Premier, Inc. (PINC) Earnings Call Transcript

Good morning, everyone, and welcome to the JPMorgan Healthcare Conference. My name is Annie Samuel, and I cover health care technology and distribution here at JPMorgan. We're thrilled to have Premier with us this morning. Presenting is going to be CEO, Mike Alkire; and CFO, Glenn Coleman. They'll do a brief presentation, and then we'll follow it up with some Q&A.

Thanks, Annie. All right. Welcome, everyone. Annie, thank you again for the quick introduction, and welcome everybody who's joining online as well. Before I jump into the presentation though, I do want to just highlight and remind you of the forward-looking statements that Glenn and I will potentially be using. And the description of our non-GAAP financial measures that are part of this presentation, we'll be using, obviously, all those financials in our Q&A as well as our presentation. So it's very interesting. So in the past, I've pretty much jumped right into strategy when I've done these presentations. But this year, we've had some pretty significant changes at the executive leadership level that we're incredibly excited about. So obviously, Glenn's brand new, and I was constantly reminded of that as we had our investor discussions this morning. Glenn's been here, what, about 60 days? And so Glenn brings a great deal of experience, 8 years as a public company CFO. Glenn's got a lot of history of creating shareholder value. Before Premier, he was at Dentsply Sirona. So a lot of great experience creating shareholder value, a lot of focus and attention around how to be most efficient with cost and has a very, very strong background with capital allocation. So we're really excited to have Glenn join the team. Also in the room with us is Dave Zito and, Dave, if you wouldn't mind standing up real quickly. So Dave's even newer. So Dave's joined the team in the last 30 or 45 days.

30.

30 days. Really excited to have Dave. Dave's new role is going to be President of our Performance Services division. Dave's background, for the most part, he's been an advisory doing a lot of work both in the provider space with pharmaceutical companies, with payers. He's been -- in large part, was the guy that built out all the advisory stuff at Navigant for the health care practice. So very, very, very strong background. Just in the last 30 or 45 days, it's been awesome to hear his perspective on some of the things he'd like to see us more focus on as a business. So I'm really excited about bringing in these 2 new leaders and obviously, we believe they're going to add a lot of value to this organization. So very excited. All right. So very quickly, I know some in the room are new to the story, and I just wanted to kind of highlight who we are, focus of the business and just a little bit about the organization. So Charlotte-based, we have about, I don't know, 2,900 employees. In 2024, we did just over $1.3 billion in revenue. We have 2 segments. The first segment is our Supply Chain segment. In Supply Chain, we have 3 prevalent parts. So first is the Group Purchasing organization, where we obviously bring the scale of our health care systems, and we leverage that scale to drive down pricing for products that the health care systems use. Second, we have this whole focus on technology enablement of the supply chain. And what that really means to us is how are we driving e-invoicing and e-payables into the health care system. Still a lot of health care uses a lot of manual paper in that exchange. Our job is to really figure out ways to technology enable it. And the way I like to describe the value to the health care systems as we build out that technology is to say they spend as much time -- a large health care system spends as much time dealing with a $1,000 invoice error as they do a $10 million invoice error. It's incredibly inefficient. And there are technologies that we have created that exist today that we can solve that issue for those health care systems. So we're really excited. That's probably in about the 12 to 18 months of its journey, and we're really excited to continue that evolution of the technology enablement of the supply chain. The third part of that business is really the co-management. So we've got some really strong capabilities that work alongside our health care systems in co-managing their supply chains, their logistic organizations and different parts of that business. And it's a fast-growing part of our business, as our health care systems, especially our medium-sized health care systems are looking for support because they either don't have the labor, they can't get access to the labor, but looking to outsource or co-manage a lot of those programs with us. So very excited about that part of the program and that's our Supply Chain. And then our Performance Services always comes back to our technology, our data and our people. And our focus is to leverage all of those technology sets, wrap around advisory services and drive performance improvements to our health care systems. What's changed over the last 5 or 6 years? Well, we have continued to evolve our algorithms where we're doing things with natural language processing, looking at Epic, Cerner and Athena and bringing machine learning to the forum. And why is that important? Because we can do things a lot more effectively as it relates to things like prior authorization. And I'm going to get into that in just a second. But we've got some capabilities where we look at the unstructured text of the physician record and we are able to use prior authorization capabilities to suggest what are the next stages in the evolution of caring for a patient. It's really good stuff. Second is HCC coding, so coding a documentation. So as a clinician is looking at caring for a patient and they may miss a box, for example, [ H1C ] may be 14 and the diabetes boxes are checked, it could -- the technology can actually prompt a clinician to say, hey, does this person have diabetes? And if, in fact, they do, it's really important in the health care setting to make sure that all those things are accounted for, for reimbursement. And so that's a real differentiator for us. And then also, we've been using that technology to identify patients for trials, drug trials. And so working with pharma looking at the various characteristics that they're interested in to bring patients for trials. Why is that so unique? Because historically, they have -- pharmaceutical companies have gone out to entities to actually drive a trial, and then they have to go out and find the patients for the trials. We now have a way to actually leverage our technology and regardless of who is in support of those trials, we can find populations to actually participate in trials. We think it will fast stream a lot of these trials and a significant portion of the trials are actually behind schedule because they can't get the right patient populations. We believe our technologies can really help support those initiatives. So we're really excited. A couple of other things before I jump off this page. 2024 was a really good year for the organization. We were recognized by U.S. News & World Report as the best company to work for. Newsweek gave us America's Greatest Places to Work (sic) [ America's Greatest Places to Work for Diversity ] recognition. And then finally, we won a bunch of recognition from Modern Healthcare to include health care management as a fantastic consulting offering. So we've been recognized for all the great work that we've been doing, and I wanted to make sure that I called those recognitions out. So it was really interesting sitting -- yesterday, I sat through the not-for-profit track. And in the not-for-profit track, it's really exciting when some of these health systems and hospitals call you out as the benchmark that they're using to measure their success. And yesterday, I noticed a number of different times that somebody said we were in the top decile. Premier's database, we were recognized as a 100 Top Hospital. All of those things are informed by the incredible data and technology that we have. So very quickly, organizations that leverage our technology, leverage our services actually perform better, and you can see here on some of these indicators. So better care, 11% lower inpatient mortality, and we consistently saw that yesterday in those presentations; 6% better operating margins; 20% more revenue in value-based care programs; 10% lower supply chain costs; and 7% lower inpatient mortality. So every year, we're always asked, what are the big themes that you see as this year sort of kind of rolls out? What are the areas that you are all focused on to support the health care systems? They kind of follow on 5 buckets this year. So the first bucket is really managing the commercial payer reimbursement. So over the last couple of years, hospitals and health systems and other providers have been struggling with getting paid on a timely basis and accurately from commercial health plans. And so we have capabilities that actually can help the health care systems short-circuit those cycles. But that is something of significance that the health care systems actually want to tackle this upcoming year. They've got some pretty significant gaps that they've got to continue to prove around. Unfortunately, some of our health systems have to actually go into working capital and other areas to actually front that capital until they get reimbursed. And so our jobs are really to continue to create offerings and capabilities to really help those health care systems get the timely payments that they deserve. Second, confronting ongoing labor shortage. We do believe these technologies that we continue to invest in are labor extenders. I mean the whole concept is how do we get clinical people out of doing administrative roles, ,how can we leverage our technology to ensure that you've got clinical people focused on the clinical aspects of the health care system. Third, evolution of robots. And when I talk about robots, it's not just some of the robots that are used in [ prostelectomies ] and those kinds of things, but also robots that are used from an administrative standpoint, helping the health care systems drive enhanced efficiencies. Fourth, greater path to supply chain resiliency. I think everybody -- we still had questions around the IV solutions issue that occurred with the hurricane. I don't think we can do enough to continue to create more resiliency in our supply chain. We've got to reduce our dependence on countries that have an over amount of production of certain products. And we've been very vocal about this for a number of years, but we've got to create more -- continue to create more resiliency and very, very critical products and especially pharmaceuticals. And so it is something we've got a number of service offerings around, and we've got a pretty significant strategy to ensure we have more resiliency there. The last is unlocking the power of advanced technology and the way I characterize this is there's a lot of conversation happening with AI, machine learning, natural language processing. We want to bring context to what that really means. So you didn't -- you won't hear us broadly use terms. When we talk about using advanced technology, we get pretty specific. We talk about using machine learning, natural language processing as it relates to an electronic medical record. That doesn't mean that we're not working with our health care systems on generative AI stuff and those kinds of things in support of what they're doing. But we know where we're focused and what we need to continue to expand on. And it's those areas of administrative costs that we think we can bend as a result of using advanced technologies. So with that, I'm going to flip it over to Glenn for a couple of slides, and then we'll get into the questions.

Thanks, Mike. As Mike mentioned, I'm new to Premier, but not new to the health care industry, day 60 or so on the job, so looking forward to it. But I thought what I would do is start off with why I joined the company and why I'm excited about the future. And I really have 2 slides that I think really portray the excitement as we move forward. But the first one is really around the growth opportunity in both of our segments. On the Supply Chain Services side, lots of opportunity to grow once you move past these contract resets and fee share renegotiations that we're currently going through, and I'll touch upon that in just a minute. And then on the Performance Services side, lots of opportunity leveraging our technology and our AI capabilities. So for me, that's an important one that we do see a long runway for growth once you move past these contract resets. And again, the majority of those resets will be done by the end of this fiscal year. Second is around having a well-positioned balance sheet. And I would just tell you that we have a great balance sheet, probably the best balance sheet I've ever had at a company. We have no debt, very strong predictable cash flows. And ultimately, that's going to lead us to supporting our long-term strategy as a company, whether it be growing organically or growing through accretive tuck-in acquisitions. And then lastly, the creation of shareholder value over the long term, which is really why I came to join the company. So starting off with our growth strategy. We have, I would say, multiple levers to grow over the long term. And again, this will happen once we get past these GPO fee share resets. But it really starts with leveraging our deep and strong relationships with our hospital systems and our suppliers. We do see growth in our underlying GPO business. We measure this by how much spend we can penetrate with our members through our gross administrative fees. And just to put this into context, over the last 5 or 6 quarters, we've been growing in that low to mid-single-digit range when you look at our gross administrative fees. But the interesting thing is we have a lot more opportunity in front of us. Today, we're only capturing about 60% of our acute spend within the hospital systems. And when you look at the nonacute side, it's actually less. So there's a long runway to go when you look at the amount of spend that we can capture within our GPO universe. So how do we grow our Supply Chain Services business? Well, first and foremost, it's about capturing market share. This is obviously difficult to do, but I'll give you one good example where we acquired the AllSpire business. This was a $3.5 billion annual purchase hospital system where we are winning share here. This was a competitive win. And so that's obviously one way we can grow our GPO business. But candidly, if you look at where the opportunity is and where most of the growth will come from, it's about capturing more spend with our existing members. We do this through a couple of ways. First, broadening our GPO contract portfolio by adding new suppliers and also new product categories. Second, it's about driving increased adoption of our high compliance programs, and this would include our SURPASS program along with AscenDrive. And candidly, I think there's a big opportunity for us to move from PPI, or physician preference items, to lower-cost alternatives that are acceptable within the overall health care system. I still think there's a large untapped category of spend for third-party services. We call them purchase services, where we can leverage our technology and our conductive platform with our customers. And these would be services such as transcriptions, [ lawn ] services, landscaping services, linen services and the like. So there's, I would say, a big untapped category of spend there. And then modernizing the health care supply chain. We have a digital supply chain solution, all the way from procure through pay and digitizing that, taking efficiencies out of the system with our [indiscernible] platform, huge opportunity for us to capture even more spend. And then lastly, I would point to the nonacute side. This is a very fast-growing area of the GPO and we think there's opportunities in the food space, along with pharmacy, including 503B plans. Outside of that, we also have a supply chain outsourcing and co-sourcing business called Nexera. And we see nice opportunities to, again, take on that for some of our hospital members to continue to grow our GPO business. In addition, we view this GPO area as a way to cross-sell into other parts of our business like Performance Services. So today, 60% of our business is GPO, our Supply Chain Services, 40% is Performance Services. But only about 1/3 of our members actually buy or use our services in both parts of our business. So really, a tremendous opportunity for us to leverage and cross-sell within our business. And so if you look at the second pillar here on the chart, Performance Services is clearly area of focus for us to strengthen our capabilities, both with automation and AI capability. And we think we've got differentiated technology that might hit on some of those points earlier. We see a ton of interest from our members that are health care providers as they look for new and creative ways to deliver better quality health care, ensure appropriate reimbursement along with reducing administrative fees and address some of the ongoing labor challenges, which is a big issue for our customers. So what are specifically some of the things that we're doing to address these customer issues? And Mike hit on some of these with the trends he pointed out earlier, but I want to just reemphasize a couple of these points. So first, clinical decision support, and here, we integrate directly into the EHRs, allowing us to channel evidence-based content directly into the physician workflows. So this helps guide decisions, improve patient outcomes, reduce waste leading to overall reduction in health care costs. And as you can imagine, these clinicians are dealing with many new research publications each and every day. So it's a lot of information coming in and just for them to keep up is a big deal. So channeling our insights to physicians at the point of care is a big positive impact and benefit. On reimbursement coding, again, Mike hit this earlier, but a key focus area for us as well as our providers, we can help here with our AI solutions by having accurate coding and documentation the first time it gets submitted, so appropriate reimbursement is actually received. Prior authorization is another one. And here, incumbent prior authorization solutions are thought of as very expensive. They're very manual in nature. So again, a nice opportunity for us in using our AI tools and capability. And we believe this will help both providers and payers address the inefficiencies along with other administrative burdens resulting in lower cost, speeding up time to care and so forth. And then lastly, the clinical trial recruitment. So most clinical trials are failing to meet the recruitment time lines, resulting in delays in patients getting treatment and adding to cost to the health care ecosystem. So what we do is we use our clinical tools, technology and data to what I'll call, flip the funnel, right? Find the patients first and then engage the sites instead of the traditional way of starting with the sites and then hoping the patients are going to be there. And then just the last 2 items on the chart. The 2 pillars here, you can see, being creative and coming up with new solutions for our customers. And a good example here would be our digital purchasing platform for non-acute providers and then leveraging our AI tools, technology and data to expand to adjacent customer spaces. And we hit on some of these earlier, but this would be moving to life sciences companies with research and clinical trials; payers with electronic prior authorization and manufacturers through our digital supply chain capabilities. So let me end with how we're going to create value for our stockholders over the long term. And I think we are well positioned to do this. You heard earlier about our industry-leading position, the critical tools, technologies, our deep customer relationships. But really, for us, it's about going to customers as One Premier, addressing the issues and the emerging trends that Mike pointed out. We've got a long runway for profitable growth today. Our guidance for this year has our EBITDA margins in the mid-25% range. If you look at our Supply Chain Services business, we're closer to 50%. And the interesting thing is as we're able to penetrate spend within the GPO, we have a fixed cost infrastructure, meaning as we drive more incremental revenues and volume, it's almost dollar for dollar flow-through to our bottom line. So we have very little variable cost. We also have over $200 million of minority investments, some of which are noncore, and these are assets we could potentially look to monetize. And this would obviously bring in additional cash to help fuel either our organic growth plans and investment that we need to support those or even doing accretive tuck-in acquisitions. Lastly, as I mentioned earlier, we have a very solid balance sheet, and we've generated strong and predictable cash flows over the past several years. In certain years, we've done over $200 million of free cash flow as an example. This, coupled with some nonstrategic asset divestitures has enabled us to pay off our debt. So we basically had no debt in our most recent SEC filing at the end of September. It's also helped us to support meaningful return of capital to shareholders through share repurchases and dividends. And this includes you purchasing $600 million of stock over the past 12 months under our existing $1 billion share repurchase program and paying out dividends with an annual yield of about 4%, which is top quartile performance when you compare it to the Russell 1000 Index. Lastly, I just want to mention we also expect to see about $100 million cash flow benefit that will start in fiscal year '26, so July 1, 2025, associated with a TRA that gets phased out with our former member owners of our company. So this was a tax benefit that we were sharing with them. That essentially goes away, and we'll receive $100 million incremental amount of cash flow coming in starting next year. So that's going to help our overall capital deployment strategy. So with that, I think that's our prepared remarks, and Annie, we'll turn it back to you for questions.

Terrific. Thank you both so much. I feel like there was a lot of new information there. So that was really, really helpful. We always start here, but given Premier's positioning within the health care ecosystem, we just always really look forward to hearing your valuable insights about what's going on within health care. So maybe we could just start with a high-level overview of how are providers feeling these days? What are the pain points? What's working? And how are they feeling about spending because it seems like maybe margins are getting a little bit better?

Yes. So first, before I answer the question, I would be remiss if I didn't introduce the rest of the team. I've got Ben Krasinski here, who runs our IR; Kaycee Kaplin is our Chief Medical Officer; and Andy Brailo, runs all of our commercial function. So I think there are 4 themes that are impacting the health care systems and, team, you can jump in as well because you're out there in the market with me. First, I do think this conversation around commercial pay and reimbursement is something really important. I think health care systems this year more than ever are going to be challenging us to create solutions and they're going to be creating solutions to figure out ways to get paid more appropriately on time and those kind of things. So -- and by the way, not just health systems, but all providers. And we have, obviously, solutions to help all providers to do that. But that's number one, get the cash flow flowing in the appropriate amount of time in the door, especially for major procedures, because those are the ones that seem to be delayed the most. Second, labor crisis. I'll continue to say this. As there are more of us that are aging, and you have the gray tsunami, there are few people taking care of that population. This was exacerbated by COVID, where there was a lot of retirement. So I will tell you there's going to still continue to be a labor crisis. It's interesting. People really focus on physicians and nurses, but it's a lot of the techs. So radiation techs, lab techs, all those folks, those are some pretty significant issues associated with labor. So health care systems are still struggling with that labor aspect. Three, Glenn and I both mentioned this, but the proliferation of technology, how do they harness it most effectively? And how do we do it at scale? So not everyone is attempting to create similar kinds of capabilities using advanced technologies, but are there ways that we can share best practices and those kinds of things across our network? Across the collaboratives that we built out, across the technology platforms that we create, how can they share that information as opposed to each of them individually making those investments? And then finally, I talked a little bit about supply chain resiliency. I don't think that's behind us. I still think we've got some pretty significant issue, especially as it relates to Southeast Asia, specifically China, overproduction of very, very specific products. And we've got to be really, really thoughtful as we unwind some of that stuff, including pharmaceuticals. And that keeps me up at night, not just for us today but for our kids and our kid's kids. So those are the 4 things that I think that health care systems are going to be profoundly focused on this year. Terry Shaw, actually the CEO of Advent, said something yesterday, and I thought that this was pretty interesting. But he said over the next 4 or 5 years, he thinks that there's going to be a drop in commercial payment by 10%. So payment from commercials are going to go more towards like Medicare, Medicaid, those kinds of things. And if that, in fact, is the case, the prerogative, the need for additional cost savings is going to be even more important for these health care systems because as you know, those other forms of reimbursement payout in comparison to commercial payments. So I just think that whole focus on operational improvement, performance improvement, all those kinds of things is going to be something they're going to continue to focus on.

That's so helpful. It's so interesting. I guess, maybe can we double-click on the point that you made earlier about moving clinical people out of administrative roles?

Sure.

Because it seems like a lot of the clinicians blame technology for increasing their administrative burden. So how are you tackling that issue?

Yes. No, it's a great question. So I think what you're referring to is primarily with the adaption of the EMR, the education and the training. And look, I'm not saying that the EMRs still don't have a long way to go. Right? So -- but I will tell you, there are certain things like nascent listening and all those kinds of things that are populating the electronic medical record or actually helping productivity and those kinds of things. But call me just somebody that's constantly being positive. I still think that, that technology enablement of that EMR is going to make life a lot easier for providers in the future because they're going to -- at their fingertips, they're going to have their medical records and all those kinds of things. Yesterday, and the provider track is really interesting, not-for-profit provider track, everybody was talking about the utilization of their EMRs by the patients and how they're making that more effective and more efficient. I just think it's a communication conduit between the patient and the provider that we've never had before. So I think eventually, it will drive more productivity. But gosh, as things just -- as we continue to train, there's conversions happening between one EMR and another, I think that's where there's a lot of frustration. Now where we're talking about technology is we're talking about how do we use advanced technology to do some of the coding and documentation so that you don't have a nurse doing chart review or prior authorization so that you don't have to spend the amount of time from a clinical standpoint to do the prior authorization that we can actually use the technology, looking at lab values, looking at health status, looking at the unstructured text of the electronic medical record doing that work. And where we have done it, we have very, very high probability. Where we've done the prior auth, we're like 99.2% accurate. It's more accurate than the manual intervention that actually has to occur and obviously, significantly less cost. So I think it's just continuing to build out those algorithms, especially on the administrative side. And you don't ever hear me really mention clinical stuff. I really do believe the clinical stuff is up to the doctors and the hospitals and the health systems to build out what they think is the most important aspects of advanced technology to help them drive more clinical standardization, more clinical efficiency.

Maybe to that point, I mean we hear so much about like AI changing health care and NVIDIA had all this splashy stuff yesterday about robots and all this exciting stuff. But I mean it seems like, maybe the real thing that you can do to solve the labor issue is allow the clinicians to operate at the top of their license, not have to do the administrative stuff and so they can kind of do more with that as opposed to kind of replacing them with robots.

That's our perspective as well. So operating at top of the license, ensuring that they're driving the kinds of value clinically that was intended when they were hired into the health system.

Right. That's great. Glenn, I want to hear from you because I thought your slide on the growth strategy was kind of a fresh perspective. It was really interesting. With fresh eyes on the business and kind of thinking about that growth strategy slide, where do you start first? Where is the low-hanging fruit?