William Blair 46th Annual Growth Stock Conference

It's my pleasure to cover Lifestance Health, and thus my pleasure to introduce our speaker today, Dave Bourdun. Dave's been with the company for almost five years, started back in 2022 with the CFO role and has now taken on the CEO role as of last February. And it's part of a broader management team that's done a really great job with this organization, operationalizing the assets and driving a lot of productivity initiatives. and more importantly, providing a solution set to individuals in need across the country. Behavioral health care has been in really high demand, and it's pretty unique to see a company that does both the clicks and mortar, so online services, virtual therapy, and then has a network of facilities and clinicians and really delivers high-quality care and integrates with primary care groups to ensure there's a continuum of care for those in need. So really good asset, and we're excited to have them here today. A couple quick housekeeping issues. I am required to let everyone know that our disclosures are available online at williamblair.com. Number two, this is the last session, so thank you all for sticking around. We will do the Q&A directly in here if there's any questions. And third, also, Peyton Chapman is in the audience. Peyton helps with investor relations, so some of you may have interacted with him, so acknowledging him as well. So with that, I'll turn it over to Dave, and again, he'll give the presentation, then we'll stay here for any Q&A.

Thanks, Ryan. I really appreciate the opening and kind words and thank you all for taking the time to learn a little bit about Lifestance. So before we start, we may make some forward-looking statements and this is some of our related disclaimers. All right, so let's get into the heat of this. So first thing is, what I want you to leave with are three things. And the first is, is that outpatient mental health is a large and growing market. The second is, is that life stance is, is the leader and we're uniquely positioned and we have durable and growing competitive advantages. And then the third is, is that we have a track record of strong and predictable financial performance. So those are the three. And we'll talk, we'll kind of drill into those as we go through the presentation so I mentioned we're uniquely positioned and we're uniquely positioned because of our scale our hybrid model the breadth of our services and our focus on commercial insurance so let me let me drill into each one of those a little bit so the first thing from a scale perspective over 8300 w-2 employed clinicians we're in 33 states we we did almost nine million visits last year with a million patients so tremendous scale no one else in the industry approaching the size and breadth of us second thing is is that we're hybrid and we have over 575 centers across our 33 states and why we still have that click-and-mortar approach I love that right the the click and mortar approach to care it's we do about 70% virtually today and 30% in our centers now you could still have the clinician in the center doing a virtual a virtual session but again that where the patient is about 70% of our visits today are virtual the next thing is the breadth of services and so we provide from a core offering perspective therapy and we'll have our master's level therapists, social workers, and psychologists doing the therapy. That's about three quarters of our clinician population. And then the other quarter are doing psychiatry, which is primarily medication management. So these are going to be your psychiatrists and your nurse practitioners. And that's really important for the patient to be able to provide holistic care for them, depending on if they need one or both of those services. In addition to that, we're starting to branch out into our specialty service lines and there's three of these that I would highlight. The first is we're the national leader in neuropsych testing. So I think this is if you have a child, you're not sure if they have ADHD, you bring them in. Our clinician will take them through a battery of tests and then you'll get a diagnosis around whether it's ADHD, it's something else, or whatever the test ends up showing. There is strong demand for this. Typically, we hire a clinician to do this service. They walk into a six to 12-month waiting list for PNT, for the neuropsych testing. The other two services are related to treatment-resistant depression. And these are TMS and Spravato. And these are the early days for us in rolling these services out. Right now, we're rolling out a handful of each of Spravato and TMS each quarter. The idea this year is to really mature the operating model, figure out what works with payers, what doesn't, what's the right staffing for these. And the great thing about it is, is very capital efficient way of being able to roll these out because we're able to leverage our existing center footprint. And for a Spravato, we'll just use a group therapy room or for a TMS chair, you just put it into a treatment office. And so very easy for us to roll these out. And that's a big opportunity for us in the coming years. The other great thing about that is that it positions us really well as emerging new therapies come out. For example, a lot of in the news around psychedelics. And if the FDA were to approve those and payers to approve those, pretty easy for us to leverage, for example, our Spravato operating model to be able to roll that out across our existing centers. All right, so that's life stance. Let's talk about the market. So we mentioned it's a large and growing market, first at a macro level, overall mental health. You can see here we have like over 60 million Americans with mental health issues. And as we understand more and more the mind-body connection, the comorbidities between mental health and physical health, we're getting an appreciation for how important it is to solve the mental health issues as it reduces total cost of care, improves productivity, presenteeism, and not doing that, obviously, there's a massive cost to society today. Go a click deeper into outpatient mental health. We believe this is about a $50 billion TAM and growing, and it's growing because there's an increasing demand for services. Just that along with there's an increasing identification or diagnosis for mental health, mental health care. Again, back to that mind-body connection and better, better understanding of the interaction between physical and mental health. The other thing that I'd highlight is you have a reduction in social stigma. So I have four kids in their 20s and there's a couple of they're more apt to go to a therapist than they are to a PCP. That's very different than when I was in my 20s. You didn't access mental health services unless you were in a pretty extreme situation. So those two things, this increasing in diagnosis and demand along with a reduction in social stigma, that's driving more need for our services. There's another really interesting dynamic and outpatient mental health and that is it's around affordability and where this comes from is we have decades of under investment in mental health whether that's society at large payers employers whatever the case is it's why there's been so much mental health parity legislation is because of this under investment one of the ways that this plays through is is that reimbursement for services from payers was historically unattractive and so you had a lot had and still do have a lot of clinicians who will not accept insurance and accept only accept what we call cash pay and um you know i read something recently said over 25 percent of therapists today will not accept any insurance at all they will they'll only do cash pay well you say all right well that's what we're dealing with but the but you're like what about the patient so the patient can't afford cash pay they want to use their insurance for for mental health just like if they're going to the PCP or a physical health specialist and so they're putting pressure on their employers the employers are putting pressure on the payers the payers individual customers are putting pressure on them for access to mental health care and so that's that's causing changes it's causing improvement in reimbursement you saw that the medicare fee for service reimbursement this year for the industry went up mid to high single digits depending on on your mix of services. So there is recognition of this lack of parity between physical health and mental health from a reimbursement perspective. You get a bit of a tailwind as payers have to focus on improving the access for mental health care. So that's the pressure on the payers. It's also pressure on the clinicians that only accept cash pay, because it's becoming more and more challenging for them to be able to fill out their patient panels with patients who only are willing to pay with cash. And what that means then is that those clinicians can no longer run a successful practice on cash pay and it's bringing them into the insurance environment. So that's the affordability. The other knock-on effect to this is that we're in a highly fragmented environment. It's probably what other aspects of the physical health, healthcare ecosystem were like decades ago. So the majority of outpatient mental health clinicians are either individual practitioners or in small, small practices. And so that this leads to this fragmentation and what we're starting to see now is the early stages of consolidation. You're seeing some players starting to consolidate for scale, you're seeing some players consolidating for breadth of services. And even an example of that would be the individual practitioner who only takes cash pay or is a 1099 clinician and they've decided they don't wanna try to make a go of it from an individual practice perspective and they're joining a life stance. That's a form of consolidation of that we're seeing in the industry. But the bottom line is his life stance is positioned really well to take advantage of all of these trends. So how do we win? So first thing is when you talk about this fragmentation of the industry, finding care for a patient, a new patient is really hard. There's a ton of friction in the environment and many of them, they give up. They're trying to find care and they just can't get it. whether it's they can't find a clinician that's taking patients today, whether it's insurance or cash pay, or they can find one, but they only take cash pay. So it's an affordability problem. And then the last thing is, well, how do you measure quality, right? So one of the benefits we have with 575 centers is at least we have Google star ratings, right? So you can go on there and you can see we're 4.7 out of five Google stars. well, that's great, but that's more of a patient satisfaction metric rather than a quality of care metric. And so it's really hard for patients to evaluate quality. Sometimes they think price is a reflection of quality. It's not in the mental health industry. And so there's a lot of friction and a lot of confusion for patients. And again, many times they end up stopping the seeking of care or they give up trying to find an insurance provider like LifeStance and they end up with cash pay. So what we're about is really simplifying and reducing that friction. And there's a number of ways that we do that. All right. So the first thing is, is that again, our clinicians are employed. Majority of outpatient mental health clinicians are 1099. Our employed clinicians are supported by a robust clinical leadership team. That clinical leadership team is powered by data and insights to help them support the frontline clinicians. This starts driving consistency and quality. So that's one thing we do. The second thing is, I mentioned the breadth of services that we have. So you get many of these small practices, they may only do therapy or psychiatry. Well, if your psychiatrist says, I really think you should get some therapy, now you're back out into this fragmented, confused ecosystem trying to find care. What we're able to do is connect you to that care all in the family, again, with the breadth of services, so we're able to better holistically treat the patient. Then you get into that hybrid model, the clicks and mortar, right? And so with that, we're able to meet the patient where they are. We see a lot of new patients, they want to do an in-person visit first, develop that therapeutic alliance with their clinician. And then they may flex between in-person and virtual. They may be in a remote area, rural area, and they can only do virtual. That's fine. They may be in an area where they're close to a center. About two-thirds of our patients are within 20 minutes of our centers. And for that, they may want to go every time with their clinician in person because that kind of connection is what's important to them. We're able to meet them where they are. And then the last thing is, as I've talked about several times, we're in network. 90% of our revenue comes from the commercial payers, 5% from the government, and then we have a little bit from cash pay that's an accommodation, usually when somebody loses their insurance. Our focus is really about reducing that affordability challenge that patients have so that's how we win with patients interestingly it's also why referral partners like us so we get we'll get hundreds of thousands of referrals from medical providers health system pcp practices the oncology ob-gyn digital health we get a lot of referrals from those kinds of partners um and it's because they it's because of this because of what we're able to offer their patients they want their patients to be able to be seen quickly and get great great care and the quickly piece is also important we typically can see a patient within three to five days and we find that a new patient within three to five days and we find that to be critical for the acquisition of new patients because they've gotten to that point of they want care and they don't want to wait a month or number of weeks they really want to be able to get in quickly and again as a general statement we're able to provide that so that's that's what you know from a referral partner perspective that along with organic traffic to our website and our scale what it leads to is a very attractive cac for us we have industry leading customer acquisition costs we spend less than two percent of revenue getting new patients it's a key part of our economic model and it's a big differentiator competitive advantage for us all right so that's the referral partner angle and the customer acquisition the referral partners also are really care about is how do you treat their patient are you delivering quality outcomes which is a nice segue for our next for the next section here so today i've been talking a lot about access that's the current phase of mental health care that we're in today the next phase is about quality and outcomes and you know that's where the the real clinical differentiation emerges and it's it's about getting people well not just getting them good enough so that they can function and survive and we believe that with our clinicians our measurement based care foundation the data that we have, our robust clinical leaderships, we're positioned to be able to lead the industry in the transition from not just access to also quality and outcomes. And what we have here on the slide is a recent study that we published. So last year, we started in a systematic way measuring the health outcomes for our patients. So every month we send them a survey for all of our active patients. And what we did was we tracked 180,000 of our adult patients who had depression and anxiety. And what we saw was 75% of them had a clinically significant improvement in their health. So we were happy with this. It was good reinforcement that what we're doing today is working. At the same time, this is just the start of the journey. And we're really excited about what the future brings for this as far as our ability to, again, lead this transition to quality and outcomes for the industry. All right, so let's get to some of the numbers. So first of all, one thing I want to point out on this slide is that this is all predominantly organically driven. So we stopped doing acquisitions. The last ones we did were in very early 2023. And then we just did our first couple tuck-ins in the first quarter of this year. So we took a three-year pause on acquisitions. Now, obviously, we started as a company in 2017. We did about 100 acquisitions, and that was really the jumpstart of the growth for LifeStance and getting to scale. But we paused, and I'll get into, like, the chapters of the company here in a second. But the important note here is this is all organically driven. So from a clinician's perspective, you can see 13% CAGR from a growth, and we have a very attractive value proposition to clinicians. At the same time, we have low single-digit market share. We're the largest, but in this highly fragmented market, we are low single-digit market share, so we have a ton of runway in front of us to be able to continue to grow. there's two areas of or cohorts of clinicians that i'll highlight for you where the growth comes from the first is is new new graduates so it could be again a master's level therapist it could be a psychiatrist but they're a new graduate they're attracted to our model one because they get all the operational support all they can do is worry about practicing but the second thing is they're getting clinical support and development they will not get that at a 1099 shop or where they're in a solo a solo practice practice enablement mso type company so we get a lot of great feedback from the new graduates around the environment and the support that they're getting and the collegial nature of our of our centers so that's one that's the new grads yeah the other end of the spectrum is experienced hires we're predominantly getting these from 1099 again they're either solo practice or small practice percent of collections and what they're looking for is to be the W the benefits of being W2 and employed they want yes a competitive compensation but they also want the benefits and they want the administrative support that comes with with being at a place like life stance where again all they have to do is focus on is practicing. Then you look at the financials so very attractive 18% CAGR again organically driven and 44% improvement in adjusted EBITDA. I mean over this time frame we doubled our adjusted EBITDA margins from five and a half percent to eleven percent last year and and I mean you're really seeing the benefits of of all the work that we've done in the past three years and it's continuing as we step into 2026. in 2026 our midpoint of our guide for revenue right now is 17 top line and we're expanding adjusted EBITDA margins by over another 150 bps so again can seeing this nice trend continuing into this year as we look out we've given a couple a couple of guidance or data points to the investment community the first is is we see a path to 15 to 20 adjusted EBITDA margins we're not saying that's the ceiling but we can see a path there in the coming years so then we had investors so that's great but like give us a little bit of a time horizon how should we think about this and so recently we put out the guidance of we'll be at mid-teens adjusted EBITDA margins in 2028 and again well on the way considering we're guiding to in the high 12s for this year all right so that so that's the financials that results in a really strong balance sheet so we have very low debt ratios our gross gross leverage is about one and a half right now we have a strong so that strong balance sheet with a lot of flexibility this will be our third year of positive free cash flow and so we get a lot of questions around how are we deploying capital and been very consistent we have three priorities in rank order it's fund organic growth that's mostly the building of new centers which cost about a billion a billion a million a center the second thing is inorganic so again we did some some tuck-ins primarily the focus there and then the third would be returning capital to shareholders in the form of a buyback in in the first quarter again because of the strength of the balance sheet and the flexibility that we have we were able to deploy capital across all three of those dimensions we've actually returned uh we've returned share to uh capital to shareholders we've spent almost 100 million dollars this year buying buying back stock in addition to doing acquisitions in addition to of building about 20 to 30 centers this year. So we feel really good about our capital deployment priorities and the strength of our balance sheet. So I mentioned, you know, the hard work we've done the last three years, and it's really, you know, you can see it as we look at these as different phases of the company or the growth horizons. And 2017 to 2022 was, that was the get to scale, get to a leadership position phase. Again, 100 acquisitions, a lot of organic growth on top of that. That was the focus of the company. We went public in 21. And what we realized was that, as we had some missteps after we went public, was that we didn't have the operational discipline that we needed to be successful going forward. We had 33 states, practices. We had 100 acquisitions. We had different tech, different processes. And so we spent the past three years fortifying the foundations, simplifying the business, focusing on financial performance, capital discipline. And again, you saw that in the previous slide with the performance of the company. Now we step into the current year, 26. And this is really about differentiation and setting the standard for the industry. And it's building on that foundation that we've been working on for the past three years. And obviously, a big part of that is tech enablement. We've got a lot of questions there. We've been rolling out digital solutions for a couple of years now. Last year, we started using some AI solutions. We're not in the business of doing a lot of development ourselves. This is more about leveraging best-in-class vendors. And then how do you put them together and integrate it to get to compelling solutions? And so we're focused there as we think about technology is patient acquisition, patient and clinician experience, as well as the quality of care. All right, so that's been our focus so far. Another thing that I would point to as we optimize and differentiate is the geographic expansion opportunity for us. So a lot of opportunity to still go deep in our markets, even though we're the largest market share. We're typically below 10 percent in a in a local area, even though that's the that's usually the the biggest practice there is. So there's a lot of opportunity to go denser. But as we look out, we're in 33 states. We we have aspirations to be in all 50. We think that's important for especially for our national referral partners. And so that's something that we're working through right now. The other is we're in about three quarters of the top 150 U.S. metros. So we have a quarter of that as wide open, wide space. And again, our primary way of entering new markets is going to be through M&A. We'll do a de novo if we need to, but our preference is to be able to buy something to be able to give us the foundation and the jump start. all right so that that so i get to the close here so again i'll start i'll i'll finish where i started with a tremendous opportunity in front of life stance large and growing market we're the leader we we have um competitive advantages that are that are that are um compelling and are growing and we have a track record of really strong financial performance and so look we're uniquely position to lead the evolution of outpatient mental health from this fragmented access focused industry into one that is about delivering quality outcomes and getting and getting patients well not just good enough to be able to function and so i'm excited about where we are but but but really the best is yet to come. Okay, thank you, appreciate the time.