DocGo Inc. Price & Performance (DCGO)

Operator. Before turning the call over to management, I would like to make the following remarks concern forward looking statements. All statements made in this conference call other than statements of historical fact are forward looking The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward looking statements. These forward looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expect Forward looking statements are inherently subject to substantial risks uncertainties and assumptions many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward looking statements. These risks, uncertainties and assumptions include, but are not limited to, those discussed in our risk factors and elsewhere in DOCCO's DocGo report on Form 10 ks quarterly reports on Form 10 Q and other reports in statements filed by DOCCO with the SEC DocGo which your attention is directed. Actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward looking statements.

In addition, today's call contains references to non GAAP financial measures. Reconciliations of these non GAAP financial measures to the most directly comparable GAAP financial measures are provided directly as part of this this call or included in our earnings release or on the current report on Form eight ks that includes our earnings release, which is posted on our website .go.com DocGo well as filed with the SEC. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time. We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events except to as the extent required by law. At this time, it is now my pleasure to turn the call over to Mr. Lee Beanstock, who CEO of Dotco.

Lee, please go ahead.

Thank you, Mike.

Thank you all for joining us today. The fourth quarter marked a period of aggressive investment as we continue to build out our CareGap closure footprint in response to strong demand from our customers, In addition, continue to invest in our current operational and management structure to support the next leg of growth across our customer verticals. We are thrilled with both the progress and the results of these programs. But these investments also come with a near term impact on profitability. While we regularly review our expenses for efficiency gains, particularly with respect to our non field headcount, we want to ensure that we retain the talent base that will be necessary for the next phase of our growth. Our goal is to build a one hundred year company that fundamentally transforms how healthcare is delivered. And achieve our mission of bringing high quality highly accessible care to all To achieve this vision, it is vital to have a clearly defined value proposition that resonates with our customers and the patients we serve. Based on our early data points, we see tremendous value creation potential from our So we plan to continue making We are adding experienced operators, top shelf sales personnel and continuing to make considerable enhancements in our tech stack to support the rapidly growing needs of our customer base.

The scale of what we continue to accomplish is a testament to the impact we are making on how healthcare is delivered. In 2024 alone, DOCCO's proprietary tech platform calculated over 15,000,000 estimated arrival times for our customers Our network of clinicians traveled over 8,800,000 miles, to facilitate care across over 1,500,000 patient interactions. These included facilitating vaccinations for over 58,000 adults and children and coordinating over 99,000 behavioral health depression screenings.

DOCO was assigned hundreds of thousands of patients for care gap closure programs and scale these programs considerably In New York, and California. All told, we provided services across 31 states in The U. S, and across The UK. I'm so proud of the fact that DOCO DocGo recognized as one of top innovators and places to work in healthcare. Last year alone, we received over 40,000 job applications from healthcare clinicians and corporate staff seeking to join us on our mission to provide high quality highly accessible care [indiscernible] A testament to the quality of our offering is our fourth quarter Care Gap closure program NPS, or Net Promoter Score of 86 To put that number in perspective, in healthcare, above 30 is deemed good, above 50 is excellent and above 70 is deemed world class. Both our patients and our customers are delighted with the quality of our programs and we see a substantial opportunity to accelerate our growth in this market via both organic and inorganic means, in the coming quarters. When working with our insurance customers, we don't go in pitching a specific care gap program. But offer a clinical platform in a mobile setting that health plans can leverage to engage their hard to reach costly patients.

This translates into a very sticky relationship we deliver strong value for our customers and they begin to look at us as partners not just a vendor. We see strong evidence of this given that many of our health plan partners from 2024 are looking to significantly expand their relationship with us from both a scope and scale perspective. I would like to take a minute and provide a few specific examples. First, a major payer in the Tristate area with 3,000,000 members that had assigned us a substantial number of lives for care gap closure, advised that it now wants to expand into PCP services. Specifically targeting their populations are unattached and underserved. And they're also considering utilizing DOCO's mobile clinics to bring care to communities that would benefit from increased access to healthcare services. Second, a major payer on the West Coast with 5,000,000 members that we provided care gap closure services for in 2024 now wants to expand our relationship to include mobile mammography, PCP, mobile clinics and transition of care services. Another West Coast customer indicated that it wants significantly expand our transition of care program to cover all hospital discharges at two of their highest volume hospitals in the region, and include chronic care management for high risk populations with diabetes and hypertension.

A major payer in New York with 5,000,000 lives is from 10,000 Medicaid members to 40,000 to 50,000 unengaged members this year. And another East Coast payer with 2,000,000 members that began with a bone density scan care gap closure program is now looking to add immunizations as well. On a macro level with payers, our customers consistently share that they are laser focused on quality initiatives as CMS and states across the country are making it harder and harder to reach quality measure thresholds, which places downward pressure on these plans ratings. In addition to our existing customer base, there has been a flurry of inbound inquiries recently can be attributed to payers looking for solutions but also a broader appreciation medical care and care gap closure programs in the home To continue building our scope of services in this vertical, earlier this month, we acquired PTI Health, a mobile phlebotomy company. We believe this is a great example of an acquisition that we can grow considerably based on demand from both PTI's existing base as well as our RAS of customers expressing interest. Our immediate plans are to expand these capabilities in the New York market meet the needs of a major national lab partner with additional geographies to follow.

In our government population health vertical, our work with the migrant related HPD contract concluded in mid December. We anticipate that associated receivables under that contract will be fully paid by the end of Q2 of this year. Regarding our migrant related programs with New York City Health and Hospitals, we continue to expect that contract to largely wind down in the first half of twenty twenty five. Our accounts receivable under all of our migraine related programs totaled approximately $150,000,000 as of year end with approximately $30,000,000 of associated payables, due to subcontractors which we expect will create a significant cash flow tailwind through mid-twenty twenty five. On the business development front, we have made considerable progress at the federal level and have secured two contracts for subcontracted work at the VA, Under these contracts, we will be facilitating vital examinations for veterans while improving access to care and help remove backlog challenges that the system has been facing. We are ideally positioned to leverage our mobile care delivery model to help serve the needs of the VA And we brought on Doctor. David Shulkin, the former Secretary of the VA, to help guide the company's efforts and drive growth in the population health vertical.

I'm also pleased to report that our mobile X-ray program in New York continues to expand has now completed over 2,000 images since inception late last year, Our hospital customer vertical which is predominantly medical transportation, continued to perform well with customer expansions in several key markets, we signed a two year contract with the major Texas healthcare system in the Dallas Fort Worth area. Keeping with our strategy, of entering markets with an anchor customer. We signed a two year contract extension with a leading Tennessee based healthcare system to continue providing services in Nashville and just announced that we are launching services in Chattanooga, Tennessee to serve their facilities in that region We are also expanding our relationship with the largest healthcare system New York State, Before I hand it to Norm, I think it's important to note that while we were able to maintain gross margins at the same level year over year, SG and A as a percentage of revenues in the fourth quarter was substantially greater than in recent periods.

We chose and will continue to choose to maintain and invest in our infrastructure to prepare for the next growth opportunities ahead.

Given the expedited drop in migrant related revenue, lost a lot of that leverage that comes with a higher revenue base. We view this as a temporary factor and anticipate that we will be able to complement our existing customer expansions already underway with accretive M and A opportunities that will allow us to return to a significantly higher revenue base all while maintaining the highest level of quality during this transitionary period. If we do not believe strongly in the growth opportunity ahead, we would be making more substantial cuts to get that SG and A percentage in line with historical levels. But that is not the case. The strategic value of being in the home and accessing traditionally difficult to reach populations to bring them preventative care is becoming increasingly obvious to customers and the pace of inbound inquiries and the pipeline in general has never been stronger. This is a time to invest in our future build critical mass and continue to deliver exceptional quality in the field and we could not be more excited about what lies ahead. At this point, I'll pass it over to Norm to cover the financials. Norm, please go ahead.

Thank you, Lee, and good afternoon. Before I run through all the fourth quarter results, I'd like to start by discussing our performance against our most recent guidance. The fourth quarter results were below the guidance range we announced back in November. Particularly in the area of adjusted EBITDA. Where our actual fourth quarter results fell short by about $10,000,000 when compared to our implied guidance range. Looking at all the contributing factors, our revenues were about $9,000,000 or 7% below our forecast with that shortfall entirely attributable to migrate related revenues as we executed an orderly wind down of some sites on a more expedited schedule, and some services were curtailed at the sites that remained operational. This revenue shortfall translated to 5,300,000.0 of the adjusted EBITDA shortfall. In addition, approximately $1,500,000 relates to incremental investments into our CareGap closure business, both in the cost of goods sold and SG and A areas of the income statement. Also contributing to the shortfall there were $3,200,000 of unanticipated expenses spread across lines of insurance, where we are self insured. So now let's turn to the actual results and operations for the fourth quarter and full year 2024. Total revenue for the fourth quarter of twenty twenty four was $120,800,000 which was a 39% decrease from $199,200,000 the fourth quarter of twenty twenty three.

The entirety of the year over year revenue decline related to migrant projects. As we have documented over the past several quarters, our migrant related work peaked in the fourth quarter of twenty twenty three and began to wind down in May of twenty twenty four, the exit from the New York City base sites. By the end of twenty twenty four, we had exited all the HPD sites, and the remaining migrant work with New York City Health and Hospitals is expected to be substantially completed by the midpoint of this year. For the full year, revenues were $616,600,000 in 2024, down 1% from 2023. Mobile health revenue for the fourth quarter twenty twenty four was $71,800,000 down 52% from the fourth quarter of twenty twenty three which was the peak of our migrant related business.

For the year, Mobile Health revenues of $423,100,000 were down 4% the 2023 level. Medical transportation revenue increased to $49,100,000 in Q4 of twenty twenty up about 1% from the transport revenues we recorded the fourth quarter of twenty twenty three. Transportation revenues for 2024 were 7% higher than in 2020 Great. And they have increased at a compound annual growth rate of 32% over the past three years. We have several recent contract wins and a robust pipeline that gives us confidence in our 15% annual revenue growth expectation for 2025 and beyond. We recorded a net loss of $7,600,000 in Q4 twenty compared with net income of $8,000,000 in the fourth quarter of twenty twenty three. For the full year, net income rose to $13,400,000 in 2024 up 34% from $10,000,000 in 2023. Adjusted EBITDA for the fourth quarter of twenty twenty four was $1,100,000 compared to $22,600,000 in last year's fourth quarter.

For the full year, adjusted EBITDA was $60,300,000 a 12% increase from $54,000,000 in 2023. The adjusted EBITDA margin for the full year of 2024 was 9.8% up from 8.6% for the full year 2023. Total GAAP gross margin percentage during the fourth quarter of twenty twenty four was 30.8% down from 31.2% in the fourth quarter of twenty twenty three. The adjusted gross margin which removes the impact of depreciation and amortization, was 33.5% in the fourth quarter of twenty twenty four, identical to the adjusted gross margin recorded in the fourth quarter twenty twenty three. During the fourth quarter of twenty twenty four, adjusted gross margin from the Mobile Health segment was 35.9% up from 32.2% in the fourth quarter of twenty twenty three. In the Transportation segment, adjusted gross margins were 30.1% in Q4 twenty twenty four, down from 37.4% in Q4 of twenty twenty three, which had benefited from several one time items. Transportation margins were still impacted in Q4 by residual subcontractor costs in one of our larger markets. However, as the fourth quarter came to a close, these subcontractor costs had been nearly eliminated. As we were able to fill staffing gaps via newly hired field personnel.

Looking at operating costs, SG and A as a percentage of total revenues amounted to 39.7% in the fourth quarter of twenty twenty four up from 27.6% in the fourth quarter of twenty twenty three. However, absolute dollar terms, SG and A declined 13% from last year's fourth quarter. As revenues declined over the second half of twenty twenty four, we saw SG and A increase as a percentage of total revenues. Reversing the operating margin expansion we had seen in the second half of twenty twenty three and in early twenty twenty four. In addition, Lee mentioned earlier, we invested aggressively in our payer vertical and additional mobile health services, These expenditures came in the areas of personnel, marketing, billing, credentialing, technology and setting up and equipping base locations for our personnel in those markets. As a result, Q4 witnessed a pause in our trend of sequentially lower SG and A costs that we would expect to be temporary. Since Q4 of twenty twenty three, our migrant related revenues peaked, have experienced a concurrent albeit smaller sequential decline in overall SG and A. In Q1 of twenty twenty four, our SG and A declined by 7% from the levels of Q4 of twenty twenty three.

In Q2, SG and A declined by another 11% and in Q3, by another 13%. In Q4 twenty twenty four, however, due to the items mentioned above, SG and A increased from the levels of Q3 by about 20%. While we will continue to invest in our growing business lines, we do expect that the sequential declines in quarterly SG and A will resume in Q1 of twenty twenty five. Now let's turn to our balance sheet where we made great strides in 2024 and which will play a key role in our ability to deliver the growth initiatives that Lee has just outlined. As of 12/31/2024, our total cash and cash equivalents including restricted cash was $107,300,000 as compared to $72,200,000 as of the end of twenty twenty three, an increase of nearly 50% year over year. Were able to build up our cash position despite spending close to $14,000,000 in 2024 on stock buybacks and an additional $5,000,000 in our equity investment in Firefly Health. We generated $70,300,000 in cash flow from operations in 2024 a very significant turnaround from 2023 when cash flow from operations was a negative $64,200,000 However, the cash flow from operations in the fourth quarter was below our own expectations, reflecting a slower than expected payment experience with New York City's Department of Housing Preservation and Development HPD, Specifically, there were two monthly invoices, totaling approximately $35,000,000 that we had expected to collect during the fourth quarter, but did not.

We have collected significant sums from HPD so far in 2025, and we continue to expect to collect everything that is outstanding. Which will further bolster our cash balance thereby increasing our investment capital. Our accounts receivable continued to decrease due to the collections of our larger invoices and reflecting the decline in migrant related revenues that we witnessed over the second half of twenty twenty four. At year end, net accounts receivable were $210,900,000 down 20% from $262,100,000 at the end of twenty twenty three despite the fact that revenues were essentially the same in both years, Consequently, our day sales outstanding DSO was one hundred and twenty five days at the end of twenty twenty four, a nice improvement one hundred and fifty three days at the end of twenty twenty three. Our goal remains to bring consolidated DSO into the ninety to one hundred day range by around the midpoint of 2025 as we collect our larger and older municipal invoices. Our largest customers are paying us regularly and payments continue to come in. Including several large payments we have received this week. As we convert our accounts receivable to cash.

Finally, turning to our guidance and outlook for 2025, we continue to expect full year revenues in the range of $410,000,000 to $450,000,000 We further expect that gross margins will remain in line with or slightly better than those of 2024. Given the expectation for ongoing investments in our new business lines, we anticipate that EBITDA margins will be in the mid single digits. However, with our large accounts receivable base continuing to shrink, as we drive collections, we expect that cash flow from operations will be significantly higher in 2025 than the $70,000,000 we generated from operations in 2024. At this point, I'd like to turn the call back over to the operator for Q and A. Operator, please go ahead.

Thank you. Ladies and gentlemen, we will now begin the question and answer session. Should you have a question, Your first question comes from Pito Chikaring from Deutsche Bank.

Hey, good morning guys. On the 2025 revenue guidance, last quarter you said that the base business would be $360,000,000 to 400,000,000 with migrants of $50,000,000 with migrants wanting down a lot faster in the fourth quarter. You assuming that the base business is growing faster in '25 or are you still thinking of the $50,000,000 for the migraines in 2025?

Hi, Peter. Absolutely. Thanks for the question. So on our last call, we shared that migraine revenues were expected to be, as you mentioned, dollars 50,000,000 this year, It's safe to say that the migrant situation is quite fluid and dynamic right now at the moment. And so we're keeping our revenue guidance the same for this year, but I do think it's entirely possible that the shift continues to move as it has been from migrant related revenues over to base business revenues. And so it has definitely possible that migrain related revenues can be below that $50,000,000 range and and in our forecast any migraine related revenues would be replaced by the base business revenues and we remove those operations and personnel over to the growing base business revenues that we're experiencing right now.

That's a pretty big growth of the base business. I mean and here we are sort of almost two months of wait through the year. I mean, do you think that the base business really pick up an extra $25,000,000 $30,000,000 $40,000,000 beyond we guided to just in November.

Yes, we're very excited about where the base business is right now. As an example, since you mentioned, our pipeline for our base business is quite robust. We have about 27 deals in the pipeline for municipal contracts, almost thirty, twenty nine health system deals in the pipeline. We have over 120 payer and provider deals. So we have a very robust pipeline, something the company has been working on all of last year as we transition out of the migrant related contracts and as we transition over to more evergreen municipal work as I was detailing earlier in the call. So we have a very robust pipeline. A lot of our customers are in expansion mode right now. As I mentioned, we're investing into that. So we feel very good about the pipeline. And as [indiscernible] Related projects are winding down. Our goal is to transition a lot of that corporate personnel and that field staff over to those growing budding base business revenues.

Okay. And then so looking at the guidance on the margin last November versus today, so that sort of $17,000,000 of investments that are new order to go from 8% to 10% to the 5%. I guess, where exactly are the $17,000,000 investments going in order to to grow? It just seems a pretty substantial amount of investments in order to keep the revenues the same. So can you sort of give us more of detail as exactly why need to spend that today versus you didn't think you'd spend that a few months ago?

Yes. I think some of the big buckets. First off, we are investing and continue to invest in the tech stack. One of the things we did at the end of Q4 is we automated our patient engagement process. And that significantly allowed us to increase our bookings for the Care Gap closure programs. I mentioned on the last call, we came very close to that 1,000 visit a week exit rate on the CareGap business to close out the year. So we're going to continue to make investments on the tech stack, We continue to bring on well trained field personnel, particularly LPNs to go into the home and deliver [indiscernible] field personnel, we are training for a very, very wide skill set We do over 35 different care gap closure procedures in the home. And so our clinicians are being trained for this wide scope of practice that is very attractive to our customers. So we want to make sure that our field personnel are equipped with the proper technology as well as the proper training to deliver an exceptional experience in the field and we are investing pretty heavily in that. I'll also say we've been investing in our business development personnel to continue to drive the pipeline and move some of these deals forward.

And so we're going to continue making investments as well in our corporate staff as well as the training field staff.

Those are the big areas.

Yes. A. P. O, it's normal. I'll just add to that. Touching on what Lee was saying. I mean some of this relates to discretionary spending that we're doing. We've spent [indiscernible] talking about the need to right size our SG and A so that it remained a relatively close percentage of revenue to what it had been in the past. Realistically though as we look through it and Lee alluded to this in his comments, we're seeing areas where we're reluctant to take out certain types of infrastructure and corporate overhead costs because these are people who are going to be a big part of the growth of some of these programs that we've been talking about. And so it's not like we've certainly haven't given up on the cost cutting. We are deeply, deeply engaged in it. And everybody here is deeply engaged in it. You're going to see the fruits of that as we go through 2025. But we're doing it in a maybe a more measured way So the trajectory of the decline in those corporate overhead costs with a change in that trajectory is one of the large reasons why we think that the EBITDA margin will be different from what we had thought a few months ago.

Okay. I'll go back to that sort of my first question. Just running some numbers here. I mean, if before you get to target sort of $50,000,000 of migrants in '25 or maintaining revenues So we're saying that base business is getting better. If I'm to offset say $37,000,000 of that, I'm just pulling the number out of the air, that's about a 10% sort of increase of the base business versus where we were in November. Are those deals already closed at this point? I mean, have you already closed 10 where we are today than we were in November. I mean, again, like as we are looking at the leverage here, SG and A leverage and gross margin and with this margin coming down, like have these deals already been closed at this point?

Yes. We have closed 10% more deals the start of this year and as we closed out the year last year. And then we have those additional deals in the pipeline as well that we're continuing Great. Thanks so much. And so Absolutely.

Thank you. The next question comes from Sara James with Cantor Fitzgerald. Please go ahead.

This is Gabby on for Sarah. I wanted to touch on the $3,200,000 of unanticipated expenses. EBITDA falling short. Can you talk about what visibility you have that that won't repeat in 2025?

Yes, it's a great question. Hey, Gabby, it's Norm. Look, the first thing I'll say about it is that when you're self insured as we are, There's no question that that there's a little bit of uncertainty about where the what those numbers are going to be like as opposed to if we are completely insured in a regular manner where paying a premium, we know what the premium is going to be by and large. And then you're just trying to predict what the premium is going to be from year to year. Here, obviously, being self insured. So there are claims that are going to come in. Their claims are going to come in at a higher or lower level than what we had reserved for There's the IBNR piece of it, which is in anticipation of the claims that were incurred but not yet reported. So there's always going to be a fluctuation. And that number can go up, that number can go down. There are a lot of things that can in that regard. So it's hard to say that it won't repeat, but likely the way we do the reserving is if you're reserving in one quarter, you're probably going to be properly reserved for the next couple of quarters.

The one thing I'll point out, and it's something we discuss here internally, at least on a monthly basis, We are saving I would estimate in the millions, if not maybe above $10,000,000 year by having things like workers' comp, auto, and even our health insurance as part of our captive insurance company. In fact, if anything, we're working on potentially moving other lines of insurance like cyber and general liability, professional liability into that place as well.

It's worked well for us. Generally speaking, I'll just use ambulance insurance or the auto part of it or the liability part of it as an example. Tends to be very, very expensive and very overpriced. And what we found is that our experience has been substantially better than what it would be. And we're consistently comparing it to the prices that are out there in the market. So we're willing to accept some fluctuation in that cost. This quarter we saw the downside of it. But on an ongoing basis, it's lower than it's lower than would have been. So we look at it on a project basis across time, we're definitely still well ahead of it. Okay, great. And then if I could just sneak in one more. I thought I heard you mention in the prepared remarks a sequential decline in SG and A throughout the quarters of twenty twenty five. Would that be on a dollar based metric or as a percentage?

Yes. So actually what I had mentioned was we had seen a sequential decline in 2024. When I start with my base as Q4 twenty twenty three, is a high point on a percentage basis, And on a dollar basis, it came down in Q1, came down in Q2 and Q3.

Popped up in Q4, I'm saying is that we would expect we fully expect that in Q1 of twenty twenty five in dollar terms SG and A will be lower than it was in this past Q4 that we just reported. Now in terms of percentage, if I look out to the year, I would say that most likely based on the way the revenues are trending and that's obviously going to be a big a big deal as far as calculating the percentage of revenue that SG and A represents, So I would say Q1 will be better than we saw in Q4. Q2 will be about the same level as Q1, maybe tech percentage basis. Once you get into Q3 and Q4, we're going to get a lot closer to that level that we had seen prior to Q4 of this year. As some of that revenue comes in that Lee was alluding to earlier, So those contract wins will translate into actual revenue. In terms of absolute dollars, we would expect we would see sequential declines in absolute dollar SG and A throughout the year.

Okay, awesome. Thank you guys.

Thank you. The next question comes from Richard Close with Canaccord. Please go ahead.

Yes, thanks for the questions. Excuse me. I jumped on late. Lee, can you tell us what the Migrate revenue specifically was in the fourth quarter and the full year? Just trying to see if like the core met that $240,000,000 to $2.60 type of number that you guys were looking for?

Absolutely. Hi, Richard. So the micro revenues in Q4 were approximately 55,000,000 and for the total year, answer your question, it's about $370,000,000 We did hit we had shared on our previous call that our expected range for the base business to be $240,000,000 to $260,000,000 the revenue guidance for that base business range. Yes, we were about $246,000,000 to $250,000,000 in that area. [indiscernible] Okay, great. Thanks.

And sorry for jumping on the call late there. Norm, did it I'm trying to remember going through my notes here quickly, but didn't something this insurance pop up a couple of years ago, I want to say, And is there any way to prevent this just based on what you're doing with guidance and whatnot, to be more conservative. So we don't have something like this Well, I don't I'm not sure what your [indiscernible] this not pop up, the best way we can prevent it from popping up again is to have it pop up now.

What I mean is, being conservatively reserved take it we have not been at the captive insurance game for very long. A couple of years. And as we get more mature, as we see the way things develop, the timing of things, for example, if you've got some related accident and you see how that typically develops over time that in year one, the claim year two, the claim goes there, different things change. We're looking at things like frequency and severity and all the different stuff an old insurance guy like myself will will like to think about it. We have a very good team that works on it. So as we get more conservative about the reserving and as we make sure that we build an IBNR for claims that haven't happened, that allows us to sort of use the accounting to smooth it out as opposed to simply being in a situation where as claims come in, I record it. And then it's you're simply subject to the timing of when claims come in. So this thing I would hope would take us a very long way towards doing exactly that, which is sort of smooth out the insurance costs as we go.

Okay. And then obviously, you guys do successful in signing new business, the pipelines and all the units or divisions seems robust in all three of them. One thing that sort of since you guys have been public is no shortage of new business But there's like upfront costs and these investments. Is there what given the investments you're making now, I guess, if you're executing on your pipeline do you think you're going to have to have another bucket of investments in the future to execute on that pipeline?

Absolutely. It's a great question, Richard. I think first and foremost, we have essentially changed a bit and we've evolved frankly our ethos of really the pipeline of deals we're pursuing, right? So the the company was very heavily oriented towards perhaps crisis response, emergency response, as part of our ambulance DNA, and a lot of the municipal mobile health projects that we are winning and pursuing were crisis related. And as a result, there were They start and then they sunset, they start, they sunset and requires investments. Our pipeline right now is really focused on evergreen opportunities. So our Care Gap closure business is is here today. We'll be here towards the end of the year. In fact, it increases as the year progresses as health plans try to make more and more progress as they go throughout the year. And then again, Unfortunately, there are always patients that are unengaged, unattributed, have access issues, have chronic conditions. And so those lists we've seen from one year to the next already from last year to this year. And become an evergreen business for us. And as we convert those patients into PCP patients, now they were their long term primary care provider, provider and so on and so on.

On the municipal side as well, we're looking at opportunities where we can be providing services to our disabled veterans, to patients that are located in hard to reach communities, but not necessarily crisis response, but rather health evaluations, health screenings and other preventative care. So those are really the sort of the evolution of the company is really moving towards long term preventative proactive care And we've really started building that pipeline last year and it's starting to come to fruition at the end of last year and into this year and we're very, very excited about that. So I think you're going to see us continue to build out that pipeline as our Bandwidth frees up from the migrant related work. We're going to pour more and more of our resources into those opportunities. And then you're going to see the pipeline build from there.

And those will be evergreen and will require less start and stop and sort of investment to get going. I do think we will invest as we win contracts We're going to acquire new vehicles. We just acquired an ADA a fleet of ADA accessible vehicles to be able to provide care to disabled veterans as an example. As part of our expansion there. And we'll see how big that gets, but these are evergreen style programs where supporting our veterans will be here. So those are the types of opportunities and pipeline we're pursuing and that will be an evergreen pipeline, which the company will benefit very greatly from.

Okay. And my final question, maybe on transportation. How are you guys thinking about like the long term growth rate of that part of the business? We're very excited about the growth opportunities for the transport space. As Norm mentioned, we've been growing that business over 30% compounded annually for the past three years. We do have a as I mentioned about just about 30 health system deals in the pipeline. A lot of those are transport related contracts. And so we think that business has has opportunity to continue to grow. We have a 15% growth rate target on that business. I will say growth there [indiscernible] come in sort of a stepwise function where we sign new large health systems and we bring them on. And then that adds considerably to the top line and then we go and work on the next one and then we add that one. And so as we are signing these health systems, we bring them on. I think, our team is doing a wonderful job on that. We have our tech platform, I think, is frankly the best in the industry. We have health systems that want to work with us, A, because the quality of our service and the team in in the field is spectacular, but also tech platform is just at the vanguard really of what's being developed in the industry.

And we're utilizing that tech platform to also essentially manage our growing fleet in the field that's handling care gap closure programs. So we've really done a great job expanding the tech platform from transport to the mobile health side of the business where we now have, as I was mentioning, we closed out the year just about at 1,000 Care Gap closure visits in one week at the end of last year. That's a lot of units out on the field. They're going We'll make sure that we manage there and that Symphony, as I call it, in the field, the right clinician with the right with the right diagnostics for the right patient need, the right care gap closure, trained to do a great quality service. And so we're utilizing that tech platform that we developed on the transport side and we think we're very, very excited about the opportunity to really take that tech platform and apply it to the mobile health side, which we've only just scratched the surface. So I think the transport business will continue to grow. I'm very excited about the opportunity to leverage the tech platform to manage the ambulances in the field but now to leverage the fly cars as we call them in the field on the mobile health space which again we're only scratching the surface.

And I think the market will very much appreciate the tech platform now in the mobile healthcare space as we expand it into that into that opportunity.

So if you're expecting 15% [indiscernible] was like 1.7 if I'm looking at it right and like 1% to 2% here in the second or fourth quarter?

Yes. So I would say, the risk of sounding very linear, I think that it's going to be somewhat linear. And I say that because look, there are a couple of hospitals in, I'll say, in New York State that we are now servicing. We haven't put out the press release yet because we're waiting for sign up, but the activity has already started. So there are hospital systems that we have begun to work with and those will ramp as we go. There are a couple where we're we think we're at one yard line or two yard line going in. And those will probably obviously not be a Q1 event, but that'll probably hit sometime in Q2. Then ramp into Q3 and Q4. So just based on what the pipeline looks like, you're going to get the full benefit of that once you get to Q3 and Q4, especially Q4. So I would anticipate that it will sort of work its way up sequentially throughout the year. So I would expect [indiscernible] transport revenues in Q1 than in Q4. And higher in Q2, Q3, Q4 and so on and so forth as we exit 2025.

Okay, helpful. Thanks.

Thank you. The next question comes from Ryan MacDonald with Needham and Company.

Hey, this is Matt Che on for Ryan.

Thanks for taking the questions. Now on the migrant revenues for 2025, is there any risk that the remaining portion gets further accelerated or pretty good visibility from here?

And I appreciate that if it winds down faster, you'll be able to replace that with core revenues, given there's the cost impact while you transition trying to gauge the risk of wind down getting further accelerated and not weighing on the EBITDA [indiscernible] [indiscernible] Matt, it's Lee. I'm happy to take that question. As I've obviously been very intimately involved in the whole process here. I think yes, it's absolutely possible that it could be less than the $50,000,000 considering the current administration and what's going on in the political landscape. And so it's it's absolutely possible.

That it could be less than $50,000,000 I would say, we would transition that personnel particularly to the opportunities I outlined in the prepared remarks.

And that's why we are basically adjusting that EBITDA guidance that we gave at the end of last year down, right? So it will cost us investment and it will cost margin to transition as you mentioned from that staff to new opportunities and that's why we're accounting for it with the lower in part, with the lower EBITDA margin guide that we just adjusted on this call.

Okay. Sounds like it's captured in the outlook [indiscernible] Maybe given the faster expansion into payers, would love any update on your targets for the payer business? I know you previously mentioned 1,000 care gap run rate and twenty twenty four and that could set up for I think 65,000 carryout closures twenty twenty five, hoping to get 10,000 primary care patients and 70,000 patients on the virtual care management. Do those targets still stand or are you thinking about where the business could get to now that you're accelerating the payer rollout?

Yes. So I think those targets still stand. We'll update them as we progress throughout the year here. Think we think about it in a few ways. So yes, we came very close to that 1,000 a week visit at the end of year. Currently, we're at about a 400 to 500 visit per week run rate right now to start the year. The beginning of the year is seasonally sort of the introductory period for the year for the health plans and so we're matching their cadence. We think our exit rate for the end of this year will be over 2,000 visits per week to give you a sense of of the scale. As we help health plans close out the year and address patients that indeed still have open gaps. So, we think that we'll continue to step up the care gap visits and the 65,000 care gap visits is absolutely the goal. I'd also say that we brought on PTI Health that's doing mobile phlebotomy in the home and we're looking at ways to also expand their scope of services now that we've brought them into the DOCO family. So we'll continue to update those metrics.

Our contracting is progressing with the health plans to evolve into the PCP provider as well as closing care gaps. And so our goal remains the same there as well to enroll 10,000 PCP patients. And as we mentioned, about 70,000 patients [indiscernible] pipeline was included as we gave our targets and guidance for this year. But as we continue to ramp and scale, we'll continue to update those. Appreciate it. Yes, Lee. Maybe just one last one.

The municipal business. I guess two parts to this question. First, last quarter you talked about, I think it was called Project Prime initiative with the goal of identifying large contractors that might benefit from subcontracting population health to DOCO Anything you can comment on that? I know early twenty twenty five is maybe where we might start to see some progress. So would love any update there.

And then second, just broadly, given the municipal programs to be influenced by federal policy and dollars We'd love to just hear your thoughts on how the changes in Washington could potentially impact your muni business or just government business in general?

Absolutely. So our Project Prime as you mentioned, where we are partnering and signing contracts with already existing service providers to municipal entities such as the VA. Is going well. As I mentioned, we signed two subcontractor contracts to provide services. For current contractors that are providing services to the VA. So that's kind of how we're ramping into that space. And as I mentioned, we signed two contracts and our team again has a pipeline of other opportunities that we are working on. So it is progressing. As I mentioned, we did sign two contracts already as part of that initiative, and we're going to continue to invest And so that's the goal. In terms of The messaging coming out of Washington I think right now our goal really has been to go after evergreen opportunities that imperatives for the municipal government have been over decades and believe will continue to be such an example providing care for our veterans is a really good example. We'll share other ones as we start to progress the pipeline through. But those are great examples of ones where it's pretty apolitical, bipartisan, providing medical care for our veterans that has been there for decades and we believe those are exactly the type of opportunities will be there in the future and the ones evergreen style municipal programs that we're pursuing.

I think that's essentially our view right now in terms of where things are progressing on the municipal [indiscernible] bringing care to populations that don't have good access to care. We do it in a more cost effective way which again also aligns with some of the messaging coming out of Washington right now where we actually do it in a more cost effective better ROI way where we're bringing dynamic care to underserved populations and as a result improving health outcomes. Which lowers the total cost of care. So we feel like we're really on the right side of of the trend here. Hello, Ryan?

Thank you.

All right. Thank you. The next question comes from David Larsen with BTIG. Please go ahead.

Hi. I think you said there was $55,000,000 of migrant revenue in the quarter. So it looks like your base was maybe 66 in the quarter if I annualize that, you're at $2.60 in base revenue.

And then if I add $50,000,000 to that for migrant revenue, that puts you up around $3.13 for the year. I think the guide is like $4.3 So there's a delta there. Like $120,000,000 If we assume 1,000 care a week at $300 a pop, I think that's around $15,000,000 or 20,000,000 which means there's another 100,000,000 of revenue to capture Just any like how much of that is you got to go win it, [indiscernible] under contract now Just thanks. Any sort of conviction you can provide around, yes, that's identified, it's in the CRM, We're in late stage discussions for that for like $50,000,000 of that $100,000,000 or half of that's already signed? Any more color would be very helpful. Thank you.

Hey, David, it's Norm Rosemar. I'll start in and maybe you can fill in some of the blanks. So first place I would start is on the transport business where we did about $194,000,000 We're looking at about $225,000,000 for next year, so that's about a $30,000,000 increase. We feel really good about taking them line by line. That I think if we look at everything that's currently contracted we ought to be able to get to that number. Now, of course, that's going to depend on how quickly we're able to ramp up or increase some of the volumes in some of the places, right? Everything is subject to that kind of thing. But that's contractor, that's called for. In fact, if anything, some of the stuff in the pipeline that Lee alluded to was not in that $225,000,000 and would be incremental to that. So there could be some potential upside there. Otherwise, in terms of terms of the different businesses that we have, obviously, we have the PTI company that came in. Which combined with HPP, it's a little bit higher than maybe your $20,000,000 in the payer program, a little bit higher than your $20,000,000 number.

And then just in general around some of the other places, I would say that most of it is already accounted for or closed. Would say there's probably still in the $25,000,000 range or so largely on the municipal [indiscernible] those things aren't contracted yet. They're covered by our fees, meaning I can point to certain contracts [indiscernible] we would get there. So we're cognizant of the fact already two months into the year, so we'd have to be in that kind of situation. But I would say the go get probably is maybe that $25,000,000 within the municipal mobile health space in particular.

That's very helpful. Thanks very much. I'll hop back in the queue. Thank you, David.

The next question comes from Michael Latimore with Northland Capital. Please go ahead. Hi. This is Aditya on behalf of Mike Latimore.

Could you give some color on the cash flow from operations? Like what do you expect [indiscernible] Sure.

So I would say, well, let's go back and look at this year. So this year, our cash flow from operations, which you'll see in the release and it's in the 10 ks, which we filed as well, was about $70,000,000 and that compares to about $60,000,000 of EBITDA. Just sort of gives you an idea that our cash flow from operations this year outstripped the EBITDA number even though EBITDA obviously is a proxy or just EBITDA is a proxy for cash flow, but because of the we had some good working capital movements where we had collections and receivables and receivables went down by about $50,000,000 year over year So we were able to to outstrip that number with the operating cash flow. And in our script here, in our prepared comments, we talked about how we would expect that regardless of where the EBITDA margins are, we fully expect we'll be able to generate some significant earnings release mentioned as well, we expect to generate some significant cash flow from operations even more so than we did in 2024 and that's simply because of the fact that we've got a lot of this migrant revenue out there that has the migrant AR out there that started to flow One thing to point out is at the end of the year, we had about $150,000,000 in accounts receivable from those migrant programs between New York City Housing Preservation Development, the HPD which is about a little bit more than $70,000,000 and H and H, which is about $79,000,000 So we've seen it two of them about $150,000,000 and against that, we have a 30,000,000 accounts payable.

So there's a big number that's out there that we are in the process of electing that should be able to help us drive that operating cash flow higher.

Got it. And what was the subcontracted labor expense as a percentage of total So that's come down quite a bit.

At one point, I think I would say our peak was probably the fourth quarter last year. That number was over 40%.

That was at the height of the of the migrant projects and while we were still trying to get to speed with our own W2 labor. If I look at it across the company, I would say the number is probably So it's dropped pretty, pretty significantly. Now I did mention we have subcontractor labor costs on both the mobile health and the transport side. On the transport side, that number was on the transport side, that was a little higher than it should have been in one of our markets. So that suppressed margins, I would say, on the transport side instead of being 30.1% for the quarter, probably would have been closer to 32%. Otherwise, that's gone by now. Subcontractors are not in there anymore. So I would expect that that subcontractor as a percent of revenue will continue to decline into Q1. It will be under 20%. Of revenue.

Got it. Thank you.

Thank you. The next question comes from David Grossman with Stifel. Please go ahead.

Hi, guys. This is Aiden Knipp on for David. Thanks for taking my questions.

Was wondering if you could provide some additional detail on just your assumptions for total OpEx for the year?

Sure.

Again, I think the way to look at it is as a percentage of revenue, which is how we're trying to how we're trying to back into it and figure it out.

And also let's look at it in context of what we did in Q4 and then the prior quarters. So our assumption is that gross margins will be pretty similar to what we saw in full year 2024. So for the full year 2024, we did 34.6%. We think we'll be at about 35%, maybe a notch higher given that there are a couple of different things that we're suppressing that number to get us to the 34.6. So we think that the natural number should be 35%. Important to note as Lee did in his comments, [indiscernible] we have not seen deterioration in the gross margin even as the revenue number has come down. So marginally or on a variable cost basis, we're certainly hanging in there. Doing pretty well. If that's the case, and then we think we're talking about a mid single digit, let's call it 5% EBITDA margin, that would mean about 30% So SG and A would be about 30% of revenue on the average as the year went on. For some context, as we mentioned in this quarter and this fourth quarter with all of the different things that are were at about 39.7 We were under 30% in the third quarter.

So I think that where we're going to come in will be a little bit higher than where we had trended, let's say, in Q2 and Q3 of this year. Because of some of those investments that we've talked about. But definitely well below the level that we saw in Q4. As a percentage even as revenue would decline as some more of the migrant stuff starts to move away. And then as we get into the back of the year where some of this core business really kicks in with its growth, and the revenue number would move sequentially higher than that percentage will probably be lower. But on a full year basis, if you look at it top down, I think that number should be at about 30%.

Of revenue. And then thanks for the details on the pipeline. That was helpful. How are you guys thinking just about conversion of that pipeline over the course of the year? And just how deals come in over time?

Yes, absolutely. So we do see it really does depend on sort of the vertical, the customer vertical. I think we at the end of last year, we saw a flurry of activity in deals on the payer side. I think we anticipate that again this year. We do have some deals that we're operationalizing right now. And I also think at the end of the year, plans really start to focus on really their their unattributed members, their unengaged members and really closing care gaps to close out the year. So that's where they're measured on. So we really gave a big push at the end of last year We were successful doing that. And some deals have continued to come in to start this year. And then I think it sort of Q3, Q4 as well, we will start to see again an uptick in the filling of the top of the funnel pipeline. On the medical transportation and hospital system side, it's pretty consistent throughout the year. As Norm mentioned, we have a number of opportunities that are at the one yard line right now. We feel very, very confident about or deals we've already signed that are in sort of ramp and expansion mode.

And in that particular medical transportation and the hospital system side, pretty uniform as we go throughout the year. And on the municipal side, one of the goals of Project Prime is to smooth out so to speak, the pipeline where municipal work tends to be very RFP driven and binary and maybe more lumpy And our work with the prime vendors is going to help us smooth that out as we start to help them expand contracts or services that they're already providing in the field. So that's part of that initiative. So I think we'll start to see some smoothing of the pipeline. We're continuing to add opportunities towards the top of the funnel. And we signed a flurry of activity towards the end of the year beginning of this year and we're going to continue to work that pipeline as aggressively as we possibly can. [indiscernible] Thank you. There are no further questions at this time. Let me turn the call over to Lee Binstak, CEO. Please go ahead, sir.

Thank you so much. Thank you to everyone for joining us and be well.

Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.