DaVita Inc.
Q2 2014 Earnings Call Transcript

Published: 1 Aug 2014

[Operator:]

Good afternoon. My name is Jenny, and I will be your conference coordinator today. At this time, I would like to welcome everyone to DaVita HealthCare Partners Second Quarter 2014 Earnings Call. [Operator Instructions] Mr. Gustafson, you may begin your conference now.

[Jim Gustafson:]

Thank you, Jenny, and welcome, everyone, to our second quarter conference call. We appreciate your continued interest in the company. I'm Jim Gustafson, Vice President of Investor Relations. And with me today are Kent Thiry, our CEO; Garry Menzel, our CFO; and Jim Hilger, our Chief Accounting Officer. First, I must apologize for the delay in our press release today. Our wire service messed up and didn't get it loaded in time. We'll make sure this does not happen in the future. Next, I'd like to move with our forward-looking disclosure statements. During this call, we may make forward-looking statements within the meaning of the federal securities laws. All of these statements are subject to known and unknown risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. For further details concerning these risks and uncertainties, please refer to our SEC filings, including our most recent annual report on Form 10-K and quarterly report on Form 10-Q. Our forward-looking statements are based on information currently available to us, and we do not intend and undertake no duty to update these statements for any reason. Additionally, we'd like to remind you that during this call, we will discuss some non-GAAP financial measures. A reconciliation of these non-GAAP measures to the most comparable GAAP financial measures is included in our Form 8-K submitted to the SEC and available on our website. I will now turn the call over to Kent Thiry, our Chief Executive Officer.

[Kent J. Thiry:]

Okay, thanks, Jim, and greetings to everyone else. I've been out sick so far this week, so if there's some moments when I push the mute button, it's to save you from hearing a bunch of coughing, so please bear with me. First, our enterprise had another solid quarter, as you've seen in the press release. That consists of 2 parts

[Garry E. Menzel:]

Thank you, Kent. First, additional comments on our Kidney Care operating metrics. Non-acquired dialysis treatment growth in the quarter was 5% when normalized for days of the week. Dialysis segment profitability was up $21 million sequentially as a result of 2 factors

[Operator:]

[Operator Instructions] And our first question comes from Mr. Justin Lake, JPMorgan.

[Justin Lake:]

First question, just, Kent, maybe you can give us some color as to what drove the decision-making on the leadership change at HCP. And then can you give us also some color on what your -- how much of your day-to-day time is going to be spent at HCP going forward versus what it was over the last 6 to 12 months?

[Kent J. Thiry:]

Yes. Thanks, Justin, for the questions. On the second question, I'll be spending a significant majority of my time on HealthCare Partners. On the first question, as you know, historically, we don't typically comment on personnel issues. So I think I just stay away from that and reiterate how excited I am to step into that role after the last 18 months of some difficulty, as you know.

[Justin Lake:]

Sure. Maybe, Kent, the way -- better way to ask it is just if maybe you can lay out for us the 2 or 3 or 4 things that are on the top of your agenda to get accomplished as a change agent coming in there?

[Kent J. Thiry:]

Yes. I think it's the things that I mentioned. And they're going to sound relatively generic, but hopefully, they'll emerge in a very substantive and nongeneric way. But it is to deepen the value proposition in existing markets with respect to MLR management and patient loyalty, ability to attract and retain physicians, et cetera. So it's sort of power alley, fastball down the middle, improvements of the value proposition in legacy markets. It's to stabilize, continue to stabilize and improve things in the 2 new markets that have consumed the most economic resources, and it's to selectively grow. And as I mentioned, we've already identified a handful of very promised opportunities and are in various stages of execution on those and are picking from a bunch more for the next handful. So I think that's kind of the trilogy of focus. If that's helpful, I recognize it's quite generic at this point.

[Justin Lake:]

Okay. And last question, just on HCP again. One, you mentioned that you expect $25 million of improvement. I didn't catch what was driving that. And then secondly, in terms of the startup losses or the new market losses, can you give us a reasonable trajectory as to when you think you can get them back to breakeven?

[Kent J. Thiry:]

On the first question, Justin, I don't think we want to break out the $25 million because it's a couple different markets, it's a lot of different variables. I think the important news for shareholders is just that we're feeling good at, at least, a year-over-year $25 million pickup, which is a very significant amount, especially in 2 markets where we have a nontrivial market position to build from. And then as to exactly what their net economic statuses and when they hit it, I don't think we want to get into that level of detail. And in part, there are decisions in each place, and we may decide to have losses go on longer. Because of the returns we think we'll ultimately get, it's really too difficult to predict. So unfortunately, I got to stay away from that.

[Operator:]

Our next question comes from Ms. Darren Lehrich, Deutsche Bank.

[Dana Syrune Nentin:]

This is Dana Nentin in for Darren. Just as it relates to HCP on the new market entry strategy, can you just discuss progress with Tandigm Health JV in Philly and then maybe update us on any similar types of relationships you have?

[Kent J. Thiry:]

Tandigm, the short answer is it's going well, but of course, that has to be qualified by the fact it's still in the early stage. We hit our target of 300 primary care physicians who signed up to work with Tandigm, which is exactly what we wanted. They are the physicians we were hoping would join. They are physicians that are committed to moving forward with IBC as a big payer and us in order to start to improve managed care in that community. And so without at all underestimating the business challenges to come, so far it's right on track. We've got the right partners, we've got the right tools, we've got the right momentum, but there's a lot of work ahead of us and time will tell. And then I guess, Dana, the other question is, might there be others? The short answer is yes. It's a model that attracted a lot of interest. We just have to decide how many we want to do at what pace. Now we don't want to get ahead of ourselves in terms of our capabilities.

[Dana Syrune Nentin:]

Okay, got it. And then continuing on HCP, can you just discuss medical cost trends in the quarter and whether your margin outlook has changed given the utilization environment?

[Kent J. Thiry:]

I don't think we have anything material to say on that. There hasn't been anything dramatic going on one way or another within the quarter. And so it's sort of business as usual, which is not to say it's a smooth line, but there's nothing noteworthy, I think, in the quarter itself.

[Operator:]

And next we have Mr. Kevin Fischbeck, Bank of America Merrill Lynch.

[Kevin M. Fischbeck:]

So I guess I just want to understand how the offsetting dynamics in the quarter that you mentioned in HCP works. You're saying that the Medicare rates you don't expect to happen in Q3 happened in Q2, so maybe it was net neutral to this quarter. But is it still net negative when you think about the yearly guidance?

[Kent J. Thiry:]

Well, certainly, it means that Q3 will be missing that incremental boost. It would have already happened, but that reality is incorporated into our total guidance for the year. And so it doesn't change our guidance, the fact that it moved from Q3 to Q2.

[Kevin M. Fischbeck:]

Okay. Then just to understand the guidance then because you basically got $20 million of out-of-period revenue, but you kept the low end the same, you took the high end down by $20 million. So did you really take the low end down by $20 million and the high end down by $40 million on a 2014 kind of earnings space then?

[Kent J. Thiry:]

Could you repeat the question, please?

[Kevin M. Fischbeck:]

Well, so your guidance for HCP, I believe, kept the low end of the range and reduced the high end by $20 million. But you're saying you got $20 million out-of-period revenue and, theoretically, operating income. So if you're just trying to focus on what you actually earned in 2014, did you essentially take the low end down by $20 million and the high end down by $40 million.

[Jim Gustafson:]

No, we did not, this is Jim Gustafson, because we had already incorporated the probability-weighted impact of this into our guidance. So that had already been incorporated into the guidance.

[Kevin M. Fischbeck:]

Okay. So the potential to kind of pick up prior year revenue for things like this is something that we should expect to happen and therefore not -- every year and therefore not to adjust out of the operating income even though it is related to the prior year?

[Kent J. Thiry:]

Let me take a stab at that. There's a certain amount of puts and takes in an IBNR-intensive business that happen all the time. And so what we try to highlight for you is when there's an unusual number of them, which we've had a time or two in the last 18 months, and when it's more than normal offsetting puts and takes. Does that help answer -- there's no black and white answer. You never expect a year in this kind of business without some prior period adjustments, but you also don't expect too many of them. Is that answering the question?

[Kevin M. Fischbeck:]

Well, I guess maybe the better way to ask it is when you talk about next year being better by $25 million, do you mean it off of this current guidance rather than off of the 2014 actual earnings in the current period?

[Kent J. Thiry:]

Okay, I get the question now. I apologize for missing it before. The comment on $25 million improvement was focused on the 2 significant new markets of New Mexico and Arizona, that in those competitive arenas, we are confident of a year-over-year $25 million OI improvement. That $25 million then would become a factor in the aggregate HCP performance, which we're not commenting on now. We were just highlighting a delta in those 2 new markets.

[Kevin M. Fischbeck:]

Okay. But I guess -- I think you said that the network $25 million number was mostly new market. Is that right? So either with that extra new market income this year, you're going to do $25 million better than that next year?

[Kent J. Thiry:]

That is correct.

[Kevin M. Fischbeck:]

Okay. All right. And then I guess when we think about -- you mentioned that there's a number of things that you're analyzing now, there's a number of things you've kind of got in the hopper for the next round of things. How do you think about the competitive landscape? I guess there was recently an article about how there's a record number of ACOs and doctors and hospitals competing for physician alignment and things like that. Do you as a company look at this and say, "We kind of have to do more than maybe we're ready for in the next 12 to 24 months because if we wait 5 years, all the partners who are the strongest partners will have done something?" How do you balance that as you analyze the opportunity set?

[Kent J. Thiry:]

Yes, very fair question. In general, on the one hand, there is increased supply of competition, more and more people trying to do population health management. On the other hand, there has been a proportional increase in demand for the same. And so I don't think there's been any fundamental change in the demand-supply relationship, which is what really matters, and nor are things going to happen quickly or I should say, there will not be a lot of successes quickly. An awful lot of the people who are getting into this space or who've gotten into it in the last year or 2 or 3 are failing, if not on an absolute basis, on a relative basis. And so I think from a strategic point of view, the important thing is to maintain a differentiated better product, and in that context, there'll be no shortage of opportunities for the next 5 to 10 years.

[Operator:]

Our next question comes from Mr. Kevin Ellich, Piper Jaffray.

[Kevin K. Ellich:]

Kent, just wanted to kind of follow up on the ACO questions. What are your updated thoughts on the care coordination model and even maybe greater use of certain physicians maybe even in hospital medicine?

[Kent J. Thiry:]

Can you elaborate a little further on the question? I think I would be groping if I answered now.

[Kevin K. Ellich:]

Yes. Sure. So one of your big competitors recently made its entry into the Hospitalists industry, and it was kind of an interesting move. Obviously, a lot of hospital medicine is used in the ACO integrated care model. I'm wondering if you guys could look to expand into that area specifically in terms of improving the coordination of care between acute and post-acute patients.

[Kent J. Thiry:]

Okay. Let me take a stab at it. You let me know if I'm not responding. We have some of the best Hospitalists operations in America now embedded within our existing markets and up to this point, have opted not to try to create what we might call a vertical and take certain capabilities outside of our legacy markets and sell them, market them, implement them on an isolated vertical basis. However, strategically, that is something we talk about regularly. Just up to this point, we've never opted to do it.

[Kevin K. Ellich:]

No. That's helpful. And then going back to your comments about population health management. Just wondering, what do you think are the keys to driving improvement in outcomes within population health management? And then also, do you think there are any hot button issues in that category as well?

[Kent J. Thiry:]

Well, I think one of the primary tenets of our answer to that question and one of the ways in which we're highly differentiated is that we believe putting the physicians in the spot of operating leadership is critical, and that's part of the legacy of HealthCare Partners, it's part of why we've been as successful as we've been. So I think that and investing in technology over the next 3, 5, 7 years, those are 2 of the primary components of the answer.

[Kevin K. Ellich:]

Okay. That's helpful. And then lastly -- no, actually, 2 questions. Thoughts on biogenerics coming in on the ESA front like Mircera. Do you have any pilots or plan to have any pilots where you could use new ESAs? And then could you prioritize uses of capital?

[Kent J. Thiry:]

Okay. On the biogenerics, we, of course, like any customer, like it when there's -- when our suppliers, whether they be vendors or partners, have competition. And so no surprise, we're in favor of there being new entrants into all products and drugs and biogenerics that we have to purchase. We're wildly in favor of that. And we will work with some companies bringing new stuff to the market if the terms make sense. And at the same time, we value very highly our historical relationship with Amgen and the clinical value of the drug that they provide. On the capital allocation, I think the way we've answered this best historically is to have people look in the rearview mirror and see that over 15 years, we've done a lot of different things in terms of our leverage ratio, in terms of buying back stock, in terms of paying down debt, in terms of changing the nature of our debt, in terms of investing in acquisitions and et cetera, et cetera, et cetera. And so I think we bring a pretty open mind to what is the right way to think about capital allocation that's very time-specific, fact-specific, et cetera, always trying to manage the risk-adjusted upside for our shareholders.

[Operator:]

Our next question comes from Mr. Gary Lieberman, Wells Fargo.

[Gary Lieberman:]

Could you talk a little bit about how you view the change of the risk adjusters next year on the Med Advantage business and how significant of a positive that could be to HCP?

[Kent J. Thiry:]

Well, I would just say, our expectations on that are baked into our guidance for this year, and next year, we've not provided guidance for. And certainly, whatever the government decides to do -- well, I guess, can you repeat the question? Are you talking about '15 or '16, Gary?

[Gary Lieberman:]

'15.

[Kent J. Thiry:]

Well, there, we have the positive of some adjustments to what they were doing on risk adjustments versus the negative of reductions to the underlying rates. And so as we provide you with guidance for '15, there will be a netting of those 2 effects.

[Gary Lieberman:]

Okay. And then I guess how are you thinking about '16?

[Kent J. Thiry:]

Who knows? I mean it's just so hard to predict what the government is going to do with -- if they compress acuity scoring, that hurts us because we have a lot of high acuity patients, and we think it would be a big mistake for the Medicare program to do that because you want to attract investment in the ill people and make them healthier, that's when the whole system works in a virtuously reinforcing way, clinically and economically. So if they compress acuity scoring, that's bad. On the other hand, of course, if they leave that the same but drop underlying overall rates, that's bad too. So we kind of have to wait and see where they come out.

[Gary Lieberman:]

Okay. And then your comments regarding new markets on HCP. It sounds somewhat more bullish than maybe you've been in the past. I guess in the past, you've talked about entering, refresh my memory, 2 or 3 markets this year, with a couple more next year and a lot more the year after that. Is that still the way to think about that? Or could that be accelerated somewhat?

[Kent J. Thiry:]

I would not presume any acceleration. And in fact, in the last quarter, I, if anything, nudged expectations towards deceleration. But I think that the difficulty here is sort of the unit of measure. We are going to do some new things and then probably more new things next year and more the year after and so on. If you just use that as sort of the crude metric, those words are probably still true. However, the math on a lot of those things is going to be quite small in the early years, just like Tandigm is not something that's going to have a huge, immense impact for a whole bunch of reasons tied to our strategy with our partner. And so the number of things we do might be quite significant, but the math of it is very hard to predict and is probably not going to be as significant as the unit number.

[Gary Lieberman:]

Okay. And then probably maybe just an update on the recovery in Albuquerque?

[Kent J. Thiry:]

I don't think it's a good idea to go into a huge amount of individual market detail. Again, we did want to convey that in the 2 new markets that have been consuming the most resources, we're looking at a very nice year-over-year improvement, '15 over '14, and the odds of that will happen are very high. And probably just leave it at that. As you do know, the government approved the acquisition by Blue Cross Blue Shield of the MA plan, and that's a good thing for us because it puts us back in network and our number of lives, our MA lives has gone up in a very nice fashion since then. But to start slicing and dicing it, I don't think is a good idea. The aggregate math is probably the best way to characterize it.

[Operator:]

Our next question comes from Ms. Margaret Kaczor, William Blair.

[Margaret Kaczor:]

A few for me. First, you guys haven't talked about the number of international patients you have right now in a while. What is that number today?

[Kent J. Thiry:]

Between 5,000 and 6,000 at this point.

[Margaret Kaczor:]

Okay. And then at what point really does that become material? Because I think that's about 100% growth year-over-year. Is that right?

[Kent J. Thiry:]

Off hand, I don't know, but it must be something in that ballpark. It's -- we have not provided a forecast of patient growth internationally for a reason because there's going to be too wide a range of outcomes at this point. We've been very pleased with the growth that's exceeded our expectations. And so I think we just have to stop there and keep on reporting it. But it's too -- there's too much uncertainty right now as you divide it across the 10 countries that we're operating in to allow us to give you a high confidence forecast.

[Margaret Kaczor:]

Okay. Can you talk a little bit about the growth in home dialysis? Are you guys still investing in that? Is there still opportunity in PD or HHD? Or is it kind of penetrated now with the bundle?

[Kent J. Thiry:]

Home dialysis continues to grow, and we think that trend will continue.

[Margaret Kaczor:]

Okay. And then one more for me. Can you give any update on kind of the dual eligible contracts that you've seen right now in California? Is it something you've kind of been walking away from right now or still kind of in negotiations? When should we hear something about that?

[Kent J. Thiry:]

We're quite excited about dual, strategically, and we have 1 contract buttoned up and signed and a few thousand lives already signed up. And at this point, we would estimate in that contract alone, we might very well end up with 10,000 or so. In addition, we're still in discussions with a couple of other parties. But even with this 1 contract, we're very excited that we're going to get an opportunity to develop some new muscles and demonstrate the power of some old ones. And so, so far that's playing itself out very, very nicely and hopefully going to lead to a lot of growth in the future.

[Operator:]

Our next question comes from Mr. Matthew Borsch, Goldman Sachs.

[Matthew Borsch:]

I just wanted to ask on HCP. If you can talk at all about how your payer contracts have evolved, if at all. Imagine with all the changing reimbursement, is that a place where you had intense negotiations over the last year? Or is it then sort of steady state on that front?

[Kent J. Thiry:]

Yes, there've been intense negotiations. And as we've said consistently, the portfolio of contracts will be amended over time and, in general, where we come from, is making them more and more partnership-oriented, with aligned upside and downside as opposed to confrontational upside, downside or whatever is the opposite of aligned. And some payers are very philosophically open to that, others are not. Hence -- and in either case, there's intense negotiations as to what that means. So we've made some nontrivial progress, but the portfolio will take a while to resolve itself. And some parts will never be aligned. Just like in Kidney Care, when we stated that we wanted to move towards more bundled contracts in the private sector, we did so over 5 years, but still, to this day, are not to the point where every private contract is bundled.

[Matthew Borsch:]

And given some of the challenges that you had with HCP, has that made you think more or less about the possibility of offering HCP as its own plan, if you will, either on your own or in some form of partnership? Is that something that you have any change in interest in, in the last 2 years?

[Kent J. Thiry:]

No. It hasn't changed our views on that at all, which is to say, strategically, we are open to being a plan. If at any point that makes strategic sense and if we have the right relationships and contracts with existing plans that may never be necessary.

[Operator:]

And there are no further questions on the phone at this time.

[Kent J. Thiry:]

Okay. Thank you, all, for your interest in DaVita HealthCare Partners, and we will do our best for you over the next 3 months. Have a good day.

[Operator:]

That concludes today's conference call. Thank you for participating. You may disconnect at this time.