in the game.

I think what you're seeing is an adjustment in the industry by the payers, and I think you've seen a little bit of round robin with how the payers have reacted. It was payer X in two years ago, payer Y last year, payer Z this year. The lives are moving between those entities as they adjust benefits, as they prioritize it differently between three or four of the big MA players out there, as you've seen and noted on. I think the answer to your question is really nuanced on a geography-by-geography basis, which payer we are dealing with, what risk pool, what's the MLR trend, what are they willing to, you know, do with us? Are they willing to share risk? What's the benefit design?

Our payer contracting team's just done a fantastic job just navigating through all of this. I think, you know, it just depends on the market and the geography. I don't think it's a cookie-cutter answer that has broad application as each payer is treating it differently. I think they have margin pressure they're trying to adjust depending on the payer and the geography. I think we're just continuing to be very sophisticated and nuanced about this. We are very forward-leaning. We love to take as much risk as we can, if we can manage it. If the payer gives us a contract that compensates us well to take that risk and compensates the physicians that are working extra hard to perform in these contracts. You have to recognize the amount of work that the physicians have to do.

We have to do increases to manage a high-cost patient population and to deliver results. You gotta get paid for it. If you don't get paid for it, you know, I don't think anybody wins. You can't have physician practices lose money as they, especially community-based doctors that are on the front line of healthcare. It's the lowest cost setting. They can impact, quality, cost, outcomes, as we all know, really well, and you got to compensate them for doing all the hard work. I think we're just gonna continue to look for opportunities with our payers, keep getting our delivery networks more dense, adding capabilities, in impacting the total cost of care and delivering it and showing that to the payers. Hopefully, we'll be pretty forward-leaning.

When, you know, the tide turns, which I think it will, I think these things get normalized. I think we're gonna flush through V28 over a couple of years here. I think the payer environment will stabilize. I think it positions us really well. You know, if there's some delayed gratification in ramping up risk, we'll do that because the doctors don't go anywhere, the patients don't go anywhere. It's just coming to a consensus with the payers on the right contract structure. I think we'll continue to be forward-leaning there.

Operator (participant)

Your next question comes from the line of David Larsen of BTIG. Please go ahead.

David Larsen (Managing Director)

Hi, congratulations on another good quarter. Can you just reconfirm the Evolent Care Partners EBITDA and revenue? Is it $10 million of EBITDA on 100 million of revenue? Then how many of those doctors do you think you'll be able to convert over to, like, your core Privia, Athena platform, where you're doing all the billing and AR for them? Thanks a lot.

Parth Mehrotra (CEO)

Yeah, thanks for the question, David. I don't think we disclosed any of those numbers. I think those were numbers that Evolent might have disclosed in their earnings call over the last couple of quarters, including this week. We're not disclosing that. I would say our revenue recognition methodology is different. We're not recognizing any premium revenue as part of that book. You know, whatever numbers you're getting from them may be different for us. Our EBITDA and top line includes everything. You'll see the results when CMS announces it in August, so we're not gonna break down EBITDA by any acquisition. Like, we've not done it for any acquisition or any line of business. It is accretive, it is contributing meaningfully to this year's EBITDA.

That's why I think this was asked earlier on the call. We grew EBITDA 39% last year. We've grown another 20% this year, doubling EBITDA on a three-year rolling basis. You know, Evolent's part of that, you know, part of that growth.

Operator (participant)

Your next question comes from the line of A.J. Rice of UBS. Please go ahead.

A.J. Rice (Managing Director and Equity Research Analyst)

Hi, everybody. A specific question, and then a broader one. On the embedded in the guidance, I know shared savings was a big source of growth last year. You are $235 up from 179 million the prior year, in contribution. What have you embedded in your guidance there? You mentioned early successes in Arizona. I just wonder if you could just update us on some of your newer markets. Are there any wins worth calling out there? How are they progressing, relative to your expectations?

Parth Mehrotra (CEO)

Yeah, thanks, A.J. Look, I think our goal is to accrue prudently, and that's been very consistent, so I'm not gonna say anything new here, and then hopefully outperform. I think you saw the actuals for 25 come in materially higher. I mean, our initial guidance was $105-110 million EBITDA. We ended the year at $125 million. A lot of it was related to shared savings, some prior years, some in-year, as we perform well. I think, our guidance, again, we've taken the same methodology. I would not expect a material jump. If we do better, you know, we'll hopefully see in the results. If we don't, then we'll hopefully, you know, stick with what we have. I think it just depends on the contract.

We have a very diversified book. You know, all of you have written really well about all the trends that impact, you know, various pools of risk. It's still a, you know, it's an environment we got to navigate carefully. We've got to perform in these deals. I wouldn't expect a material step-up, and, you know, there'll be some, but, you know, we'll see how the year progresses as we get data, and we'll keep updating that.

Operator (participant)

Your next question comes from.

Parth Mehrotra (CEO)

Oh, sorry. By the way, I forgot the second part of the question on the growth in other markets. Look, I think it's a portfolio approach. I mean, we're now in, you know, 24 states, some ACO only, some with a full model. I think there are some markets that are doing really well. You can see overall how we've progressed as a company. We don't break out EBITDA by market or things like that, but, you know, overall, with our guidance, we are close to 29% EBITDA to Care Margin. That should tell you that the whole company, you know, the mature markets are running well ahead of that number, and there are some markets that are maturing. Some are still negative EBITDA. Some may not be doing that well. It's a portfolio approach.

We evaluate all our markets. You know, some markets, if we don't think are working well, we'll exit. We exited Delaware, as an example, two years ago. You'll see us be very, very prudent with this business. I don't think you can make mistakes, and I think if you think some deal structures or anchor partners or markets are not working well, you know, and we have an opportunity to do it differently, I think, you know, you got to keep pruning the tree here to keep letting it grow really well. I think, you know, again, the whole overall business is in a very good shape. If there are markets, there are always puts and takes.

Some do better one year, but we take a five, 10-year view, like I said earlier, to just develop very dense physician networks here, with community-based providers. That's our strategy overall.

Operator (participant)

Next question comes from the line of Elizabeth Anderson of Evercore ISI. Please go ahead.

Jenny Shen (Equity Research Associate)

Hey, good morning, guys. This is Jenny Shen for Elizabeth. Thanks for taking my question. As CMS transitions from the ACO REACH program towards the new LEAD Model, how are you guys evaluating whether that framework sort of aligns with Privia's long-term value-based strategy? As your value-based book continues to grow and scale, how do you think about maintaining the consistency of performance across cohorts, particularly as the provider mix evolves?

Parth Mehrotra (CEO)

... Yeah, I appreciate the question, Jenny Shen. You know, like with any new program, we'll evaluate it. It goes into effect next year. I think we're still going through the details of LEAD Model versus ACO REACH. I think what bodes well is with the ACO REACH sunsetting, it allows our sales team to reach out to a lot of physician practices and providers that may have participated in ACO REACH. By the way, like, 2025-2026, anybody who's in ACO REACH is gonna see a pretty significant decline in the shared savings, just given how they changed some of the elements of that program. And we're still studying LEAD Model.

I think MSSP ENHANCED track versus LEAD, you know, we're doing the work. If you have a pretty mature ACO and an MSSP ENHANCED track that you've been in for the last many years, like we have, the bar is pretty high to go to a new program overall. You know, there'll be opportunities in particular states. We'll evaluate it ACO by ACO. You can participate in one, not both. It's on a bin basis. Like with any program, any changes that CMS has done over the past 10 years, you know, we'll just evaluate it. There may be cases where we enter into LEAD in a particular state or not. It just depends on the patient population, the state, the ACO, how we think the actuarial underwriting happens. I think, you know, it's just TBD as to...

You know, once we are in it, we'll obviously communicate it with you guys. We do have some Reach lives today, you know, so we'll see if they move into MSSP Enhanced or Lead. As we work with other new partners, we'll see if Lead makes sense or not. You know, we're evaluating it like others. The second question. Look, I think it just varies. You know, you gotta go ACO by ACO. You gotta go through the maturity of the patient pool. You have to look at the relative benchmarks. You have to look at which value-based contracts you're in. While it's a generic question, again, the answer is much nuanced. This is healthcare. It happens locally in every state, every pool, every patient population, every payer, every contract's different.

I think that's a core value proposition and moat around this business. It's, it's hard to replicate. A lot of people can enter these businesses, but, you know, I think you all have seen it on how hard it is to make real money and real free cash flow. You gotta have real capabilities and, you know, a great team all around from a risk management perspective, underwriting perspective, you know, influences in delivery of care and, you know, total cost of care management with these practices and how you work with them, the data, the technology stack. All of it is a core, you know, competence of this business that is very, very hard to replicate.

I think given the diversity of our book and the number of contracts and the payers we work with, and the scale we are operating this at across different types of patient populations on slide six, I think just speaks for itself and how we've been able to convert, you know, deliver value to the payers, generate shared savings, share that with physician practices, and obviously, EBITDA with our end free cash flow with our shareholders. I think that just speaks for itself.

Operator (participant)

Your next question comes from the line of Jessica Tassan of Piper Sandler. Please go ahead.

Jessica Tassan (Senior Research Analyst)

Congrats on the really strong year. I'm interested to understand first, kind of what are the specific AI tools that you've rolled out nationally to all of your network providers? What did that rollout process look like? Any early outcomes or savings data that you can share. I guess, going forward, what kind of clinical category would you maybe target for AI-enabled improvement? For example, are care transitions an opportunity? Is end-of-life care planning an opportunity? Just curious if there's any, you know, one or two categories that you'd call out. Thanks.

Parth Mehrotra (CEO)

I appreciate the question, Jess. I mean, this stacks to what Josh asked right at the beginning of the call, so I'm not gonna repeat all of that. Hopefully, you got some of that. Look, I think, you know, from a category perspective, given the five buckets I described earlier, I mean, we're looking at, you know, interaction with the patients, so we're looking at care gap closures, we're looking at chart prep, scheduling patients, interaction with patients, Agentic AI as it relates to patient engagement, medication adherence, you know, risk assessment, obviously, you know, clinical decision support.

All of that to just, you know, how the doctors interact with the patients, stratify the population, work with the high acuity patients, and, you know, just there's so much productivity lift we can get given our physicians are capacity constrained, the ability and the need to work deeply with every patient is front and center, as we specifically as payment models evolve to different versions of value-based care. I think all of those are elements where, you know, we are, we are focused on. Obviously, like I said, like there's a whole host of applications on revenue cycle, on the fee-for-service workflows. You know, from a company perspective, like I said, I mean, we're working with some existing companies that we work with today as they innovate.

We invested in this business called Navina, like we talked about last year. I mentioned it earlier, that was pretty tangible for us. There are a number of new innovators in the space that we are partnering with, piloting some of them. You know, at some point, once it's more baked, you know, we'll obviously highlight more. Those are the categories, and there are a lot of new companies out there. I think this is like I said earlier, I mean, this is gonna be a three, five, seven-year journey. The technology is evolving really fast. The improvements that we see are, and the applications are pretty amazing already. I think you're gonna see a lot more adoption and how we can implement in every single one of those buckets.

We're super excited on this journey. I think it'll be a journey, and I think it's gonna be pretty margin accretive and productivity enhancing, going forward for a business like ours.

Operator (participant)

Your next question comes from the line of Michael Ha of Baird. Please go ahead.

Michael Ha (Senior Research Analyst)

Thank you. As you look across the broader value-based care M&A landscape, it appears to be heating up in a pretty big way, only very recently. Acquisitions being made, especially in South Florida, interest ramping up in California. A lot of this coming from a couple of your large payer partners looking to really build greater market saturation. Some of these multiples we're hearing of, they're not too far off from your own, but the quality of these assets appear to be much lower. I'm curious to hear your thoughts on all of this. How does it look to you? Does it seem rational? What do you think is driving the activity? Is it simply we're now entering the end of E28 and the narrative is beginning to pick up again?

As you look ahead, how does all that you're seeing today impact your own M&A strategy? Thank you.

Parth Mehrotra (CEO)

Yeah, that's a good question. Look, I'm not gonna comment on what others have done recently or any particular deal. As you know, we're not in the clinic M&A space. You highlighted two geographies in South Florida and Southern California that almost run very, very differently from a large part of this country, from a healthcare delivery and risk-taking and the concentration of MA population. Those are very unique geographies. The assets are unique. Some of the payers have ROFRs on some of the assets. You're seeing that in transactions. I can't comment on the multiples they're paying or. You know, we're just not in the MA clinic business. I mean, like I said, we believe in shared risk. We believe in community-based doctors staying autonomous, independent, and helping them.

I think to the broader questions, other than, you know, commenting on those specific transactions and the multiples, you know, I think Whit asked this question earlier, I think we are positioned really well. We have a very diversified model. We can look at assets across the spectrum, ACO entities, medical groups, MSO entities, service providers, whatever have you, I think we can hopefully be a partner of choice. I think we're gonna be pretty aggressive. I think finding quality assets is key. I think what you highlighted there is very important. You could spend a lot of money buying a lot of things, and they don't have the same quality of earnings. They don't have free cash flow. They don't have EBITDA. I don't wanna spoil slide 11 for you guys and our investors.

You know, it's, we're gonna be very, very disciplined, and if we can get an asset that we can improve, you know, we're gonna buy and integrate and synergize, and just be disciplined in how we do this. You know, while we have a lot of balance sheet capacity with our free cash flow, with our cash balance, with any potential debt capacity, even though we don't like leverage on this business, you know, I think, we are primed to do larger deals and make an impact and hopefully consolidate the space and continue this compounding of EBITDA. I think we're gonna be very thoughtful.

We don't like to pay big multiples, especially for assets that are lower quality, so I think we're gonna be pretty disciplined in how we approach this.

Operator (participant)

Your next question comes from the line of Allen Lutz of Bank of America. Please go ahead.

Allen Lutz (Equity Research Analyst)

Great, thanks for the question, guys. Thinking more about the long-term 20% EBITDA growth number you have out there. You've got a lot of levers in your portfolio to drive this every year. I was wondering, could you break down how you see the components of driving that 20% growth in a, in a, just a typical year among organic, inorganic margin expansion or whatever it may be? Then which components do you view as, say, higher visibility versus lower visibility? Thanks.

Parth Mehrotra (CEO)

Yeah, I appreciate the question. Look, I think you got to go back to slide 11, you know, again, to look at this on a multi-year basis. You highlighted some of the components, but, you know, those are: you enter new states, you add implemented providers in existing and new states, you add value-based lives in value-based contracts on which we have the potential to earn, you know, care management fees and 40% on shared savings, versus our low double-digit management fees on the, on the fee-for-service book. You can do M&A, and then you grow same store, and then you improve the cost structure like we've done, both on platform, practice, you know, on platform contributions, so the cost of platform, and then also on sales, marketing, and G&A.

As you've seen on that slide 11, like, every year is different. The components are different. They all work together. Some years we've scaled the cost structure really well. Like this past year, you look at 2022 to 2023, we grew pretty fast. We entered five new states. You know, the cost structure didn't scale, like, Adjusted EBITDA margin barely improved across those two years. I think it'll ebb and flow, but the direction is hopefully towards the upward right. Like I said earlier, with the application of AI and everything else, I think we're gonna continue to get this margin profile better. If we do acquisitions, you know, we're gonna synergize them. If we enter new states, some of them lose money in the first couple of years.

I think it just depends, but given the whole book, where it stands today, I think you're gonna see us pursue all those four components. You know, it'll be a combination of both organic and inorganic growth. At our size now, I mean, the law of large numbers is gonna start playing up. Given our balance sheet strength and all the discussions on, and the questions we got on M&A, you know, M&A is a core component of the strategy as we roll up the industry. I think you're gonna see us press on all four, but how it evolves, which year, which component's higher or lower, I think it'll just vary, but, you know, we're gonna keep executing on all of those.

Operator (participant)

Your next question comes from the line of Daniel Grosslight of Citi. Please go ahead.

Daniel Grosslight (Senior Research Analyst of Healthcare Technology)

Hi, guys. Thanks for taking the question. Parth, you guys have been, you know, very forward in thinking and frankly, right on taking on risk. I think that's been a recurring theme on a lot of these earnings calls, but it does seem like some of your competitors are now beginning to adopt your type of model or at least approach to risk-taking, which I guess is good, because imitation is the best form of flattery. It does, I would think, or it might change the conversation you're having with physicians who are now hearing a similar pitch from others. I'm just hoping you can, you know, talk a little bit about your provider recruitment, you know, over the next couple of years, if your conversations with providers have shifted at all, and if so, how has that sales pitch gone?

Parth Mehrotra (CEO)

Yeah, that's a good question. I think it builds on some of the themes on the earlier questions. Look, I mean, arguably speaking, the perceived barriers to entry in this business can be lower. Anybody can start an ACO if they raise capital from some VC or private equity fund. The issue is performing and building core competence on how you deliver value, and then execute day in, day out, every year after year, across cycles, and deliver shared savings for the payers, for the doctors, and generate free cash. That's where the core competence is. I don't think the pitch is any different. We execute the way we do. Our track record speaks for itself. I think a lot of money got raised.

A lot of money that was raised got spent in giving, irrational, you know, call it contracts or economics to... Without sharing the appropriate level of risk. We've said consistently, I'll repeat it, you gotta share the risk with the doctor, an entity like Privia and the payer. That's the best long-term strategy that can outlast eight, nine years of performance, like you see on page 11, across any cycle. You do artificial things, and, you know, the viability of the business can be put to question. We've seen that, like, a lot of companies have not performed well, they're surviving. I think physician practices that may have partnered with an XYZ company, if they're happy, they're happy. If they're performing, you know, it's good.

We have a full service offering with our medical group that, again, a lot of the competitors don't have, to join our medical groups for all lines of business, every patient, every specialty, technology stack, payer contracts, and then we have full suite of value-based, you know, obviously contracts to help them perform in those in a very integrated manner. We think that's a very differentiated approach. And now we have a lot of history and data to speak for itself. Look, obviously, there are some competitors that are doing really well. I think we want them to perform really well because that's good for the industry. I think the TAM is pretty large, and, hopefully, we're one of the survivors and consolidators.

You know, you'll have some great companies out there that do really well, and then, you know, hopefully, some of them, which were not that great, hopefully, we can consolidate over time. I think, hopefully, our results just speak for themselves as to how we're doing, but I don't think it's changing our strategy in any particular manner.

Operator (participant)

Your next question comes from the line of Ryan Langston of TD Cowen. Please go ahead.

Ryan Langston (Director and Senior Analyst)

The paragraph talked about the IMS acquisition, saying there was pretty strong sales momentum, in that state. I guess, can you just give us a sense on the organic pickup from IMS? I'm just trying to sort of understand broadly what the growth trajectory looks like on some of these larger deals as you ramp up in new states. Thanks.

Parth Mehrotra (CEO)

Yeah, I mean, we don't break it up, you know, but I think you got the size of that group if you go to the website. You can see it was a pretty meaningful group, a very large multi-specialty group, carved themselves out of health system, and then they found us, we found them, and there are a lot of synergies in the business model. I think, like I said earlier, in one of the answers to the question, I mean, when you get a sizable group, you know, hopefully the snowballing starts sooner. Our best salespeople are our physicians. If we do well for them, they speak for ourself, for us. I think, again, like, it's a five-year strategy to build a big medical group there. I just don't think any one year makes a difference.

We establish ourselves, we establish the sales team, we start knocking on doors, and we start performing. You know, I think we're gonna continue to expect, hopefully, new signings and implemented providers and, you know, it's, you start small and build it up.

Operator (participant)

Your next question comes from the line of Richard Close of Canaccord Genuity. Please go ahead.

Parth Mehrotra (CEO)

Richard?

Operator (participant)

Your next question comes from the line of Ryan Halstead of RBC. Please go ahead.

Ryan Halstead (Managing Director of Equity Research)

Morning. Thanks for fitting me in. Maybe just one last question on your appetite for new business development. Just how are you thinking about kind of the best return on your investment as you're thinking about, either expansion into new markets or, you know, as you were just alluding to, maybe investing in some of your more recently entered markets and really trying to build density? Just all in light of, you know, the challenging payer landscape that you've been referring to. You know, how does that sort of impact your philosophy on return on that invested capital?

Parth Mehrotra (CEO)

Yeah, that's a great question. Look, I think every deal is different, and you got to evaluate it on its merit. Given our capital position and free cash flow profile, I think we have the luxury to do both. We have to take a portfolio approach. These markets and these dense networks take time to build. I think, we are pressing on all cylinders. It's a little bit, you know, it may sound like everything, everywhere, all at once, but each market runs with its own P&L. They have business leaders that, you know, are responsible for growing those markets. We can do in-market BD as opportunities arise to continue to add to density. We, we can add new markets, we can add new capabilities, we can buy businesses like we did with the Evolent deal.

You're seeing us do a whole wide variety of transactions over the last, you know, five, six years, at least the ones that we've disclosed being a public company. I think you're gonna continue to see that. I think we take a long enough view. The whole business is performing really well, so if there's a market where we know we're gonna lose money as we invest and put the sales team on the ground, and if it's a smaller anchor partner, but it's a, it's a big state with big, good demographics and enough independent physicians, we'll take a five-year view because, you know, we understand the unit economics of this business really well.

I mean, when you get a business which is operating close to 30% EBITDA to Care Margin that we thought we would do five, six years ago, generating this much cash, I think we've seen across, you know, 15 states with the medical group model and now, you know, nine more states with the ACO only model, I think we know what works, what doesn't work. We've seen a lot of issues over the years. We've worked with a lot of payers, you know, different healthcare geographies, different payer dynamics, different health system dynamics. We take all that into consideration as we take that five to 10-year view, I think we have the luxury to do that because, you know, very few companies are in this position where they can invest with that kind of a mindset.

I think we're pretty fortunate, and we're gonna keep pressing on all those fronts.

Operator (participant)

There are no further questions at this time. Please continue, gentlemen.

Parth Mehrotra (CEO)

Thank you for listening to our call today. We appreciate your continued interest and look forward to speaking to you again in the near future. Thank you, operator.

Operator (participant)

Ladies and gentlemen, this concludes today's call. We thank you for participating. You may now disconnect your lines.