EX-99.2 3 ex992.htm EX-99.2 ex992
February 25, 2025 Fourth Quarter 2024 Earnings Results Copyright © 2024 agilon health


 
2 Disclaimers and Forward-Looking Statements FORWARD-LOOKING STATEMENTS AND OTHER INFORMATION Statements in this presentation that are not historical factual statements are “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements include, among other things, statements regarding our and our officers’ intent, belief or expectation as identified by the use of words such as “believes,” “expects,” “may,” “will,” “shall,” “should,” “would,” “could,” “seeks,” “aims,” “projects,” “is optimistic,” “intends,” “plans,” “estimates,” “anticipates” or the negative versions of these words or other comparable terms. Examples of forward-looking statements include, among other things: statements regarding timing, outcomes and other details relating to current, pending or contemplated new markets, growth opportunities, expected revenue and net income, total and average membership, Adjusted EBITDA, Medical Margin, geography entry costs and other financial projections, guidance and assumptions. Forward-looking statements reflect our current expectations and views about future events and are subject to risks and uncertainties that could significantly affect our future financial condition and results of operations. While forward-looking statements reflect our good faith belief and assumptions we believe to be reasonable based upon current information, we can give no assurance that our expectations or forecasts will be attained. Forward-looking statements are subject to known and unknown risks and uncertainties, many of which may be outside our control, including but not limited to: our history of net losses and the expectation that our expenses will increase in the future; failure to identify and develop successful new geographies, physician partners and payors, or execute upon our growth initiatives; success in executing our operating strategies or achieving results consistent with our historical performance; medical expenses incurred on behalf of our members may exceed revenues we receive; our ability to maintain and secure contracts with Medicare Advantage payors on favorable terms, if at all; our ability to grow new physician partner relationships sufficient to recover startup costs; availability of additional capital, on acceptable terms or at all, to support our business in the future; significant reduction in our membership; transition to a Total Care Model may be challenging for physician partners; public health crises, such as pandemics or epidemics, could adversely affect us; inaccuracy in estimates of our members’ risk adjustment factors, medical services expense, incurred but not reported claims, and earnings pursuant to payor contracts; the impact of restrictive clauses or exclusivity provisions in some of our contracts with physician partners; our ability to hire and retain qualified personnel; our ability to realize the full value of our intangible assets; security breaches, cybersecurity attacks, loss of data and other disruptions to our information systems; our ability to protect the confidentiality of our know-how and other proprietary and internally developed information; reliance on our subsidiaries; Environmental, Social, and Governance issues; reliance on a limited number of key payors; our use of artificial intelligence; the limited terms of contracts with our payors and our ability to renew them upon expiration; our ability to navigate the changing healthcare payor market reliance on our payors, physician partners and other providers to operate our business; our ability to obtain accurate and complete diagnosis data; reliance on third-party software, data, infrastructure and bandwidth; consolidation and competition in the healthcare industry; the impact of changes to, and dependence on, federal government healthcare programs; uncertain or adverse economic and macroeconomic conditions, including a downturn or decrease in government expenditures; regulation of the healthcare industry and our and our physician partners’ ability to comply with such laws and regulations; federal and state investigations, audits and enforcement actions; repayment obligations arising out of payor audits; negative publicity regarding the managed healthcare industry generally; our use, disclosure and processing of personally identifiable information, protected health information, and de-identified data; failure to obtain or maintain an insurance license, a certificate of authority or an equivalent authorization; current and potential securities class action litigation; lawsuits not covered by insurance; changes in tax laws and regulations, or changes in related judgments or assumptions; our indebtedness and our potential to incur more debt; dependence on our subsidiaries for cash to fund all of our operations and expenses; provisions in our governing documents; ability to achieve a return on your investment depends on appreciation in the price of our common stock; and sustainability issues. These risks and uncertainties that could cause actual results and outcomes to differ from those reflected in forward-looking statements include, but are not limited to, those factors discussed in our filings with the Securities and Exchange Commission (the “SEC”), including the factors discussed under “Risk Factors” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2024, which can be found at the SEC’s website at www.sec.gov. Except as required by law, we do not undertake, and hereby disclaim, any obligation to update any forward-looking statements, which speak only as of the date on which they are made. NON-GAAP This presentation includes references to non-GAAP financial measures, including but not limited to Medical Margin and Adjusted EBITDA. We believe medical margin and Adjusted EBITDA help identify underlying trends in our business and facilitate evaluation of period-to- period operating performance of our operations by eliminating items that are variable in nature and not considered by us in the evaluation of ongoing operating performance, allowing comparison of our recurring core business operating results over multiple periods. We also believe medical margin and Adjusted EBITDA provide useful information about our operating results, enhance the overall understanding of our past performance and future prospects, and allow for greater transparency with respect to key metrics we use for financial and operational decision-making. We believe medical margin and Adjusted EBITDA or similarly titled non-GAAP measures are widely used by investors, securities analysts, ratings agencies, and other parties in evaluating companies in our industry as a measure of financial performance. Other companies may calculate medical margin and Adjusted EBITDA or similarly titled non-GAAP measures differently from the way we calculate these metrics. As a result, our presentation of medical margin and Adjusted EBITDA may not be comparable to similarly titled measures of other companies, limiting their usefulness as comparative measures Medical Margin and Adjusted EBITDA have limitations as analytical tools and should not be considered in isolation or as an alternative to GAAP measures or other financial statement data presented in agilon’s consolidated financial statements. Reconciliation of such non-GAAP measures to the applicable GAAP measures are set forth in the appendix. TRADEMARKS All rights to the trademarks included herein, other than the Company’s trademarks, belong to their respective owners and our use hereof does not imply any endorsement by the owners of these trademarks. . Copyright © 2025 agilon health


 
3 Strengthening the business for long-term success Key Takeaways Disciplined growth balancing near-term market challenges and optimizing long-term opportunity Investing in advanced clinical and operational capabilities to help reduce variability and enhance quality outcomes Strategic actions combined with cost discipline to help drive near-term improvement and sustainable long- term profitability


 
4 Quarter Ending December 31, 2024 Year Ending December 31, 2024 Medicare Advantage Members 527,000 527,000 ACO REACH Members 132,000 132,000 Total Members Live on Platform 659,000 659,000 Avg. Medicare Advantage Members 527,000 522,000 Total Revenues ($M) $1,522 $6,061 Gross Profit ($M) ($38) $5 Medical Margin ($M) $1 $205 Net Income (Loss) ($M) ($106) ($260) Adjusted EBITDA ($M) ($84) ($154) Geography Entry Costs ($M) $11 $34 2024 Financial Performance


 
5 Quarter Ending March 31, 2025 Year Ending December 31, 2025 Medicare Advantage Members 490,000 – 510,000 490,000 – 520,000 ACO REACH Members 105,000 – 115,000 105,000 – 115,000 Total Members Live on Platform 595,000 – 625,000 595,000 – 635,000 Avg. Medicare Advantage Members 490,000 – 510,000 489,000 – 516,000 Total Revenues ($M) $1,480 – $1,520 $5,825 – $6,025 Medical Margin ($M) $125 – $140 $275 – $325 Adjusted EBITDA ($M) $10 – $25 ($95) – ($55) Geography Entry Costs ($M) $10 – $9 $40 – $35 Financial Outlook Note: We have not reconciled guidance for Medical Margin to Gross Profit or Adjusted EBITDA to net income (loss), the most comparable GAAP measures, and have not provided forward-looking guidance for net income (loss) in each case because of the uncertainty around certain items that may impact Gross Profit or net income (loss), including non-cash stock-based compensation.


 
Membership Bridge FY2024 to 2025 Guide Membership Guidance Bridge for Full Year 2025 6 MA Membership REACH Membership • Smart growth (partnership/contract exits paired with measured future growth). • Class of 2025: 20K members across 3 new partners. • ~3% same geography growth. • Discipline and smart growth also applied to REACH. • Partnership exits includes completion of the Hawaii market exit and the exit of one MSSP partnership. • The reduction in existing markets reflects continued focus on member attribution.


 
Medical Cost Trend Bridge – FY2024 to 2025 Guide Medical Cost Guidance Bridge for Full Year 2025 7 *Reflects medical claims for Y2+ markets (classes 2024 & prior) for comparable year-over-year. Key Highlights • The 2025 medical cost projections assume that the elevated utilization seen in 2024 will continue. • 2024 closed with a 6.8% medical cost trend, which we estimate has 50 basis points associated with the two-midnight rule. • For 2025 the estimated cost trend is 6.3% gross and 5.3% net. The 1% difference is due to effect of payor bids which we expect to lower medical expense in 2025.


 
Medical Margin Bridge – FY2024 to 2025 Guide Medical Margin Guidance Bridge for Full Year 2025 8 2025 Key Highlights • Focused on balanced growth prioritizing margin maturation: • Strategic exit of select partnerships/contracts create a step-up in baseline earnings. • Smaller class of ‘25 primarily “glide path” - reducing the beta prior to going full-risk. • Drivers • Estimated gross cost trend of 6.3% and 5.3% net for year 2+ markets. The 1% difference is due to the effect of payor bids. This compares to a 2024 cost trend of 6.8% observed in 2024. • 2% RAF improvement net of 2nd year of v28 phase-in. • Part D exposure reduced to <30% of membership. partially offsetting IRA impact. • Approx. $50M benefit from operating initiatives- quality, and clinical expense mgt. Note: We have not reconciled guidance for Medical Margin to Gross Profit or Adjusted EBITDA to net income (loss), the most comparable GAAP measures, and have not provided forward-looking guidance for net income (loss) in each case because of the uncertainty around certain items that may impact Gross Profit or net income (loss), including non-cash stock-based compensation.


 
ADJUSTED EBITDA Bridge - FY2024 to 2025 Guide Adjusted EBITDA Guidance Bridge for Full Year 2025 9 2025 Key Highlights • Strategic exit of select partnerships/contracts creates a larger step-up in baseline Adjusted EBITDA (the drag to Adjusted EBITDA was greater than medical margin due to corresponding operating expenses). • Impact from: • Continued elevated utilization more than offsetting rate reimbursements. • Risk adjustment v28 phase-in pressures. • Remaining Part D exposure net of IRA impact. • Benefit from: • Discipline on G&A with minimal growth (demonstrates the fixed cost nature and future leverage of the business). • Operating Initiatives. Note: We have not reconciled guidance for Medical Margin to Gross Profit or Adjusted EBITDA to net income (loss), the most comparable GAAP measures, and have not provided forward-looking guidance for net income (loss) in each case because of the uncertainty around certain items that may impact Gross Profit or net income (loss), including non-cash stock-based compensation.


 
10 Appendix Copyright © 2024 agilon health


 
11 Non-GAAP Reconciliations (Dollars in thousands) Three Months Ended December 2024 Twelve Months Ended December 2024 Gross profit(1) $ (38,255) $ 4,841 Other operating revenue (3,242) (12,815) Other medical expenses 42,063 213,159 Medical margin $ 566 $ 205,185 1) Gross profit is defined as total revenues less medical services expenses and other medical expense. Medical Margin


 
12 Non-GAAP Reconciliations (Dollars in thousands) Three Months Ended December 2024 Twelve Months Ended December 2024 Net income (loss)(1) $ (105,790) $ (260,101) (Income) loss from discontinued operations, net of income taxes (640) 9,824 Interest expense 1,574 6,177 Income tax expense (benefit) 1,757 1,451 Depreciation and amortization 6,494 24,463 Impairments 3,596 3,596 Severance and related costs (159) 4,577 Stock-based compensation expense 2,282 50,657 EBITDA adjustment related to equity method investments(2) 2,557 17,582 Other(3) 4,359 (12,441) Adjusted EBITDA $ (83,970) $ (154,215) 1) Includes direct geography entry costs, including investments to develop and expand our platform and costs in geographies that are in implementation and are not yet generating revenue and investments to grow existing markets. For the three and twelve months ended December 31, 2024, (i) $3.4 million and $5.4 million, respectively, are included in other medical expenses and (ii) $7.3 million and $28.5 million, respectively, are included in general and administrative expenses. 2) Includes elimination of certain administrative services provided by agilon health, inc. to equity method investments. 3) Includes interest income, transaction-related costs and elimination of certain administrative services provided by agilon health, inc. to equity method investments. Adjusted EBITDA