Earnings Call Transcript
Option Care Health, Inc. (OPCH)
Earnings Call Transcript - OPCH Q2 2021
Operator, Operator
Ladies and gentlemen, thank you for standing by, and welcome to the Option Care Health Second Quarter 2021 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speakers’ presentation, there will be a question-and-answer session. I would now like to hand the conference over to your speaker for today, Mike Shapiro. You may begin.
Michael Shapiro, Executive Vice President
Good morning, and thanks for joining us this morning. Before we begin, please note that during this call, we will make certain forward-looking statements that reflect our current views related to our future financial performance, future events, and industry and market conditions. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our comments. We encourage you to review the information in the reports we file with the SEC regarding the specific risks and uncertainties. You should also review the section entitled Forward-looking Statements in this morning's press release. During the call, we will use non-GAAP financial measures when talking about the company's performance and financial condition. You can find additional information on these non-GAAP measures in this morning's press release posted on the Investor Relations portion of our website. With that, I'll turn the call over to John Rademacher, Chief Executive Officer.
John Rademacher, CEO
Thanks, Mike, and good morning, everyone. As you can imagine, we are quite pleased with the overall progress we are making, the expanded number of patients we are serving, and the financial results the team has delivered in the second quarter. Our confidence in this enterprise has never been higher. We continue to translate strong revenue expansion into leveraged earnings growth on our scalable platform. As we sit here today, we are increasing our growth and earnings expectations for the full year based on the first half momentum. Equally important, we continue to invest in strategic initiatives to build upon our unique national platform. As we entered 2021, we remained in the midst of the pandemic's second wave, and we were also managing supply chain dynamics for certain therapies. Consequently, we guided to 6% to 7% revenue growth. Over the past few quarters, we've seen referral patterns return to pre-COVID levels, and in some instances including several chronic therapies, we've seen referrals considerably above pre-COVID levels. The team has remained offensive, so to speak, and we’ve focused on balanced growth across our acute and chronic portfolios through collaborations with our payer partners and referral sources. In the second quarter, we saw strong sequential growth over the first quarter in both therapy portfolios as momentum has clearly increased. Recall, the comparative quarter for 2020 is challenging given the disruptive referral patterns with the onset of the pandemic. Regardless, we saw high-single-digit acute growth over the prior year and high-teens chronic growth with particular strength in newer therapies for multiple sclerosis and myasthenia gravis. Our topline results affirm that our unique value proposition is resonating with manufacturers, payers, and referral sources. For the full year, we now expect to generate double-digit topline growth based on the momentum generated in the first half. Despite our strong topline results, we remain in a very dynamic environment. Our supply chain situation is clearly improving, especially with respect to immunoglobulins, which we highlighted as a risk entering into the year. Like most companies, we are facing challenging labor markets, and given our strategic investments in clinical expertise, we continue to manage tight labor conditions for skilled clinicians. We have been able thus far to successfully navigate the challenging labor market to maintain a reputation of dependability with referral sources that has been the hallmark of the Option Care Health team over the challenging pandemic situation. We continue to monitor the situation closely, and we are proactively addressing the situation through talent development, technology enhancements, labor efficiencies, and deepening partnerships with home health agencies. Aside from the solid growth in the second quarter, we continue to invest in future growth catalysts. Early in Q2, we closed on the BioCure acquisition, and I'm pleased to report that the integration is already complete. This complementary tuck-in has reinforced our IG go-to-market efforts and strengthened a number of key geographic markets for us. We also recently announced a technology collaboration with AlayaCare, one of our existing trusted technology partners, to co-develop market-leading patient engagement and clinical management software. As we have articulated on many occasions, we have invested tens of millions of dollars into our integrated technology suite to optimize the patient experience and maintain an efficient operating model. AlayaCare has been in the trenches with us for quite a while, and we are excited to introduce additional tools to improve the therapy experience for our patients and their families. Over the past six months, we've invested in additional infusion suite capacity and are aggressively moving to open 10 to 15 additional standalone infusion centers by year-end. Infusion center capacity is a key growth-enabling initiative to improve the patient experience and optimize our clinical workforce. Infusion center capacity provides additional labor efficiency and partially mitigates the challenging labor market we currently face. I'm also thrilled with the addition of Dr. Seema Kumbhat to the newly created role of Chief Medical Officer. The patient experience is at the forefront of everything we do, and Seema brings a unique perspective to my leadership team as we continue to raise the clinical bar in this industry. Mike will unpack the results in a few minutes, but I'm very encouraged by the topline growth and our ability to leverage our infrastructure to deliver higher levels of profitability. As we announced in the release this morning, we have significantly increased our guidance for the full year for both revenue and adjusted EBITDA based on the momentum the team established in the first half. The midpoint of the guidance range implies an EBITDA margin north of 8% for the year, and we're only getting started. Our ability to translate earnings into cash flow has been strong, delivering over $70 million of cash flow from operations in the quarter. We also achieved our full year leverage target of four times at mid-year. Again, I couldn't be prouder of the team and how they continue to execute our strategy in light of continued market dynamics. Before I turn over to Mike, I want to spend a few minutes on the recent approval of Aduhelm for Alzheimer's. As an organization that serves patients with challenging chronic conditions every day, we are encouraged that new therapies are emerging for what is a devastating condition for patients and their families. Clinically, the profile of Aduhelm fits quite well with the alternate site setting given an older patient population, many with complicating conditions, and a preference for limited travel for therapy. However, the reimbursement pathway for this emerging therapy remains challenging in the home and alternate site setting as the majority of the targeted population is covered by Medicare. As we have communicated on multiple occasions, Medicare currently does not adequately reimburse for home infusion at levels to support care. We continue to monitor CMS and the payers' approach to coverage determination, and are separately working with the industry coalition to seek legislative improvement to reimbursement for home infusion. In the current landscape, we do not see Aduhelm as a near-term opportunity until the Medicare reimbursement environment changes. Consequently, none of our guidance reflects any benefit from Aduhelm at this time. So, overall, I’m very pleased with the second quarter results, the performance by the entire team, and where we are positioned heading into the second half of the year. You'll recall in the first quarter call, I commented that we were quickly pivoting from integration to acceleration, and clearly we've made that turn. With that, I'll turn the call over to Mike to review the results in a bit more detail.
Michael Shapiro, Executive Vice President
Thanks, John, and good morning, everyone. Overall, the second quarter can be summed up in strong topline growth that translated into margin expansion and spending leverage to deliver accelerated earnings growth and cash flow generation. Remember that similar to virtually all healthcare enterprises, the second quarter of 2020 is an atypical comp, as we saw an initial spike in patient referrals followed by a stagnant period as individuals stayed away from medical facilities. Nonetheless, we generated 16% topline growth overall, with high single digit growth in acute and high teens growth in the chronic portfolio. Sequentially, we generated a little over $100 million in revenue over the first quarter, as referral volumes continued to rebound off the pandemic lows. Our results continue to reflect some ASP headwind for certain therapies, but clearly the volumes more than offset. Despite the faster growing chronic portfolio, we drove a gross margin rate expansion in the quarter as we continue to drive network efficiencies and manage our procurement strategies within each portfolio. We don't talk much about bad debt as it has considerably improved over the past few years, but in the quarter, we drove bad debt down to a little over 2%, which represents about a half a percentage point improvement over the prior year. That improvement dropped straight through and helped offset the chronic mix headwind at the margin line. Again, the team fights for every basis point of leverage at the gross margin line, and thus far, we have been able to offset the mix impact. Spending leverage continues to improve as SG&A as a percent of revenue dropped by 130 basis points, driving an EBITDA margin of 8.5%. This is the first quarter that we've delivered a margin north of 8%, and as John mentioned, we're just getting started. Cash pays the light bills, not EBITDA, and our ability to translate earnings into cash flow continues to accelerate. In Q2, we generated cash flow from operations of more than $73 million and increased cash balances by $48 million, despite deploying more than $18 million to acquire BioCure. We finished the second quarter with a net debt to leverage ratio of 4.0 times, which was our full year commitment. Our cash and working capital profile continues to improve and provides considerable flexibility as we open the aperture on inorganic opportunities. Just a reminder that we maintain a favorable cove-light debt structure, with no maturities until 2026. As we think about the back half, we clearly expect revenue to exceed previously communicated guidance. We anticipate continued sequential improvement, albeit not at the level we saw from Q1 to Q2. With solid acute levels maintained and chronic acceleration, we see full year revenue growth of 10% to 15% based on the revised guidance issued this morning. We are increasing profit expectations based on the solid topline and are increasing EBITDA expectations to $275 million to $285 million. Relative to our initial guidance back in March, we've increased our EBITDA midpoint by approximately 11%, based on better visibility around revenue trends and our procurement strategies. That will translate into higher cash flow generation and an improved leverage profile before potential capital deployment. We remain active on the M&A front, and our guidance does not incorporate any inorganic contribution in the back half, other than the BioCure acquisition. Before we wrap our prepared remarks and open the call to Q&A, I wanted to clarify a few items regarding the most recent secondary share offering by our primary shareholder in June. At the time of the merger two years ago, an entity formed by Madison Dearborn Partners and Walgreens Boots Alliance held approximately 136 million shares, excluding escrowed shares that have since been canceled, or approximately 80% of the total outstanding shares. Over the past year, through a series of secondary offerings, that entity, which has been, and continues to be controlled by Madison Dearborn, has sold approximately 68 million shares and has reduced its investment, as of today, to approximately 68 million shares, or just under 38% of the total outstanding shares. Until the most recent secondary offering, Madison Dearborn and Walgreens allocated the proceeds from such offerings based on their pro-rata interest in the entity, or approximately on a 52/48 basis, respectively. However, with the recent offering of 17.25 million shares, Madison Dearborn and Walgreens agreed in principle to allocate all of the offering proceeds to Madison Dearborn and other shareholders. Thus, as of today, Walgreens has an indirect financial interest in approximately 21% of the total outstanding shares of Option Care Health, with Madison Dearborn and affiliates indirectly holding the remaining 17%. While we wanted to clarify their respective financial position, given the recent dynamics, we don't have any further comments on their investment strategy or any insight on future intentions by either of the shareholders. In closing, we are very encouraged by the strength of the second quarter results and have raised our expectations considerably in the second half based on the first half momentum. And with that, we'll open the call to Q&A.
Operator, Operator
Our first question comes from the line of Pito Chickering with Deutsche Bank. Your line is open.
Pito Chickering, Analyst
Hey, good morning, guys. Thanks for taking my questions. Just a couple ones here. On the topline growth this quarter, obviously extremely strong. Can you give us just some more color on sort of chronic versus acute? And then within chronic, you mentioned, I think, multiple sclerosis as a growth area. Just give us some more details as to what really outperformed this quarter whether sequentially versus year-over-year?
John Rademacher, CEO
Good morning, Pito. It's John. Yes. So, first and foremost, really pleased with the balance that we saw across both the acute and chronic portfolio. I think as we've talked about before, as we expected things to start opening up within the hospital, and as patients return to receiving care, we saw increased flow of referrals as we had mentioned, and really some strength in the acute area that in some ways had been lagging through that process. So, referrals increased as we had called out. We've done a really good job of converting those referrals to starts, and I think that some of the investments we made to increase our reach and frequency are starting to pay dividends as things open up. On the chronic side, again, good execution by the team. We continue to see strength across the portfolio there. I do believe that as we called out, we were able to navigate the IG marketplace pretty adeptly. And so, really didn't feel any constraints from the IG side because of supply chain issues. So, all in all, very balanced. Good execution by the team. Deepening those relationships with the referral sources to be their partner of choice as they're looking for opportunities to transition patients onto care with us.
Michael Shapiro, Executive Vice President
Hey, Pito, it's Mike. The only thing I'd add is, look, as we mentioned, obviously the prior year comp is a little wonky, given the results from the second quarter and just the state of the market back then. I think, as John said on the chronic side, great payer collaboration, more of the same, and the value proposition is resonating. And on the acute side, again, we had an easier comp, and I think as we've said, we’ve prided ourselves on our dependability and reliability in what remains a very challenging market dynamic. And so, relative to the first quarter and prior year, there are more trips into the batter's box. Based on the phenomenal team in the field and their focus, we're getting more hits each time we're walking into the batter's box.
Pito Chickering, Analyst
A follow-up question for you on margins. For SG&A, obviously huge topline growth here. We've got some SG&A leverage sequentially. I guess, trying to understand sort of how much leverage we should be modeling on the SG&A line when you have sort of these big revenue beats, or where is that conversion ratio? Kind of as you think about the next year or two, can you help us understand as revenues continue to grow at these levels or what is your fixed variable component within SG&A kind of just assuming that that’s the primary margin driver going forward in the next couple of years?
John Rademacher, CEO
Yes. The spending leverage is really part and parcel to our overall strategy where going forward, based on the infrastructure that we’ve established over the last several years, we have estimated that within our SG&A line, it's roughly 75% to 80% fixed. There's obviously some natural inflation, and there are some variable components, but that gives us the confidence that with this topline growth outlook that we have, we are highly confident that spending will grow at a pace meaningfully below the topline. That gives us the confidence, obviously, in margin expansion. We're never going to give up on driving spending leverage, and I think going forward, we have even more confidence that we'll continue to be able to drive that. Again, also in the disclosure this morning, our integration costs, which are included in that line, are really starting to decelerate as well. And as we look going forward, again, I don't think we have spending as a percent of revenue leverage. We just have a high degree of confidence that it will continue to drop. Maybe not at the pace that we've realized over the last year, because again, remember in the second quarter of 2020, we were still in the process of harvesting SG&A synergies. But nonetheless, like every other organization, we've learned a lot during the pandemic about how much more efficiently we can operate, and we'll continue to look for those cost outs.
Pito Chickering, Analyst
And then a quick follow-up. I understand that you guys are not guiding to any impact this year for Alzheimer's, but just curious sort of two questions, number one, on the commercial customers, those should be able to sort of fall within home infusion, although they're a much smaller customer base relative to all Alzheimer's, but is Alzheimer's a - do these gross margins track generally in line with the chronic business, and just any color on what you’re seeing on the commercial side of the business on managed care or if it's a physician pushback? Thanks so much.
John Rademacher, CEO
Yes. Look, I think it's too soon to tell on some of that stuff, Pito. As I said in my prepared remarks, I mean, we're trying to be very thoughtful in the way that we look at this. There are still a lot of questions around coverage determination and which payers are going to allow this from an authorization standpoint. So, at this point in time, without knowing kind of what payers are in and how they're actually going to provide coverage determination, really don't have an answer to that question, which is why we were conservative in our approach, indicating that it's not really in our guidance. In the near term, we don't expect a significant amount of value. I will say, as I said in my opening comments, look, we do think that we have a really great platform in order to support these types of products, and it's a matter of making certain that we're working both in Washington as well as with our payer community to let them understand the value that we can bring to this patient population.
Pito Chickering, Analyst
Great. Thanks a lot, guys. Excellent quarter.
Operator, Operator
Thank you. Our next question comes from the line of Matt Larew with William Blair. Your line is open.
Matthew Larew, Analyst
Hi, good morning, and congratulations on the quarter. Just wanted to follow up on a comment you made. I think you mentioned there were several chronic therapies that were trending well above pre-COVID. So, could you maybe give us a sense for where in particular you're seeing strength? And is that from payer side of care redirection efforts? Is that new therapies you're involved in? Just a little more color there would be interesting.
John Rademacher, CEO
Yes, good morning, Matt. It's John. Specifically to your question, so a couple of areas. In chronic inflammatory disease, we've seen that move ahead of where we were from a historical basis. A lot of that is in payer collaboration, in working around site of care initiatives, and helping support patient choice as they're making decisions around where to receive care, sometimes out of hospital outpatient departments and physician practices onto service with us. So, we continue to work closely across the payer community to identify those opportunities and find ways to deepen our partnership in supporting their goals of providing high quality care at an appropriate cost. This has been part of our overall strategy, and the execution was strong in the second quarter.
Matthew Larew, Analyst
Okay. It sounds sustainable. The second one, again, interesting comments, John and Mike, you both have made today. I think it was, we're just getting started in terms of the EBITDA margin, building off levels from today. And I think just a couple of years ago, the idea was getting to this sort of 8%, 9% level over some time. So, I think this is as bullish as I've heard you on the long-term margin picture. So, I guess maybe if you could expand on the, we're just getting started comments, and what in particular you've been encouraged by there.
Michael Shapiro, Executive Vice President
Sure, Matt. it's Mike. Look, when we put these organizations together, we were making a lot of expectations around the margin expansion. Those were comments made in the locker room, so to speak. Now that we've been out on the paint for a number of quarters and have been able to truly demonstrate how scalable this platform is, it just gives us a higher level of confidence. In the middle of the integration, we got a couple of curve balls with the pandemic, and I think we just continue to learn around how much bricks and mortar we need, how virtually we can operate this business. I think it continues to add to the number of areas where we think we can leverage technology and infrastructure. We announced the collaboration with AlayaCare, which has been just a phenomenal technology partner of ours. We see additional areas where we can improve the patient experience at the same time that we can provide that value to payers and patients, and at the same time do it in a more efficient manner. The candid reality is as we go forward, we continue to believe that the chronic portfolio will grow faster than the acute. Again, we received some benefits and have been able to offset that mix shift with bad debt and procurement strategies. Regardless of what we view as the reality of portfolio mix headwinds, we are highly confident that we will be able to grow the spending components of this business and the capital efficiency of this business considerably below the topline. I don't think we'll see the EBITDA expansion of the big steps that we've seen over the last two years, as we're almost at the two-year anniversary of the merger. But nonetheless, I think we have a high degree of confidence we'll continue to chip away at a higher and higher EBITDA margin, and I wouldn't put an upward limit on what that could be.
Matthew Larew, Analyst
Okay. That's great. Thanks.
Operator, Operator
Thank you. Our next question comes from the line of David MacDonald with Truist. Your line is open.
David MacDonald, Analyst
Thank you. Good morning, guys, just a couple of questions. First, on home health, we've seen some interesting announcements out of some of the bigger home health guys about treating more acute patients. And when you look at the services that they're bringing, home infusion is really a hole across the board. Can you just talk about the opportunity to work more collaboratively with the major home health players? You mentioned a little bit during your prepared remarks around staffing, etc. But if you could just spend a minute on that, that'd be helpful.
John Rademacher, CEO
Hey, Dave. Good morning. We continue to look for those opportunities to deepen the relationship. I think as you'll recall, we had announced earlier, sort of late last year, and then again earlier this year, around some of the work we are doing with Amedisys on the monoclonal antibodies. We do think there are opportunities for us to be a partner in that process, both in looking at opportunities to leverage clinical resources as we did with the Amedisys team, as well as to support their patient population. We are pleased with the position that we're in. We think there are opportunities for some additional deepening of partnerships and creation of new ones there. We're well positioned in order to participate in that activity as we move forward.
David MacDonald, Analyst
Okay. Secondly, you talked about 10 to 15 new infusion centers by year-end. Can you give us a sense, either percentage of revenue or percentage of nursing hours, or whatever you think the best metric, that are currently running through these centers, and then how much you think you can potentially push that, just given the pretty significant leverage in - around labor within those centers?
John Rademacher, CEO
Yes, Dave. We have been monitoring and tracking, and I think as we've talked about before, we look at the percentage of nursing visits that we conduct in those facilities, as opposed to in the home. We’ve been running in the high teens, and we've been really focusing on that. Through the second quarter, we were at 20% of our nursing visits being done in one of our infusion suites. Our expectations as we move forward is we can be pushing that post by the expansion that we talked about of opening more centers and having more convenient facilities available for the patient population, as well as the growth that we're seeing in the patient centers, especially on the chronic side. I think we're looking to push north of that, whether we can get to 23% to 25%, I think those are realistic. Those are the goals we're pushing the organization on. There is a level of patient satisfaction and convenience that we're factoring into not only the efficiencies that we can gain out of that, but also retention and satisfaction of the patient population given the facilities and the features and benefits that we build in there. We've talked historically about the work we had to do on integration, and a lot of work to rationalize some of the redundant infrastructure we had. So, as we move past that integration effort and now really start focusing around these growth levers, we expect that this will be a bigger part of our go-to-market strategy and a bigger part of our point-of-care service model as we're looking at the opportunity ahead. We're building that into our CapEx plans as we move forward. So, it's not a deviation from what you've seen historically as we're pretty efficient in being able to stand these up in a capital-light way.
David MacDonald, Analyst
Okay. And then just last question for me. If I look at net debt to the midpoint of ‘21 EBITDA guidance, it’s actually south of four times. When you think about the long-term outlook here, what range would you like to run the business in, in terms of leverage? And then, on a go-forward basis, is it fair to assume further deleveraging will be more about growing the denominator, as opposed to shrinking the numerator?
John Rademacher, CEO
Thanks, Dave. I was waiting for the leverage question. Look, we're thrilled with the capital efficiency and the cash flow generation of the business. We mentioned we wanted to be at or below four times net leverage by the end of the year. We’re there at mid-year, and that's in a quarter where we deployed $18.5 million for M&A. That's another area where we get really excited because with cash interest dropping and with CapEx relatively static, we see the incremental earnings to incremental cash flow as quite significant. I think we expect to operate this business below four times. How far below will be dictated partially by what the strategic opportunities lie ahead of us. I would tell you that our M&A activity is robust, and it is likely that we will have some additional news to share before the end of the year. That's an exciting aspect and a serious responsibility that we take in terms of how we create value for shareholders. Given where we are mid-year, and considering the fact that we'll continue to drift south, just based on the earnings and cash flow trajectory, our access to capital will be substantial.
David MacDonald, Analyst
Okay. Thanks. Congratulations.
Operator, Operator
Thank you. Our next question comes from the line of Jamie Perse with Goldman Sachs. Your line is open.
Jamie Perse, Analyst
Hey. Good morning, John and Mike. I wanted to just touch on the long-term growth algorithm and level-set how you guys are all thinking about that. Just given the step-up in growth this quarter, the growth investments you talked about, the new infusion suite, is it time to kind of level-set us on where you think this business can grow long-term?
John Rademacher, CEO
Yes, Jamie, look, obviously we're not in a position to provide longer term guidance, but the way we've characterized it is, we see this industry in a mid to high single digit topline growth trajectory. We’ve tried to establish a reputation of laying out guidance that we have an extremely high degree of confidence that we will deliver. We also believe over the last couple of years, we've demonstrated that we can grow faster than the market, just based on the unique aspect of this model. We see that as a base case before inorganic capital deployment of somewhere in the low to mid-teens. This year, we're thrilled with the momentum in the business that we've built. One note of caution just around the comp of 2020; it gets a little atypical. As we go forward, I think we have a very high degree of confidence in that base case. As we get closer to 2022, we'll revisit that. But for now, I still think that longer term is still a logical zip code to focus on.
Jamie Perse, Analyst
Okay, fair enough. I wanted to come back to the Medicare reimbursement and the issues there. I know that's a barrier to increase confidence on the Aduhelm side. I'm wondering if that were to improve, what that would mean to the base business. Forgetting the Alzheimer's for the moment, how could that change the number of therapies that are addressed in these alternate sites and your outlook for the business?
John Rademacher, CEO
Yes, Jamie, look, as we've talked about before, the current way that Medicare reimburses, especially in the home, is just inadequate for the care that's provided. We're working on multiple approaches to that, both with the industry and independently through the process of getting a better reimbursement scheme that reflects not only the care plan and oversight, but also the nursing interventions that we provide, not just the drug and the drug reimbursement per their process. Our current focus is getting the calendar dates fixed around getting a per diem for when a patient is truly under our care. We're managing them through that process, and that's been the focus. More broadly, we'll continue to look for expansion opportunities to expand access to the Medicare population, but this is going to take time and it's complex, given all the different priorities in Washington, DC.
Jamie Perse, Analyst
Okay. Thank you. Congrats on the quarter.
Operator, Operator
Thank you. Our next question comes from the line of Lisa Gill with JPMorgan. Your line is open.
Michael Minchak, Analyst
Thanks. It's actually Mike Minchak on for Lisa this morning. Just a couple of questions. So, first, with respect to gross margins, clearly a very strong quarter there with nice year-over-year growth. I was just wondering if you could comment at all on sort of the trends you saw within both segments of the business. Was this - was the growth there sort of more mix-driven or given the pickup of growth in the acute therapies, are you seeing favorable margin trends within both categories? And if so, maybe what are the key drivers there?
Michael Shapiro, Executive Vice President
Hey, Mike, it's Shapiro. I'll start. A couple of key dynamics within gross margin. First and foremost, we continue to aggressively drive down bad debt. Any amount of bad debt is unacceptable, and we've driven it down a couple of full percentage points over the last year. As we've seen bad debt drift down towards 2%, that's an immediate gross margin benefit. Aside from that, within each of the therapy categories, we have been aggressively working on our procurement strategies. We’ve got a procurement team that's second to none. We also continue to work with the manufacturers and suppliers. We benefit from having direct relationships with most of our suppliers. As we collaborate with them on market expansion and promoting the therapy, that can result in better margins within each of those categories. A, we still saw some ASP headwind. We still saw some mix headwind from chronic growing a little faster than acute. Again, acute benefited from an easy comp in terms of the year-over-year, but I would say the way I would characterize it is probably the latter assertion that we saw good margin traction within each of the individual portfolios.
Operator, Operator
Thank you. Our next question comes from the line of Kevin Fischbeck with Bank of America. Your line is open.
Joanna Gajuk, Analyst
Good morning. Actually, this is Joanna Gajuk filling in for Kevin today. Thanks for taking the questions. I want to follow up on a couple of these things you were discussing right before on that infusion suite that you expect to add, I guess, 10 to 15, it sounds like in the second half of this year. For reference point, can you talk about how many of the suites did you add this year, over the last 12 months, or maybe before the pandemic, kind of get a sense of acceleration since - in those suites being added? And I guess to that, as you mentioned, that it's a very cost-efficient way of growing. Can you give us a ballpark, I guess, of CapEx expectations for the year?
Michael Shapiro, Executive Vice President
Sure. It's Mike. So, today, we have a little north of 120 infusion suites, almost 400 chairs coast to coast. A lot of these are standalone. Many of these are incorporated into our care management centers and pharmacies. As John mentioned, roughly 20% of our nursing events occur in one of our suites. We view this as both a clinical labor efficiency strategy and a growth support platform for many of the chronic conditions and patient cohorts that we support. We've added some in the first half. We have an aggressive expansion plan in the back half. These are relatively efficient investments. Our CapEx is in the $25 million to $30 million range. That has been and will continue to be absorbed and funded through what we view as a very efficient capital investment.
John Rademacher, CEO
I would respond to that in two ways. Certainly, the infusion suites and adding the additional chairs that we did, give broader access to capitalize on that. A lot of that was driven by deepening partnerships that we have with the payer community, and the commercial team to make certain that from a reach and frequency, they're getting out into the market. I think it's just one component of what is the comprehensive go-to-market strategy. We expect to continue capturing our fair share of demand in the marketplace and look for those opportunities to continue down the growth momentum.
Joanna Gajuk, Analyst
And to follow up on something you said also on this topic of you could gain market share. Can you talk about your relationships with your payers? Is there a clear drive for these payers to shrink their networks? And I guess, are you the beneficiary of that dynamic?
John Rademacher, CEO
Yes. Look, we’ll give you their strategy from our perspective. If we are offering high-quality care at an appropriate cost in a setting in which patients want to receive the care, we think we're really well positioned. The national network that we have gives them the confidence that patients or their members, regardless of their location, will be well-served and have superior clinical outcomes based on the capability sets that we have. We think we're on the right side of narrowing of networks because we should be a preferred partner for them there. Our focus is around patient satisfaction and high quality outcomes. If we do that, we expect we’ll be on the right side of those conversations.
Joanna Gajuk, Analyst
Oh, yes, definitely, because I guess there's not really a unified quality scoring system for home infusion, but I guess it's really more about the payer relationship then I guess how this relationship progresses. So, I understand that, and thank you for answering the questions. Thanks.
John Rademacher, CEO
You’re welcome.
Operator, Operator
Thank you. Our next question comes from the line of Mike Petusky with Barrington Research. Your line is open.
Michael Petusky, Analyst
Hey, good morning, guys. A couple of questions. Mike, I guess on the bad debt expense improvement, was that driven by maybe some of the old BioScrip stuff being cleared out or things that you guys have done? And then, I guess, I always thought that maybe 2% was about as good as it could get there. And I'm just curious if you think there's meaningful room there below 2%. Thanks.
Michael Shapiro, Executive Vice President
Yes. Look, I'll arrange a call with our revenue cycle team, who will assure you that 2% is way too high. All kidding aside, Mike, we've focused on this for the last five years. Revenue doesn't pay the light bill. Converting it to cash and getting cash in the bank. Through our technology, we've dramatically improved our collectability, on both the Option Care side and what I would call the legacy BioScrip side. We provide the services and present clean claims, and follow up with payers. If you present an accurate, timely claim to a payer, they pay you very timely. Our accounts receivable have come down dramatically on a combined basis. There is modest growth, but nowhere close to revenue. Our DSO continues to improve. I would say, 2% might've been the theoretical low. I will tell you that we have a team that is just getting started on that front. I expect we'll dip below 2%. How far? What matters is getting that cash in the bank.
Michael Petusky, Analyst
Okay, terrific. John, I guess you guys, along with a lot of other healthcare companies, have expressed that they've learned things about their businesses during COVID in 2020 and into early ’21. I'm curious if there are things that you can sort of call out that if this Delta variant becomes a significant issue, that you feel will position you well as you deal with any challenges related to that variant.
John Rademacher, CEO
Yes. A couple of things we’ve talked about previously. Some of the investment in the technology stack allows us to be efficient. This enables us to charge on a virtual basis, utilize that tool to improve patient engagement and support. We're going to continue to leverage that where appropriate. Our team has become very adept at capturing the demand in the marketplace, even though we weren't allowed into facilities for a while or had restricted access. We're going to continue to execute around those paths. From an operating standpoint, we figured out how to be effective with a remote workforce and leveraging technology to collaborate in ways that we just weren't doing before the pandemic. We're going to continue those efforts as we move forward, because we expect to maintain efficiency and effectiveness with those collaboration tools.
Michael Petusky, Analyst
Can I just ask, according to an article I think I read this morning, it looks like the Delta variant is sort of ripping through a couple of key states. Have you guys noticed any meaningful dip in patient referrals or anything else in the states that appear to be hit the hardest?
John Rademacher, CEO
Yes. We certainly feel the impact as hospitals reset. If they reduce or eliminate elective surgeries, we feel the impacts. We also feel the impact when patients aren't going to specialists for diagnosis or for care. We monitor that on a market-by-market basis. We feel the impacts, but right now, it's been a pretty short duration for the variant and we're trying to monitor and manage that closely.
Michael Petusky, Analyst
Okay. Thanks, guys.
Operator, Operator
Thank you. Our next question comes from the line of Richard Close with Canaccord Genuity. Your line is open.
Richard Close, Analyst
Great. Thanks. Congratulations on a great quarter. A lot of questions have been asked here, but first of all, Mike, I would ask, you made some comments with respect to your conservatism in the past, obviously because of the merger, first and foremost, and then COVID last year. Just to be clear, your conservative stance hasn't necessarily changed, despite your updated guidance, correct?
Michael Shapiro, Executive Vice President
I think that's fair.
Richard Close, Analyst
Okay. And then maybe just to dive in on the technology side a little bit. You talked about technology with respect to bad debt and then on this new collaboration for engagement. I'm just curious, on the tens of millions of dollars you spent previously, do you think you've realized all the benefits from that technology as of now? And then looking forward on this collaboration, where do you see the benefits coming from the technology, and maybe how quickly?
John Rademacher, CEO
Yes. First and foremost, we are still in a process. We will fully deploy the technology here in August across all of our platforms. There is still some opportunity that we see from interoperability, and tightening some of the processes and efficiencies we can receive from that. We're excited about the opportunity to have that patient interface and drive a better patient experience and engagement through this collaboration with AlayaCare.
Michael Shapiro, Executive Vice President
Yes, I think from a return perspective, Rich, I think we absolutely have generated returns greater than we expected. Those platforms continue to be highly scalable going forward.
Richard Close, Analyst
Okay. That’s very helpful. And then, John, I just wanted to touch on the labor market. You did mention that quite a bit in your prepared remarks. Is that the biggest headwind for you guys as you look forward, just managing the labor component? Just any thoughts there would be helpful.
John Rademacher, CEO
Yes. It certainly is a headwind. You don't pick up many newspapers that don't highlight this constraint. It is market-by-market driven, and certainly some of the clinical resources, nursing being one of those areas that we're watching closely. We like our model in the sense that we have full-time, part-time, per diem, and the strength of some of our agency relationships allows us to flex through that process. But yes, that is an area that we are keeping our eye on. The other thing we're watching is the Delta variant and how the impacts will shape the second half of the year.
Richard Close, Analyst
Okay, great. Thanks. Congratulations.
Operator, Operator
Thank you. Our next question comes from the line of Frank Takkinen with Lake Street Capital Markets. Your line is now open.
Frank Takkinen, Analyst
Hey, thanks for taking my questions and congrats on the quarter. A lot's been covered. I'll keep it to one relatively simple one. Mike, can you just remind us on interest expense thoughts, as well as any potential or likelihood of a refinance? I think there's a rate lock expiration coming up. So, just maybe give us overall thought process around interest expense, as we think about the back half of this year and into 2022.
Michael Shapiro, Executive Vice President
Sure, Frank. When we started this journey, we were burning about $110 million in cash interest. We're right now in the second quarter at an annual rate in the low 60s. That still includes - as you always keep me honest - a rate swap that swaps our rates to 2% fixed. That expires near the end of the third quarter, and at that time, we should take another meaningful step down to somewhere in the low to mid-50s, which represents a 50% cut in our cash interest from a couple of years ago. We're thrilled with the decline. Regarding refinancing, our cap structure is cove-light. We have no maturities for five years. We will continue to look opportunistically at our cap structure, and if there are opportunities to improve it, you can bet we will capitalize on those opportunities.
Frank Takkinen, Analyst
Perfect. Thanks and congrats again on the quarter.
Operator, Operator
I'm showing no further questions in the queue. I would now like to turn the call back over to John for closing remarks.
John Rademacher, CEO
Great. Thank you. In closing, look, I'm very pleased with the performance of the team and the strength of our first half results. Our focus remains on providing extraordinary care to the patients that we serve, and capitalizing on the momentum we are gaining, even in this dynamic environment. Thank you for joining us this morning, and please stay safe.
Operator, Operator
Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.