Alignment Healthcare (NASDAQ:ALHC) Q1 2026 Earnings Call

0:00 Good afternoon, and welcome to Alignment Healthcare's First Quarter twenty twenty six Earnings Conference Call and Webcast. All participants will be in a listen only mode. After today's presentation, there will be an opportunity to ask questions. To ask questions during this session, you will need to press 11 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press 11 again. Please note that this event is being recorded. Leading today's call are John Kayo, Founder and CEO and Jim Head, Chief Financial Officer. Before we begin, we would like to remind you that certain statements made during this call will be forward looking statements as defined by the Private Securities Litigation Reform Act.

0:48 These forward looking statements are subject to various risks and uncertainties and reflect our current expectations based on our beliefs, assumptions, and information currently available to us. Descriptions of some of the factors that could cause actual results to differ materially from these forward looking statements are discussed in more detail in our filings with the SEC, including the Risk Factors section on our annual report on Form 10 ks for the fiscal year ended 12/31/2025. Although we believe our expectations are reasonable, we undertake no obligation to revise any statements to reflect changes that occur after this call. In addition, please note that the company will be discussing certain non GAAP financial measures that they believe are important in evaluating performance.

1:43 Details on the relationship between these non GAAP measures to the most comparable GAAP measures and reconciliation of historical non GAAP financial measures can be found in the press release that is posted on the company's website in our Form 10 Q for the fiscal quarter ended 03/31/2026. I would now like to hand the conference over to CEO, John Kayo. Please go ahead, sir. Hello, and thank you for joining us on our first quarter earnings conference call. For first quarter twenty twenty six, health plan membership of 284,800 represented year over year membership growth of approximately 31%. This supported total revenue of 1,200,000,000, which increased 33% year over year.

2:34 Adjusted gross profit of 146,000,000 represented an adjusted MBR of 88.2%, which improved by 20 basis points year over year. Meanwhile, adjusted SG and A of 108,000,000 improved as a percentage of revenue by 60 basis points year over year to 8.7%. Our adjusted EBITDA was 38,000,000 which grew by 88% compared to the prior year. This result exceeded the high end of our guidance range and implies an adjusted EBITDA margin of 3.1%. Our results this quarter reflect strong execution across sales and member retention, as well as our clinical operations.

3:20 Performance in our SG and A ratio also reflects the early outcomes of investments we've made to scale our infrastructure. Progress we are making across each of these areas is giving us even more confidence today that we're on the right path towards our goal of 1,000,000 members. Growing and scaling a business as rapidly as we are in an industry as complex as Medicare Advantage is not a straight line. That being said, we are progressing very nicely as we continue to scale the company and achieve our near term growth and margin expansion objectives. Importantly, our operational discipline and unique model gives us swift visibility across the organization. This enables us to identify issues quickly and take actions to manage their near term impact.

4:11 We focus deeply on continuously identifying opportunities to improve and deploy solutions to create even greater durability across our company. For example, the CMS rule change impacted our observation determination process and drove inpatient admissions per thousand towards the higher end of our expectations in Q1. This process change was resolved by the end of February, but impacted our first quarter inpatient admissions per thousand, which was in the high 150 this quarter. We absorbed this headwind within our Q1 adjusted EBITDA beat and are well positioned as we enter the second quarter. As we build upon our culture of continuous improvement this year, we are scrutinizing and revalidating every aspect of our people, process, technology and clinical culture to ensure they are positioned to scale.

5:06 Through this process, we focused on opportunities to deliver more cost efficiencies through claims automation, improvements to our contract management infrastructure, and scalability of our provider data management. For example, just twelve months ago, our claims auto adjudication rate was less than 15. Now our year to date auto adjudication rate is over 60%, and we expect to drive even higher claims automation as we progress throughout this year. Meanwhile, we are also deploying contract management solutions that leverage AI to create a more dynamic contract management platform and taking the next leap forward in our AIVA AI risk stratification models to create even greater precision in our clinical engagement efforts.

5:53 We are also investing in our talent by adding team members who will drive greater scalability within our technology infrastructure. These are just a few of the actions we are taking to support our near term results and accelerate progress to our long term growth and margin objectives. Finally, before I turn the floor over to Jim, I'd like to spend a few minutes discussing the 2027 final rate notice, which was announced earlier this month. At a high level, we are encouraged by the administration's continued pursuit of actions that drive sustainability within the MA program. In a continuation of meaningful policy changes like the WISER pilot program that tackle overspending in traditional Medicare, we also applaud the administration's actions to address overutilization of skin substitute products and fee for service.

6:46 By taking action to create more accountability across every stakeholder in the healthcare ecosystem, we believe the program will increasingly reward those who deliver true, measurable value to members over the long term. Importantly, these dynamics continue to reinforce a core point. Medicare Advantage is a durable program that is here to stay. In that context, we also believe Alignment is particularly well positioned to succeed regardless of the rate environment. Our clinical first approach enables us to deliver high quality outcomes at a low cost and forms the sustainable competitive moat that sets us apart from our competitors.

7:32 In closing, our first quarter results reinforce the strength and durability of our model. We are executing with discipline, scaling thoughtfully and continuing to translate our clinical approach into consistent financial performance. We're continuing to invest in the scalability of our platform, including automation, AI enabled workflows and enhancements to our clinical infrastructure, all of which position us to drive further efficiency and growth over time. With a path toward a million members and unique opportunity to take share and grow profitably across all of our markets, we believe we are well positioned for the years ahead. With that, I'll turn the call over to Jim to further discuss our financial results and outlook.

8:19 Jim? Thanks, John. I'll dive straight into our first quarter results. For the quarter ended March 2026, health plan membership of 284,800 increased 31 year over year, driven by strong execution on sales and retention. Increase in memberships supported revenue of $1,200,000,000 in the quarter, representing 33% growth year over year. First quarter adjusted gross profit of $146,000,000 represented an MBR of 88.2%, which reflects an improvement of approximately 20 basis points year over year. Our adjusted gross profit performance this quarter was underpinned by strong engagement from our clinical teams. Their disciplined execution held inpatient admissions per thousand within our range of expectations despite the temporary disruption to our utilization management process that John previously discussed.

9:16 Meanwhile, the remainder of our medical costs were in line with supplemental benefit costs and Part D running modestly favorable through the first three months of the year. Moving on to operating expenses. Our SG and A discipline and scalability initiatives, such as back office automation, supported outperformance in our operating cost ratio. For the first quarter, GAAP SG and A was $121,000,000 Our adjusted SG and A was $108,000,000 an increase of 24% year over year. Adjusted SG and A as a percentage of revenue declined from 9.4% in the first quarter of 'twenty five to 8.7% in the first quarter of twenty twenty six. This represents approximately 60 basis points of improvement year over year and outperformed the midpoint of our implied guidance range by 50 basis points even as we continued to make focused investments.

10:13 Taken together, first quarter adjusted EBITDA of $38,000,000 produced an adjusted EBITDA margin of 3.1%, which represents 90 basis points of margin expansion year over year. Turning to our balance sheet. We generated strong operating cash flow in the quarter and concluded with $726,000,000 in cash, cash equivalents and short term investments. Our liquidity profile remains strong with ample cash available to the parent company. The funded leverage ratio at the end of Q1 improved to 2.6 times trailing twelve month EBITDA. Turning to our guidance. For the full year 2026, we expect health plan membership to be between 294,299 members, revenue to be in the range of 5.16 to 5,210,000,000, adjusted gross profit to be between $620,000,000 and $650,000,000, and adjusted EBITDA to be in the range of 138 to 163,000,000.

11:20 For the second quarter, we expect health plan membership to be between 288,290 members, revenue to be in the range of 1,300,000,000 to 1,320,000,000 adjusted gross profit to be between $167,000,000 and $177,000,000 and adjusted EBITDA to be in the range of 50,000,000 to $60,000,000 As it pertains to our full year guidance, we are increasing our membership growth expectation given continued strength within our sales operations and outperformance in member retention through the open enrollment period. We believe our disciplined approach to sales growth and focus on retention is serving us well this year, particularly as we absorb the impact of the third and final phase in of V28.

12:09 In conjunction with the increase in our membership outlook, we are also raising our full year revenue guidance to approximately $5,200,000,000 at the midpoint, which reflects 31% growth year over year. With respect to our profitability metrics, we are raising the low end of each of our adjusted gross profit and adjusted EBITDA guidance ranges by 5,000,000 to reflect confidence in our full year objectives following the strong start to the year. Within our outlook expectations, we continue to assume that inpatient admissions per thousand will run higher year over year. As a reminder, this is primarily due to changes in our mix of membership. In 2026, we intentionally focused on growth amongst high acuity populations whom we believe will benefit most from our clinical model.

12:58 Consistent with past years, we also do not incorporate any assumption for final suite pickup from new members into our outlook assumptions. Taken together, our implied first half guidance reflects confidence that the strong performance we delivered in Q1 will continue into Q2. The midpoint of our guidance implies that approximately 60% of our full year EBITDA will be generated in the first half of twenty twenty six. This compares to approximately 55 of the full year EBITDA in the first half of twenty twenty five, excluding new member final suites. Further, on that same basis, this represents nearly 100 basis points of first half adjusted EBITDA margin expansion year over year.

13:45 In closing, we continue to deliver upon our promises each quarter as we assess, refine, and scale our core workflows and processes. Each of the transformational projects we are investing in and deploying today are establishing the foundation upon which we can scale to achieve our ultimate potential. Our meticulous and disciplined execution to date leaves us even more encouraged about the opportunities ahead. With that, let's open the call to questions. Operator? Thank you. Our first question will come from the line of Matthew Gillmor with KeyBanc. Your line is open. Please go ahead.

14:46 Hey, good afternoon. Maybe following up on the hospital observation issue. It sounds like this was temporary, but can you just walk us through what changed, how it was resolved and give us some sense for how hospital utilization trended now that it's been resolved? Yeah, hey, Matt, it's John. Yeah, basically we paid authorizations at full acute rates when we should have paid them at observation rates. It was a workflow problem and we of course corrected it but it impacted our January numbers, a couple million dollars I think it was. And ADK wise, we were, a little bit higher by a couple of days. And, you know, we wanted to share that with everybody.

15:35 And it's really part of really how we are, you know, kind of looking at every part of our company to, just continuously get better. And we'll talk about that a little bit more, I think. But, I don't think it's a, you know, systemic problem. I think it was a one month blip. And, we'll we'll we'll have that course correct. We have it course corrected. Got it. And just to confirm, John, that this is an internal thing that you all call it. Yeah. Yeah. Yeah. Exactly. It's an internal workflow issue. It's not a utilization issue. Yeah. Utilization, I think, fine. And Jim Jim's got some insights. Okay. All right. Yeah, Matt, I'll jump in on the utilization because I think that's important.

16:25 There's lots of points of reference out there. But utilization was notwithstanding what John described, which I kind of call a one time course correction, utilization was tracking very closely to what we expected. And as you're aware, we had admits in the high 150s. Absent that issue that John described, we're probably in the mid 150s. And that is pretty much what we thought was going to happen. The flu is one thing that everybody's talking about. It wasn't a big driver, positive or negative, in our numbers. We track admits with respiratory problems. We look at our Part B costs, etcetera. And it was pretty much in line.

17:11 So we've got our eyes on all those categories, and it felt like things were tracking pretty nicely to what we expected. And we see that in April as well. All right. I appreciate it. I'll leave it there. Thank you. And one moment for our next question. Our next question comes from the line of John Stansell with JPMorgan Securities. Your line is open. Please go ahead. Great. Thanks for taking my question. I just want to talk a little bit about 2Q MBR. Stripping out sweeps, it seems like it improves by a pretty decent amount. Even And after adjusting for a couple of million of incremental pressure that's not going to recur in 1Q. Can you talk about what's assumed for year over year improvement in the second quarter that is maybe different from the first quarter? Thanks.

17:59 Yes, John, second quarter is usually our seasonal better quarter. And so there's just a natural decline in the MBR. So that's a good thing, and was expected. But I do want to step back and describe we're laying out the actuals for first quarter. We're guiding on second quarter. And it's a pretty strong first half that we're positing. We set a reasonably high bar this year, by the way. But through the first half, we're expecting improvements across all our margins. MBR, SG and A, EBITDA. MBR, first half, 40 basis points. SG and A, 40 basis points. EBITDA is 90 to 100 basis points. So really strong first half.

18:52 And that's apples to apples on a pre sweep basis. And we mentioned on the call, 60% of our profits are in the first half versus 55%. But all the while, we're making investments in the business to scale it. So we're really doing this balancing act of trying to make sure that we're executing very, very well, investing in the future. We're bringing on talented folks across the enterprise. We're making investments in systems and processes. But we have our eyes on continuing to improve our execution clinically and get our margins up. And so this is really a continuation of what we were doing in 2025, and we march into 2026. First half feels very good.

19:39 Great. And then maybe just taking a step back and thinking about some of the changes in the final rate notice, the, I'll call it, deferral of a new risk model. How are you thinking about maybe reasons why that didn't make it in? And then as we think about potentially a new risk model in say '28 or '29, you know, what we can take away from what was proposed versus what might actually be implemented? Thanks. Yeah. Hey, John. Yeah. I I personally think there is gonna be some some changes. I think there's gonna be, you know, more normalization, if you will. I I don't think there's enough outcomes, feedback that that CMS has yet to to have initiated it in this past final notice.

20:30 I think, you know, I I actually don't know, but I believe that, they're gonna be working, on this as a focus of a a topic of focus in the, preliminary notice, the advanced notice coming up, and then we'll see something in in the '27 to maybe be implemented, you know, by '29, something like that. But I I think I think CMS has been pretty, you know, consistent with with their message of, you know, ensuring that coding is not some form of a gamified, you know, competitive advantage for people. Know, and and obviously I think that, you know, I think that's a good thing for the industry and I think it serves us really, really well.

21:18 And it it it really puts the purest form of who's got the highest quality at the lowest price point. And this those organizations should be, you know, rewarded to succeed. That answer your question, John? It definitely did. Thank you. Yep. Thank you. One moment for our next question. Our next question comes from the line of Scott Fidel with Goldman Sachs. Your line is open. Please go ahead. Hi. Thanks and good evening. Just was hoping to just get a little bit more detail, if you don't mind, just on the inpatient issue that just so we can fully understand this. And so what I'm hearing from the call was, I think Jim had talked about there was a CMS rule change.

22:10 It sounds like internally, you may have needed to make some adjustments to some of your systems as a result of that. And that is where maybe some of this disruption occurred. So one, just want to sort of confirm that or if there's another sort of backdrop to that? And then sort of two questions just sort of around that would be in terms of your markets, is this something that like a it's an internal system that sort of covers all of your markets or just California? So that was one. And then two, if it led to you guys paying full acute as compared to observation, is there an opportunity for you to claw back some of those additional reimbursements that you should not have paid? Is that not something that you're gonna have a resolution to? That was my first question, Scott, but the answer is unfortunately no.

23:06 Yeah, no, it's a rule change that requires us to basically make authorizations a little bit more timely basis. And the backdrop of it is we've shared this with you guys in the past, which is we've kind of moved from this world of kind of capitation and delegation. And even in our shared risk businesses, we've had, you know, the the certain administrative functions that were delegated to the IPAs. And one of the things we've shared with you in the past is we have started de delegating certain IPAs. That strategy has been phenomenal for us and the IPA. We just have a good process.

23:53 But there's more and more of the de delegation of the acute authorization process, what we would call that concurrent review process. And it's a competency that we are getting better and better and better at. And it's competency that we need to make sure that we have the more we scale outside of California. Because I think a lot of the networks that are being constructed are really going to be with the direct providers, practices, etc. Without having an IPA or an MSL like we have in California. So I think that's the context.

24:40 Yeah. And Scott, given we put this as an example of corrective action and how we get on stuff fast. So by the end of January, we saw a little bit of an anomaly in our numbers. And then we went and found the root cause. And we knew that we were kind of going through a changeover at the beginning of the year, and we had staffed up and things like that. But by February, we'd identified it and already corrected it. But it was a little bit of a drag on our adjusted gross profit. We want to call it up. But this is the kind of maniacal attention to detail that John talks about and what you have to do to successfully execute. We've corrected it. 80 ks is back exactly where we thought it was going to be by the time we got to February and March.

25:32 And we of perfected that workflow and now we're ready to move ahead. Yep. Last point really is we shared that with you all because we want to signal with you that a lot of the performance we are being able to achieve now was made two years ago on operational decisions. You know, the most obvious one is the SG and A percentage being below 9%. And so we're always continually refining all of our workflows and it's a lot of focus of our time everywhere in the company. And the message is we're preparing ourselves to really grow and to support that growth in the same way that we have thus far.

26:25 And know that's that was the one line that I mentioned. It's not going be a straight line but I feel really good about this year, guys. I really do. And even for '27, twenty eight's a little bit far out, but and, you know, we I think, if anything, we've proven to be all we've kind of do what we say we're going to do. Got it. Got it. And if I could just follow-up. And certainly, we appreciate you calling it out, certainly, as compared to us being in the dark about it. So thank you for that. And then just to clarify sort of one, so John, it sounds like maybe the SKU might have been to some of the outside of California markets in terms of just how this flowed through to some of the delegation. And then the other follow-up would be, Jim, I know you mentioned sort of there was a separate dynamic around, it sounds more like a mix impact on inpatient from sort of product mix change. Is that sort of despip? Or maybe if you could just sort of clarify, or is that sort of the new markets just maybe clarify what specific mix change there was that impacted that?

27:30 Thanks a lot. Scott, it's not just an ex California issue. It really was just a corporate a corporate function that we're really scaling and growing, putting new systems in, putting in new workflows, all of that. It's really limited to that and it's not just a function of the ex California. And then Jim. Go ahead, Jim. Yeah. And as it pertains to 80 ks being slightly higher, that a mix issue. And it's a growth and a mix issue, Scott. And in that instance, there's a lot of growth outside of California, and there's a lot of growth in more acute populations.

28:18 And so we had planned for that as we came in. If you remember on our fourth quarter call, we talked about it. ADK is going to be inpatient admissions per thousand or ADK is going to be a little bit higher this year. It's going to tick up a little bit because we were making an investment in that population that we know has a lot of embedded gross margin. We're willing to make that investment. All of that is baked into our guidance at the beginning of the year and our outlook in the first half. So this is we're kind of tracking as to what we thought was going to happen. Okay. So it's new member sort of mix and that it's some of the new markets, and then sort of both of the product sets in terms of traditional HMO and then DFIP, or of skewed just towards one of those?

29:04 No. It's the you know, we talked about a lot of our ADP growth being in the, C SNP LIS and dual individual population, like, about 50% growth. That's what we're talking about in terms of Okay. Yeah. That's what I that's what I was trying to to clarify. So okay. Alright. Perfect. Yeah. Thank you. All of that all of that is exactly tracking is how we expect it. So that you know, the good news is we knew this we we we absolutely embraced going after that population because we think we can be very successful with them. Yeah. So when you were saying more acute population, were referring to the SNPs, not that the traditional HMOs new members were more acute. It was more the decent. That's what I was just trying to confirm. Awesome. Okay, thank you. Yes.

29:51 Thank you. And one moment for our next question. Our next question will come from the line of Whit Mayo with Leerink. Your line is open. Please go ahead. Thanks. Maybe just a follow-up on that, how you're feeling about risk adjustment versus expectations given this focus on the more medically complex members this year? I think I'll break it into two pieces. Our loyal population, which we really have a good line of sight. We're very good at predicting that and tracking it. And as it pertains to risk adjustment on the new members, we call them the newbies, that's where we're very cautious.

30:37 So we book to the paid MMR, which means what CMS pays us will record as revenues. Now, what that does is provides opportunity for upside in the second quarter when we get the final suites. So I think that you'll get more information when we get more information in the second quarter on that. But we are probably a little bit different than others in that we take a cautious stance on our newbies until CMS is giving us paid files that recognize that upside. Okay. And maybe just my follow-up. I don't think we've talked about RADV in a while. I just wanted to get your take, John, on the 2020 audit methodology that was issued a few weeks ago. Just what's different you see about the 2020 audits versus maybe the 2018 and '19?

31:34 Well, big one is the kind of the ongoing litigation around extrapolation methodology which is a huge deal with respect to potential financial exposure and you know for those of you that don't know that part of the extrapolation methodology is no longer in the 2020 audits. Not to say that they won't come back down sometime down in the future. And if we feel very good about that entire process, We've scrubbed that area very tightly and I'm not worried about that. Okay, thanks. Thank you and one moment for our next question.

32:20 And our next question is going to come from the line of Michael with Baird. Your line is open. Please go ahead. Hi. Thank you. So it sounds like this inpatient admit issue is fully resolved, but it sounds like you realized anomalies in end of January. So would you say you knew about it by the time you reported earnings? And then secondly, just wanted to ask about the LIS members. It sounds like they were in line this quarter. But I was wondering if you actually talk more about like higher mix of these members, how it might impact your cohort maturation into '27? Because if I'm thinking about it correctly, right, year one and year two generally largest step up in MLR improvement, is it more pronounced next year given, you know, higher LIS member mix? Meaning if you're getting say like a thirty, forty bit headwind and MLR this year does that turn around into a larger tailwind next year?

33:21 Thank you. Yeah, I can take this and Jim can provide color commentary. I I think we have to wait a little bit in terms of getting the sweep data in. It's kinda linked to the prior question. We gotta get the sweep data in on the newbies. I think from an MLR point of view, it's kind of consistent depending upon market. It's kind of in the high eighties, low nineties on the newbies that we got inclusive of the standards. So I don't I don't think it's like rampant. But your point on the opportunity for we to improve embedded earnings, you know, once we have, you know, more time with these newbie members, particularly the the the SNIP members, I think is a is a good call out.

34:13 The way I'm looking at this is when you look at the overall consolidated MLR, we are then kind of looking at well how much of the MLR is supplemental benefits and you know we've kind of shared in the past it's in that five to 6% range. And so your medical MLR you know it's kind of $82.83 is the way that that's the way we think about it. And then you say, of that how much is newbie versus how much is loyal? And to your point, the the the bigger proportion of our membership that becomes bigger and bigger that becomes loyal, that embedded earnings is gonna get stronger and stronger. And then when you add on top of that some of these people process and technology changes that we're making that impact both MLR and SG and A, that's kind of where we're striving to get to, you know, where we just are so good at all this, there's nobody that can compete with us with respect to bids.

35:19 And then we start taking this thing out and expanding aggressively. That's kind of how I'm thinking about it. Michael Got it. Michael, you asked about kind of were we aware of when we I guess when we did earnings at the end of the fourth quarter earnings call in February, were we aware of what was going on? The answer is yes. When you turn the page every year, there's always a little bit of ambiguity in January in terms of how you're predicting the rest of the year. And so when we did our guidance, etcetera, we understood the issue and incorporated that into our guidance. And I think corrective action is the right way to describe it. We fixed it fast.

36:05 It didn't take months. It took thirty days to fix it. And I think you're seeing in our first half guide that we feel pretty good that we've got line of sight the first six months of the year, and things are performing quite well. Great. Thank you. And just a quick clarification. What would MLR have been if you did not have that issue in January? And then on DPPs Okay. Yeah, I was thinking it's probably maybe 30 basis points higher or something like 30 basis points lower, something like that. Okay, got Yeah. Got it. And if I could ask just one on GCP.

36:50 They're up a lot again this quarter, I think, like 10 year to year. Last quarter is up six days, which love to see that. Also noticing paid incurred is tracking well down year to year. But I know last quarter there's some, I think timing dynamics around claims payment. So I was just wondering, were there any unique dynamics this quarter that might explain the large increase? And just would love to get your thoughts on the level of conservatism in your reserve methodology recently? Because it feels like there's a nice cushion. Thanks. Yeah. And Michael, I think I'm tracking the DCPs reserve build stuff like that. I'll just say, generally speaking, our reserve methodology is exactly the same. We're conservative and consistent.

37:35 We haven't really changed our processes or our stance. It's not like we were conservative last year. We're less conservative this year. We're growing fast. But that's all part of it. The DCPs did pick up a little bit. There is some Part D components in there called CMS Part D type stuff, which makes it a little bit anomalous. Generally speaking, classic IBNR days, these claims payable has been moving upwards. Over the last three or four quarters, we're just three quarters. We've just there's been a little bit of volatility in the page, but we're working through that. But I wouldn't read into building conservatism, but I would certainly not say that we're that we've changed anything and we're less conservative at this point. So it feels like it's a good quality of earnings, so to speak, this quarter on that.

38:26 Got it. Thank you. Thank you. And one moment for our next question. Next question will come from the line of Jessica Kasson with Piper Sandler. Your line is open. Please go ahead. Hi, guys. Thanks for taking the question. I'm curious to know how you're thinking about supporting the bridge model for GLP-one that launches this summer. I know the economics are separate from Part C, but just in terms of getting people who can benefit on the drug and adherent retaining them into 20 seven and possibly capturing some trend benefits. Just interested to know how you're thinking about about that that launch this summer. The the kind of voluntary pilot is what you're asking about?

39:12 Yep. Yeah. We we we we actually said we would participate with certain conditions. I think you guys know that they didn't get the, you know, the 80% that they wanted, and so they're kind of extending that time period. And that kind of gets into, you know, a little bit of our product strategy for the 27 bids, which I'd I'd like to not discuss at this point. It's just kind of how I'm thinking about it. I'm not sure I had to adjust. It's alright. I can come back in a few months.

39:58 Maybe then just on 27, to the extent that you guys are willing to comment, it sounds like the message for '26 is we're really happy with the growth for '27, sustained growth. So can you just update us on new market plans for '27 post rate announcement? Or are you still planning to add at least And one in the then whether you guys consider the '27 rates adequate? And if not, should we just expect kind of marginal benefit cuts to offset whatever the delta might be? Yeah. Other kinds of questions we're getting are, gee, you know, with only 2.48% net, you know, are you guys gonna just, like, grow like crazy again like you did in '25, basically? And, again, I I don't wanna comment on any bid tactics.

40:47 I will say just for competitive reasons. I will say that we will be expanding into new markets, some large markets next year. I'm not going to comment yet where and or if we're getting new states. But I think, again, we think about all of this as a portfolio of assets and think it's fair to say for we to expand where we have risk based capital and capital efficient way is probably still the best way for we to grow, whether that be California, Texas, North Carolina, you know, Vegas, you know, we're doing great, you know, etcetera.

41:36 I think the other part of what's driving our decisioning is again this this discussion around the operational framework and and and and can it support the level of growth in the new markets? And I think the answer is yes, given our performance. But I probably want to see another year of outcomes and I think we can continue getting the growth. I think you'll see us getting good margin expansion and I think you'll start seeing that in some of the discussions around '27.

42:21 And we'll talk about that in the fall. So after the bids are in. Alright great thank you. Thank you and one moment for our next question. Our next question will come from the line of Ryan Langston with TD Cowen. Your line is open please go ahead. Hi, good evening. Just on the G and A, I appreciate the comments on the benefits from investments and some automation. But was there any impact from timing in the first quarter that might sort of reverse out in the rest of the year? Should we maybe expect that level of performance to kind of carry through the back half of the year? I there is always a little bit of timing in the first quarter where you want to make sure that you've got cushion to for hiring, spending, things like that. But I think it was there's just a lot of good performance across all the categories, even beyond labor, for instance.

43:22 Now, as it pertains to whether we're going to pass that along, it's early in the year and this as John and I have been talking about, we're really making investments in the business. So I suspect that we're not going to just turn that into a beat on the year just yet. But on the other hand, it gives a little bit of comfort that we can continue to make investments in the business. And obviously, we're monitoring this holistically from a margin perspective, percentage of revenues, and whether we're going to meet our commitments. So obviously, it's nice to have an early good start, but that doesn't mean we're ready to give it all back and put it into the margin. Okay. And then can you just maybe talk a little bit about capital expenditures for 2026 and beyond? I mean, is there sort of an opportunity or maybe even a desire to push that up a little bit, just given where the free cash flow generation is now?

44:18 Thanks. Yeah. Our capital expenditures are largely software development. We do have a little bit of hardware. And we've got kind of a roadmap set up where this year, we were probably in the $40,000,000 spend range. It's a little bit we're coming out of the block a little bit softer than that, but that will accelerate. That's well within our means. Now, on the other hand, the ability to if we have the we have the dollars, we we also need to make sure that we're we've got the, you know, the right project, the right bandwidth, and we're getting the right returns out of it. So that is a little bit more of the constraint versus, you know, the quality and the returns versus whether we have the capital for it. So we feel pretty good about 40. My guess is that could tick up a little bit, but it's gonna as we accelerate our revenues it's certainly going to come down as a percentage of revenues over time.

45:18 Yeah and just to add to that, I mean we have not shared with you all and you know we won't on this call we will likely have more transparency on the next call around how we're deploying AI. And you know I I think the opportunities for us in terms of our clinical operations, our provider data, our stars, our MR, like every part of the company can benefit from that and will continue to drive down the the s g and a in particular and the MLR, I think.

46:04 And and so what we've had to do to to maximize the benefit of AI and the tools that are available to us, I think are just amazing, is make sure we understand, and validate all of the data. We I think we have the best data in the industry and we're gonna get that even better. And I think our workflows, our end to end provider workflows or end to end member workflows or end to end STARS workflows, all of that is getting documented molecularly now so that we can apply the AI tools on top of that and that's where the CapEx is going towards. Got it. Thank you. Yep.

46:51 Thank you. One moment for our next question. Also in fairness to everyone, please limit yourselves to one question and one follow-up. And our next question will come from the line of Justin Lake with Wolfe Research. Your line is open. Please go ahead. Hi, this is Dylan on for Justin. From a trend perspective, some of your peers have talked about a moderation beyond weather and flu. Have you seen any early signs there? And then also curious on the churn rate you're seeing early in 2026 compared to 2025. Thanks. Well, this is Jim. I'll take the second question first. Churn meaning retention. We're actually tracking really nicely on retention. That's been one of the helpful components of our membership growth year to date, OEP, etcetera. So we feel pretty good about that.

47:45 As it pertains to trends, I mentioned earlier in the Q and A, flu and other trends are we track them and they're not jumping out as anything anomalous per se. Now that's our book of business and how we think about things. But I will say that we look across the major categories of medical spend and the trends seem very consistent for us. And obviously, environment you guys know pretty well, it's low single digits. What we haven't talked about on the call here is Part D, which is tracking very nicely this year. We had a little bit of outperformance in Q1 in the margins. That was a good thing. We're not ready to kind of turn that into a expectation full increase.

48:39 But Part D is doing really, really nice. And that's over the last couple of years, that's been a big watch out. So we feel pretty good about that. But trend wise, we just we just have a different kind of rhythm than some of the other commercially focused or some of the other MCOs. I don't think it's just because it's our footprint. I think it's because we are it's the way we set up our utilization management. I think it's the way we work with our providers. And there's some capitation in there that cushions us along the way. Not necessarily global cap, but some of the capitation is absorbing some of those flu season trends, etcetera. Thank you. And one moment for our next question.

49:32 Our next question will come from the line of Andrew Mock with Barclays. Your line is open. Please go ahead. Hi, good evening. Alignment is predominantly an HMO business, but you leaned a little bit more into the PPO product this year. Can you walk us through the rationale behind that decision? And how are you thinking about the relative attractiveness of the PPO product given some of the recent plan exits across the market? And do you expect PPO to become a larger driver of your growth over time? Thanks. Yeah. Hey, Andrew, John. Part of the reason we were willing and able to do it last year and for this year is that over half of the business is globally capitated. And so that factored in the way we think about things. I think that the logic around stratifying members, caring for the members through our care anywhere program, you know, kind of positioning that part of the kind of the kind of the call it the clinical part of the business is something that should and could work for us as we think about extending the product, particularly outside of California.

50:56 I don't think we have figured out the secret sauce yet, frankly. And I think that I I think the only way to deal with that is is, you know, probably gonna be with higher member premiums going in the future. We are not going to be, I don't think, talking about again 27 bids. But you know, I think long term from an industry perspective that whole whole part of the world was supported by high RAF scores. And I just don't think that's gonna happen going forward. And I think the unit economics are gonna be pretty tough for people. If anybody can do it, it should be us.

51:44 But candidly, I, you know, I I don't think we've cracked that code quite yet. Great, thank you. Thank you. And one moment for our next question. Our next question comes from the line of Jonathan Young with UBS. Your line is open. Please go ahead. Hi, thanks for taking the question. I recall last quarter we talked about you still had some provider engagement negotiations outstanding in some states that you were thinking about entering. Has that progressed any further? And does the final rate update make difference in terms of those negotiations? So you were negotiating when the advance came out and then obviously the final is out. Does that change that negotiation process? No. No. Yeah. I know exactly what you're talking about. I wouldn't characterize it as negotiation.

52:32 I think the negotiations part was fine. It was more around the engagement, the provider engagement model. And in some markets the answer is yes. And then we'll share with you where we're expanding to. In some markets, the answer is no. And I think that will also have, know, what would kind of dictate, you know, where we expand into certain markets or new states. I I think the negotiations part is really interesting is people the the the delivery system, I can get on a whole thing on delivery systems if you guys want, but they really need an alternative.

53:17 They want an alternative to a payer that's willing to move market share to them without the kind of high denial rates some of the larger folks have. That's not to say that we're not good at it. It's just we're actually the model is very different. That though requires a high degree of engagement with the clinically integrated networks that are typically owned by these integrated delivery networks. These large monoliths now they're becoming somewhat monopolistic but that's a whole different topic. And so it's really important we find the right doctors and practices we can work with.

54:06 And we're leaning into that significantly as we think about more scale outside of California. Great. Thanks. And just to follow-up just on the denial portion of it. Given the MCOs broadly speaking are reducing the amount of prior auths, etcetera, presumably denials, does this make it harder to contract within that context? Thanks. No. It's it's it's gonna be really interesting. Think it's where is the emphasis and I think a lot of the AHIP discussions and what CMS is pushing the large plans is really around commercial. I mean there's a little bit also that the exchanges in CAID and CARE dragged into that as well.

54:53 But denial rates are like less than 2%. I won't name names but some of the larger ones are 13 to 15%. And, you know, some of the data we pulled that Harrison pulled and shared with us just a few weeks ago was really interesting, and I'd encourage you all to get that. It's all publicly available. I I do think we need to, as an industry, talk about, and I think you guys need to understand this part is, you know, when when I get every single health system CEO and CFO say that Medicare Advantage pays them 85% or 86% of traditional Medicare.

55:43 The inference is the plans are denying care or, you know, kind of playing insurance games. When in fact I would posit that we think about that statement differently meaning I from our experience, we are paying the health systems a 100% of what they deserve to be paid. And so when we talk about the same degree of program integrity that was applied to MA as it relates to coding for the insurers, We got to start looking at program integrity on hospital billing practices in the context of this affordability discussion. And if 100% of the claims and authorizations we get from hospitals and systems is acute as opposed to observations, you can ask the question. How are we going to make sure that everybody's aligned on the accuracy of those billings that are submitted to the plans?

56:49 And so you got to look at the denominator also. The denominator is traditional Medicare. Well, traditional Medicare isn't editing any of their submissions. Would pause it. And so we got to just kind of deal with that issue and that that is it that's going to be a policy issue. And if you heard the hospital CEOs, you know, in front of Congress the other I think was earlier this week is all the plans. Everything's bad about the plans and I would just reject that. We're paying we are we are paying hospitals 100% contraction of what they should. And our denial rates are very, very low. So that's kind of my soapbox on that.

57:35 Thanks so much. Thank you. And one moment for our next question. Our next question will come from the line of Craig Jones with Bank of America. Your line is open. Please go ahead. Great. Thank you. So I wanted to follow-up on the final rate notice. Chris Klomp was out with some comments after the final rate notice was published that he was happy with that 2.5% number as it is roughly in line with, you know, where general inflation comes in and thought that that should be a target for just health care spend increases going forward. So do you think that 2% to 3% is where we will continue to see, you know, these rate notices going forward? And if that's the case, what kind of, you know, level of unmanaged trend, I guess, could you manage could you manage without having to to cut benefits if if that's where the the rate notice comes in?

58:27 It's pretty insightful question there. I think overall trend nationally as industry is way higher than 2.48%. And I think the default scenario for a lot of the plans is going to modulate Delta through, you know, kind of either tougher unit economics with the providers or to your point benefit reductions. I think for us, you've got to look at the specific geographic impact of some of this information. And so, you know, I think it's public out there that when you when you look at the data region by region, for example, you know, County's rate increases are closer to 6%.

59:22 Okay, so obviously that stands to benefit us significantly. So those are the kind of factors we're considering now and I've shared this with you in the past that we're doing our business plans now market by market, in preparation for the bids. So I I feel I feel pretty good about where we're positioned, you know, for for 27 bids. But, yeah, trend is no way trend is gonna be at 2.40%. There's just no way. I mean, that's I love Chris. I have a lot of respect for him. But, you know, it's just the trend is a lot higher and which gets to and speaks to affordability which gets back to hospital billing.

1:00:15 Thank you and one moment for our next question. Our last question will come from the line of Ryan Daniels with William Blair. Your line is open. Please go ahead. Yes, guys. Thanks for taking the final one here to close the evening. John, you talked a little bit about ancillary benefits and the impact on MLR. And Jim, you've talked about capital deployment. Let's tie those two together and get your latest thoughts on maybe deploying some capital to bring some of that in house, especially as you approach that 300,000 member number and think about going into new markets. Is that another strategy along with AI to kind of help the cost profile of the organization? Thanks. Yeah, absolutely, Ryan. The supplemental benefits, if you kind of look at the large the larger we get and a lot of our larger competitors have those captives we could call them, whether it be a behavioral health HMO, you know, dental PPO, you know, vision PPO, transportation, all that stuff right now we pay external vendors.

1:01:25 And so it's an opportunity for us to lower MLR by bringing some of that in house. And I've kind of alluded to that in the past where if we focus kind of M and A dollars, it could be in those areas, which were you know, are relatively low risk, low capital, high return, you know, and so whether it's a dental PPO or a dental HMO even and those are some of the decisions we're weighing right now. You'd see that company, you know, if we bought it something or if we started something, you'd see that with 300,000 customers. That's pretty good win for everybody. Obviously that is not something we're embedding into any of our thinking for the first half guidance.

1:02:13 That would be an additional upside for us in the future. Thank you. Thank you. This will conclude today's question and answer session. Ladies and gentlemen, this will also conclude today's conference call. Thank you for participating, and you may now disconnect. Everyone, have a great day.