Privia Health Group Q1 2022 Earnings Call Transcript

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Provided by Quartr
May 12, 2022

Key Takeaways

  • Positive Sentiment: Practice collections increased 63.3% year-over-year to $561.9 million in Q1, reflecting robust revenue growth.
  • Positive Sentiment: Adjusted EBITDA reached a quarterly record of $14.8 million, up 48.8% year-over-year, with margins expanding to 20.7% of care margin.
  • Neutral Sentiment: Introduced $48.3 million in Q1 capitated revenue as a new line item, demonstrating diversified revenue streams.
  • Positive Sentiment: Attributed lives in value-based contracts grew 17.6% year-over-year to 848,000 across over 80 at-risk payer arrangements.
  • Positive Sentiment: Ended Q1 with a net cash position exceeding $283 million and expects over 90% of adjusted EBITDA to convert to free cash flow for 2022.
AI Generated. May Contain Errors.
Earnings Conference Call
Privia Health Group Q1 2022
00:00 / 00:00

There are 15 speakers on the call.

Operator

Good day and thank you for standing by. Welcome to the Provia Health Q1 2022 Conference Call. At this time, all participants are in a listen only mode. After the speakers' presentation, there will be a question and answer Please be advised that today's conference is being recorded.

Speaker 1

I would now like to hand the

Operator

conference over to your speaker today, Robert Borchardt, SVP of Investor and Corporate Communications. Please go ahead.

Speaker 2

Thank you, Gigi, and good morning, everyone. Joining me today are Sean Morris, our Chief Executive Officer Parth Marotta, President and Chief Operating Officer and David Moundcastle, our Chief Financial Officer. This call is being webcast and can be accessed from the Investor Relations section of priviahealth.com. Today's press release highlighting our The financial results reported today and in the press release are preliminary and are not final until our Form 10 Q for the quarter ended March 31, 2022, is filed with the Securities and Exchange Commission. Some of the statements we will make today are forward looking in nature based on our current expectations and our view of our As of May 12, 2022.

Speaker 2

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 in conjunction 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, And reconciliations of these measures to comparable GAAP measures are included in our press release and the accompanying slide presentation posted on our website. Now I'll turn the call over to Sean.

Speaker 3

Thank you, Robert, and good morning, everyone. We are very proud of the success that of our healthcare ecosystem and we are honored to be one of the nation's leading physician enablement organizations. This past Tuesday, we were excited to celebrate our 1 year anniversary As a public company at the NASDAQ marketplace along with 17 physician leaders representing our more than 3,300 physicians and providers across 8 states and the District of Columbia. With our continued momentum in the existing markets, Privia Health posted another Strong quarter of financial and operating performance in the Q1 of 2022. We remain highly confident in our growth outlook for 2022 and beyond as we continue to organize physicians in the scale provider networks across our country.

Speaker 3

This morning, I'll present an overview of the key highlights, Park will provide a business update and then David will conclude with our recent financial performance and updated outlook for 2022 before we take your questions. Pravia Health is continuing to execute at a very high level and our first quarter results clearly highlight this. Our practice collections increased more than 63% year over year and our operating model is already working at scale. Adjusted EBITDA was a quarterly record and was up over 48% while we're investing across our enterprise to support this accelerated top line growth. The business momentum and high forward visibility into our growth metrics is reflected in our updated financial guidance for 2022.

Speaker 3

Our growth is being driven by a balanced set of strategic initiatives. This includes continued same store growth driven by the strength in ambulatory utilization across all of our existing practice locations. This patient volume is a benefit to both our fever service collections as well as supporting the performance in our value based arrangements as we serve patients in lower cost care settings. As we align with and enable our provider partners and expand Our number of attributed lives, our operational execution and clinical performance is continuing to drive strong results across our value based arrangements. We generated another solid quarter of new provider additions in existing markets and in combination with a sustained high level of provider retention.

Speaker 3

In addition, our active business development pipeline remains robust as we look to enter many new markets over the next few years. With that, let me ask Parq to provide more details on market position and expansion.

Speaker 4

Thanks, Sean. Privia Health is building 1 of the largest primary care Our business model has a number of distinct attributes that are applicable across all 50 states as we partner with all provider types, serve all patients across all reimbursement models and participate in value based arrangements in the broadest possible way. Our model offers a tremendous market opportunity for growth in the physician enablement space as we scale nationally and partner with independent providers as well as health system or other facility affiliated or employed providers. We introduced Privia Care Partners in the second half of twenty twenty one as a highly complementary partnership model. This is offered to provide a practice looking to partner with Privia, but wanting to start first with a risk bearing entity only such as our ACOs.

Speaker 4

One advantage of our platform is that we contract across commercial, Medicare and Medicaid programs. This offers much broader value based care opportunities for A unique component of our growth strategy is our ability to monetize our at scale medical groups and risk bearing entities as we gain density in our markets. We are able to offer a number of these value added services to our physician and payer partners as part of an integrated ambulatory care delivery system. Underlying our integrated medical groups and risk bearing entities in each of our geographies is Privia's tech enabled clinical and management services platform. This enables us to maximize physician alignment and deliver superior outcomes in value based arrangements without owning the underlying practice.

Speaker 4

As Sean noted, our business momentum has continued to be extremely encouraging across both existing and potential new geographies. Our national footprint now includes 3,370 implemented providers, caring for more than 3,800,000 patients across our 8 70 practice locations in 8 states in the District of Columbia. As one of the largest provider groups in the country, Our scale and geographic density is also defined by our breadth of medical specialties. While approximately 65% of our practice partners are primary care focused, Including internal medicine, family medicine, pediatrics and OBGYNs, we actually partner with more than 50 specialty types. This provides Privia with some unique advantages as we partner with payers to offer a broad ambulatory care delivery network that can improve patient outcomes and reduce costs across the value based care spectrum.

Speaker 4

Our operating model and strategy has led Privia to have one of the broadest, most balanced and well diversified value based care platforms in the industry. Our more than 80 at risk payer contracts now cover approximately 848,000 This is up 17.6% from a year ago and more than 10% since the end of 2021 giving us a lot of momentum and visibility for the remainder of 2022. We take upside and downside risk in many of our payer contracts covering nearly 2 thirds of the attributed Medicare lives across MSSP and Medicare Advantage Programs. This thoughtful move to risk continues to provide significant opportunities for top line and EBITDA growth as we execute on our goals and on greater shared savings in the years to come. Now I'll ask David to review our Q1 financial results and updated outlook for 2022.

Speaker 5

Thanks, Bhar. Our outstanding Q1 performance highlights that our operating model is already working at scale and our business momentum continued into 2022. Practice collections increased to $561,900,000 up 63.3% from Q1 a year ago. As we noted last quarter, We will report our capitated revenue as a new line item in our sources of revenue section of our 10 Q. Capitated revenue was $48,300,000 in Q1.

Speaker 5

Care margin increased 36.4 percent and adjusted EBITDA was a record $14,800,000 up 48.8 percent over the same period last Our expected as expected, our top line grew faster than EBITDA this quarter due to the new capitated arrangements as well as investment across our business enterprise to support this accelerating top line growth. At the same time, you can clearly see the operating leverage in our model as our top line and care margin growth is translating nicely into EBITDA growth and margin expansion. Our adjusted EBITDA margin as a percentage of Care margin increased 180 basis points from a year ago to reach 20.7%. Given our first quarter performance, business momentum and visibility through the rest of to be in the mid to high end of our guidance ranges with platform contribution and adjusted EBITDA expected to reach the high end. Our guidance for This includes growing existing practices, increasing attribution in risk based contracts, adding new providers, identifying opportunities to expand our platform and opening new markets over time.

Speaker 5

Our underlying assumptions are unchanged from 1 of Privia Health's key differentiators is our solid balance sheet and positive annual free cash flow. We ended Q1 with a net cash position of more than $283,000,000 with capital expenditures of less than $1,000,000 we continue to expect more than 90% of our adjusted EBITDA to convert to free cash flow for the full year 2022. This financial flexibility and strength gives us confidence to invest in our growth initiatives and fund all strategic opportunities in the foreseeable future without reliance on any external sources of capital to continue to expand our platform nationally. We continue to grow and expand our business with all types of health care providers that are looking to partner with scaled financially sound organizations to improve outcomes for their entire patient population. With that, operator, we are now ready for our first question.

Operator

Thank you. Please standby while we compile the Q and A roster. Our first question comes from the line of Josh Ken from Nephron Research. Your line is now open.

Speaker 6

Hi, thanks. Good morning. Just first numbers question, I think I heard you say, I

Speaker 7

think David said they were going to put it

Speaker 6

in the queue. With the practice collections, the 561, how much of that was value based care? Was that the $48,000,000 that you mentioned. And what was that number a year ago? And if you could just remind us the assumptions you make in terms of Cools for value based care earnings sort of this early in the year.

Speaker 4

Thanks, Josh, for the question. Look, you'll see the disclosure in the queue where we'll clearly mention the capitated piece of the revenue or the practice collections. There's obviously other shared savings accruals and the care management's fee that we've also broken out. So you'll see that in the queue. But roughly you'll see that accreting much faster than last year because of the capitated arrangements that we that started this year.

Speaker 2

But we stated that revenue from capitation was $48,300,000 $48,300,000 from the new capitated revenue, correct. And again, there's

Speaker 5

a table in the queue that's going to break out the revenue.

Speaker 6

Okay. But the total value based care portion of practice collections would Higher than that $48,300,000 Is that right?

Speaker 4

Yes, that's absolutely right.

Speaker 5

Correct. Right. So for example, shared savings increased as an example.

Speaker 6

Right. Okay. And then, of your providers, I'm just curious if you could give us just to sort of look on the pipeline, but how many providers are Sold as of today, but not yet in that or as of March 31, but not yet implemented. And maybe if you just have broad comments on that pipeline for

Speaker 4

Yes, definitely. So we don't disclose sole providers. But as you understand our model, it takes about 5 to 6 months to implement providers, credential them in our medical groups and so forth. So at this point sitting in May, we almost have visibility through to the end of the year And the pipeline is pretty full. We had a record sales year last year and one of our best first quarters this year.

Speaker 4

A lot of momentum we continue to see in our existing geographies and obviously the business development pipeline is pretty robust. So all of that will translate into the implemented provider growth For the rest of this year and then going into 2023.

Speaker 6

Okay. That's helpful. Thanks.

Operator

Thank you. Our next question comes from the line of A. J. Rice with Credit Suisse. Your line is now open.

Speaker 8

Hi, everybody. First of all, I guess just on the capitated lines, I think at oneone you said in Medicare Advantage at about 23,000. Looking at your 106,000 today, if 28% are in full risk, that puts you at about 30,000. Can you give us a sense of How that's likely to trend over the rest of the year? Have a view of where you'll end the year on capsated MA lives?

Speaker 8

And is there a Seasonality to the additions of those lives?

Speaker 4

Yes, sure. So we started with 23,000. Obviously, the intent is to grow that Year over year. Now as we stated previously, we'll be very thoughtful in adding lives to the capitated arrangements once we are certain that the So you should see an accretion. And while we're not going to break out specifics, that has trended up From the 23,000 numbers, so your estimate is ballpark, right?

Speaker 4

And then again, as we enter into this is this should be pretty front end loaded in the beginning of the year, The nature of these contracts relative to, for example, the commercial or the MSSP attribution. So pretty much you should see that Stable now going into the rest of the year and then as we add lives, it likely be at the beginning of next year.

Speaker 8

Okay. And then maybe just a follow-up, another sort of clarification question on the Q1 practice Collection that came in above the high end of your range. Is there any seasonality or step down that occurs in Q2, Q3 That we should think of, given the strong start?

Speaker 4

No. In fact, Q1 is typically the lowest quarter. We are seeing a lot of momentum, Both in terms of our physician adds ending last year, beginning of this year, so that's reflected in the strong print. Also utilization has continued to be ahead of our expectations. It's been tough to predict, but we've tried to be on the conservative side.

Speaker 4

And if that Comes in ahead of our expectations that flows into the practice collection numbers and then down the P and L in the operating leverage with our EBITDA outperforming. And then finally, the value based arrangements continue to perform well across all our programs. So our accrual estimates reflect that for each of our programs. So it's a pretty broad based growth and we like to see it that

Speaker 8

Okay, great. Thanks a lot.

Operator

Thank you. Our next question comes from the line of Lisa Gill from JPMorgan. Your line is now open.

Speaker 1

Great. I just first want to start with cash flow. I appreciate your comment around 90% of adjusted EBITDA for the year, but Cash flow in the Q1 was negative and it looks like you had a nice increase on the receivable side. Is that just a timing issue? Can you maybe just talk about how to think about cash flow would be my first question?

Speaker 5

Yes. Thanks, Lisa. Yes, it's definitely just timing issue, we're expecting the trend this year to kind of mirror last year. We do have one unique item in Q1 where we pay our annual bonuses. So that's a relatively large cash outflow in Q1.

Speaker 5

And then just the timing of our value based arrangements and when we receive that cash, We expect it to be similar to last year. So Q1 is generally our equal to or negative cash flow quarter, And then it just builds from there. But we are still expecting sort of 90% plus by the end of the year.

Speaker 1

Okay, great. And then just another question. As we think about Just the timing of things, and you had a nice beat, congratulations in the Q1. And as we think about the guidance for EBITDA For the rest of the year, is there seasonality? Do you have some kind of increased expectations, for example, around Rising labor rates, is there anything you would call out specifically as to how to think about the Q1 beat and the guidance for the rest of the year?

Speaker 4

Yes, sure, Lisa. It's Bharat. Look, it's a great start to the year and gives us a lot of confidence. We gave you our guidance 6 weeks ago, and We are here guiding to the high end on EBITDA and Care margin, so and platform contribution. So the bottom line metrics are Really showing the operating leverage in the business as top line performs.

Speaker 4

Our hope is that continues. Obviously, stuff to predict utilization and things like that, but the EBITDA trend should mirror last year. Again, we should continue to hopefully see that same Seasonality, so our hope is that this strength continues into the year and we'll update the guidance as it goes. But again, it's pretty early in the year, but

Operator

Thank you. Our next question comes from the line of Ryan Daniels from William Blair. Your line is now open.

Speaker 9

Yes, good morning. Thanks for taking the question. Maybe one financial and one more strategic. Just on the financial, obviously, strong start to the year, But I'm curious what the delta is between the reiteration of lives and at risk lives and providers and then the revenue and profits. Are you seeing better Utilization, is that the key driver, better risk adjustment?

Speaker 9

Just any color there to give us some feel for that delta would be great.

Speaker 4

Hey, Ryan, it's Bharat. So on practice collections, like I mentioned, it's fairly broad based beat across both utilization on the fee for service, Good performance on value based care and then provider adds were pretty strong ending last year. We've implemented providers and attributed lives. Those metrics, it's still Q1 in the year, and we are nicely ahead sequentially from Q4 last year, but it's still early in the year, so we're maintaining our guidance. Our hope is we keep seeing that momentum and we'll update it.

Speaker 4

Obviously, the guidance does not include any new markets that we may add during the course of the year. We have a pretty active BD pipeline. So hopefully, We'll update that as we did last year when we entered those markets. But again, given the visibility and those two metrics move the slowest In terms of just how providers are implemented, how lives are added during the course of the year, so much more stable. But it's great to see the outperformance On both collections and then flowing through the P and L down to EBITDA.

Speaker 9

Okay. Absolutely. That's helpful. And then A more strategic question and maybe I'm overthinking this a bit, but your partnership with Surgery Partners seems like an interesting case study for your business model and that It's in a pretty small state, which I assume you could only move into with your type of multi payer platform. And then number 2, kind of speaks to the ability to manage A wide number of specialists and maybe downstream and ambulatory care.

Speaker 9

So can you speak to that a little bit? Again, I know it's not a huge revenue driver, but it seems pretty strategic to the

Speaker 4

Yes, definitely. I'll start and Sean can add. Look, just broadly speaking, if you take a step back, our strategy is to build These very large scale medical groups focused on primary care providers and then we surround them with the right specialists, we partner with lower cost health systems Then obviously entities like surgery partners and providing these value added ancillaries as part of this broader ambulatory care delivery system if you will. This is what we believe is fundamentally going to be a very valuable entity and where the buck is moving. It allows us to have a very broad access The TAM participate in 50 states, all patients, all payers, all reimbursement models.

Speaker 4

The only other company That does this at somewhat national scale, given the assets they've acquired as OptumCare, as you know, but very similar strategy. We are a fraction of the size. Obviously, don't have the balance sheet, but we are trying to do that in a very thoughtful capital efficient partnership model, but we're trying to achieve the same result. Yes, Ryan.

Speaker 3

The only thing I would add or reiterate, as you mentioned or noted to in Parkland is the ability to move into a state like Montana And get there early, teach the doctors kind of value based levers. And it really, until you point out, was a company like Surgery Partners going to on the Our strategies aligned really well. I mean, they're a low cost setting and we can go out, kind of build the medical group as we Kind of direct that care to the lowest call setting, enter value based arrangements and move that market over a period of time as we kind of work and align with payers that want to The market that way. So it's we are we would obviously seek other partners like that. It makes a lot of sense for us And to get into a market early and establish ourselves with the relationships with those types of providers.

Speaker 9

Perfect. Thanks and congrats on the momentum.

Speaker 10

Thank you, Todd.

Operator

Thank you. Our next question comes from the line of Whit Mayo from SVB Securities. Your line is now open.

Speaker 11

Thanks. I think I just want to start first with the investments that you guys were making coming into 2022, I think given a lot of the growth momentum, the new markets, the ACOs, the risk platform, you You needed to stand up some infrastructure. Has anything changed on those investments? Do you need to make more or less? Just any early observations or thoughts would be helpful.

Speaker 4

Yes. Hey Whit, thanks for the question. No, they stand as you stated and as we have communicated at our last earnings call. We're continuing to make those investments. It is obviously great to see the organization execution across the board.

Speaker 4

You're seeing that in the financials Very clearly as we've outperformed on the top line. And the beauty of the business is despite those investments, we are Forming on EBITDA and free cash flow. And I think you're getting this business given our guidance that is now growing 35% this year On the top line and 35% plus on EBITDA, we're not sacrificing that any compression from those investments. It speaks to the scale of the business already and where we are with our margin profile pretty much halfway there or more than halfway there from a long term margin. We feel pretty good about where we are with the investments.

Speaker 4

We'll obviously there's a big TAM out there and looking to enter new markets, but we are thoughtfully investing in the business. But the momentum is helping us not sacrifice EBITDA as we make those investments.

Speaker 11

Yes. No, that's helpful. And You've sort of alluded to this a couple of times, so I wanted to get more directly and specific on the ACO performance in the quarter. I know it's Early, but you're getting some feed of data in from CMS that should give you some visibility into sort of how you're tracking versus expectations. How are you tracking versus your internal plan there just with the new ACOs and also those that have converted into the extended track?

Speaker 11

Thanks.

Speaker 4

Yes, definitely. So the data we typically get is lagged, as you know. So the data we get now is reflective of our performance In the performance year 2021, it's still early stages for the new ACOs, but all the data we received is reflected in our accruals. And As we stated, that's a little bit ahead of our expectations and that's reflected in the financial statements and then in both the top and the bottom line. So I think we've We expect to perform pretty well when it's all said and done by the time August comes and we get the final true up And hopefully our accruals are reflecting that.

Speaker 4

As far as the new ACOs are concerned, again, pretty early stage. We just got started Jan 1. So we'll continue to get that data over the course of this year and we'll reflect that appropriately in our guidance.

Speaker 11

Okay, great. Thanks guys.

Operator

Thank you. Our next question comes from the line of Jessica Tazeen from Piper Sandler. Your line is now open.

Speaker 7

Hi, good morning. Thank you for taking the questions. So I just have one quick one on the implemented provider count and then a follow So on implemented providers, you guys announced Montana in early February. Can you just confirm whether or not those 65 Montana Providers are now included in the implemented provider count?

Speaker 4

Yes. Hey, Jess. So they're expected to be implemented at some point in Q2. So they'll likely be reflected when we report our Q2 results.

Speaker 7

Got it. That's helpful. And then just maybe, any comments on fee for service volume trends 2Q quarter to date relative to 1Q and then maybe just on a historical basis, I don't know if we should be thinking about Fee for service practice collections per provider is normal in 2018 or 2019, but comping 2Q quarter to date relative to

Speaker 4

So we continue to see the trend with utilization well above our expectations. That continued from Q4 last year into Q1 this year and nothing's changed in the 1st couple of months here in Q2. So hopefully that continues. Again, we like to be conservative. It's been tough to predict these last 24 months, but hopefully that momentum continues.

Speaker 4

But we are well over Pre COVID baselines, by wide respect, we think our practices are gaining market share on a same store basis, Given the strength of the platform and the strength of these practices during that time. So I think we see a lot of momentum and hopefully that

Operator

Got it. Thank you. Thank you. Our next question comes from the line of Sandy Draper from Guggenheim. Your line is now open.

Speaker 12

Thanks very much and good morning. Just, I think Still a clarification here. I'm not quite sure. I think you may have addressed it, but I didn't quite get it, so I apologize. Looks like in the Q1, your Care margin was about 12.7%.

Speaker 4

But if

Speaker 12

you look at your full year guidance here, it applies close to 13.5%. And so we're thinking about that trending up. Just remind me, what are the key drivers and do you expect that to be linear or are there any sort of Notable quarters where you get true ups for any of the recapitalized or shared savings where you have a big jump It pushes that up and then it comes back down. Just trying to think about pacing that line and the trajectory going from 12.7% in the first quarter to get to sort of a 13.5% for the year? Thanks.

Speaker 4

Hey, Sandy. Thanks for the question. So the trend should pretty much Mimic 2021 or previous years where you'll see it's low in the beginning of the year and then ramps up by Q3. The one thing that does get trued up is our accrual estimates for prior periods When we get most of our value based care results later in the year, sort of if there's a big deviation on the positive side, you should See that care margin as a percentage of practice collections trend up. Obviously, we entered the capitated arrangements this year.

Speaker 4

So we are accruing for those and not expecting Much to flow down to care margin from those this year. So there'll be some anomaly driven by that. But again, that should be the trend and that's reflected in the guidance.

Speaker 12

Great. That's helpful. And then the follow-up. And this relates to, I think some of the questions at the very beginning. When I one of the ways I look at it is Practice collections per provider, and that was up really nicely on a year over year and sequential basis.

Speaker 12

Should we generally think about outside of a really big ad that that should be the level you think you saw This quarter of practice collections per provider should be relatively stable unless obviously if you add a big chunk of providers, You may actually see just based on the math, it dropped down a little bit or is there anything that wasn't related to the individual Providers again going back to some of the shared savings other stuff that maybe not be purely provider based to think about what's on building that out. Thanks.

Speaker 4

Sure. So generally speaking, it should be stable accounting for any health care inflation or contractual adjustments that we have on the fee for service book. I do think it should be important that you separate out the capitated revenue and then calculate that number from From the practice collections because that started this year, so there'll be a big jump in practice collections due to those capitated arrangements. So I think once you normalize for that, You should see a fairly stable trend ticking upwards slightly, but hopefully that should remain fairly stable over time. Okay.

Speaker 4

Yes, that's helpful. So I guess we'll wait

Speaker 12

for the queue and make those adjustments and do that going forward. Thanks, Mark.

Operator

Thank you. Our next question comes from the line of Adam Romp from Bank of America. Your line is now open.

Speaker 10

Hey, thanks. Going back to the discussion about multi specialty groups and the comparison to OptumCare, Q2, I guess, are one of the only ones that I cover at least in value based care that are connecting both primary care assets and specialists. And you mentioned that it creates some synergies in value based care. But to me, I still don't really understand how exactly that works. Like it makes a lot of sense on the commercial side To add scale and get negotiating leverage and higher unit costs and you mentioned utilization being stronger than you expected.

Speaker 10

So How exactly is it creating efficiencies on the value side? And do specialists get any of the shared savings, for example?

Speaker 4

Yes. Good question, Adam. So I'll start and Sean will add. So look fundamentally what we recognize is In any value based arrangements, 80% of the cost downstream from a primary care provider are largely fee for service. So whether it's the specialist, It's facilities, inpatient, outpatient and obviously the drug spend.

Speaker 4

And the strategy is therefore to have a broad Delivery system that can impact some of that cost trend with alternative site of care strategies, lower cost, higher quality specialists and so forth. But then more importantly, play the value based theme where the primary care provider may not be fully at risk In pools like the commercial pool that we have or even in upside only MSSP where the primary care provider doesn't need to take full risk, But you're impacting enough of the cost trend that is accruing to the payer of healthcare. I think that's our strategy going in. And then obviously, we do participate In bundles and programs like that, where appropriate, where the specialists can really impact with an alternative side of care strategy. It's something we're looking closely with our partnership with Surgery Partners as an example.

Speaker 4

So obviously that helps us participate much more broadly than most.

Speaker 3

Adam, this is Shyam. So if you think about kind of just at a high level what we do, we build medical groups. They're Always primary care focused. That's where the attributed lives come from, over 80 value based arrangements.

Speaker 5

But at the end of

Speaker 3

and primary care focused, That's what we're always going to be. But at the same time, as we build these medical groups, we're very strategic about when we begin to see density in a market, in a state, What type of providers should we be adding depending on the level of risk we're taking and what that cohort of patients looks like? And I'll give you the example of Medicare Advantage. As we get dense and build density in a certain geography, you'd say there's 5 to 6 specialties that you really want to I guess to get the right volume to the right providers, think about Sites of service and ambulatory surgery, all those type of things that are the levers of just traditional any kind of traditional managed care. But Our primary care physicians have compacts, is what we say, with these types of doctors.

Speaker 3

And then we are kind of looking to add those Specialist to our group. So you're beginning to manage the professional risk and then you have a huge input I guess outcome then on the institutional pools. And so But then we're moving upstream to professional and then fifty-fifty and really starting to kind of think about how we impact that institutional pool. And we've been very open about we think the best long term, most sustainable arrangements are where the payer is accepting risk with us, And they have incentives to build the right benefit structure for their patients. They have incentives to go out and get the most Competitive arrangements with the acute care facilities and so on.

Speaker 3

So that's what we I mean, we're in the business of building highly aligned Primary care focused medical groups that can take care of every type of patient regardless of the type of program they're in. I hope that's helpful.

Speaker 10

Yes. No, it is. Appreciate it. And then one more follow-up to what you said earlier. You said that you wouldn't expect practice collections per Doctor, I think to rise over time aside from cost inflation, but my understanding was that you were helping the Build out their patient panels and maximize revenue and lift their rates.

Speaker 10

So why wouldn't that number trend up Significantly over time?

Speaker 4

Yes. Over 2 or 3 year period, you should expect that to happen absolutely. On a quarter by quarter basis, You would not see that kind of movement. And again, you'll have to, as I mentioned to Sandy, separate out the value based components. If you're looking at just the fee for service line, obviously there's a good uptrend when the doctors join us and then it stabilizes and then it creeps up with With 3,300 providers, it's a much more stable metric now than it was a few years ago.

Speaker 4

But again, it's Impacted by specialty mix and the majority of each of our markets.

Speaker 10

Okay, got it. Thanks.

Operator

Thank you. Our next question comes from the line of David Larsen from BTIG. Your line is now open.

Speaker 13

Hi, congratulations on the good quarter. Can you talk a little bit about the nature of the value based care deals that you're working in. We've heard from Washington, there's a little bit of exhaustion from around like the provider relief fund and sending dollars to providers. There's There's sequestration where I think there was a 1% thing in April, there's another 1% thing in July and there's less sort of tolerance for upside only risk deals. How is that impacting your book, if at all or your provider clients?

Speaker 13

Is it a headwind or is it actually a tailwind? Thanks.

Speaker 3

David, thanks. This is Sean. We talk a lot about it's important And the type of providers that are attracted to Privia, they want value based arrangements across their whole panel. And Simeon, that gets into the 80 plus, it gets into today. If you look at these kind of breaking those pools out, commercial tends to be across the country up I can tell you, if you're any sophisticated provider and you're doing well, you're wanting to move And so payers are coming to you and said, hey, how can we share risk in certain corridors or in some way on the commercial?

Speaker 3

So that There's discussions about that. We have those discussions. So then you take you start breaking down the other Medicaid. Medicaid tends to be upside. It's It's very state specific what opportunities you have, what opportunity how you can affect that.

Speaker 3

Then you get into the Medicare population, you break that out into 2 buckets. Obviously, We've been in the government business a long time. The team here at Privia has a lot of experience in government programs. We like them. We break those out into we participate in MSSP.

Speaker 3

Pete, a lot of discussion about the success recently by CMS being pretty vocal about kind of stopping doing Many programs that they don't feel they're getting shared savings or getting savings for the taxpayer and doing more of the programs that are being successful. We've been in MSP, I guess since the beginning 7 years ago, really successful run the have the number one out of the top 100 ACOs in the Mid Atlantic And the shared savings percentage, so a lot of success there. Medicare Advantage team has a lot of that. We've moved into that. But I think what when you this is me speaking.

Speaker 3

I don't want to speak for CMMI and CMS, but they're narrowing their programs. We support Yes, that the because these programs are built over decades, they're not built over 2 or 3 years. And we think that as these programs Continue to improve, you'll see us in those programs. We're going to do analysis. And should we move our physicians in from one program to the next, We do that with our doctors.

Speaker 3

They're sharing risk with us. They're putting up money and they have skin in the game. So we're very thoughtful in how we move from program to program when We were measuring the headwinds and the tailwinds when we make those decisions. So we're pretty supportive of the decisions that's coming out of CMS now and that Be very thoughtful, be very supportive, continue to improve upon the programs. I think the other thing I haven't mentioned is there Yes.

Speaker 3

I think you'd agree what they're saying is they'd like to see more, I guess, similar the payer the commercial payers doing And I think you're going to start seeing some of that. We were there programs, I don't want to say the quality metrics are the same, but they're going to be upside And CMS has been you're saying they want to they'd start off upside, but they want you to move to risk. And your last question is, I think that's exactly what we're built to do. We're very thoughtful about it. And maybe we're kind of monotonous in our discussions, but we that's So this is we're very supportive of what they're out there saying and the way they're taking the programs.

Speaker 13

Okay, great. Thanks very much. And then just one more quick one. There's a lot going on in the market with inflation, labor costs, rising interest rates and a slight pullback in the stock market, which I imagine is impacting the physician groups that probably have their capital invested in the market. How is that impacting volumes to your practices and your cash Collections and like how are April, March, April, May volumes, how do they compare to January?

Speaker 13

Did you get a bump up From COVID in January and that's what drove the sort of cash collections upside or are you just sort of seeing continued strong volumes as we progress through the year?

Speaker 4

Yes, I think it's 2 things for us. 1 is, obviously, we continue to see utilization much higher than what we expected. So As the world normalizes and we're seeing that come in much, much stronger. We said that last quarter, we see the So that's obviously helping on the fee for service book. We also think our practices are gaining market share On a same store basis and that's reflective of how well they're doing with us with our platform.

Speaker 4

We're able to enhance productivity and they're able to add patient panels and so forth, Add other providers to the same practice. So I think that's helping us on a same store basis. And then look, the model today is really set up well where We're seeing this flywheel effect with our existing physicians asking their colleagues to join an entity like Privia, Where there are all these challenges, complexity of value based programs, the infrastructure, the technology stack and so forth. And I think independent physicians are realizing our model of being best of both worlds where they're part of something bigger, yet maintain their autonomy And are supported by a bigger entity from all of these things and have a real governance structure around our Singleton Medical groups. It gives them this best of both worlds dynamics, which is hard to get relative to selling their practice to somebody, whether it's a health system, whether it's a private equity entity and so forth.

Speaker 4

So I think we're seeing all that momentum all the way in terms of and that's all reflected in the growth in the financial statements.

Speaker 3

Yes. Park's last point was What I was going to kind of add on was I mentioned in my prepared remarks, we spent I spent time At the NASDAQ was 17 of our physicians we invited. And there's no no one is Immune to what's going on and the inflationary markets are seeing, but it does it's reflecting Kind of I think our growth where physicians are they're seeing pressures that they probably hadn't seen in the last few years and our physicians have performed really well. They understand value based care is in their market. They want to perform better.

Speaker 3

Their peers are seeing them be successful and They're telling their peers about it and a lot of our pipeline is full of where our providers have spoken with their colleagues about joining. So They're not immune to it and it's in an odd way, it's driving some and fueling some of the I guess some of our growth, if that's helpful. Great.

Speaker 13

Thanks very much. Congrats on a good quarter.

Speaker 4

Thank you.

Operator

Thank you. Our next question comes from the line of Richard Close from Canaccord. Your line is now open.

Speaker 14

Yes, Sean, I wanted to just expand on that. Obviously, you've been around this business for a long time seeing Ups and downs in the economy and whatnot, how do you think if Things deteriorate from here. How do you think that changes the pipeline for you guys? Do physicians Choose different models or prefer different models. Just curious based on your experience.

Speaker 3

Richard, you almost offended me in calling me old. No, just kidding. Yes, it's kind of, I guess, an addition to the last question. I mean, they're not immune to it. I mean, but I mean, the it is we the providers have been pretty open over the last year, but the providers that come to us are kind of They self select in.

Speaker 3

They're not looking to sell their practice. They're not looking to join a hospital. Some are Leaving systems in some markets, we've seen some of that in some markets we're out in and talking to different physicians. But I think it's Like I said, in an odd way, I hate to admit it almost, it's helpful. I mean, there's doctors are looking to it is a little bit of best Both worlds, they want their autonomy.

Speaker 3

And these doctors, some came to our recent Board meeting and the Board member said, why do you join? And they said, number 1, autonomy. Number 2 is we perform better on Number 2 is we perform better in this market and it's better to be part of something larger, but we want that autonomy. And And we're getting the tools necessary to move into arrangements that we've either been kind of what's somewhat successful, but we know those type of arrangements are going to grow over time. So And the great thing is, is we have we've got a lot of sales momentum and the pipeline is very robust as we continue to say.

Speaker 3

So Yes. I think it's driving some growth. But at the end of the day, we've got to be successful and results are what Drive success for physicians.

Speaker 4

Richard, the one thing I'll add is, we offer something to also health systems and other facility Affiliated or employed providers as we mentioned and as you know, they are facing a lot more of these pressures in a much more acute manner than the In the community independent doctor practices, obviously the staffing issues, inflationary pressures in the hospitals and so forth. I think 40%, 50% of the providers are in that ecosystem in the country today. And our ability to offer and partner with health systems And entities like Surgery Partners, an example, is also really positive for our business as we go through this period. That's a good point, Art. It's just those discussions have really grown over the last 18 months.

Speaker 3

And I think the pressures of COVID and now the inflationary Factors we're seeing are going to continue that momentum.

Speaker 14

Do you think that if Duuations come down from the perspective of selling your practice that ultimately That benefits you guys in terms of deciding to partner with someone like yourself. Is that a tailwind for you?

Speaker 4

I think, in summary, it should be. We've all obviously shied away from buying practices, as you know, in our model. We think that misaligns interest. So obviously, as physicians, those who were looking to sell or were on the borderline and are not getting what they expected, I think it's a tailwind for us.

Speaker 14

Okay. Thank you.

Operator

Thank you. Our last question comes from the line of Taji Phillips from Jefferies. Your line is now open.

Speaker 2

Hey guys, it's Brian and Keelitz. All our questions have been answered. Thank you so much. Appreciate it.

Speaker 4

Thanks, Brian.

Operator

Thanks. Thank you. At this time, I'm showing no further questions. I would like to turn the call back over to Mr. Morris for closing remarks.

Speaker 3

Thank you, operator. I want to thank everybody for joining and listening in today. We're excited as you can tell. We're looking forward to continue to at this high level for the remainder of 'twenty two and we look forward to speaking to you again out of the next quarter, but appreciate your continued support of Privia. Enjoy the rest of your day.

Speaker 3

Thanks.

Operator

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

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