GoHealth, Inc. Q4 FY2023 Earnings Call

Good morning. Welcome to GoHealth's Fourth Quarter and Full Year 2023 Earnings Call. My name is Michelle, and I will be your operator for today's call. At this time, all participants are in a listen-only mode. Following the prepared remarks, we will conduct a question-and-answer session. As a reminder, this call is being recorded. I would like now to turn the conference over to John Shave, Vice President of Investor Relations. Please go ahead.

Thank you, and good morning. Welcome to GoHealth's fourth quarter and full year results call. Joining me today are Vijay Kotte, Chief Executive Officer; and Jason Schulz, Chief Financial Officer. Today's conference call contains forward-looking statements based on our current expectations. Numerous known and unknown risks and uncertainties may cause actual results to differ materially from those anticipated or projected in these statements. Many of the factors that will determine future results are beyond the company's ability to control or predict. You should not place any undue reliance on any forward-looking statements, and the company undertakes no obligation to update or revise any of these statements, whether due to new information, future events or otherwise. Earlier today, we issued a press release containing our results for the fourth quarter and full year 2023. We have posted the release on the GoHealth website under the Investor Relations tab. In the press release, we have listed a number of risk factors that you should consider in conjunction with our forward-looking statements. We encourage you to consider the other risk factors described in our Form 10-K and Form 10-Q reports filed with the Securities and Exchange Commission for additional information. During this call, we will be discussing certain non-GAAP financial measures. These measures are reconciled to the most directly comparable GAAP financial measures and reconciliations are set forth in the press release. You may also refer to the investor presentation posted to the Investor Relations section of our website for reconciliations of non-GAAP measures to the most comparable GAAP measures discussed during this earnings call. I will now turn the call over to GoHealth's CEO, Vijay Kotte.

Thank you, John, and good morning, everyone. I'm pleased to share with you today our 2023 results, which reflect significant year-over-year improvement in revenue, adjusted EBITDA, and operating cash flow. The shift to the non-agency operating model continues to drive cash generation. Our consumer-centric focus enables our evolution from enrollment to engagement with trust as the foundation. We provide guidance and insight to Medicare consumers in a landscape marked by confusion and uncertainty. Over 65 million people in the United States are eligible for Medicare and about half of them are on Medicare Advantage plans. One-third of Medicare beneficiaries live in counties with more than 50 plans available to choose from. Navigating these options can be confusing and stressful. We are proud that our team helped over 2 million consumers assess their benefit options in 2023, leveraging our proprietary Encompass workflow, including our PlanFit tool and PlanFit Checkup. Backed by analytics from nearly 30 million consumer touchpoints and machine learning technology, our proprietary PlanFit tool helps GoHealth's licensed agents match consumers to the best plan for them based on their profile and priorities. During the fourth quarter of 2023, we announced the launch of PlanFit Checkup. PlanFit Checkup removes the stress and enhances the experience for consumers shopping for a Medicare Advantage plan. As we previously shared, there are three consumer outcomes for a PlanFit Checkup. One, we enroll a consumer in a new plan because it's the best thing for their needs. Two, we tell the consumer about a better plan and they choose not to switch. Or three, we reassure the consumer that they are in the best plan for their needs and no enrollment takes place. Importantly, GoHealth agents who complete a PlanFit Checkup are compensated regardless of whether the assessment results in an enrollment. In Q4, we performed over 300,000 PlanFit Checkups. We enrolled over 200,000 of these consumers into a better plan option for their needs. Over 100,000 additional consumers were told they were on the best plan already and we did not enroll them in a new plan. We provided this peace of mind to the consumer whether we already had a relationship with them and more importantly, when we did not have an existing relationship with them, thus building and reinforcing trust in each and every instance. During 2023's annual enrollment period, we faced the best test of the integrity of the PlanFit Checkup experience. Our marketing initiatives worked as planned. Our agents showed up, worked hard, and took more opportunities per day than ever before. However, from a health plan product offering standpoint, this AEP was different than we have previously seen. An analysis from Milliman revealed that for the first time in recent years, benefits for Medicare Advantage plans stayed relatively flat year-over-year. This led to a market environment with minimal product differentiation, providing few incentives for consumers to switch plans. The traditional enrollment-centric broker model might have still switched consumers to new plans with similar benefits or even subpar benefits to get a commission, but we chose to honor the integrity of our PlanFit Checkup process and the investment in trusted relationships with consumers and only recommended a change when there was a justified reason to do so. With our high integrity process, in 2023, we expanded our market leadership and continued to be a leading producer of Medicare Advantage policies for our primary health plan partners. We believe our Encompass transformation is working. As a reminder, we launched the Encompass workflow in 2022. We are now operating at scale with all key partners. With over 75% of our employed agent submissions in Q4 flowing through the Encompass workflow, we have observed a market increase in submission quality as seen by lower complaints and CTM rates. Our strategic shift has significantly impacted revenue composition. Over 50% of revenue is now generated from the non-agency line, surpassing our traditional agency line or lifetime value revenue. Leveraging the Encompass workflow and adjustments to our LTV revenue recognition process has led to a stabilized back-book asset valued just under $900 million net of our constraint reserves. This stability is evidenced by the absence of a Lookback Adjustment for the first time in several years. While we observed positive retention trends in late 2023, we have opted not to adjust LTV positively at this time. Underlying that approach is our expectation that there will be benefit disruptions for the 2025 benefit year, potentially leading to more switching. We're investing in long-term trusted relationships and not just trying to maximize the short-term return of an enrollment. We believe this is not only the right thing to do, but also the right thing for the business and the right thing for health plans. It is in the best interest of the consumer and 100% in line with what CMS is looking for from brokers. We are excited about the brand and proof points we are establishing and the proprietary tools, tactics, and incentives we have built. We recognize that health plans are facing regulatory changes for Medicare Advantage that may impact benefit investments. There is no question that Medicare Advantage continues to have a strong value proposition for Medicare eligible consumers. We expect to see more shopping and likely more switching as uncertainty on benefit stability appears probable in the upcoming AEP. More than ever, consumers will need to find a trusted advisor to help them navigate the volume of options and the impact of benefit changes, and we believe GoHealth is that trusted advisor. Instead of providing specific 2024 guidance, we will share our general expectations for several key areas of our financial performance. First, we expect submission volume to grow in line with the overall Medicare market. Second, we expect our revenue to be flat year-over-year with incremental operating efficiency resulting in modest margin expansion. Finally, cash flow from operations is expected to be flat to slightly up as we continue our transition into the Encompass model and shift to non-agency revenue. There are a handful of market factors that could influence our performance in the year. First is the final rate notice on commissions impacting 2024 AEP. Second is the final 2025 marketing rule from CMS impacting 2024 AEP. Third is the degree to which there is health plan product and benefit differentiation between 2024 and 2025, which will indicate the amount of switching we should expect. Fourth is marketing efficiency within this election season. And finally, there is a relative health plan competitiveness and the effect on planned mix. Any of these factors alone or combined could significantly affect our performance for the full year 2024. We expect these key variables to become clear throughout the year with some of the most material remaining unknown until the early part of Q4, right before and during AEP. Our strategic and long-term outlook remain resolute, driven by a commitment to transforming the consumer healthcare journey. I am extremely proud of our team as they navigated through an important and transformative year punctuated by a unique AEP. They rose to the occasion, embraced PlanFit, and delivered peace of mind through our compelling consumer value proposition. With that, I will turn it over to Jason to detail our financial results.

Thank you, Vijay. As we review our performance for 2023, I'm pleased to share that GoHealth has demonstrated financial and operational strength. One of our primary goals in 2023 was to continue to improve our operating cash flow. We delivered on this objective with $109 million of cash flow from operations, a nearly 80% improvement from the $61 million in 2022. We ended the year with $90 million of cash on hand. In addition to our strong cash flow, we generated significant improvement in revenue and adjusted EBITDA. Our journey through the year has been marked by substantial improvements across key financial metrics, underlying the effectiveness of our strategic initiatives and the resilience of our business model. We reported revenues for 2023 of $735 million, an increase of $104 million as compared to $631 million in 2022, a 16% improvement. As a reminder, 2022 revenue included a $276 million Lookback Adjustment that reduced revenue as a result of an actuarial review of our back-book. As Vijay noted, we did not record a Lookback Adjustment for 2023, the first time since 2020. The work we have done with our Encompass model to derisk the business from our agency revenue has resulted in higher quality revenue and a strong balance sheet. Our adjusted EBITDA, excluding non-Encompass BPO, was $73 million for the year, a 78% improvement from $42 million before the Lookback Adjustment in 2022. This increase underscores our operational improvement and our focus on sustainable profitability. Another way to look at our results is on a cash adjusted EBITDA basis. In 2023, we generated $142 million of cash adjusted EBITDA, which is up from $98 million in 2022 and a negative $301 million in 2021. Cash adjusted EBITDA is simply taking our reported adjusted EBITDA plus the year-over-year change in our net contract asset. If the net contract asset has gone down, this is a result of higher cash collections from our back-book and the inverse is true if the net contract asset has increased year-over-year. We believe that cash adjusted EBITDA is a helpful measure of our business as it neutralizes the impact of the LTV estimates related to future years. As I mentioned, 2023 saw us achieving a robust cash flow from operations of $109 million, up from $61 million in 2022. This $48 million increase is a testament to our disciplined cash management and our successful execution of our operational strategies. In the first quarter of 2024, we successfully negotiated an amendment to our debt agreement, adjusting the leverage ratio of requirements for the duration of the loan facility. We will focus on refinancing our debt over the next few months as we aim to optimize our debt structure. We believe this amendment provides additional flexibility to support this goal, while continuing to invest in the business for future growth. In addition, we have committed to a $50 million term loan paydown in early Q2 and an additional $25 million paydown in early Q4 of this year, which we plan to fund from our strong balance sheet and liquidity. More information will be available in our 10-K filing. I will now turn the call back to Vijay for closing remarks.

Our confidence in our business and operational model continues to remain resolute. We firmly believe that prioritizing consumer needs and aligning with CMS, regulators, and health plan standards is a sound long-term strategy for our shareholders. Our focused business transformation efforts bolster our positive outlook. We are well positioned to overcome unique market dynamics and seize opportunities to further enhance shareholder value. With that, we'll now take your questions.

Thank you. Our first question comes from Ben Hendrix with RBC Capital Markets. Your line is open.

Thank you. I have a quick question regarding the submission volume in relation to Medicare growth. I'm curious about any fundamental changes in your ability to capture growth opportunities in Medicare. Has there been any shift in your Encompass strategy that we should know about? Additionally, how do you perceive your competitive stance against peers who are still following the ASC 606 strategy in the long term? Finally, how should we evaluate the competitive differences between the two platforms based on what we observed this past AEP? Thank you.

Yes, thanks for the question, Ben. Just to clarify, are there any material changes to the way we are operating or thinking about our Encompass model and pre-funding specifically relative to the 606 versus 605 more like LTV versus the more Encompass pre-funded model? We are still very confident that the Encompass workflow that we put in place is the right thing for consumers and we are committed to that model. We want to make sure that we are continuously putting the consumer at the center of everything we do. And as part of that we think there are costs to running that business model that we are contemplating and appropriately investing in the way that we get reimbursed by our health plans for that model. As you think about the overall market landscape, as we indicated, there is a lot of benefit instability that may be coming up in the upcoming AEP season and in the future. When you look two years ago versus this last AEP versus what we're anticipating in the future, consumers should likely shop more, which is what we've said all year. We want them to shop, we expected them to shop, they are shopping. But when it comes to the appropriate time to make switches, it is either because they've got incrementally much better benefits, or, conversely, when they have a lot of change in their benefit structure. And what we saw in this last AEP, it was one of the unique AEPs where there was some negative, but really not a lot of changes, and so less and less of a reason for people to make changes. With a high-integrity process like the Encompass workflow we have, you are going to deliver a result where you're just providing peace of mind as opposed to new enrollment. So just in short, we are staying committed and we believe there's a lot of future viability and excitement about the differentiation of the Encompass workflow. The quality is better and we're delivering a better experience that plays the long run with that relationship with the consumer. And as it relates to the market dynamics, we would expect that, as we noted, we saw some positivity on LTVs, or retention, in the latter part of 2023, but in anticipation of some of the disruptions we expect going forward for the portion of the business that we still haven't on the LTV basis or 606 basis as you referred to, we were trying to maintain some conservatism on that as we continue to see the market dynamics play out.

Thank you very much.

One moment for the next question. The next question comes from Pat McCann with Noble Capital Market. Your line is open.

Hey, everyone. Thank you for taking my question. I'm curious if, with the rapid growth in Medicare Advantage plan options, you're seeing that trend continue. Are there more carriers introducing options into the market? Also, could you discuss how Encompass provides customers with access to the widest range of plans, especially as these policy options are changing quickly?

Yes. Thanks, Pat, for the question. Just to restate. One is, how do we think about the plan options increasing, following the trend that we've seen in previous years? And then the follow-up was how do we make sure that the consumers have access to being able to decipher between all of those plans? Is that the right way to re-state your question? So on the first one, it's an interesting question and it's really a health plan by health plan question as to who's going to be introducing or contracting the number of plans available. As I said in the previous response, there are offensive and defensive reasons why a consumer may want to make a change. Offensively, if their benefits in the market that they're in have significant improvement, then they might want to shop and potentially make a switch. If there's disruption in the marketplace of health plans leaving or degradation to benefits, it also triggers a moment where they should shop and likely make some change to the benefit choice. And so, we're anticipating more of the latter as we kind of heard some of the things from the health plans. Not to say that some might still make some investments in benefits, but you're seeing the general landscape of what's hitting the challenges of the Medicare Advantage health plans profitability, such that there's likely going to be more tweaks and adjustments that require the nuance of our PlanFit technology and the trusted structure or the foundation upon which we operate the Encompass workflow. So we don't know per se if there's going to be a lot more. I would say my gut feeling is probably not a lot of growth in brand new plans, but what we do know is, we've heard that plans are indicating they will likely be exiting certain geographies, causing some of that disruption, but still more to come, as we alluded to. And that the market dynamics won't really be known until much later in the year as to what's really going to happen on that. Now in the second question you asked about how do we make sure the consumers have access to all those plans? Well, we work with most of the major plans within the health plans in the country. Those health plan options, if they've got 50, 100, or 300, they are all in our PlanFit tool. Ultimately, when our agents go through and do a needs assessment, they understand where the consumer lives, they get their Medicare eligibility to understand if they're eligible for SNP plans, meaning dual special needs plans, chronic special needs plans, or just traditional Medicare Advantage plans. And then we filter through their needs compared to the current plan and then lay out those top three to five options that are available to them based upon their specific needs. We believe that's how you're taking that stress and confusion out of the marketplace and enabling the consumer to make an informed decision for them without pushing them down a path but empowering them with the data.

Thanks, that is. And then if you don't mind, if I could ask just a follow-up question to something you spoke about as far as the non-agency revenue and how it has eclipsed 50%, 60% in Q4. Given that, is there any color you could give as to your expectations for how that number will shift as a percentage of sales as we look forward into 2024?

We will continue to provide qualitative insights on our expectations for cash flow from operations. We anticipate that this dynamic will shift and improve cash flow as we move towards the non-agency model. This shift depends on the growth mix in the market and the competitiveness of benefits. We are committed to shifting more towards that model, and while we saw a significant increase this year, we hope to see continued progress in that direction.

Thanks. And then, I was going to try to ask about the debt repayments, but Jason kind of covered that here just previously. So that's all I've got. Thank you so much, guys.

Thanks, Pat.

One moment for the next question. The next question comes from Jim Sidoti with Sidoti & Company. Your line is open.

Hi, good morning and thanks for taking the questions. Vijay, you've made several changes since you arrived in terms of staffing levels and strategies. I'm just curious, are you happy with the progress you've made to date and should we expect any big adjustments in 2024?

Thanks Jim for the question. What we did when we first came here, if you go back in time, and I won't relive all of history, but first we were trying to stabilize the business, right? To really just stabilize things and understand where our strengths were, weaknesses were, to invest in the strengths and try to mitigate and control for those weaknesses and whatever market factors were playing in that. What we really doubled down on was that we're playing a long game strategy. Part of the issues that we saw in the industry is the missing piece within healthcare, specifically within what was considered the e-broker industry: a lack of trust and consistency. That was present among all parties involved. That was from regulators, from health plans, but also from the consumers, etc. We've really invested in the Encompass workflow and process to transform that component of who we are to be a leader in proving that we can not just drive appropriate enrollment, but drive trust and credibility within the industry. What we've done with the PlanFit space, what we've done with PlanFit Checkup, and to the extent that we are now in conversations with health plans to be able to be compensated for doing the right thing in those PlanFit space is showing that we're really delivering an opportunity to provide peace of mind to the consumer, which we believe plays for the longitudinal relationship that we're building versus where the industry has been and where most companies have been, which is trying to just drive enrollments in the short-term period without thinking about supporting a consumer over a 15-20 year lifespan. So I guess my response to that is, yes I'm very proud of where we are. I think we've absolutely laid the foundation of resetting where the industry is at of actually being a value-add of not just driving enrollments, but driving empowerment to the consumers to make the decisions for themselves in a very confusing world. As you are seeing in the diversification away from the LTV volatilities that have been there from moving to the non-agency line has also been something that we're very excited about. What we can't always control for, but we've built the model and we continue to find is how the health plans are performing in any given year, and how their financial translates into their investments and the benefits in any given year.

Have the health plan partners accepted the shift towards Encompass? Are they supportive of this change? Do you believe other companies in the industry will also make similar adjustments?

I'll answer the last part first. It's hard for me to assess what other players are going to do. I think everybody's got different strategies as to how do they address their short-term needs versus thinking about the long-term as to who they want to be, etc. But as it relates to the health plan, the health plans have leaned into this. As we indicated in the prepared remarks, we had nearly 75 plus percent of all of our enrollments run through the Encompass workflow. That is the multi-tiered approach, it is the high touch, really shopping experience that is unparalleled in the industry at this point. The health plans have found that that is higher quality and resulting in better results. They have definitely leaned into wanting us to continue that program and supporting us through that process. They wanted us to find ways to expand that program. As you know, we have downline agents who work underneath our umbrella, use our technology as well, expanding that as well so that we can improve the quality of those downlines similar to what we've done with our internal agents. So we have definite strong support on it, pretty much driven off of the fact that we're delivering better quality, while still maintaining pretty high volumes at the same time.

And it's clear that the shift has improved your ability to predict cash flows and receivables from collection of receivables, but do you think it's also improved your ability to predict future revenues?

I think it's from the stability of the revenue that we are booking and recognizing in a period, it is absolutely giving us better predictability of that. So when you think about cash and you think about the revenue you book in a period, we can manage our cash flow in a much better way when you have the Encompass world with our shift to non-agency. You also have an ability, when you book that revenue, as you saw in this last period, even with that Encompass workflow, we still have 606 revenue running through the Encompass workflow, such that that quality and predictability and stability of what we write under that is even higher. So we have higher confidence in what we book on a 606 basis because it will never go to zero, as we've always said. Then you have an even higher confidence of what you book in revenue for that that runs through the non-agency line now.

And then just back to my initial question. If you have this better visibility on revenue, should we expect any major changes on investments and operating expenses in 2024?

We're going to continue to invest. There will be incremental investments in technology that you should expect for us to continue to get standardization, systematic improvements in the experience for the consumer, more engagement points as we described, moving from just enrollment to more of that engagement, activation, and full support of the consumer through the process. You'll see some more investment in that as we go into the year. In most of that, we're finding internal opportunities to reallocate our dollars to make those investments within the company for the future.

Great. Thank you.

One moment for our next question. The next question comes from Sandeep Soorya with Delaware Street Capital. Your line is open.

Hi, can you guys hear me okay?

Yes. Hi, Sandeep. How are you?

Hi, good. Thanks for taking the question. I have a couple questions. The first is, how should we think about the proposed regulations? And how do we think about regulations in general on the Encompass business relative to the agency business?

Great question, Sandeep. I think as we've all learned, it is really important to wait for two things when it comes to proposed regulations. As we know, this is an annual event. There is a proposed rule, and then there is a final rule. Even after a final rule comes out, it's generally not specific enough to get clear guidance from it. You end up going to each individual health plan in our business to understand their interpretation of those rules. So I think it's a little too early as to understanding what it would be, what it could be, etc. What I would say is, we are generally in alignment with the concept of protecting the consumers. We want to make sure that there is more access to all the different health plans and the information around that, and that there aren't inappropriate incentives to sway that unbiased shopping experience. We've always been supportive of that, and I think we've proven in the last period that we're absolutely investing in that experience. As we look at what the proposed rule is and what they're controlling for, I think they're really trying to find more and more ways to drive that, to support that experience. So we believe there's a lot of great regulations already out there today before the proposed rule that could lean into just really focusing on enforcing what's already there with all the bad actors that are out there causing more of the noise than the problem. But that said, again, to your primary question, it's more left to let's see what comes out. Let's see what the interpretations of that are going to be. Assuming most of what you're describing is less about operational workflows. I think we've proven that year-over-year, as there are changes, we're pretty nimble in being able to accommodate those types of changes when CMS has those. The real question is the uncertainty around just like in the commission rates year-over-year, this same dynamic of now in the proposed rule if there could be impact to compensation. But as we think about our Encompass workflow specifically, that was built on really doing a fair market value of delivered services for the activities that we are performing on behalf of the health plan. When you think about that, that is a model that has full documentation and background behind it. So we're very excited about how that prepares us for what is to come, but again, we've got to see the details of what comes out.

Thank you. I have a few long-term questions, specifically regarding revenue growth, EBITDA margins, and EBITDA growth over the next two to four years or three to five years. Additionally, considering the strong cash flow this year, how should we evaluate cash flow dynamics in the upcoming years?

I believe that as we have discussed, there is significant potential for growth in the market, particularly concerning the Medicare consumer demographic. The market experiences cycles, and during periods of high interest, businesses like ours can see substantial growth. We have recently observed shifts in market dynamics, where consumers are reassessing their financial and health plan needs, especially noted during the last Annual Enrollment Period. Many were cautious, particularly regarding non-special needs plans, leading to minimal new product investments that year. As we transition into a different phase of the cycle, companies often reduce benefits, which could present exciting opportunities for us despite a lesser focus on growth. Over a five-year period, these cycles in Medicare tend to recur frequently. Regarding revenue, margin expansion, and cash flow, there's variability depending on benefits and market conditions. We understand that controlling margin expansion depends greatly on our operational efficiency and how well we manage our invested resources. We will keep investing in our current operations, focusing on enhancing marketing effectiveness over the long term. While we aim to achieve efficiency in our consumer engagement calls, it won't drastically change from our current enrollment business. Our cash flow strategy emphasizes maintaining a strong and predictable cash flow without overspending in pursuit of revenue. We want to ensure a balanced approach, demonstrating consistent performance in cash flow operations and total cash. Ultimately, our goal is to grow our cash flow alongside our earnings over the long term.

Okay, great. That's it for me. Thank you.

I show no further questions at this time. I would now like to turn the call back to Vijay for closing remarks.

Thank you. And again, thank you all for joining today. Lots of really good questions. We are excited about where the business is to play for these long-term relationships. We've made a significant investment in those consumers who need our services the most. Trust and peace of mind in a complex and confusing world is critical. That is going to be an important thing not just today, but especially as we go into this next AEP and as we look into the future. We're excited about the value we can deliver to the consumers, shareholders, and all the health plans and regulators involved because we do believe that is the key to the future and we're very, very thankful to our team as we continue to invest in delivering that consistent experience. So thanks, and we look forward to speaking to you all again soon.

This concludes today's conference call. Thank you for your participation. You may now disconnect.