American Healthcare REIT Q1 2025 Earnings Call Transcript

Quartr
Provided by Quartr
May 9, 2025

Key Takeaways

  • 15.1% same-store NOI growth in Q1 2025, led by Trilogy (19.8%) and SHOP (30.7%), driven by occupancy gains, rate increases and expense discipline.
  • Raised full-year same-store NOI guidance to 9%–13% (from 7%–10%) and increased NFFO per share outlook to $1.58–$1.64.
  • Built an over $300 million acquisition pipeline in operating segments with mostly off-market deals and two new regional operator partnerships, expected to close late Q3 into Q4.
  • Noted a sharp uptick in April move-ins and ongoing dynamic pricing, which together with margin improvements should sustain occupancy and RevPAR momentum.
  • Maintained a healthy balance sheet with net debt/EBITDA of 4.5× and raised $48 million via an ATM at an average price of $30.22 per share.
AI Generated. May Contain Errors.
Earnings Conference Call
American Healthcare REIT Q1 2025
00:00 / 00:00

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Operator

Thank you for standing by. My name is Kate, and I will be your conference operator today. At this time, I would like to welcome everyone to the American Healthcare REIT Q1 2025 Earnings Conference Call. All lines have been placed on mute to prevent any background noise. After the speaker's remarks, there will be a question-and-answer session. If you would like to ask a question during this time, simply press Star, followed by the number one on your telephone keypad. If you would like to withdraw your question, press Star one again. Thank you. I would now like to turn the call over to Alan Peterson, Vice President of Investor Relations and Finance. Please go ahead.

Alan Peterson
Alan Peterson
VP of Investor Relations & Finance at American Healthcare REIT

Good morning. Thank you for joining us for American Healthcare REIT's First Quarter 2025 Earnings Conference Call. With me today are Danny Prosky, President and CEO; Gabe Willhite, Chief Operating Officer; Stefan Oh, Chief Investment Officer; and Brian Peay, Chief Financial Officer. On today's call, Danny, Gabe, Stefan, and Brian will provide high-level commentary discussing our operational results, financial position, changes related to our increased 2025 guidance, and other recent news relating to American Healthcare REIT. Following these remarks, we will conduct a question-and-answer session. Please be advised that this call will include forward-looking statements. All statements made during this call, other than statements of historical fact, are forward-looking statements that are subject to numerous risks and uncertainties that could cause actual results to differ materially from those projected in these statements. Therefore, you should exercise caution in interpreting and relying on them.

Alan Peterson
Alan Peterson
VP of Investor Relations & Finance at American Healthcare REIT

I refer you to our SEC filings for a more detailed discussion of the risks that could impact our future operating results, financial condition, and prospects. All forward-looking statements speak only as of today, May 9th, 2025, or such other dates as may otherwise be specified. We assume no obligation to update or revise any forward-looking statements, whether as a result of new information, future events, or otherwise, except as required by law. During the call, we will discuss certain non-GAAP financial measures, which we believe can be useful in evaluating the company's operating performance. These measures should not be considered in isolation or as a substitute for our financial results prepared in accordance with GAAP.

Alan Peterson
Alan Peterson
VP of Investor Relations & Finance at American Healthcare REIT

Reconciliations of non-GAAP financial measures discussed on this call to the most directly comparable measures calculated in accordance with GAAP are included in our earnings release, supplemental information package, and our filings with the SEC. You can find these documents as well as an audio webcast replay of this conference call on the Investor Relations section of our website at www.americanhealthcarereit.com. With that, I'll turn the call over to our President and CEO, Danny Prosky.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Thanks, Alan. Good day, everyone, and thank you for joining us today. Let me begin by stating how proud I am of the team here at AHR, as well as our operating partners, for kicking off 2025 with such strong results, particularly within our operating portfolio. These results are a direct outcome of our unwavering focus on delivering high-quality care and facilitating better health outcomes across our campuses and properties. This combined commitment continues to drive consistent and sustainable financial performance. As I've shared in the past, this commitment to care is the primary goal for all of us here at AHR, and it is embedded in every decision we make and every partnership we establish.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

This week, we held our annual operator summit here in Southern California and worked together to share best practices, as well as to continue to reinforce our emphasis on quality care, quality outcomes, resident satisfaction, as well as employee retention and satisfaction in our buildings. During the first quarter, we delivered strong operational performance and successfully executed a creative capital allocation initiative. Our capital markets activity in the first quarter further strengthens our company's financial position and supports our planned external growth for this year and beyond. I would like to congratulate Stefan and the rest of the investments team for compiling a pipeline of well over $300 million of acquisitions that we expect to close before year-end, which is in addition to the assets we have already closed on so far this year.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Looking at performance across our diversified healthcare portfolio, we achieved 15.1% same-store NOI growth year-over-year in Q1 2025. This growth was led by our operating portfolio, which includes our integrated senior health campuses, which we also refer to as Trilogy, as well as our senior housing operating properties or SHOP segment. As described in last quarter's call, we anticipated the colder winter months and flu season might modestly weigh on first-quarter growth. However, the diversification within our operating portfolio, including properties and campuses serving a variety of long-term care needs, proved to be a positive force during this typically slower growth period. The post-acute skilled nursing settings within Trilogy performed particularly well, and due to the strong performance, we are increasing our full-year same-store NOI growth expectations for the Trilogy segment.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

As we move into the warmer spring and summer months, our teams and operating partners are well-positioned to capture growing demand for assisted living care within our markets. We expect continued growth across the operating portfolio throughout the rest of the year, and we have already seen a sharp uptick in move-ins since the end of Q1. This occupancy trend, as well as strong improvements in RevPOR and margins, allows us to increase full-year 2025 guidance for our SHOP segment as well. It is our long-term view that the senior housing industry is benefiting and should continue to benefit from a multi-year tailwind of favorable fundamentals. On the capital allocation front, our investments team is actively identifying new growth opportunities with our existing operating partners, as well as identifying new prospective operating partners that will complement our current regional operator base.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

These new partnerships will allow us to maintain our strategic focus on working with market leaders in the communities they serve. At the same time, they expand our opportunity set while preserving our hands-on asset management approach to drive strong performance across our operating portfolio. Stefan will provide more detail on some of the promising new relationships we've been cultivating. Finally, as a result of a conducive capital markets environment, we sourced attractively priced capital utilizing our ATM program in Q1 2025. As of the end of the quarter, our net debt to annualized adjusted EBITDA stood at 4.5x. The financial capacity we've built over time will continue to support our development initiatives and enable us to execute on the new SHOP acquisition opportunities that our team has and will continue to unlock.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Before I turn it over to the rest of the team, I'd like to once again thank everyone at AHR and our partners for their outstanding execution during what we expected to be a more turbulent winter season. These results are a testament to the hard work you all put in to ensure we provide the highest standard of care that we can to the individuals and families who trust us with their care. With that, I'll turn it over to Gabe to walk us through our operational results in more detail.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Thank you, Danny. Q1 2025 was a very strong quarter for performance across our portfolio as we delivered sector-leading same-store NOI growth for the fifth consecutive quarter. NOI growth compared to the first quarter of 2024 was led once again by our operating portfolio segments of Trilogy and SHOP, which posted another quarter of growth exceeding 20% collectively.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Year-over-year, same-store NOI growth increased by 19.8% at Trilogy and 30.7% within SHOP in Q1 2025. That strong growth was driven by a combination of things: occupancy gains, mid-single-digit RevPOR and average daily rate growth, and disciplined expense control. Trilogy's campuses and their unique business model once again proved the merits of operating various long-term care settings at scale within their five-state footprint. Because Trilogy facilities provide care to seniors at all acuity levels, Trilogy's integrated senior health campuses, more than any other asset type, benefit more broadly from the secular demand wave of the aging population. For example, when we saw some softness in assisted living demand last quarter due to a particularly difficult flu season, Trilogy experienced a corresponding increase in skilled nursing demand for seniors and a net increase in occupancy as a result.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

We see this capacity to dynamically meet the evolving care needs of seniors as a major advantage of the Trilogy model that adds meaningful value and improves resident outcomes. In the first quarter, strong performance in the skilled nursing setting drove compelling growth at Trilogy in the aggregate. We also continue to see Trilogy benefit from its multiple levers for sustained growth. Not only did we realize occupancy gains and strong revenue optimization, but we saw Trilogy's commitment to quality positively impact both QMIX and skilled nursing rates, which also led to strong financial results. Trilogy's overall CMS five-star rating is now over four on average, and its quality rating is 4.8, which we believe are industry-leading. These high-quality ratings make them an attractive option, especially for Medicare Advantage plans that are now more than ever seeking quality operators.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

In Q1, we were able to substantially expand our relationships with Medicare Advantage plans at attractive rates, which should provide a powerful tailwind through 2025 and beyond. Our over 30% same-store NOI growth in SHOP was once again sector-leading and was the result of several key strategies. Revenue management and optimization led to 8.8% year-over-year revenue growth and nearly 2% revenue growth from the fourth quarter of 2024, despite a slight sequential pullback in occupancy. The decline was in part due to a difficult flu season in our markets and also in part due to our commitment to revenue and expense optimization in the face of higher-than-normal involuntary move-outs. This is an important point. While growing occupancy will always be an important driver for our portfolio performance, as I've said many times in the past, we don't want to make the mistake of myopically focusing on occupancy growth.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Instead, we take a much more holistic approach with our operators, always starting with quality of care first and also looking at other key drivers like rate, rank concessions, referral fees, and other factors that positively impact margin and ultimately NOI. That approach worked in 2024. It worked in Q1 2025, and we expect it to continue to work through the end of 2025 and beyond. As we enter the spring and summer selling season, we expect new move-in momentum to continue and demand to ramp up in the coming months, allowing the SHOP segment to build on its solid foundation. Lastly, before I turn it over to Stefan, as Danny mentioned earlier, we hosted our operators during our annual operator summit this past week, and I came away tremendously proud of their commitment to the communities they serve.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

I'm excited about the strength of our core regional partners as they build on a successful 2024. The initiatives and collaboration fostered at the summit give us great confidence in making 2025 just as successful, if not more so, than last year. With that, I'll pass it over to Stefan to share his thoughts on recent transaction activity and AHR's investment efforts.

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

Thanks, Gabe. These first few months of 2025 have marked a robust period for deal activity. We successfully closed several recently announced investments and have developed a solid pipeline of future investments that we are well-positioned to close on. During the quarter, we completed the previously announced lease buyout of a Trilogy campus for approximately $16.1 million. Subsequent to quarter-end, we closed on the acquisition of a $65 million SHOP community in the Mid-Atlantic region, which we had previously disclosed was under contract. Upon closing, we transitioned the operations to Heritage Senior Living, one of our existing regional operating partners. Looking at more recent activity, our investments team has remained focused on sourcing new opportunities. As we reported yesterday, our current pipeline consists of over $300 million of potential acquisitions that have been awarded to us, all of which are in the operating portfolio segments.

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

Although many of these are still early in the investment process, we are excited to share the progress we've made in unlocking strong opportunities to complement our portfolio with the quality of these potential acquisitions and the opportunity to establish new operator relationships with groups we have known well for some time in the industry. Among the deals in our pipeline, we have been underwriting a few opportunities in collaboration with two new regional operating partners. Like our existing operating partners, they have all the qualities we look for in our operators. They are local market specialists focusing on delivering high-quality care and outcomes for residents. These relationships have been cultivated alongside our asset management team and are based on prior informal experience.

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

If we close on these deals, it would mark the first formal partnerships with these operators and would not only complement our existing operator group, but also widen the opportunity set that this expanded pool of partners will continue to expose us to. While we are not disclosing names at this stage, we look forward to sharing more details as these opportunities progress. Shifting to development, we started two new projects in the first quarter within our Trilogy segment and expect to break ground on additional developments over the balance of the year. All projects currently in our pipeline remain on schedule and within budget, consistent with our historical experience of developments at Trilogy. On the disposition front, we continue to recycle capital out of lower-growth assets and segments, positioning us to reallocate capital towards investments with more attractive risk-adjusted returns within our Trilogy and SHOP segments.

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

During the quarter and subsequent to quarter-end, we sold five properties for gross proceeds of approximately $40 million. I'm incredibly proud of all that our team has accomplished in such a short period and look forward to unlocking even more opportunities through the remainder of the year. As always, we remain disciplined and selective. Our underwriting continues to prioritize properties that align within our geographic footprint, operator model, and long-term return expectations. With that, I'll turn it over to Brian.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

Thanks, Stefan. Q1 2025 was another quarter of strong execution and demonstrated discipline from our organization. During the quarter, we reported normalized funds from operations, or NFFO, of $0.38 per fully diluted share, representing an increase of over 26% compared to Q1 2024. This result was driven primarily by our operating portfolio, which represents 71% of our net operating income and includes Trilogy and SHOP, and further supported by our capital markets activity. During the quarter, we raised approximately $48 million through our ATM program at an average price of $30.22 per share. The strength and resiliency demonstrated by our portfolio during Q1 and the continued demand for our facilities and services drives our decision to raise our full-year 2025 same-store NOI growth targets and NFFO per share guidance.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

This increase in guidance is supported not only by our Q1 results, but also by various KPIs such as traffic, leads, and tours across our operating portfolio, suggesting demand is strong in the long-term care sector and stronger than we had originally anticipated within our portfolio, which is appropriately positioned to capture that demand. The continuing efforts of our regional operators, in conjunction with our asset management teams, drove impressive RevPOR growth of 6% in our SHOP portfolio, despite a difficult operating environment in the first quarter brought on by seasonal headwinds, not the least of which was a quite brutal flu season. We're looking forward to improving occupancies and net operating income growth throughout the remainder of 2025 in our Trilogy and SHOP segments.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

We are increasing our full-year 2025 same-store NOI growth targets for the total portfolio to a new range of 9%-13% from a prior range of 7%-10%. This increase is driven by higher expectations within our Trilogy segment, where we are revising same-store NOI growth guidance upward to a range of 12%-16% from a previous range of 10%-12%. Additionally, in our SHOP segment, we are increasing same-store NOI growth guidance to 20%-24% from a previous target range of 18%-22%. Guidance for our other property segments remains unchanged. These changes in same-store NOI growth guidance also dictate an increase to our NFFO per fully diluted share guidance, which we are raising by $0.03 at the midpoint to a new range of $1.58-$1.64 from a prior range of $1.56-$1.60.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

Our guidance does not include any assumptions beyond what was disclosed in our earnings released last night. In particular, it excludes the deals in our acquisition pipeline of over $300 million that we have been awarded, since we are still early in the transaction process and cannot provide certainty around timing or execution yet. For additional color, we believe that these acquisitions will close later in the year and will only have a nominal impact on 2025 earnings. Our guidance also does not include any further capital markets activity beyond the ATM issuances already completed in our underlying assumptions. Additional line item guidance details can be found in our supplemental disclosure document on our website or in the 8-K furnished to the SEC yesterday. Finally, shifting to the balance sheet, our net debt to EBITDA at the end of Q1 stood at 4.5x.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

We continue to manage debt levels with discipline and remain committed to sourcing attractively priced capital that supports long-term growth and shareholder returns. That being said, our cash on hand, future retained earnings, disposition proceeds, and capacity on our line of credit are able to support our external growth targets, both from anticipated acquisitions as well as committed development activity at Trilogy. With that, Operator, we're ready to open the line for questions.

Operator

At this time, I would like to remind everyone, in order to ask a question, please press star, then the number one on your telephone keypad. We request that you limit yourself to one question and one follow-up. Also, you're welcome to re-queue for additional questions. We will pause for just a moment to compile the Q&A roster. Your first question comes from the line of Farrell Granath with Bank of America. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hi, Farrell.

Farrell Granath
Farrell Granath
Equity Research Associate at Bank of America

Hi, good afternoon. Thanks for taking my question. My first one is on your pipeline. Can you give a little bit more detail on expected close and where you are in the various stages of that pipeline?

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

Yeah, so I think, as you can understand, we really only truly were able to focus on external growth starting in the fourth quarter. We've ramped up this pipeline pretty quickly, and that's basically generated what you've seen in the $65 million SHOP asset that we closed and the additional pipeline of over $300 million. The timing of these transactions is going to vary quite a bit simply because the process does take some time. Some of them do have regulatory approvals that need to happen. Also, quite frankly, they're just in a mixed bag of where they are in the process. I would say, generally speaking, these transactions, I think you can look at some of them as a late third quarter, but most likely fourth quarter close.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

Keep in mind, Pharrell, that the pipeline is not maybe how most people define pipeline. For us, these are assets that we have won. The bidding is no longer continuing. We are either under LOI, we are negotiating the LOI, or we are actually under contract. We certainly would have a higher certainty of close on what we call pipeline. Nothing is guaranteed. Obviously, if we uncover something during diligence, we could potentially walk if we cannot get regulatory approval. We would walk, but ultimately, we feel pretty good about this pipeline.

Farrell Granath
Farrell Granath
Equity Research Associate at Bank of America

Great. Thank you. My second one is about your MOB and your triple-net portfolio. How are you generally thinking about that, just given the yield that you're able to receive on the more operating portfolio? I guess just longer term, your strategy?

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah, Farrell, this is Dan. I'll answer that one. The size of those portfolios has been shrinking over the last several years. We made a conscious decision to cull our MOB portfolio probably over three years ago, kind of recognizing that we're going to see better risk-adjusted returns in long-term care. We've been selling off kind of our non-core, non-strategic MOBs for a few years. I believe we had about 110 of them a few years ago, and now we're kind of in the 80s. You'll continue to see us do that, mostly smaller buildings off-campus, the ones we're less excited about holding long-term. Overall, it's not like we dislike the MOB space. We just favor senior housing right now. That's just where the better risk-adjusted returns are. On the triple-net side, that segment of the business has been shrinking as well.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

It's not like we have anything particularly against triple-net leases. Frankly, if the right opportunity came along for a triple-net lease, we'd consider it. That being said, we had one large portfolio that we made a decision to sell last year because we felt it was higher risk. If you look at what's left today, it's well below 10% of our NOI. We've got great tenants, good coverage. We're not actively looking to sell anything there, but if somebody came along and made a great offer, we'd consider it. Clearly, the growth is going to be in our operating portfolio, which is now, as Brian mentioned, well above 70% of our NOI and climbing.

Farrell Granath
Farrell Granath
Equity Research Associate at Bank of America

Great. Thank you so much.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Thank you.

Operator

Your next question comes from the line of Austin Wurschmidt with KeyBanc Capital Markets. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hey, Austin.

Austin Wurschmidt
Austin Wurschmidt
Senior REIT Analyst at KeyBanc Capital Markets

Yeah, great. Hey, good morning, everybody. Just wanted to circle back on the investment pipeline and was wondering if you could share some additional details around how many deals are in the pipeline, how competitive the process was in order to win these deals, and then just anything around economics that you can share at this point. Thank you.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Sure, Austin. I actually have that in front of me, so I'll take that one. This is Danny. As we mentioned, the pipeline is well north of $300 million. It is a mix of SHOP and Trilogy, more SHOP than Trilogy. Almost all newer buildings, the vast majority, I think with the exception of two, have been built in the last 10 years. Really nice assets. Average per unit cost in the low $200,000s. We think the price is very, very attractive. There are some stabilized assets in there where you're talking about a going yield, mid-sixes to eight. You have quite a few assets there that are really new, that are not yet stabilized, or kind of have kind of more of a value-add component.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

What we're trying to do is we're trying to sell off the assets that are older and less attractive with less growth. If you look at the MOBs we've sold and the few long-term care assets we've sold, they tend to be older assets, and we're really focusing on newer, higher-quality assets. Anything you want to add, Stefan?

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

Yeah, I would say one of the things I would point out is, as we've been building this pipeline, several of these assets have actually come to us on an off-market or direct basis. As we're executing the strategy, it's not just a matter of us looking at broker deals, but again, going back to what our original strategy was with our operators, it's really being able to work with them, have them bring us transactions that work for them or what they're seeing, or potentially even bring us assets that are in their existing portfolio that they want to sell.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah, and thank you for saying that, Stefan. I'm looking at the list here. The majority of these assets were not listed by a broker or were not widely marketed. The majority are assets where we had kind of the inside track with either the owner, the operator, or in some cases, a broker.

Austin Wurschmidt
Austin Wurschmidt
Senior REIT Analyst at KeyBanc Capital Markets

Got it. That's helpful. Kind of going back to your comments, Danny, about selling non-core assets, you guys, your cost of capital continues to improve. You mentioned the focus on selling some of the slower growth non-core products in the portfolio. How do we think about the mix between continuing to use the ATM and using these non-core asset sales to fund plans around future investment activity?

Brian Peay
Brian Peay
CFO at American Healthcare REIT

Yeah, Austin, this is Brian. You touched on it. I would say from a proceeds perspective of how we're going to pay for these things, first and foremost, the cheapest cost of capital that we have, the cheapest capital we can source, is our retained earnings. And if you look at our dividend payout ratio, it's obviously getting down to around the target. I think it was below target last quarter. So we do have retained earnings. That would be the first source of capital to pay for acquisitions. Dispositions is the next one. Again, you're taking lower, slower growth assets, and you're deploying that money back into better quality, higher growth assets. That's a terrific use of that right there. Our current cost, and I say current, I mean immediate cost of equity, is definitely below our incremental cost of debt.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

We do not necessarily think about that as a long-term cost of equity capital. What I mean by that is, over the last 57 years, the S&P has returned 10.5%. I think that investors should expect a 10% return on their investment. On a total return basis for us, that includes the dividend at 3%, plus we need to grow earnings. I think that is a fair valuation of our long-term cost of equity. Having said that, the ATM has been good to us. We have been able to source capital at attractive rates at very low cost. We are very price-sensitive. I would not anticipate that we are going to just flood the market if the stock is not performing well. If we can take advantage of a good stock price, then we will. As I say, we are extremely price-sensitive.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

I think with all of that and cash on hand, we should be more than able to take care of the pipeline that we've got. Stefan is out there continuing to build for the next tranche of assets.

Austin Wurschmidt
Austin Wurschmidt
Senior REIT Analyst at KeyBanc Capital Markets

Thanks, Brian. Appreciate the details.

Operator

Your next question comes from the line of Michael Carroll with RBC Capital Markets. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hi, Mike.

Michael Carroll
Michael Carroll
Managing Director at RBC Capital Markets

Hey, Danny. Thanks for taking my question. Just real quick, I wanted to highlight what's going on with Trilogy. I know your occupancy has increased a decent amount. Can we kind of spend some time on the rates, I guess, specifically on the Medicaid side? I know the rates have been up pretty good over the past few years. When do most of those states reset those rates? Is it July, and should we expect that to moderate as we kind of get into later in the year, or is there something else going on there that's helping to push those rates higher?

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Hey, Mike, it's Gabe. I'll take that one. Yes, July is the day for most of the states. What we're anticipating and expecting is kind of a raise in line with inflation. There is a path to outperformance of that. The states that Trilogy operates in, all to a certain extent, have a value-based care component, with Ohio having the largest component of value-based care. What that means is that the states will give you an add-on to the Medicaid rate if you can demonstrate outperformance on certain quality measures, as you know. I think Trilogy still has opportunity to capture the total dollars that are available for that outperformance. It's a matter of tracking the right stats. It's a matter of reporting, and it's a matter of aging into the reporting to show that you've demonstrated over the appropriate period.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Obviously, each state has its nuances around that. A long way of saying I view inflationary increases as kind of the floor and the expectation with some opportunity for outperformance that you would see probably in the second half of the year.

Michael Carroll
Michael Carroll
Managing Director at RBC Capital Markets

Okay, that's interesting. Then again, similar to that on the Medicare Advantage side, how often are those rates updated? Is that more of a negotiation that happens throughout the year, or is there specific dates where that occurs?

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

I believe that's a rolling negotiation and would happen organically, especially because we're looking at new Medicare Advantage plans that are not contracting with Trilogy currently. So we've substantially expanded the universe of residents of the states that Trilogy operates, having access to Trilogy facilities by signing up with new Medicare Advantage plans that we haven't had contracts with in the past. I think that's a pretty significant tailwind from a census perspective at Trilogy. The extent of it is really tough to measure today. I think if we do outperform at Trilogy throughout the rest of the year, Medicare Advantage would be a likely candidate for the reason why. It's not just the rate at the Medicare Advantage plans. It's the access to more people, more people that can get higher quality of care.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

What we have seen more recently, I guess in the last six months, is Medicare Advantage plans really leaning into quality. As Trilogy has been able to demonstrate that quality over and over again, like I said in my remarks, their five-star ratings continue to go up. They are realizing the value, and they are more willing to work with Trilogy on a rate that works for both. I would also say, as Trilogy's occupancy goes up on the skilled nursing side, this all plays into the broader strategy of optimizing QMIX. You will see the Medicaid risk or the Medicaid days at Trilogy kind of decline over time, and the Medicare Advantage and Medicare stays increase over time as Trilogy kind of optimizes for that QMIX.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah, just a reminder, this is Danny, that the Medicare Advantage contracts are typically written as a percentage of Medicare.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

If there's a Medicare increase, say on October 1, your Medicare Advantage rates will go up as well.

Michael Carroll
Michael Carroll
Managing Director at RBC Capital Markets

Okay, perfect. I appreciate it.

Operator

Your next question comes from the line of Ronald Kamdem with Morgan Stanley. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hi, Ron.

Ronald Kamdem
Ronald Kamdem
Managing Director and Head of US REITs and CRE Research at Morgan Stanley

Hey, congrats on the great quarter. Just two quick ones. First, I think you talked about sort of the strong move into April. Obviously, we're getting into the peak selling season here. I guess I'm just curious if you could provide some color of where pricing is going out and anything you're doing sort of different this year versus sort of previous years in terms of capturing this demand would be helpful.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah, first thing I'd say is you're right. We've certainly seen a sharp increase in move-ins in April. I don't like to predict the future, but I feel pretty comfortable that the rest of this quarter and next quarter, I think, will be strong as well, but we'll have to wait and see. From a pricing perspective, we did have rate increases on either January or March 1st, depending on the buildings. It kind of varies. We raised the street rate, and we raised the rate on in-place residents. However, not everybody saw a rate increase. For example, if somebody moved in November 1st, we didn't turn around and raise the rate on January 1st, right? They get a certain amount of time before we raise their rate. The impact of those rate increases will continue throughout the year.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I think the big focus this year and last year, a couple of things, actually. Number one is a reduction of concessions. Even if the rates only went up, I think our average rate increase was 6%+ last year or this year. If you're working with fewer concessions, meaning less free rent, less payments to places like Place for Mom, I think that has a big impact. I think we really saw that had a significant impact on Q1 numbers, where in some cases, occupancy may have dropped a little bit, but you still saw margin, NOI, and RevPAR move up substantially. The other thing is dynamic pricing, which is something Trilogy has been way ahead of the curve on.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

One of the things that was a topic at our operator summit, I'm not sure if you want to say anything else about that, Gabe.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Yeah, in going back, we've talked about this before. The Trilogy management team was working with revenue management specialists that had an aviation background, a hospitality background, to help them price every unit individually at least quarterly so that as occupancy ramps, the street rate makes sense so that you're getting paid for the quality.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah, and I think it also allows you to differentiate between not all two-bedroom suites are identical, right? Some may have a better view. I think the idea is not just to have three different pricing levels, one for studio, one for one-bedroom, one for two-bedroom, but in some cases, be able to charge more for better rooms, etc. I think the RevPOR numbers reflect that.

Ronald Kamdem
Ronald Kamdem
Managing Director and Head of US REITs and CRE Research at Morgan Stanley

Great. My second one, just really quickly, is really just on tariffs. Clearly, the potential for less supply or even lower supply is really solid for the sector. Just wondering, post sort of tariff announcement, how are you guys thinking about sort of the ripple effect on the business, whether it's Trilogy development, whether it's food, whether it's whatever? Just what are you guys focused on?

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I think number one is I think we're better positioned than almost any other industry. I think if you look at the sector as a whole, when the market was getting hit with all the tariff news, I think that the healthcare services and REITs held up much better. If you kind of look at our big expense line items, wages, I think are indirectly over the long term, maybe there's an effect if there's more going on in the states with fewer workers. I don't think I expect any kind of immediate impact from that. If anything, if there's a downturn in economic activity, it may actually help us from an employment perspective. I don't think it's going to have a tremendous impact on food. Construction costs for Trilogy in particular, where we do development, could have an impact on that.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I mean, I do not necessarily think construction costs are coming down anytime soon. I think any, I do not see a tremendous impact from tariffs. Frankly, if it does push up inflation a little bit, I think we would just recover that through higher rates. I mean, there may be a little bit of a delay, but we are very well positioned for higher expenses and higher inflation.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

The one thing I'd add to that, Ron, this is Gabe, is the industry, as you well know and have written about, is facing a huge issue relative to supply and really needs to start developing to meet the demand that's building. Tariffs and anything else that's inflationary only puts more pressure on the ability for private companies to develop senior housing assets by keeping financing costs of that development higher than what makes sense for it to happen. We closely watch the construction starts. I think until rates come down or you have multiple years of compounding NOI growth, it's still going to be very difficult for new supply to pencil out and for new supply to come online. It's great for us in our existing portfolio. I think demand will continue to ramp. Occupancies will continue to grow.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

At some point, I mean, the industry really does need to start building again to meet the demand so that the people that are going to need that care have access to it.

Ronald Kamdem
Ronald Kamdem
Managing Director and Head of US REITs and CRE Research at Morgan Stanley

Great. That's it for me. Thanks so much.

Operator

Your next question comes from the line of Joe Dickstein with Jefferies. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hey, Joe. Welcome.

Joe Dickstein
Joe Dickstein
Equity Research VP at Jefferies

How's it going?

Joe Dickstein
Joe Dickstein
Equity Research VP at Jefferies

Thank you. Congrats on the strong quarter, and thanks for taking my questions. Trilogy outperformance was largely driven by the skilled side in one Q. You noted that you were now seeing a sharp uptick in move-ins for the AL side. I'm just trying to get a sense of which channels are driving these move-ins. Are these residents that are entirely new to the Trilogy model, or are these residents that are being converted from skilled to assisted living? Any color there would be helpful.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I was referring to the SHOP segment where we've seen a tremendous uptick in move-ins. Not that we haven't seen it at Trilogy, but I don't think it's been as sharp and obvious as the rest of the SHOP portfolio. It's been kind of slow and steady at Trilogy. Trilogy didn't see the drop-off in Q1 as heavily as the rest of the SHOP portfolio. Traditionally, in the past, Trilogy has emphasized a lot of its move-ins from the skilled side of the business. Over the last five, six years, since we bought Trilogy nine years ago, we've been working with them closely to improve on their marketing. I'll give you an example. Trilogy opens up several new facilities a year. Traditionally, they would fill up the skilled side first and then use the skilled residents to fill up the AL.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

The last couple that we've seen, the ones we visited, it was actually the opposite. The AL and IL was filling up faster than the skilled. They are focusing much more heavily on marketing and not just relying on skilled residents to fill up their AL beds.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

Yeah, so Joe, it's Brian, just give you a couple of quick data points here. If you think about a skilled nursing resident at Trilogy, when they're ready to leave skilled nursing, 70% of those—and this is a pretty good long-term trend for them—70% of those people are going to go home, which is terrific. I'm quite happy for them. 10% of those people are going to move into a Trilogy senior housing bed. That 10% of those people represent 40% of the tenants, the new residents moving into a senior housing bed at Trilogy. That's a really long-term trend for those guys. What it is, it's essentially self-generated leads. I mean, I'm talking long-term averages. I don't see that doing anything except potentially increasing where penetration rates get even higher for Trilogy.

Brian Peay
Brian Peay
CFO at American Healthcare REIT

Again, thrilled that those senior housing residents are able to go home. To the extent that they can't, then they're a huge source of additional residents in our senior housing.

Joe Dickstein
Joe Dickstein
Equity Research VP at Jefferies

Got it. That's helpful color. For my second one, you mentioned that you held the operator summit this week. I know in the past, the team has viewed Trilogy as a resource for some of your smaller SHOP operators. Are there any anecdotes that you can share from the summit related to how Trilogy is helping improve SHOP operational efficiency?

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Yeah, I'll take that, Joe, it's Gabe. A couple of things I want to point out, and thanks for asking about it. One, if you look at our proxy, you'll see that we've got a proposal for a manager incentive plan, a stock plan. That's really intended for us to convert what Trilogy's long-term incentive plan is today based on cash into AHR stock. The goal there is not only building on what we believe is already best-in-class alignment, but also to allow Trilogy to participate in the value creation from supporting some of our regional SHOP operators. Our strategy is a little different than some of our competitors. We focus on smaller regional densities with a regional operator that generally has a headquarters within driving distance from the communities that they manage for us.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

What you get with that is better control over the culture, better control over the care, and that pulls through to NOI, and we've seen it over and over again. What you kind of lose with regional operators is the size and scale to build out sophisticated platforms to help them grow their businesses. What we have with Trilogy now, where we have this incentive plan that's based on AHR stock, is the ability to partner with them to use their platform to help support the regional operators. That can mean a lot of different things, and a lot of them did come up at our operator summit last week. That can mean taking Trilogy's GPO, and it's a very low-friction decision to say, "Hey, if you can buy supplies for cheaper through Trilogy's GPO, do you want to sign up for it?" Usually, that's a yes.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

That can mean Trilogy helping with their revenue management platform that they've already got internally to help our other operators set the right prices dynamically for each unit within our portfolio. That can mean talent acquisition, retention, and training. And Trilogy trains better than anybody probably on planet Earth caregivers in this industry. It can mean marketing, web presence, mobile presence, Google search optimization. All those things and more are available to the regional operators now through Trilogy's platform in a way that I don't think anybody else can compete with, where we have alignment and a great partner in Trilogy that's a world-class operator. We're at different levels of incorporating those options. Frankly, different operators, I think, will utilize the resources differently over time. Also, frankly, we don't want to give out all the secrets of how we're able to do what we're doing.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

What I can tell you is the feedback from the operator summit was incredibly positive. We feel really good about the bench that we currently have. The new operators that we're in talks with for acquisitions were also able to attend, and they fit in perfectly with the group that we already have, which is regional operators with a strong reputation for resident care. We think that collectively, that adds platform value that's going to come through in NOI and growth for the company over the long period, not over the next two and three years only, but over decades.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

By the way, Joe, that is a lot that Gabe touched on, but we did not even talk about patient care, right? I mean, if you look at what excites me the most about all this technology is, I mean, it is great for everything Gabe mentioned. I agree. I think from a patient care quality of outcomes perspective, I think I am even excited more about that because if you look at some of the stuff that they are working on now, as far as being able to support the resident care, it is very exciting. I think that in the long term, I think, is going to be as beneficial, if not more, than everything else.

Joe Dickstein
Joe Dickstein
Equity Research VP at Jefferies

Great. Thanks for the time, guys. Appreciate it.

Operator

Your next question comes from the line of Michael Stroyeck with Green Street. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hey, Mike.

Michael Stroyeck
Michael Stroyeck
Equity Research Analyst at Green Street

Hey, good morning. Thanks for the time. Maybe going back to the outpatient segment. On those 12 assets that were pulled out of same store, what sort of cap rates do you expect on those dispositions? When do you actually expect to close on those sales?

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

I’d say it’s a pretty mixed bag. I mean, some of these are assets that are small, that are not in markets that we want to continue to be in. Some have struggled with leasing. I think it’s hard to pinpoint exactly what kind of an average cap rate would be. I think overall, what it really brings is it really does clean up the portfolio for us in terms of really refining where we want our MOB portfolio to sit.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I think we sold two already and have a—I mean, our expectation is the majority, if not all of these, will sell.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Yeah. This is not financial engineering, Mike. We're committed to marketing these of the 14 assets that are outside of the same store pool. Two of them have sold. Two of them are under contract. We're in various stages of negotiation and exposure with the remainder of them. I would be surprised—I mean, we're not a seller at any price, but I'd be surprised if any of these come back into the same store pool because we were unsuccessful in selling them. And Stefan's right. I mean, we actually had a wonderful run of being able to sell non-core assets for a long time, even when the financing markets were entirely shut down. They were smaller buildings. They were more bite-sized. Non-leverage buyers were able to take them down. There's attributes of that in the remaining 14. So I feel good about our ability to execute on this.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

It is a bit of addition through subtraction, right? What's left over in our outpatient medical portfolio is much higher quality, much larger, much higher percentage on campus, and higher growth prospects.

Michael Stroyeck
Michael Stroyeck
Equity Research Analyst at Green Street

Got it. That's helpful. Maybe going back to the rate discussion on Trilogy, average daily rate growth saw a little bit of a deceleration in Q1 on the senior housing side of the business. Can you just explain what drove that dip and where you expect that to trend for the remainder of the year?

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah. Happy to do it. I think mainly that number is a little noisy in the supplemental because it does not account for the bed mix shift. As we have talked about before, the beds that we are adding at Trilogy, a good amount of them are independent living villas, independent living beds, rather than the assisted living beds. Those come at a much lower rate, but a much higher margin than assisted living. Net-net, I think it is still pretty compelling growth, but the number looks a little bit lower because the universe of beds has shifted a bit. Trilogy was able to pass through about a 6% increase on the private side throughout its senior housing.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I think the bed mix shift, along with kind of the timing of that rate increases for people who moved in later in the year, is accounting for that number looking different than the 6% number.

Michael Stroyeck
Michael Stroyeck
Equity Research Analyst at Green Street

Understood. Thanks for the time.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Sure. Thanks for the questions.

Operator

Again, if you would like to ask a question, press star one on your telephone keypad. Your next question comes from the line of Seth Bergey with City. Your line is open.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Hi, Seth.

Seth Bergey
Seth Bergey
Senior Analyst at Citi

Hey, how's it going? Thanks for taking my questions. I guess my first one, and you kind of touched on it a little bit already, but I think with the acquisition pipeline, you mentioned bringing two new operators kind of that you haven't partnered with before. Can you just kind of talk about the process too, on how you evaluate new operators and kind of where do you see that opportunity set kind of as you think about future investments?

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

Yeah, sure. We are constantly reviewing and analyzing and underwriting potential operators. I mean, that has just been something that we've consistently done. It's not just in anticipation of acquisitions. We always want to be prepared if there's any need for us to replace an operator. In this case, these two operators are groups that we've actually had prior experience with, folks from our team that have either worked with them in the past or have known them very well. These were actually groups that we had identified as ones that we wanted to grow with at some point in time. I think really what happened here is that we started to see some opportunities in the markets in which they operate.

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

That was kind of the key for us to say, "Okay, I think this is the right time for us to move forward with these groups." Effectively, we're also looking at where do these folks operate? How do they complement the existing operator pool that we have? Are they going to be in markets where we want to grow and can help us to expand our growth into those markets? These were actually fantastic opportunities for us. We were very happy to be able to identify some assets that we could work with them. We think what it also does for us is it will allow us to have future growth.

Stefan Oh
Stefan Oh
Chief Investment Officer at American Healthcare REIT

It'll give us more opportunities to see additional assets in those markets, help us with our growth, but also diversify our operator pool as well so that we can always have coverage in the areas that we want to be in.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah. So Seth, just to make sure you understand, in both of these instances, we identified the operator before we identified the building. So these are operators we've been looking for opportunities with. I think Stefan, correct me if I'm wrong, in one or two of the instances, they actually helped us identify the building, I believe.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Yeah.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah. One of them, I know for sure.

Gabe Willhite
Gabe Willhite
COO at American Healthcare REIT

Yeah.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

I know we've worked on other opportunities with these operators that we weren't able to lock up. We've been working with these folks for a while. It just came down to finding the right buildings to bring them into.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

It is not a situation where we are chasing the shiny penny. We have been tracking these guys for years, in some cases, decades, if you are thinking about some of our employees where they worked at previously. It is really now a function of it is the right deal at the right time, and we have a cost of capital that we are able to take advantage of.

Seth Bergey
Seth Bergey
Senior Analyst at Citi

Great. Thank you. That's helpful. I guess for my follow-up, I noticed in your supplemental, you disclosed kind of a new campus development. I think in the past, you'd kind of focus on IL Villas and expansion. Can you kind of talk about that new campus project and whether or not you see kind of other opportunities to do that type of development?

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Yeah. We typically start two to three new campuses a year with Trilogy. Trilogy development includes new campuses, it includes the IL Villas, and it includes expansions. Those are kind of the three different buckets. We will continuously, unless things change, be working on all three of those segments. The one that you mentioned, the one that's on our list, is an opportunity that came to us in Michigan. It's actually a new AL building that I don't believe ever actually opened. The local authority reached out to Trilogy. It's part of a new development, a new planned development, and said, "Hey, will you come in and take over this building?" Trilogy took a look. What they're doing is they're basically redeveloping the building. They'll keep most of it, obviously, and they'll add skilled nursing to it to turn it into an integrated senior health campus.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

That's how that went around. It's a little bit different. Most Trilogies are completely 100% ground up, but more than one time, they found existing buildings and incorporated them into their footprint, into their model. You will see us start additional campuses this year. We just haven't started them yet. We usually start them kind of in the spring or summer months. That will be added to the list sometime in the next quarter or two.

Seth Bergey
Seth Bergey
Senior Analyst at Citi

Great. Thank you.

Operator

I will turn the call back over to Danny Prosky for closing remarks.

Danny Prosky
Danny Prosky
President and CEO at American Healthcare REIT

Thank you very much. I appreciate everybody taking time on a Friday afternoon to listen to our earnings call. As you all know, myself, Brian, Gabe, Stefan, we are available if anybody has any follow-up questions. Thanks again. I would like to wish everybody a wonderful weekend and a very happy Mother's Day. Thank you, operator.

Operator

Ladies and gentlemen, that concludes today's call. Thank you all for joining. You may now disconnect.

Executives
    • Alan Peterson
      Alan Peterson
      VP of Investor Relations & Finance
    • Brian Peay
      Brian Peay
      CFO
    • Danny Prosky
      Danny Prosky
      President and CEO
    • Stefan Oh
      Stefan Oh
      Chief Investment Officer
    • Gabe Willhite
      Gabe Willhite
      COO
Analysts
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