UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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FORM 8-K
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CURRENT REPORT
Pursuant to Section 13 or 15(d)
of the Securities Exchange Act of 1934
Date of Report (Date of earliest event reported): June 5, 2024
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(Exact name of registrant as specified in its charter)
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| (State or Other Jurisdiction of Incorporation) | (Commission File Number) | (I.R.S. Employer Identification No.) | ||||||
(Address of Principal Executive Offices) (Zip Code)
(844 ) 310-2247
(Registrant's telephone number, including area code)
N/A
(Former name or former address, if changed since last report)
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Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:
| Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) | |||||
| Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) | |||||
| Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) | |||||
| Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) | |||||
Securities registered pursuant to Section 12(b) of the Act:
| Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||||||
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§230.405 of this chapter) or Rule 12b-2 of the Securities Exchange Act of 1934 (§240.12b-2 of this chapter).
Emerging growth company o
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. o
Item 8.01. Other Events.
On June 5, 2024, Alignment Healthcare, Inc. (the “Company”) posted to the Company’s corporate website at www.alignmenthealth.com an investor presentation (the “Investor Presentation”) to be used from time to time in meetings with investors and analysts. A copy of the Investor Presentation is attached as Exhibit 99.1 and is incorporated herein by reference.
Item 9.01. Financial Statements and Exhibits.
(d)Exhibits
| Exhibit Number | Description | |||||||
| 99.1 | ||||||||
| 104 | Cover Page Interactive Data File (embedded within the Inline XBRL document) | |||||||
SIGNATURE
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned hereunto duly authorized.
| Alignment Healthcare, Inc. | ||||||||
| Date: June 6, 2024 | By: | /s/ Christopher J. Joyce | ||||||
| Christopher J. Joyce | ||||||||
| Chief Legal and Administrative Officer | ||||||||
1 A NEW ERA OF AGING Alignment Health USA, LLC Confidential and Proprietary Information Copyright Alignment Health USA, LLC 2024 All Rights Reserved | Unauthorized Use Prohibited William Blair 44th Annual Growth Stock Conference
2 Legal Disclaimer Forward Looking Statements This presentation contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, as amended. Forward-looking statements are subject to risks and uncertainties and are based on assumptions that may prove to be inaccurate, which could cause actual results to differ materially from those expected or implied by the forward-looking statements. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance. Important risks and uncertainties that could cause the Company’s actual results and financial condition to differ materially from those indicated in the forward-looking statements include, among others, the following: the Company's ability to attract new members and enter new markets, including the need for certain governmental approvals; its ability to maintain a high rating for its plans on the Five Star Quality Rating System; our ability to develop and maintain satisfactory relationships with care providers that service our members; risks associated with being a government contractor; changes in laws and regulations applicable to its business model; risks related to its indebtedness, including the potential for rising interest rates; changes in market or industry conditions and receptivity to its technology and services; results of litigation or a security incident; and the impact of shortages of qualified personnel and related increases in its labor costs. For a detailed discussion of the risk factors that could affect the Company's actual results, please refer to the risk factors identified in its Annual Report on Form 10-K for the year ended December 31, 2023, and the other periodic reports it files with the SEC. All information provided in this Current Report on Form 8-K is as of the date hereof, and the Company undertakes no duty to update or revise this information unless required by law. This presentation includes certain market and industry data and statistics, which are based on publicly available information, industry publications and surveys, reports from government agencies, reports by market research firms and our own estimates based on our management’s knowledge of, and experience in, the industry and market in which we compete. Third-party industry publications and forecasts have been obtained from sources we generally believe to be reliable. In addition, certain information contained in this presentation represents management estimates. While we believe our internal estimates to be reasonable, they have not been verified by any independent sources. Such data involve risks and uncertainties and are subject to change. This presentation contains certain “non-GAAP” financial measures within the meaning of Item 10 of Regulation S-K promulgated by the SEC. We believe that non-GAAP financial measures provide an additional way of viewing aspects of our operations that, when viewed with the GAAP results, provide a more complete understanding of our results of operations and the factors and trends affecting our business. These non-GAAP financial measures are also used by our management to evaluate financial results and to plan and forecast future periods. However, non-GAAP financial measures should be considered as a supplement to, and not as a substitute for, or superior to, the corresponding measures calculated in accordance with GAAP. Non-GAAP financial measures used by us may differ from the non-GAAP measures used by other companies, including our competitors. To supplement our consolidated financial statements presented on a GAAP basis, we disclose the following non-GAAP measures: Medical Benefits Ratio, Adjusted EBITDA and Adjusted Gross Profit, as these are performance measures that our management uses to assess our operating performance. Because these measures facilitate internal comparisons of our historical operating performance on a more consistent basis, we use these measures for business planning purposes and in evaluating acquisition opportunities. For a reconciliation of these non-GAAP measures to the corresponding measures calculated in accordance with GAAP, see the Appendix to this presentation.
3 Year-to-Date Recap Exceptional Growth Results • 165,100 health plan members as of Mar. 31, 2024 • 51% YoY membership growth • 30% YoY reduction in new member voluntary disenrollment during the first quarter • Investments in AVA, network, sales operations and member experience continue to drive growth momentum 2024 Profitability Outlook • 2024 outlook implies 260 basis points of YoY operating cost ratio leverage • Disciplined product bids and strong clinical engagement resulted in an adj. MBR excluding ACO REACH increase of only 150 basis points in Q1 while driving substantial membership growth • Ramping new member engagement supports MBR outlook through the remainder of the year Strong 2025 Positioning • Strong Stars positioning in California ➢ Roughly 95% of Alignment’s California members are in plans that will have a 4-star payment level in 2025. ➢ ~700,000 individuals in competing plans that will decline below a 4-star payment level in 2025 • Alignment’s weighted average benchmark update of 5.0% is more than double the national average of 2.4% • Retention of 2024 members presents margin expansion opportunity in 2025 • Well positioned to execute in second phase-in of v28 risk model changes Successful First Quarter Positions Alignment to Deliver Upon 2024 Outlook and 2025 Growth and Profitability Objectives
4 • Curated Products tailored to senior lifestyles • High-quality provider networks • Concierge-level support for a premium member experience • Improve health outcomes through AVA insights and Care Anywhere clinical intervention • Medical savings result from lowering avoidable costs • Reinvestment into superior products using savings derived from medical savings Product and Network Control MA Platform Enables Virtuous Cycle • Alignment Virtual Application (AVA): Purpose-built technology platform • Detailed, real time member data to support health plan operations • Actionable insights enable timely medical intervention by our Care Anywhere teams Data Proximity and Richness: AVA • Care Anywhere (CAW): Employed clinical teams who act on AVA insights • Engage proactively with our highest-risk seniors to improve member health • Agile teams deployed at home and virtually Capital Efficient Clinical Engagement: CAW 1 2 3 4 Payvider Model: Visibility, Control and Durability
5 Purpose-Built Medicare Advantage Platform Company D R IV E S S U S TA IN AB LE GROWTH PERSONALIZED CARE S U P E R IO R EXPERIENCE AND ENGAG EM E N T RIC HES T C O V E R A G E A N D B E N EF IT S H IG H -Q U A L IT Y , L O W -C O S T CARE 1 2 3 4 5 AVA Technology • Developed deeper provider relationships • Bolstered 24/7 concierge services • Addressed member townhall feedback • Insourced member experience functions • Enhanced supplemental vendor management • Streamlined 2024 product benefits • Increased employed Care Anywhere clinical staff and engagement • Invested in Stars capabilities • YoY net membership adds of 55,400 as of 1Q 2024; implies 51% YoY growth • Ensured YoY benefit stability • Launched co-branded relationships • Invested in curated, ethnic-oriented products Virtuous Cycle: Doing Well by Doing Good
6 Our Model Enables Us to Manage Costs while Growing Quickly Notes: 1. Alignment MBR reflects adj. MBR excluding ACO REACH. MBR metrics for peers represent the most comparable reported measure to an individual MA MBR. YoY membership comparisons exclude the impact of acquired membership. Alignment Healthcare Peer 1 Peer 2 Peer 6 Peer 4 Peer 3 Peer 5 -1.0% 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% -20% -10% 0% 10% 20% 30% 40% 50% 60% Y o Y C h a n g e i n Q 1 M B R ( % ) YoY Change in Q1 MA Membership (%) Q1 2024 YoY Change in MBR (%) vs Change in MA Membership (%) B e tt e r Better • Alignment has differentiated itself by achieving superior growth while leveraging its care model and AVA to manage MBR • In comparison to a peer group of national publicly traded health plans, Alignment was the fastest growing MA plan growing at a rate 25x the average of the peer set • MBR for the peer set increased an average of 280bps year-over-year, with higher growth health plans among the peer set showing even greater MBR increases
7 Creates Visibility, Control, and Durability Across Value Drivers Required for Success AVA Platform Performance Management Real-time outcome tracking and performance measurement across value drivers Unified Data Platform Actionable Data and Insights | Accurate, Timely, Complete Core Infrastructure Applications Integrated applications and data across the company Value Drivers Product • Sales • Retention • Stars • Risk Adjustment • Utilization • Unit Cost • G&A Scale Growth Applications Broker and member portals Quality / Risk Adjustment Applications Timely, complete, accurate and compliant documentation Quality / Stars Applications Effective quality program management Care Management Applications Population health and care management
8 74% MEMBERSHIP 5% INSTITUTIONAL CLAIMS 7% MEMBERSHIP 19% INSTITUTIONAL CLAIMS 7% MEMBERSHIP 1% INSTITUTIONAL CLAIMS HEALTHY PRE-CHRONICHEALTHY UTILIZER Notes: 1. Based on at-risk members, Aug 2022 - Jul 2023 dates of service. 2. Based on October 2022 to September 2023 encounter data. 3. Estimated number of visits per year includes members who had an initial CAW visit plus estimates including program-based follow-up activities and engagement (telephonic and virtual). 12% MEMBERSHIP 74% INSTITUTIONAL CLAIMS 74% MEMBERSHIP 5% INSTITUTIONAL COSTS 26% MEMBERSHIP 95% INSTITUTIONAL COSTS Average Member Primary Care Physician (PCP) Visits Per Year: ~5 (2) CHRONIC Estimated Care Anywhere Member Touches Per Year: ~25 (3) Care Anywhere Team Physician Social Worker Advanced Practice Clinician Case Manager Proactive Outreach | 24/7 access | Enhanced Care Coordination Behavioral Health Coach Care Coordinator Medical Assistant We Control Costs by Managing Care AVA | Member Risk Stratification AVA stratifies members into risk categories; Care Anywhere teams proactively target interventions for chronic, high-risk members (1)
9 Personalized Healthcare Notes: 1. All identifying patient information is changed to conceal patient identity. Underlying medical information contains real patient data. This report has been truncated for display purposes. • Extreme risk indicates high priority for Care Anywhere clinical engagement • Members predicted to be “Extreme” and “High Risk” account for 64% of hospital admissions • Homelessness and Duals tags suggest the member could benefit from deployment of Care Anywhere social worker to address underlying social determinants of health • Wheelchair usage prompts a care coordinator to arrange transportation to the next medical appointment using the member’s transportation benefit • Increases likelihood of follow-through on a medically necessary visit, thereby improving member health and reducing cost• Computer algorithms identify potential undocumented conditions and generate supporting clinical logic • Clinical alerts and lab results provide medical context for medical staff and PCPs during Care Anywhere and doctor visits • HEDIS gaps indicate Stars improvement opportunity • Computer algorithms generate detailed action notes for Care Anywhere staff to address during a virtual or in-person visit Delivered at the Home and Virtually
10 Visibility and Control at the Patient Level Notes: 1. All identifying patient information is changed to conceal patient identity. Underlying medical information contains real patient data. This report has been truncated for display purposes. • Filtering criteria used to precisely analyze and address specific population cohorts with targeted campaigns • Key information callouts provide Care Anywhere APCs with a snapshot overview of their patient panels • The admission risk score category leverages the entirety of AVA’s data feeds and proprietary AI algorithms to stratify and rank the admission risk of Alignment’s members • Care Anywhere clinicians target engagement of “Extreme” and “Very High” risk categories
11 • 200+ unique data sources • Admission, discharge, transfer (ADT) feeds from approximately 11,000 hospitals and facilities • Same-day pharmacy and lab data connections from the vast majority of pharmacies and labs in the US • Over 13,000 distinct demographic attributes 1 Data Collection & Ingestion Under a Single Source of Truth Visibility and Control at the Market Level • Data and predictive insights are aggregated into KPI dashboards across the enterprise for daily performance monitoring • Workflow tools support daily clinical, financial and operational activities • Detailed patient information, clinical gaps and care journey conveniently accessible for virtual calls and home visits 2 Daily KPI Tracking & Score Cards • Medical cost management foundations: In- home visits, network provider reviews, 24/7 telephonic and electronic support are all supported by AVA intelligent insights • Clinical leaders and regional operators meet daily to address utilization hotspots • Management of key clinical metrics drives financial outcomes: inpatient admissions per thousand, obs. rate, 30-day readmission, etc. 3 Actionable Operations HIEsIoT Devices Consumer Data / SDOH EHR / EMRsMedical Claims CRM / Call Center ADT Events Labs Genomics Rx ClaimsUnstructured Medical Data HRAs Unified Data Platform Actionable Data | Accurate, Timely, Complete Physician Social WorkerAdvanced Practice Clinician Case ManagerBehavioral Health Coach Care Coordinator Medical Assistant
12 316 255 228 201 150 Jan Feb Mar Apr YE 2024 Inpatient Admissions per Thousand IPA Case Study: Rapid Response to Utilization Hotspots • Alignment grew membership substantially with a new IPA relationship during the 2024 AEP. Members in this IPA were previously not well managed. • AVA’s real time admission, discharge and transfer feeds immediately flagged signs of high utilization in January, signaling the need for clinical intervention. • Care Anywhere rapidly deployed clinical resources toward post-discharge management and ongoing chronic disease management for those identified as high risk . • Alignment medical leadership collaborated with the IPA on after-hours case management and joint operating reviews. • Inpatient admissions per thousand were reduced by 36% in the first 3 months due to AVA’s timely insights and Care Anywhere’s quick clinical response. Targeting another ~35% reduction by year-end. 36% reduction in Inpatient APK in 3 months Actual Results Operating Target
13 2 Product Investment $0 $50 $100 $150 $200 $250 $300 2018 2019 2020 2021 2022 2023 2024 Average Rebate Value ($ pmpm) 3 Membership Growth 1 Medical Outcomes IPA Case Study: MBR Management Drives Virtuous Cycle • Initial Entry: Members who were paneled to doctors affiliated with the IPA were extremely complex (70% dually-eligible) but received only basic case management services that were insufficient for their health profile. • Market Improvement: Care Anywhere deployment leveraged greater use of health coaches and social workers to address the social and clinical issues in this population. AVA insights jointly used by Alignment and IPA’s case management teams to coordinate on chronic care management and member outreach. Financial alignment created by shared-upside risk pool arrangement supported collaborative efforts to improve member health. • Results: AVA insights and market actions resulted in visibility into and management of member chronic conditions, social issues, and inpatient admission reductions. A portion of medical cost savings were reinvested in product benefits which resulted in high-margin growth. 80 100 120 140 160 180 200 220 60% 65% 70% 75% 80% 85% 90% 95% 2018 2019 2020 2021 2022 2023 MBR (%) and Inpatient Admissions per Thousand MBR (%) Inpatient APK 0 500 1,000 1,500 2,000 2,500 3,000 2018 2019 2020 2021 2022 2023 Average Medicare Advantage Enrollment
14 Disruptive, purpose-built Medicare Advantage platform The Medicare Advantage Platform for the Future Investments in operations and AVA accelerating our virtuous cycle Medical cost visibility and control supports 2024 profitability outlook Widening advantages versus incumbents on Stars and risk model changes Positioned to expand margin and grow at or above 20% in 2025 and beyond