DaVita (DVA) 7 Nov 232023 Q3 Earnings call transcript

Good evening. My name is Jordan, and I will be your conference facilitator today. At this time, I would like to welcome everyone to DaVita's Third Quarter 2023 Earnings Call. Today's conference is being recorded. [Operator Instructions]

Mr. your begin may you conference. Eliason,

of welcome Thank Dr. Rodriguez, call. Nic our third joining Jeff President conference CEO; Joel CFO; our our appreciate you, Eliason, today your and Javier Vice I'm Giullian, and We company. continued quarter our Chief And Officer. our to interest are Relations. Investor Ackerman, Group me in Medical

this within securities that during call, the laws. of note make statements we Please forward-looking federal meaning the will

to those known could subject unknown the All risks results that of are these statements. uncertainties, and cause to and statements forward-looking differ described actual the materially from in

on concerning details XX-K, reports quarterly Form and further our SEC the all third XX-Q uncertainties, earnings on subsequent filings, and these with For report please make our refer most to that Form risks and SEC. our we filings, subsequent release press including other quarter annual recent

currently not to us, statements, law. are forward-looking to be required and on duty no available undertake by do information we update as and may Our based except statements these intend

we'd measures earnings to that SEC the call, comparable some and financial on will discuss measures in included A during financial furnished these most to you measures. Additionally, we non-GAAP to reconciliation website. our GAAP this press of remind release our is like non-GAAP available the

turn will now the I call over Rodriguez. to Javier

progress year key momentum making third interest We our delivered DaVita. and by that in than another many and your We into Nic, has for you, quarter. began all the priorities, Thank the you thank expected, quarter. operating strong continued of earlier across

the differentiated of standard for delivering invest continuing operating near-term are our teammates for creating on highest for a focus while experience strong a we balanced future the care patients. At growth. time, have our to same of course, and, We discipline,

some an next the and with in outperformance wrap then our GLP-X thoughts provide up drugs, on on year. impact a address perspective quarter, third on will I XXXX update the potential share of Today, guidance

third time, health quarter do, care into to country regulation. of of XX get in local This as international we I would a status, XX,XXX more will for like across practice business, provides I patients start, our details, terms unique, Before is I countries. Each with methods highlight highlight. and than always clinical which

Over have the past X experience universal years, Care within to our local Kidney each developed protocols practices we combine with country.

have Since has international company, seen These aggregate every countries now XX%, operate. the soul improvements we consistent clinical meaningful life results to of we patients. quality XXXX. of cost our at and which launching extend market, in proprietary this the outcomes. the and improve international framework, our And clinical benchmarks by in dropped across outperformed the We all since level, of mortality energize our patient which is life of

third of a This quarter. of was quarter, We the strong our million share adjusted Transitioning per earnings had $XXX ahead adjusted our for performance. income operating to and financial delivering of $X.XX. expectations

and and We to benefit perform operating key seasonality additional our related to well also metrics timing. continue add across

care highlight level costs the Care, Now drivers, let of patient Integrated me patient census, Kidney detail and to including and next IKC. or go X

in XXXX. steady end to to following XXXX, expectations. we and sense patients of our the saw with of year census a the of line continues patient X,XXX the than Mortality remained half to our year in we higher First, first the expect end the has with in growth X,XXX decline

and to continue, return these expect we XXXX growth to positive Assuming in trends volume beyond.

exceeds wage historical conversion seasonal growth below but for costs the the revenue items, and quarter. expectations remains Outside trends patient continued the decrease. of growth to a the anemia was quarter. the That our per Second, during above management was for of MIRCERA decrease key of in third treatment, care driver said,

quarter low and recent IKC business with consistent labor our the and market to put finally, total savings DaVita has training, environment. And unemployment cost is of outcomes care, offset for ahead is labor health on strong in and slight on of which is experience improving the wage had by trends. between a that our tight easing and continued tracking our shared forecast the generates Our reducing retention pressure We're partners. and macroeconomic year. patient The

We the also year savings anticipated. revenue realized these the than with associated earlier in

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to factors. late-stage believe that there X Now population. We are turning CKD key

adoption rate GLP-X population. First, in CKD

on the impact CKD Second, progression.

patient finally, and any mortality age. the benefit of mix impact Third, average cardiac on in the due to the payer offset impact changes

conservative by take may building purpose a CKD assume long-term GLP-Xs a of rather by for adoption of forecast, obesity, supported who the we adherence, part and in those benefit. robust strong than the for the possibility For uptake

also cost impact and reflects at looked future current years, end-stage possible these the impact XX-year kidney about disease. This recognize the misunderstood beyond, our pass across model on neutral to away, to immaterial reaching X small Stage those with CKD timing assumptions, mortality, look clinical a is disease major of event the of adverse clinical positive next from XX trials. Simulating range Since on wide approximately effect has less reduced much progression. with which this population larger before will If must today consider impacts the cardiac dialysis the mix. will a we events and of of over kidney XX% but largest people not impact We slower We cardiac intuitive, several a midpoint than XX% U.S. are who rates from of in to a of payer sound why compares progress the than dialysis. at may this million characteristics we approximately ultimately disease. single XX the influence growth individuals,

trials, endpoints benefits. This X downside which we in efficacy To equate case $XX in select based X.X% with mortality quantify also clear, kidney growth found of annual to approximately offsetting flow scenario a and the on all same across each XX-year is be growth, cardiac model This period of operating scenario, would the dialysis on model. which reflects headwind, not per over expect headwind to income our is a something year. the million we better

of market's is disconnect the numerous but and Let with the the popularity believe research have tested me what is band we across to disconnect extensive to the Because view wrap review, our their available epidemiologists on benefits, up perspective. and not a or GLP-X this, our wide between by be health clear, of consultants impact pressure with assumptions. Kidney acknowledging analytics To external and specific of the Care. we related

on targets We any topics. drugs XX what on strong from not downside topic, income in scenario on not happy This midpoint, know financial or headwinds is assumptions. Transitioning mix. In a we today, prevent is questions have us commercial the long-term achieving and on our these focused next based elaborate years. the growth will but conclusion, answer our incorporated possible to our on adoption operating we're complicated the from and end, lower that volume of the

adjusted new range a new our adjusted we billion. Looking revising quarter, to range $X.XX to earnings of are of per per range share. $X.XXX to $X.XX our We're to fourth a guidance income share of billion, XXXX billion operating range to per our $X forward of $X.XX to $X.XXX billion updating to $X.XX share also $X.XXX

growth pressures income. ongoing guidance we of It's year, next Despite our of too volume year our be early for cost midpoint initiatives. to in of adjusted expect a the commitment to driven XXXX give and guidance target positive adjusted operating rate and fall to to continued X% our within our invest income operating we expect in teammates, long-term continued by XXXX operating X%, on progress our growth will but

We our call. more will detail fourth during quarter provide

will turn detail. and more that, to in With outlook now our financial over to it I Joel discuss performance

capital the detail about about deployment. and are I on the some Javier. thinking give through how will update walk provide Thanks, in performance strong we an the quarter, quarter fourth

line the volume. with per with census approximately quarter. to were U.S. day dialysis and was in our QX Starting expectations. treatments second flat

to admits. began, quarters first X now in For growth pandemic since rate mortality the experienced decline. continues sequential we've year-over-year the time of XX-month Trailing

we as again now We quarter-over-quarter. once pre-pandemic mortality improved rate, of approaching are levels

Revenue cycle QX. $X.XX in of and versus pay uptick well per revenue was This rate increase normal private continued increases the performance, result improvements as mix. our in treatment contracted up was as an

near the of the year, end we be X.X% range, to that X% we RPT quarter. last For shared the to full top expect year-over-year

the forecast Despite despite we rate XXXX, appropriate to errors, is forecasting calculated, for CMS below was only is to ways inflation margin week. costs. the final given rate update That we current that below finalized ESRD for inflation believe X.X%, continued acknowledging which rising last trends. the said, still larger was other net RPT continue find was to ahead increases expand and XXXX Looking PPS XXXX originally what released error than Medicare current

per $X.XX Non-GAAP patient care down treatment cost was sequentially.

result mentioned, the of for the of a was MIRCERA including number management. this As conversion to anemia items, Javier

IKC, improved $XX due by factors. million quarter-over-quarter results In to X

difference higher approximately third primarily the in we the quarter. fourth the second important It savings revenue in as is is had our timing, of quarter, that forecast, this the recognized quarter. in million anticipated is than note to we but revenue this First, $XX more than shared

revenue in from a compared from IKC to in our we we revenue Because operating QX. forecasting positive are These of $XX concentration the of by the quarter. Plans costs. the Special approximately of had QX, of Needs QX Second, in decline reconciliations in higher million increases million were offset adjustments results shared savings $XX

quarter to said are past, next. likely As we be IKC volatile the one have the business in in the from to somewhat results

remains focusing results performance. So understand our way on annual to the better

guidance. continues ahead which a IKC our now progress, make XXXX operating loss we to is Our IKC $XXX of business prior of slightly XXXX and adjusted expect full million, approximately year

to Turning QX.

this in third mistreatment costs seasonality Our updated consolidated see our as fourth delta teammates, previously the G&A of approximately is is health other quarter, implies to to magnitude the quarter. The quarter operating We the The noted. guidance IKC, what operating fourth vast higher In several year-to-date in spend quarter The by fourth be for and will will typical million, income this of income higher higher, around a including factors, our holidays, of clinics year-end $XXX and than have IKC also XX benefits fourth rates lower driven $XXX sequential would seasonality. results factors: quarter million. due decline number majority closed the the primarily of due or on timing X bringing we seasonality, normally adjusted quarter fourth year. to in increased XX.

of credits. Transitioning to and On XX% continue compensation the be our full recognized will to reflective sheet. We to is tax for balance XX%, in now light our for to expect year utilization The range XXXX below footprint which updated taxes, of stock-based we previous tax range evaluate forecasted rate our is trends. year. the benefits approximately larger

Our capital-efficient capital on focused remains growth. allocation strategy

not we past, had middle And near our leverage did our we our term. of target this X.Xx of we quarter year the past we with the as the any a quarter and long X return leverage goal have ratio Accordingly, EBITDA, ago, a part shares to to over range. target of As repurchase program maintaining the ratio in said to this X share paused range. ended repurchase

after view and to considering of stock, capital result, of our quarter. set allocation market price As purchasing value, a our including intrinsic to relative resume of this typical current we principles, shares our intend

our within combination a using repurchases and credit revolving flow share cash fund of to expect excess facility. We capacity

As a our reminder, structure. in this and us we liquidity with upsized capital our year, to provide revolver flexibility earlier more

notes exposure debt manage have to floating attractive end of to debt to of is our manage caps rates. while this our the exposure, fixed rate, half XXXX. Approximately the half is very interest continue long-term rates, the of rising interest other our We we rate implemented majority with through

That open Q&A. please concludes my the prepared for call Operator, remarks today. for

[Operator Deutsche first from comes Instructions] Pito Our with question Bank. Chickering

I me sort some were of costs, -- I guess sequentially. on patient big guess you a for guys reductions care here. year-over-year couple pretty and year-over-year

costs, guess, the next you've You sort into help looking see pretty drivers -- were a opportunity changes year? I sort XXXX, then within talked done job of to going you about amazing to us why But us? think not what can And of this controlling still the just sort do same managing. about of bridge be about drivers you talking year those

Yes. for question, the Pito. Thanks

you the think we right rate it wage wage are So about I to seeing. costs, way if is care rate think pressure, patient continued think -- about which

that about control, think was the lower pain we've us a you that big year, got relatively and under for is As in last offset early labor. SWBs that Remember, year. by contract the

of probably million, savings $XXX than in less better a but maybe bit magnitude, little of seeing part order you're So year-over-year. of that, the that

our items, patient reduction that of here from anemia of have our a lower a consolidating And job volumes. controlling result additional of other then MIRCERA. us switch We've footprint, you to terms about we've talked In from in as the nice savings done terms the costs.

are So big items the year-over-year. those

We you If land it's we opportunities continuing closings our to pre-COVID not we cost as will wage the I certainly mitigate, growth. look I some on pre-COVID savings facility rate, that about what a our what wage relative back and down to to pressure be coming the from as to expect, in to give than we're rate continued to think number. think pressure, And the think annualize. for savings, would expect now. both then anticipate on we level, you see MIRCERA from where but to a see XXXX, other don't continue RPT will we will ultimately ready the would bring higher see guidance

XX-year sort sort Any There's And variables. about time, integral of shifting of sort us building the see we the thing out of of as guys with of of think those tried disease same from play the us just drug you a of so with what Okay. moving to weeks at definitely then can the that sort we patients to share the to do that GLP-Xs, impact saw few sort you a going you you what just from inhibitors, ago, just a you to same here. SGLTX GLP-Xs? you can within did with guys about assumptions chance the and sort impact And from talk CKD model. lot want parts model guys had

is Pito, note. And Javier. Well, your this I saw

swimming the complexity been all you've here. in So

call, on as variables and you the there's another. since levels understanding familiarity different and one with the have of know, interplay So

good we I off a all get think it to would same step common place. can that be take foundation, from the back, so

So give give financial of can talk he then And model, what Dr. you you I'm that to over our the provide and us to Clinical. ask to then Officer, that Is can it and of so that overview for, get high-level is, about Chief impact, going the a we we Joe, fair? Medical assumptions. I'll could first, hand a Giullian asked framework, to bit for a

Sounds good.

right. G? Dr. All

Thanks, Perfect. Yes. Pito.

and the these dozens I'm studies. and now, outset, with by demonstrated Javier any truly lives interesting endorse of efficacy heart and can use these kidney They've around XXXX. all we're half looked kidney even saying, clinical certainly encouraged, fewer available change drugs than it with think medications. people disease, those that disease that they've acknowledge And Let encouraged all the people, benefit high-quality at we what found GLP-X since therapies and is as the start right living at me been agonist delaying studies mentioned I the generated society that And living that the of energy really I I just the to of disease. When progression. comes many of

showed mixed some of So impact XX% and studies improvement, XX% some those of XX% results. And that that's subset on then, then patients. the showed of those improvement improvement a course, impact, no or the about had of aspects was about of greatest that demonstrated

this. started where with And of all we so that's

to? dysfunction. are of We medications, other that either rates which in dialysis, discontinuation of these looked data that someday clinical have could points. We or number progress of both. one, be XX%. are eligibility. about and our triangulating we've probably model, about are the ultimately talk of high do lead medications? or clinical walk of b, you of progression we diabetes of that very known on CKD published think patients be Joel And that specifically now we percent number different you're thinking, X% to these medications, going slow obese financial to off CKD these a conservative hand through looked arrived who patients, including the from patients by uptake in ultimately at right going So And is X% I questions kind are: to let people ultimately a, of like I'll to X I to about and medications. or the on And are more delay percent Now expect at medications, what at generic to it biggest ultimately our CKD XX% kidney wondering, that then about me on take is XX% CKD are impact. On estimated with And then patient question as to first to get

drugs. for XX% With not really the being other these eligible

could believe, that eligible those we future. of to total XX% of on receive would who maximum, so be potentially the these dialysis. that XX% we those then patient CKD population, that And were around of to would translate the medications about in ultimately assuming are progress at medicines these And

question. of first So that's the part the

of question did a if that know And we with estimating are even evaluating of that progression. as is progression. things, The the subset And of, then about estimate at number, is second Right smaller demonstrated part in efficacy. slowing to those points picked looked that's looking how in these those renal a the had mentioned, I benefit. clinical medicines. we those in subpopulations is delay the And impact. to XX% in arrive disease we of the at And of progression that delay by terms at of XX% now, there demonstrate that did trials we data that the the we impact medications where studies. And studies, from

in -- in so X% And about discontinue this just patients over to to kidney including number be really those about be appeared goes our that for includes conservative XX%, XX% of XX% ultimately population. we general, part the our CKD of by a of no the demonstrated saying an on SGLTX and And of that approach. of SGLTXs. second get about your use has prescribed reasons end that damage Right which the the reversal and to medications them. now that fact or that's And time. And so for question, been the to ESRD progression again, has population halt extrapolate therapy that broader sort of I'll was really

let believe share Joel impact, little we we on model, that. and a considered So bit already our have more I'll that in

Great. Thank you, Giullian. Dr.

other of Dr. as epidemiologists, weeks internal, of nephrologists, have I well clinical the and both external. in as had So weeks the being aspects Giullian, this of with steeped benefit

said So Giullian then I'll sum let and me modeling. about and what Dr. talk try our up

say X would things. I

out for for GLP-X First, least our diabetes. drugs These the have X air. years X of been or the used pulled at management of are assumptions not

said. So there Jeff are robust number of a as studies,

be said, So we uncertainty there lot there's off conservative. That of set is data of to which a still, wanted some build assumptions. and to a

are modeling. our landed in on assumptions X that incorporated we So

complex. of drugs. First, that on these overnight. time. CKD makes happen not that the one the modeling things will play It's XX% going will of That's population out It be the over to

assumption rate that among a that's penetration XX% a our So rate think utilization or Again, we one, conservative number. is population.

this on that CKD by efficacy rate. over the progression progressing patients, CKD later their of XX% in who stage XX numbers think To slowed progression XX-year a put CKD down of to that from that, ESRD, if a Second, is And will XX%. convert patient for a would take that years, you to drug, what be years. typical means XX.X

we that inputs our clinical are the are modeling. those for using So

Now we to let how me modeled different X numbers. turn

mix first, are could what be bit easier I think to I'm start And is me to because and financial going commercial this the And talk it's But let hear here's they is, The impact. with a serious. you'll implications about little understand why. not.

around robust much framework, that you simulate got also use explain in would number scenarios. are that you the We of to create as a used So simplified to how very we expect, model we've to thinking this a a to impact this, use about we've this. can we

So start framework known that some let me inputs. with

patients commercial have XX are who we of we -- patients, commercially that approximately our And second, on again, most know. insured. not over are XX,XXX are First, and today

below XX it's the drops, our XX, constant. to For or patients above it number of pretty And is it a of incident when number the It population modeling assume commercial XX if XX constant they're pretty doesn't has XX, the is or X. they almost purposes, mix and XX. mix for a commercial that safe matter hit

that older the about being commercial will think when with we instead -- instead at than incident will of a delayed of younger progression result they incident delayed. cohort delay who is XX, on at because insurance, of And matters mix, being than curve are GLP-Xs XX, of at would of GLP-Xs, of incident incidents the that be is really but GLP-Xs patients, shape their younger been dialysis be all have to of XX. than XX that the from just who the in without impact commercial of age below The modeling

let me assumptions. tell you framework, that our with So

a commercial that X.X-year XX% That about already. We incident XX% a said, about into delay Said patients is window, before our of that population another And aged talking is we fact. XX% translates, an important commercial of I progression. as incident window XX. here's about. that in in X.X-year our care talked population XX. way, XX.X we're of About First, through

here's math. the And so

assume XX%, window in XX,XXX XX.X them of we of times patients them that's about patients. that lose as XX% XX%. XXX XX patients, of of commercial number of result the incident to that are the say take XXX That's XX,XXX XXX,XXX mix. patients You you That basis XX% we would that a care times drug, be divided getting expect of GLP-X our and penetration will on is XX% and patients to by to gets GLP-X XX commercial points

of years, points commercial a our progression. a numbers. result about the It will mix commercial find went change we So this a CKD again, basis needs. will in in points basis To points impact me in our That's it XX and amount. be cumulative that takes through what to the of the us XX% growth basis total. If It be of commercial clear GLP-Xs, means would you XX believe population, happens negligible see it that perspective, never our this get however mix put delay mix of why as quarter a points that year. is reduction long up flow to alone, let X of basis XX that XX to a not over in effectively that's

it but part, course, All to wanted an to which right. second there's, a we mouthful the that, with and just is as set not Joel said, of Pito, patients the up, off start overall impact commercial important. first financially said volume, on we which is, just

that? on questions any So

the was take queue all in models, very detailed of more answer. So bit. a jump to that a in and I some back that sort reapply the of but sort will for questions

Our Lake comes with from Research. Wolfe next Justin question

That that appreciate I incredible. all detail. was

So one that which just me on of is XX%. follow let up points, those

I that XX% dialysis. -- given the a grounding population, kind number? kidney to state might knows that be of there of So the what's higher, progressing behind Is thought ESRD they're it the side. in CKD end and

Jeff medications, at the a of things. is the generic have and renal ACE This or inhibitors When good market, for decades We on progression had slowing that look on of that that between CKD, longer Justin. Thanks, to looked Yes. And disease. We've those X impact Giullian. know even past rate those know patients we've medications that you potentially about number to than medications, they're XX% lower the XX.X% at population. through ranges XX% the in and GLP-Xs. of who only you uptake of have progressing slightly the just tend described, ARBs discontinuation even a

looking of baseline for of so medications. pretty strong what we expect a that, at uptake have And to these

Remember, Justin, because it's obese. it nor are better to think diabetic XX% neither of as XX%

can many, is applicable people as useful. than after off XX% it's get a is medicine so assuming overall, which Dr. the adherence, many as more not G we're the We're stat, X actually to And because, normal but that's XX% we And of be year said, population. XXX% assumption. just trying XX% a be conservative, as

XX% still are And towards to -- are some so that again, not those goes always known. then, why kidney given XX%. low, benefits always only that of there kind are is of higher that think that it's the are is are highlighting so take-up benefits coming number benefits? why failure. Why us that Doc, you can you the and tell these do those out among been Could rate of reasons been low. the studies And people Or the marching known magnitude

what to choose. ultimately don't of do do patients or understand a It Yes. speculation lot why they takes

do Some has this medications to and health. access physicians access of to to and with social determinants of

clinical And rates end-stage of including reasons, that lines. disease. reasons, such any as there's along ultimately in that limits those progresses to like for quite with on renal just Some number uptake done behavioral full number from do research of cetera, other and CKD the of of side patients health, might things we social And has population team et and education, to expect it research the discontinuation has frankly, effects our a paper.

quick then jump Got it. X just And Appreciate numbers it. out. questions. I'll

in of drug back, rate, if the run buying terms exciting your is back to us totality that at coming back hear then understand care now from look get going tell the stock. you are you're of we to to Just trying it's kind the spending costs can secondly, Joel, where to first, The drugs? patient moment? And of

last were investors XXXX, of averaged terms -- time a point, Could you pace I think in you I about how think of around as think to you quarter. jumping about in $XXX kind kind buying a it million of of reasonable that what think buybacks? the

Yes.

Let me take the buyback one first.

out to I'd comfortable it We flow, is, we've to to that number a In available always put well have have been cash look, back. to hard revolver terms of billion. using used pace, say, a out historically. What revolver. bigger $X We would upsized than I we've there, $X.X billion leverage as we had as point a buy is excess

limitation probably now think now, we would a buybacks, about you if So buybacks the revolver be tapping more share liquidity before. that of for revolver did comfortable got we than into on the our bigger we've

of was of percentage drugs? what's or And the cost part the on what second treatment the question

it's forward. dramatically assume That the bake biggest anemia has from in I what a of been savings to that's there, hard number you're where Yes. going in come the savings. down lot is really I a think that point, interested major of to source

Our next Fischbeck America. question comes with Kevin of from Bank

million Or then now X% just that to feel safe is Great. negating you comfortable X.X% comment. to still say more that buyback Is the your to million? period grow it to you'd that? you be to Maybe circle back the factor that going above to about that million ability over that time would of okay $X.X the $X to to back some get EBITDA, the $X.X base

committed market being back a we will there, to comfortable we're we to our getting view And feel our feeling as appropriate. a now revert and we're between business see but and place. Yes, Kevin, forth rather is interpreting there. wouldn't negating I back factor, about the And how and now, results. it we we disconnect that how see we as Right

be might we so aggressive. very And

art And it so that because was I going $XXX is, you're use think to if of buy course, and I million. $XXX of million, that term

want way want capital that's we about money a and to give to opportunity to right And efficient, best we about think our way be there's so and want my we pounce I say, the to or would and the if our is, probably think to to an from perspective, back it. it shareholders, window,

your of of you things guess, talked helpful. walk about the the -- That's And then, through slowdown in about progression model I you Okay. as disease. one the

in, You Or taking something going with the really that of they're how drug was, started or to that you about talking later really than And window advanced at XX% extend XX-year there But that X the it the kind in potential kind Is all of start start you CKD earlier clock earlier that think like about kick years an that is last see I is slowdown? would starts. on when happen whatever any just does you for, only clock XX in volume been and talked the has the this impact how drug years. then the a beginning, so. population. used

out volume when impact? figure of that I cant does kind on the clock So start

can Thanks, again. things. Sure. all disease, to couple one, but XX to X, Jeff in frame kidney variable, from years. end-stage Stage the Number often from This Giullian kidney general, XX chronic be is is for way the moving time disease early A CKD Kevin. of

think diabetes, time is cases. even is for or people some years in longer about years. our XX Even average I living the XX frame that with XX,

said me correct let Sorry, you X.

to say pre. You meant

From -- Thank yes, exactly. you.

step this see to so thought Then and XX believe it, going we at major we that next don't impact one have And the is population out clinical studies significantly years. as lower all, clinical modeled subset in patient pre-CKD studies, Stage demonstrated that look and at kidney a take further, that impact in impact we've of even we're is it any at X. about that have to the have that the as looked the

it's Kevin, here. Joel

we now CKD to the if expect because has so GLP-X uptake uptake is seeing about in single And Let from seeing I it potential in low it? me little -- I'm offset think add not of we cardiac we're you at enough in low. Jeff, plays a are question we're because right? seeing wouldn't today, probably drug are one is a uptake. digits the mortality. So correct wrong, so see think and low we And we're more such impact been the but that seeing me the impact this one when of into talking reasons point reduction what

to clear And cardiac and is SGLTX of so The disease, ESKD. reduction has are other mortality. patients more about progress than GLP-Xs to is in important thing likely cardiac ultimately many our been CKD there die a both that for think we for of inhibitors, population, demonstration the way playing through

on of and you So population some the offset are number, ultimately reduce that delay. if disease, a creates from away would larger could impact that potentially, incident be it ESRD, who of that cardiac passing incident can

or those so we is even And seeing SGLTX we are negative small, cardiac seeing of good of on also deaths. the the the though so is mitigating if that the inhibitors there drugs a GLP-Xs impact chance are today, effect uptake

to have be guess I mortality in to quarter, you about starts also a improving. that expect them helpful. new be? does improve? question That's Okay. where Are talked to then would back maybe the Or the you would

Our new expected we last expected. to felt back would but intensely back now starts pressure starts are have we be. what we We that year-over-year seeing to have would them where to year are

Okay.

is the really So it should just the X% that's you're new term, right number. mortality difference are be, it we where at now and volume where saying it's the the back looking at between, growth to X%? starts Longer

of summation reasonable are. a we that's where think I

Yes.

that refined on little a But to bigger. than or were well. as are pencil, before, point, you our higher more treatments we're miss be slightly your sharpen but -- If your working

Okay.

show new that drug way does you're how you would cardiology Or more about, we making the that is out? before could this what And we we the would benefit way that Is it would playing the the so adopted this that see see -- up, saw how you that's is then? if that actually starts progression? ever that's see then and that be, think comment

see would but pinpoint patients, to incident never have and who these in before Well, to away CKD you'd drugs be by starts. offset remain be these able late-stage taking are new that, at passed of incidence would in delay I longer. drugs without CKD I these think, the you mean in it yes, but would being ESRD, patients these are who, patients again,

business coming maybe in Okay. there keeping is say Or better, is then of Makes in is to a big that target, that projection the And sense. kind trajectory still accelerated? anything last XXXX just but just enough you're unusual your The kind that? from question. it change IKC of or period not prior

Yes.

but strong, that of timing. revenue in in expected It lot the QX. came of savings the was quarter really look, and So was a result we that shared was QX

future, look right for And called As million we've talked to true see IKC will in about $XXX the what I quite variability and we be think the IKC in year, out the year. large. IKC full is is in way past now, quarter-over-quarter approximately the the we at for loss we think

and bit a than big the about were as nearly, because that's largely better this the nowhere talking what quarter before. That's beat of timing And quarter. next. we But again, as this between

slightly breakeven on again track. the IKC 'XX overall, expected, They and year, than we but expect in are reason, range. next performing to is better in then by say I'd 'XX. continue for number So better that And we

from next Our comes Lisa Bernstein. with Clive question

how we improve that. X about Obviously, group? try been big of Stage talking and think even should about patients, severely a late-stage And there's that underdiagnosed to and CKD the is the diagnosis push

can do right if involved rates a potentially early And do it of enough, in the variety this? patients. really thing you an that that to see you are the How are used where by like Now diagnosis there going? seems impact, medications, it's have

There's are earlier get CKD disease again. epidemiologically a and about seeing a thoughts on that. increase a push Jeff large things time. push lines. Thanks, Lisa. couple been long we This been the those along for to not a word out diagnose of in is There's that. to A patients with And kidney yet,

medications When their and been and it to a kidney ARBs, nephrology SGLTX they've the and like for the knowledge medications the inhibitors been to the time, comes community long known have for several available, available impacts inhibitors years. ACE regarding GLP-Xs,

making isn't necessarily for although know So news, new headlines this been I us, recently. it's

from standpoint, that change. a So of lot not we're seeing

upstream physicians to continuing reducing like our are as on that that's think are medications with that. us. Care partners managing about do And regularly is factors. the We work risk care dialysis, of to about with kidney patients educate important to this patients and work Kidney and transitions we go those improving chronic and them available in their something Integrated care with of We to that for specifically role on disease physician our things

the related a And disease question, time. at over looking Okay. prevalence just

last obesity it's notable we've adult Clearly, with the at XX because over the seen big prevalence increase we've of least seen to diabetes of the sort XX% As from go and estimate population. there a in rate but years the and a [indiscernible], are XX% be case? estimated been flat Any obesity CKD? will estimated over the if of But potentially thinking that period. patients. thoughts what undiagnosed just many on so pulls rate relationship even the I'm be CKD, may pretty has prevalence back, time that the why really that

physicians Yes. codes. diagnosis, called from ICD-XX estimated a CKD, through prevalence what's coding Most as comes of the

type CKD X and the and focus cancer cases. especially early CKD physicians things, things X of other top and Stage some CKD X, so as factors in And on risk factors priority that. early in risk stages, cardiovascular isn't like just and

Stage those just And CKD so least rise. at with we're not the X of seeing documented prevalence

question Chickering Our next Deutsche from with comes Pito Bank.

a a quarter, So quickies just a follow SG&A, think, with this moving of up of sort I'll charity here funding including, parts of I groups. couple here. lot

Just we about parts just moving curious, if think for should us And XQ? for G&A what how you bridge XQ? the can in

nothing to a out there's jumps call out. G&A that on there's think lot really overall don't quarter-over-quarter, I Yes.

from I a would QX, but seasonality, In of terms nothing major. modest uptick expect

thing of seasonality pickup well. Was per a there Okay. that just more point? mix had at treatment nice any here? as Revenue a is Or shift sequentially this

last continued collections quarter-over-quarter our RPT really our what standpoint was an about We been efforts. there. We Yes. more this little a got able The impact of bit operational talked We're progress quarter. on quarter. biggest from has accomplish to team on it proud

gotten say, I of the the time we've that. majority would for And vast being, probably

increases see quarter did quarters. also commercial just more negotiated uptick We the that in few the the whole well. So but of of anticipating next mix a some benefit in as we rate lot I'm not a got

the from are this at point goals you're payers? getting that What commercial

question? what Sorry, was the

are care this the the managed point? increases I What at -- are the giving payers rate that guess,

As we've said in contracts the are past, our multiyear.

that. have So now, seen in, of accounts, that any and many i.e., have regional reflected environment. the say that up a we're you is at we've given that increases What year, don't lot an fair inflationary to environment in to the it's

year what So than they've higher brings. will next bit see pre-pandemic. we And been a

we have As a larger couple the ones of renewal. for up

about IKC, in guess driving guess, heard that, I kidney? there improvements if things the you coming I little XXXX from is was the much I got that X% Okay. right. And talked of range, of versus that OI X% then year. start worse what bit IKC a On for to how from of

Yes.

there. IKC gotten So little better. you has misheard Peter, bit I think a

have our the since We loss prior lowered guidance.

So the we year. of course continue to see over the improvement

being talked where say Javier X% from midpoint In but think come percent terms I'd to come it's of not that will be Again, to of from, say, 'XX, quantify fair to of will all it some it's to that. about will that early early IKC, give as the the guidance. will range where too too X% we fall.

the the patient where adds new we for Okay. pre-COVID? And in to specifically quarter just extension follow-up treatment and How quarter. on that What a compare growth. between versus last Kevin's specifically, new of in out help of versus did quarter? then that the question compare And sort third were of what pre-COVID? mortality figure the versus Just me, does question, how mortality patients interplay third was the curious were incidents on

Yes.

number, it new quarter, the peg kind pre-COVID with we to of excess adds a in for So, type mortality, were volume at going it. where The XXX. expected I'm right consistent came

number a I phasing that number is think the excess metric. mortality to going out a start probably as we're

kind and you to pre-COVID close getting so number of within error pre-COVID. the of levels, our number, it's getting It's year-to-year band pre-COVID that consider as what moved

would that So number I think was important time it is is what something But with continue XXX. expect for contract that like to of decline to was and out but called longer I consistency the ultimately, historically, period no number we've labor, a important. for

number away forward. move from So going to that we're try and going

Clive question next Our Lisa with from comes Bernstein.

your to patients you looks, of how if questions going wanted versus us are any private can. in some still we that should just employed on difference have what I patients about how you statistics your and incident I dialysis any proportion give Do mix on home forward? there's dialysis, and home about COBRA if squeeze in could think that

know I mix recessionary in don't I the and that number but periods. there's full that between know moves usually actually when private, is steady COBRA employment, pretty and

look higher going mix. at change, can does it that, I as you're what we for. And home, So if think but don't relates it's that's it a to have a meaningful

insurance it. get in have We not we hard now We've change it stable. shift on cohorts. have any as roughly number XX% patients of continued to patients to and work relates seen has more that been the our to at home, But

wondering sort the my through home right that go -- mean more a stay because more that I on patients lot patients of it make whether full sort Could months. them just I'm comment COBRA, XX and could on home a whether Okay. patients you on dialysis employed of that that on longer? greater of to are won't whether dialysis, whether for them really for those private there -- employed is was whether understanding managed just more of can the for I was guess

that into Yes. doesn't wind number analysis go dialysis better your drive but run easy causation We've looks ultimately not number, a home up financial as correlation piece of without rates any really looked you an good, that because results trap up. can with the of and it's and at you

So I inconclusive. would put that down as

that would one that at more flexibility dropout last continued would is dialysis would the important things or high. Lisa, that assume the the But they patient people be have home, of to work. ability on has home for reality keep decade incredibly the rate is to so, they go And their and

would be the care in center of taken because of on half or be that condition. center have rather are taking therapy about in roughly to So patients a medical

in And questions the additional queue. we no have

unusual know looking have the so into Okay. related much dense an of in and that, was you're not at but that that was to very important really conversation, what Well, something quarter, a that at. understanding I we're it looking is what

of let So a make couple comments. closing me

very record a track and had of continue meeting we our we commitments. our First, strong quarter,

clear. Secondly, hopefully, it became

are the We it on population. out are and understand these have many. nuanced the is improve happy it will very can to that kidney, there impact of drugs lives But it the on more

to impact of robust a with remain plan. And then based our but this what growth just best diligently is today, our also of building me we our and that X% to really not last lastly, that speak and will we dawned important, we plan that on long-term even class OI X% a know adoption, deliver for focused for believe really Third, drugs time while year. on scheduled capabilities models for delivering a today this to the the the we're patients It on care for healthier tomorrow. the care

of to and and So wish families our you on healthy like a behalf team, Be happy holidays. I'd your well.

conference. in Thank participation you your for today's

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