AdaptHealth Corp. (AHCO) September 2026 Conference Transcript

But I'm Brian DeKeele, Healthcare Services Analyst here at Jefferies. Welcome to the 2026 Jefferies Healthcare Services and IT Conference here in Nashville. We're very excited to have AdaptHealth. Normally, I'd start the conversation with Suzanne and say, give us the lay of the land, what's happening. But there was news that came out on the company last week. And so today we have Harris Curry, the company's new CFO. So maybe I'll start with you, Harris. Maybe just a little bit of an intro on yourself, your background. and why you chose to be here with ADAPT.

So let me start with why I chose to come to ADAPT. ADAPT, market leader, great market positioning, opportunity to grow significantly, no issues to speak of, just pure change of leadership there, and I'm excited to come in and provide help to provide that next step of growth for the company. My background, 20-plus years in the public company environment at Luminex Corporation. a biotech company in Austin Texas we you know we implemented SOX we grew the company from zero revenue took it public got it up to a couple billion dollar valuation sold it to Diasaurin a lot of work there a lot of similar things to do here when you're on a significant growth trajectory and I look forward to being apply all the scars and bruises and scrapes that I built over that time to help adapt as we move forward.

That's awesome, and great to meet you. Maybe, Suzanne, now I'll turn to you. Second quarter, lots of moving pieces. We obviously saw a guidance revision, and as you think through the issues or challenges that you're facing today, maybe if you can help the investment community think through what's transitory and what are the mitigation efforts that you guys are pushing through in order to, to Harris' point, and bring back growth to the business. Sure.

Before I start there, I just officially want to welcome Harris. This is our first appearance together. But I also, given this webcast, I want to say thank you to our prior CFO, Jason Clemens. Many of you know and really was, brought the company through some very good and difficult times. And so I just want to acknowledge his six-plus years of service to ADAPT and wish him well. And he says hi to all his friends and officially welcome my new partner and CFO, the business. So 2Q did come with a lot of new news. We have been, over the last couple of years, really transforming Adapt to what its full potential can be. And so if you think about what we were focused on the last couple of years, it was one around the leadership team and talent. We've brought in a significant amount of leadership and talent across the business, which I'm very proud of that. They're all now got a year or two in seat, and you're starting to really see the difference that they're making. The second thing is we got very focused on our portfolio. The first reason we had to do that was obviously we wanted to get serious about paying down our debt, which we have made progress on over the last couple years. But we also wanted to simplify the business. So for those of you that are newer to the ADAPT story, it was over 100, I think over 160 acquisitions over a couple of years that came together. And through those acquisitions, each acquisition had a different portfolio or not different. They had the core products, but they would have these what I'll call little stragglers. And when we looked at our portfolio a couple of years ago, we had a lot of businesses that we weren't at scale or weren't profitable. So we set out to clean up our portfolio and to make it focused on sleep, respiratory, and what we call our wellness at home, which is our home medical equipment. That work, once diabetes is divested in the first half of next year, is basically complete. We've pruned the portfolio to a point that we can be super focused on driving the best clinical and economic value for patients in sleep health, respiratory health, and home medical equipment. So that was part two. And then the third part that we've been focused on the last couple years is what I call acquiring patients. And there's two big moves we've made there. The first one was we stood up what we call our enterprise commercial team. That's a team that's now calling on big hospital health systems. And we're making great progress there where we can go into a geography, be the preferred provider for these hospital health systems, and build around that footprint. But the other big move we made is we expanded our capitated business. A few years ago, we became the capitated provider, one of two capitated providers for Humana across the country, and that has performed very well for us. And we have a handful of other capitated arrangements with patients, but about two quarters, three quarters ago now, we went live with Kaiser Permanente across the entire country. And that has been a big move for us. What it did for us strategically is it allowed us to enter the West Coast. We were mostly an East Coast, Midwest company. And with the addition of this business, we stood up 40 brand new locations in California, thousands of people, fleet. And it was a gigantic undertaking. And so right now what we're working through is getting that business performing to its expectations which I'm confident it will and that capitated business what it does for us is it allows us to take big chunks of patient volume and make it exclusive to adapt that's what's driving partly some of the consolidations that's happening in this industry and we're well prepared now with a national footprint to continue to drive that volume of patients our way.

Now, it's a great segue, Suzanne, to the question I'm going to ask you. It relates specific to Kaiser. Obviously, a big contract, maybe just capitation in general, right? It's been a big growth engine for you. How do we think about the opportunity to drive more capitation agreements on a national scale? And then the learnings from Kaiser.

Obviously, implementing a new contract like that has been challenging. like you said you had to stand up 40 new locations but and it looks like utilization was also probably higher than you expected so if you can walk us through your growth outlook as it relates to capitation and the the opportunities set there and then the operational learnings you know contracts like humana or kaiser whatever it may be they're they're far and few between and you take one big one on and you digest it and then you know i don't even know if there's another one of that size and we're now digesting that you know small little ones regional ones are totally fine right now but until we you know in the spirit of simplifying our business and being methodical we will get that one right and then we'll think about the next big expansion but we are open to the smaller ones around that as evidenced by last quarter when we announced you know the expansion Humana into Florida and Texas. Easy for us, digestible, we did it. In terms of how I think about capitation in general as a growth driver, so, you know, last quarter we put up 16% organic growth. We foresee that, you know, this year because of that contract we will deliver very nice organic growth and that was part of the strategy is we had to first get the patients cared for at no matter what it took and so think of it this way this is how these arrangements work is the customer and adapt get together we look at data that suggests that for this patient population this is what you can expect in terms of utilization it's actually pretty straightforward forward. When that is an accurate data set, you can forecast utilization. And so as you get going in the relationship, there's always tweaks. Oh, okay, that data may not have been 100% right on. We have to adjust. And in the spirit of partnership, when you have an exclusive relationship with a payer, everybody wants to get it right. The contract calls for later corridors and all of that. But out of the gate, the partnership wants to get it right. Why? Because the patient is the one who suffers if you don't. And so you go into this with the spirit of partnership that says, okay, this is what we'd expect. And then we compare that up against actuals. And then the partnership works to adjust that accordingly. Because if it doesn't get right, and one of the parties falls down in responsibility, that patient can't get discharged. They're missing a discharge from the hospital, which is way more costly, I can tell you, than having that patient be transitioned out to our care. 25% of hospital discharges result in some kind of product that comes from a home medical equipment and service provider. And so we are incredibly important to that hospital ecosystem to make sure that that flow of patients to their home where everyone's trying to get works. And so in the spirit of partnership, that's what we're working on is, one, making sure that the utilization payment is accurate, and two, the way that that handoff happens, meaning from the provider, whoever that provider is, in this case it's our capitated partner, to us, that workflow is as smooth and simple as possible. When we took over that contract, it wasn't as smooth and simple as possible, but that's what we're working to make it, is so that we can make sure that that's most efficient. The other benefit of a capitated agreement is you have less administrative burden, but you also don't have to fund a commercial team. That business is exclusive to you. So there's some real benefits to both parties to cutting out that cost in health care.

That makes sense. Maybe shifting gears a little bit. So we've talked about growth in the top line. In the second quarter, you called out a new headwind with a pricing adjustment from a manufacturing partner. Any updates you can share with us? Because I think you were saying on the Q2 call that you're trying to renegotiate a contract or get back into contract with them. And as we think about new or returning entrants in the CPAP space from a manufacturing perspective, how are you strategizing around that?

I'll take that one first. So in all that we do, the way it works is, in some cases, a prescription comes to us, and that provider may want a particular brand for their patient. That's not always the case. So when that's not the case, we have to make sure that we work with the patient to see if they have any preference, of course. But if not, then getting them that product and the brand, you know, doesn't matter as much. So that's the role we play, which is why we have to make sure that we carry all products so that if a prescription comes in, we can make sure that we have that product. But then after that, what is the most clinically efficient for the patient and most economical for us? That's how it works. And what we referenced in the Q2 is that we did not expect a price increase. The problem that we're trying to solve here is that the way that our world works is, of course, volume-paced buying and contracting with our manufacturers. Those are typically very strong relationships, and I would suggest they still are. We need each other. We are essentially their commercial team. They make the product. And so we both have incentive to make sure that that share of patients that are up for grab, that there's no shifting or movement going on, that it's fair across the board. And so pricing comes into that. So I'm confident that we'll continue to reach the right terms with all of our manufacturing partners. But we thought in the fairness to the timing of the earnings call to call out that risk.

Maybe just to follow up on that, I mean, calling out that risk translates to about a $60 million EBITDA headwind on an annualized basis. So until we get to some form of resolution or a new pricing agreement, what are the mitigating moves that you can do to try to offset that headwind?

And that risk is if we didn't reach new terms. and what we would have to do, as I suggested, is we would have to look at product mix to make sure that we protect our bottom line as well.

Do you have the ability to go back to the payers and say, well, guess what, pricing went up on the product?

No, that's not how, you know, managed care payer contracts are much longer term, and so we wouldn't be able to pass on that price.

So maybe shifting gears. So when I think of some of the comments you made earlier about diabetes and just rationalizing the business that was kind of big news right like it's a big strategic shift to refocus the business today so how are you thinking about you know what the strategy going forward is number one and then maybe like capital reallocation as you think about the proceeds from the pending sale of the diabetes segment the proceeds first and foremost will go towards debt and then with continuing cash generation will be in service to our strategy which is really the heart of your question so with the divestiture of diabetes the whole idea was or there was so much opportunity we saw in the

sleep and respiratory market out there the trends are in our favor sleep health is something everyone's talking about the GLP is the wearables the home sleep diagnostic testing we are seeing that top of the funnel momentum and volume coming that we couldn't justify putting extra dollars into diabetes it allows us now to take those extra dollars now with our debt profile being where it will be post diabetes to continue to invest in growing our sleep and respiratory footprint. Growth for us comes from acquiring patients. And the way that we're looking at that is we want to grow in specific geography. So we have a national footprint, but when you can go into a geography and have 50% even market share or more, you can imagine as a growing, as a prescriber, and you're sitting with the patient and you're saying, okay, what insurance do you have and they say Humana or they say Kaiser and the and the doctor referring provider says oh that has to go to adapt at some point that prescribing provider says most of my patients are adapt anyway I'm just it's easy wear the easy button and so we're looking at building not only proximity in the geographies we serve which would be all of your like any particularly any city that has an NFL team, we should be dominant there. We could network out to the rural areas, but we want to be dominant in those high population areas. And then we want to be dominant in the payer space. So we enjoy like 99% of payer coverage. That is also a moat to our business. So not only will we be able to serve that geography, but we could serve any insurance. And so our growth strategy is all around capturing those patients and having them transition to adapt when they need sleep, respiratory, or some kind of home medical equipment. That's where we'll drive the growth because, to your point, we're price takers in a way, right? We negotiate managed care contracts and all of that kind of stuff. However, that supply chain purchasing power is incredibly important to us. And the only way you get that is with volume. um furthermore with our what now um almost 700 locations across the is that right 700 seven okay about 690 700 locations across the united states that footprint that fixed cost you can drive a lot of volume through that without adding on and so you may need it like take the Kaiser example, for example, because of where the patients were, we had to stand up 40 new locations. Those locations are not full. And so once we stabilize the operations and we continue hitting our SLAs, what I've talked about before is now we bring in two halo effects. The first one is which is we know somewhere between 10 and 20 percent of hospitals, of patients that go to the Kaiser hospitals are not, um, have different insurance. So we'll be able to take that population. The second is we'll put a sales force around those 40 locations and go drive more volume into that fixed footprint. So all of our growth is around building up our locations to max capacity and driving as many patients that we can care for through that footprint.

Now that makes a lot of sense. So maybe let's take a step back for a little bit. Um, when we think of, because I appreciate the comments on driving volume, driving patient growth, but when we think about broader demand for sleep, what's your outlook there? And then one of the questions we get asked a lot is, is there a tightness and capacity on the sleep doctor's side that's proving to be a bottleneck for getting patients to you guys? So curious what you're seeing and then how you think that will grow going forward in terms of the demand for sleep.

We do think or have seen and heard that there is a bit of a bottleneck, which is why so many people are looking at the home diagnostic testing. I mean, I'm sure many people in this room would shake their head that they're wearing some wearable or something has brought your attention that maybe I should look at my sleep. I mean, it just seems like it's a topic these days. That bottleneck, I think, is going to get freed up because we are seeing a lot more referrals from home diagnostic testing that don't require a patient to go into a sleep center like they used to. So I think it's just matter of time we have said mid single digits for for sleep comfortably that's what we're seeing so we're we're excited about that market where you know with the recent announcement of our joint venture we're looking at different ways where patients don't want to go the traditional route so we've entered into a direct-to-consumer joint venture we spun out our e-commerce business and put it over there because I think there's many many ways patients will find the therapy they need for that, you know, for sleep wellness.

And then maybe I'll circle back just to the point of the diabetes business divestiture. When we think of kind of like stranded corporate costs associated with that, what is that opportunity set in terms of trying to bring down the cost structure as you spin off diabetes?

Yeah. So I just want to make sure everyone's clear in the comments that we made in our Q2 earnings call where we said there was 60 of stranded cost, 60 million of stranded costs. Really what that is, is there's two buckets. There's really 30 million of true stranded because there's 30 in there that basically resolve itself upon the transaction, at the closing of the transaction. And so those are things like people that aren't transacting over to Cardinal that you know but had to do we're in that business real estate that potentially was a hundred percent that doesn't move over so all of that that first 30 kind of goes at the time of closing so what the problem we're solving for is the 30 million that stays and that 30 million that stays we believe we can grow into or out of I don't know what the right way to frame that, grow through in the two to three year period, because our growth trajectory and the West Coast expansion we talked about, select M&A in those NFL type cities will take care of that. We did, however, and we've started the $19 million restructure that we took, our investment in technology that we're making, those things, too, will offset those stranded costs. The investments that we make in technology and AI are geared towards reducing the administrative labor burden on our business, and those things will have an impact at that same period of time that we're trying to absorb that $30 million.

Got it. Maybe I'll move to a different topic. As the business shifts more to a capitated model, or capitation is becoming a bigger part of it, does the free cash flow outlook or profile of the business change, especially as you rationalize the portfolio to the new strategy?

We've said that long-term we don't believe so, that we're still going to that 6% to 7% yield is where we're at.

Got it. It's hard to be at a health care conference nowadays without talking AI or GLPs. So I'll go the GLP route first. Sleep, there's a lot of discussion on that, right? How do the GLPs affect demand for sleep products? Some people thought initially that it would be a headwind, and now it looks like it's becoming a tailwind. Where do you stand on that, and what are you seeing in terms of demand for sleep within your patient population?

I think it can be both. I don't think it has to be either. I think that there is certainly a portion of people, and they say, depending on what you read, between 10% and 20% of patients who will be relieved or their sleep apnea, OSA, will be minimized as a result of losing weight. I think that makes sense. But there is also that disease state, or OSA, also comes with structural, regardless of what your weight is, you are going to have it. So I think it's offset. However, what we're seeing, I mean, we're breaking records in referral volume for sleep health. I think that is offset in those fortunate patients that that resolves by awareness. The awareness that is coming in terms of, oh, I can go to a doctor and they're just not going to say to me, lose weight. They're going to say, oh, well, not only can you lose weight, but you can also feel better because you're sleeping better. It's this cycle that patients are realizing I need both. Furthermore, I follow, you know, ResMed's data, and we have data of our own. We are not, they're showing, obviously, that the combo treatment is a better option. I believe that, and we're seeing that. And then in our own data, in terms of retention of patients, we're seeing similar patterns, that you're not seeing that drop-off and that patients are more adherent and compliant on a dual therapy.

So that checks the GLP box. Now I'll go with the AI question. And I think you and I have in the past chatted about how you can deploy AI to engage patients, among other things. So curious what AI initiatives you're rolling out right now within the company.

Yep. So the one that we announced last quarter, which I've seen in action and it's really quite amazing, is the mask fitting. um you know and typically that would require a patient to come into a facility work with try on a couple different masks right um now right in their in their app our app they can scan their face and it will give them in order which mask fits them best um so one on our side no labor involved two in the comfort of their home they can put in that order they can retest it periodically let's say they grew a beard and now don't have one or something like that so that that has real benefits we're building it in a lot in in our like I said our administrative portion of our business where before just a very simple example let's say a doctor prescribed something to us in the past and it came with a 50-page sleep study and and prescription that would come in by fax in the old days well still does in lots of cases our people would have to read through it sort through it find the information they need. Now what we're seeing is with the use of AI and technology, that that ability to go from prescription to delivery is being wholly handled by AI and intake and other types of technology that's cutting out that entire administrative burden. And that's the journey that we're on. That's where we think we have the most impact for us.

That's awesome. And then Suzanne, as we think, maybe just to refresh the audience on the reimbursement outlook for the products that you're going to be selling going forward under the new, the refocused adapt, what does that reimbursement outlook look like for you guys?

Right now, we believe it's stable. There's, there's two benefits. Our reimbursement looks fairly stable and our regulatory environment looks really stable. So when we, you know, now that we're kind of sidestepped competitive bid with a divestiture of diabetes, we still will bid for some of our PCS, our, these products that we have that service only they'll either service our capitated or our hospital business no longer are we selling it to individual prescribers we will bid there it's a small piece of our business but if you take competitive bid out of the future for us so to speak um the regulatory environment and the reimbursement is is as steady as i've seen in health care and i've been in health care a long time for our industry um so for us the focus isn't so much there it's on continuing to drive organic growth through, you know, as many patients as we can pull through our channel, stabilizing the workflows out on the West Coast to drive efficient and effective performance for our partner while we work through that partnership agreement, and then getting the whole rest of the business focused on sleep, respiratory, and home medical, keeping them focused, which is performing exceptionally well and getting them focused on the geographies that matter and continuing to just build in those geographies.

Suzanne, we have two minutes left here. So maybe I was going to ask a question that probably your last comment answered, but how do you give investors or what would you share with investors to give them confidence in the inflection in the business and your outlook for the next, say, two to three years?

Sure. The last couple of years, we've driven a lot of change. Like I started, this was a company that we were basically a holding company for about 160 very small companies. And we've taken some tough decisions and actions to bring this together, what we call OneAdapt. I know there's no great branding there, but the idea here is how do we become a national player where volume and scale matter? And I think if you look back on the decisions and actions that we've taken over the last two years, it's all been in service to that, along with obviously, you know, bringing in sophisticated talent to drive a scaled business. As I look out over the next couple years, the challenges that the smaller players in this space are absorbing are our benefits. And what I mean by that is customers want they don't want a hundred different hme providers to deal with they're looking at narrowing the network well they have the choice of narrowing to us or predominantly narrowing to us and so this consolidation in the industry that happened many years ago when competitive bid happened is happening again you're seeing that happen and so volume naturally needs a place to go. And when we're showing up to a payer or a hospital or a capitated partner and saying, we can take care of your patients across your geography or across that nation, that is a value prop that's really resonating. As we bring in technology and we're, you know, one thing Kaiser did is it challenged us to think differently. So the workflows that we're deploying and the use of technology has sped up as a result of that challenge. And you see that in business. When When you're up against it and you have a very significant problem to solve, you take a different look at the problem. And that's what this did for us the last year. So the silver lining of absorbing 12 million patients in service to made us think differently. And it's going to help us on that contract. But really what I'm most excited about is helping our base business think differently. We are showing up so much better for our patients as a result of the challenge we had. And because of that, I think we're going to have a continued growth. Well, I know we will over the next couple of years where doctors and providers and payers are going to say that's the most obvious choice. They're a national player with scale and with expertise. And oh, by the way, their clinical value and service levels are better than anyone else. That's how we're going to win.

That's awesome. Thank you, Suzanne. Thank you, Harris. Nice to meet you. Thanks, everyone.

Thank you. Thank you, Brian.