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Edited Transcript of BIOS earnings conference call or presentation 6-Nov-19 1:30pm GMT

Q3 2019 Option Care Health Inc Earnings Call

ELMSFORD Nov 20, 2019 (Thomson StreetEvents) -- Edited Transcript of Option Care Health Inc earnings conference call or presentation Wednesday, November 6, 2019 at 1:30:00pm GMT

TEXT version of Transcript

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Corporate Participants

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* John C. Rademacher

Option Care Health, Inc. - CEO, President & Director

* Michael H. Shapiro

Option Care Health, Inc. - CFO

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Conference Call Participants

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* Brooks Gregory O'Neil

Lake Street Capital Markets, LLC, Research Division - Senior Research Analyst

* David Samuel MacDonald

SunTrust Robinson Humphrey, Inc., Research Division - MD

* Jason Michael Plagman

Jefferies LLC, Research Division - VP

* Michael John Petusky

Barrington Research Associates, Inc., Research Division - MD & Senior Investment Analyst

* Richard Collamer Close

Canaccord Genuity Corp., Research Division - MD & Senior Analyst

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Presentation

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Operator [1]

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Ladies and gentlemen, thank you for standing by, and welcome to the Option Care Health Third Quarter 2019 Earnings Conference Call. (Operator Instructions) Please be advised that today's conference is being recorded. (Operator Instructions)

I would now like to hand the conference over to Chief Financial Officer, Mike Shapiro. Thank you. Please go ahead, sir.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [2]

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Thanks, Bridget. Good morning, and thank you for joining us for the Option Care Health Third Quarter Earnings Call. I'm joined this morning by John Rademacher, Chief Executive Officer of Option Care Health.

Before we begin, please note that during the call, we will make certain forward-looking statements that reflect our current views related to our future financial performance, future events and industry and market conditions. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our comments. We encourage you to review the information in the reports we filed with the SEC regarding the specific risks and uncertainties. You should also review the section titled Forward-Looking Statements in this morning's press release.

During the call, we'll use non-GAAP financial measures when talking about the company's performance and financial condition. You can find additional information on these non-GAAP measures in this morning's press release posted on the Investor Relations portion of our website.

And with that, I'll turn the call over to John.

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [3]

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Thanks, Mike, and good morning, everyone, and thank you for joining us on what is our first earnings call as one organization. By now, hopefully, you have seen our press release sharing our results for the third quarter. On behalf of the entire leadership team and the over 6,000 team members of Option Care Health, I'm thrilled to share an update on our efforts to integrate and set the standard for alternate site infusion therapy.

Overall, I am very pleased with the progress we have made, and I'm very proud of how our 2 businesses have come together in a short time frame to begin building a truly extraordinary organization as one team with a unified purpose.

I want to spend a few minutes reviewing the high-level financial results before revisiting the merits of the merger and providing an update on the progress over the past 90 days. Mike will walk you through the financial results for the quarter in a bit more detail, but I do want to reiterate that as a result of the merger on August 6, our performance as released this morning represents a full quarter of Option Care, and incorporates legacy BioScrip results from the date of the merger through the end of the quarter. So the results as reported do not represent a full quarter's results as a merged enterprise. While we are not providing pro forma results for the quarter, we'll try to frame the results on a comparable full quarter basis where possible.

Net revenue for the quarter was $615.9 million representing a 24.7% growth over prior year on a reported basis. On a comparable basis, net revenue was up 2.3%. This is lighter than our historical results, but given the level of disruption over the past 90 days as we've integrated 2 sales teams and commercial organization, I'm pleased with the results, nonetheless. While our commercial integration efforts continue, I anticipate revenue accelerating into the fourth quarter as we stabilize territory and resource alignment and sharpen our commercial execution.

Adjusted EBITDA for the third quarter was $34.8 million. As you can imagine, there are a number of moving pieces given the merger activities in the quarter, and Mike will address the earnings performance in a few minutes. I would highlight that there are a number of areas in which we have harmonized our accounting policies, which creates some year-over-year comparison challenges. Mike and I are aligned that we will deploy conservative and consistent principles that will build on the strength of our improved capital structure, and we will strive to be as transparent as possible with our external stakeholders.

One of the key merits of the merger has always been cash flow potential of the combined organization, and despite the merger-related outflows in the third quarter, we increased our cash balances and finished with more than $50 million on the balance sheet. I am comfortable with our capital position at the end of the third quarter, and the performance reaffirms our belief in the cash-generation potential for Option Care Health.

Stepping back for a minute from the quarterly results, I want to remind everyone of the merits of the merger between Option Care and BioScrip and the opportunity that lies ahead. Option Care Health is the nation's largest independent provider of infusion services in the alternate site setting. With a network of over 120 compounding pharmacies and approximately 2,900 clinicians, we are licensed in all 50 states and have unparalleled ability to reach approximately 96% of the U.S. population. The investments we have made in our people, infrastructure and technology enable us to scale up rapidly and raise the level of infusion care going forward efficiently and effectively.

We've talked about the economic justification for the merger and the cost synergy potential, but I'm also excited about the opportunity to collaborate with our payer and health system partners to help drive better outcomes for our patients. Providing infusion therapy under our model traditionally costs 1/4 to 1/3 of what it costs to provide similar treatment in the acute setting. So we are energized about leveraging our scale and clinical expertise to disrupt the traditional paradigm of delivering infusion in settings that are more expensive and transitioning these patients on to service in the home or 1 of our 150 ambulatory treatment sites.

Finally, I'd like to spend the remainder of my time this morning providing an update on our integration efforts to date. Shortly after we announced the merger in March of this year, we established an integration management office with dedicated resources to begin developing our integration plans to hit the ground running, and the team has done just that. We knew that any successful merger requires a team to establish a north star that will guide decisions and actions across the organization, to move with speed and reduce uncertainty, to find a blend of best practices across both entities and to provide frequent, clear and honest communications broadly to all team members.

As we have approached the incredibly complex integration, highly effective and compassionate patient care has always been at the center of both organizations, and will continue to be our north star in terms of focus. Every one of our team members understands that there is a loved one on the receiving end of everything that we do, and this has been a galvanizing aspect as we bring the 2 teams together, while at the same time, we are acting with a sense of urgency to integrate the organizations as quickly and effectively as possible.

Before the merger was completed, we had already identified the new executive leadership team, which was a blend of the 2 legacy organizations. And as we have announced, virtually all leadership positions, several layers deep, it's been a best athlete drill across the board, and we've created a tremendous team, splitting roughly 60-40 across the legacy Option Care and BioScrip organization.

It is truly an extraordinary organization of talented professionals who share my passion for delivering extraordinary service to the patients with whom we are entrusted for their care. We also committed to the concept of best of both. Whereas we entered the merger with a belief that we had much to learn from each other, and we would begin to build the integration planning process with openness to take the best practices from either organization.

Since the transaction closed, we've established our organizational leadership model and have identified all key leaders for their respective areas. We know that accelerating top line growth is critical to our success, and integrating and reorganizing our 2 commercial organizations is critically important.

From day 1 post merger, we initiated a comprehensive review of our combined customer base, the market opportunities and the appropriate alignment of our resources to maximize our reach. Given the focus of the team, I'd estimate, we're 80% complete in realigning of our field sales team as of the end of the third quarter. This is one of the more complex areas to harmonize as we have considerable territory overlap.

We've reassigned and redeployed resources where we can, but there's no avoiding the disruptive nature of this exercise. We estimate that 45% of our commercial organization has a territory or new portfolio of accounts as a result. It just underscores the commercial alignment efforts will take time, but as I said, we've made tremendous progress to date. The goal of this exercise was to increase the reach and frequency of our selling resources, and based on the analytics and monitoring we have in place, we are seeing early signs of achieving these targets.

We've also made considerable progress on our procurement efforts to date as we've consistently highlighted procurement as a shorter runway to capture and realize synergies. This is broader than just taking best contract in negotiating a price. As Mike will highlight, we've made progress in getting current with vendors on past due invoices, which has afforded us a platform from which we can form more collaborative and productive relationships with our procurement partners. We have initiated contact with all of our key commercial payers to begin harmonizing contracts and then to start work with some of the more innovative health plans to design programs that not only encourage the best site of selection but also enhance the value for member, payer and us as the provider.

I'm also pleased with better efforts to drive operational efficiencies in the field are taking shape. As we've mentioned previously, we estimate that integration of our operations will take 18 to 24 months as the complexity around system integration, pharmacy licensure, credentialing and overall service continuity is significant.

We have considerable experience in this area and ensuring seamless patient care and high-service levels for our referral partners and payers is the priority. To date, I am very pleased with the multifunctional efforts to begin standardizing our field operations that will generate a more efficient and effective model.

One of the initial activities for the clinical team was to standardize the quality management system for all our facilities and to prioritize and deploy capital to eliminate any deferred maintenance and to bring the entire fleet of facilities up to the same high standards. This process is well underway, and we have made strong progress in deploying standard operating procedures, supporting technology and making facility upgrades where appropriate.

As you know, revenue cycle management is a vital component in driving our financial performance. Both organizations have placed a significant amount of focus to stabilize and improve the performance of these functions. As I mentioned earlier, and as is apparent in our statement of cash flows, we have seen improving velocity of cash collections across both organizations as we increase the productivity and effectiveness of our efforts. We still have a significant amount of work ahead us to drive better-than-historical results but we are building and executing plans to utilize technology and more effectively deploy resources to increase the speed and accuracy of our claims submission.

Throughout this entire process, both pre close and since, we've worked tirelessly to provide a constant stream of communication to our team members to ensure that everyone is up to speed on the integration plans and how it may affect them. We have engaged teams from across all disciplines and from both legacy organizations to help us define, describe and communicate the purpose, mission and values of Option Care Health. And we are finding ways to identify and recognize team members who are modeling the desired behaviors and living the values.

So a few thoughts in closing. We know that a successful merger of this size and complexity requires disciplined execution. So it's early and in no way are we over the hump, but I am very encouraged by the progress to date and that we are on track with the plans that we've established. We have a significant amount of work ahead of us, but I've never been more excited about our team, our enterprise and the opportunities that lie ahead.

With that, I'll turn the call over to Mike to walk through the third quarter results. Mike?

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Michael H. Shapiro, Option Care Health, Inc. - CFO [4]

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Thanks, John. Again, before I comment on the specific results for the third quarter, I want to reiterate John's earlier comments regarding the reported results. In our disclosures today, we are reporting the financial results for Option Care Health for the third quarter, which is comprised of legacy Option Care results for the entire third quarter and BioScrip from August 6, prospectively. All historical results in our disclosures are Option Care stand-alone, as mandated by the accounting standards. We'll do our best to provide high-level comparative context estimating results for a full quarter where possible in our comments.

For the third quarter, net revenue of $615.9 million represents reported growth of 24.7% or approximately 2.3% on a comparable basis. As John mentioned earlier, and as we've anticipated as we talked openly about our synergy capture efforts, integrating the commercial organizations generated some disruption in our revenue in the quarter. However, we're encouraged that we're in the later innings of the commercial integration and remain confident in our longer-term top line expectations as a unified organization.

Regarding revenue, recall that we deduct our provision for bad debt and recognize both positive and negative contractual adjustments to arrive at net revenue. As we brought the 2 enterprises together, we have harmonized our accounting policies and practices, including our reserve methodology for bad debt and contractual revenue adjustments. We employ a conservative reserve methodology that objectively assesses reserved requirements based on historical collections. And for the quarter, we have reserved 3.9% based on that criteria in the reported results. Note that as we unify the bad debt and contractual policy across the entire book, this has had an impact on the net revenue results as reported.

In the reported results, we estimate that the policy has resulted in a $9 million year-over-year negative impact considering what was reported last year and this year.

Again, as John mentioned, we have seen consistent improvements over the past few quarters in cash velocity and are seeing our aging improve. However, our reserving methodology is solely based on historical collection activity, and as a result, it takes time for the reserve level to reflect current collection impact.

Gross profit of $137.8 million represented 22.4% of net revenue. And on a reported basis grew 27.3%. We're encouraged by gross margin expansion despite higher revenue reserve level as we've successfully driven operational efficiencies and are yet to start realizing the merger-related synergies to a material extent.

SG&A of $133.5 million is up 55% on a reported basis. However, note that in the third quarter, it includes approximately $21 million in deal-related expenses.

Adjusted EBITDA of $34.8 million grew 32% on a reported basis. Adjusted EBITDA margin of 5.6% expanded 30 bps compared to last year, and again, we're yet to start seeing the impact of the cost synergies. And again, analyzing comparable Q3 results to last year is difficult given the drop-through on the bad debt and contractual policy harmonization. We estimate that excluding the impact related to bad debt and contractual adjustments, adjusted EBITDA growth on a comparable basis would have been in the mid-teens.

For the quarter, reported net loss of $43 million reflects the impact of the merger, which translates into a net loss per share of $0.07. Again, we have provided a reconciliation from net loss to adjusted EBITDA in the press release this morning.

Shifting to cash flow and working capital, I'm very pleased with our performance in the third quarter despite the disruption from the merger activities. We have maintained a relentless focus on cash collections, and we have seen an acceleration in collection performance across the organization. As previously disclosed in Q2 Option Care financial, results we drove a $26 million reduction in accounts receivable in the first half of the year, and we drove reductions across the entire organization in the third quarter. For Q3, cash flow from operations was an outflow of $6 million. However, it's important to note that we have spent more than $15 million in the quarter to get caught up on past due balances with key vendors which helps with our procurement efforts. We funded all of the initial phases of integration through cash on hand. And despite having established a $150 million revolver as part of our new capital structure, we have no outstanding borrowings against the revolver.

So we exited the third quarter with very strong liquidity, including $53 million in cash balances and no revolver borrowings. Our leverage profile remains consistent with what we articulated, and we see a passive deleveraging as we enter 2020. In addition, you'll note that the cash flow disclosures, in particular, reflect significant impacts of purchase accounting, and I'd refer you to the relevant sections of our 10-Q for more information.

As John mentioned, we are very encouraged by the integration efforts to date and the progress we've made. We have outlined since March, our expectation to generate at least $60 million in cost synergies over an 18- to 24-month horizon, and based on our visibility thus far, our confidence remains very high.

Again, it's early, and our third quarter results do not incorporate any significant synergies, given it represents less than 2 months as a merged entity. As a reminder, we see synergy opportunities falling into 3 primary categories: procurement savings of $10 million to $15 million to be achieved on a run rate basis within 9 to 12 months; spending savings of $35 million to $40 million manifesting in both SG&A and cost of service to be achieved over a 12- to 18-month period; and finally, network optimization savings of approximately $20 million to $25 million over a 24-month period.

Finally, before we open the call to questions, I did want to establish expectations for when we will provide more granular guidance for our financial outlook. Given the current dynamics of the integration and our ongoing planning activities, we are not providing guidance for the balance of 2019 or full year 2020 at this point. We anticipate providing guidance for 2020 when we report Q4 results in the first quarter.

So with that, I'll turn the call back over to the operator, and we'll open the call for Q&A.

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Questions and Answers

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Operator [1]

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(Operator Instructions) Our first question comes from the line of David MacDonald with SunTrust.

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David Samuel MacDonald, SunTrust Robinson Humphrey, Inc., Research Division - MD [2]

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A couple of quick questions. Mike, just first on the bad debt. Can you kind of segment that out a little bit? When we look at the 3.9%, should we think about kind of the legacy BIOS probably being in the 5% range and Option Care being in the 3% range? Is that a fair way to think about it? And then secondly, would you expect cash flow to be kind of "normalized" in the fourth quarter when we look at it. And then I've got 1 or 2 more.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [3]

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Sure, you bet, Dave. Yes. Look, as we harmonize the bad debt, again, as you know, this is a relatively subjective area. And it's a -- there is a level of subjectivity in judgment. But as we bring it together, the policy that we've established is relatively consistent with what we've historically deployed. I think the way you're thinking about it is directionally correct in terms of the impact on the specific books. But again, as we think about it going forward, it's really 1 aging going forward and 1 hindsight analysis as we accrue going forward.

As it relates to cash flow, again, look, we're very encouraged that, excluding the disbursement outflow, very encouraged that we were effectively generating cash, excluding that onetime catch up. So that gives us some wind in the sails as we go into the fourth quarter as we continue to look to fund the integration through cash generation. Again, we're not in a position to provide specific guidance for the fourth quarter. But clearly, we feel good about our ability to fund the integration.

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David Samuel MacDonald, SunTrust Robinson Humphrey, Inc., Research Division - MD [4]

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And Mike, just on -- back on the cash flow, is that kind of $9 million, a relatively clean quarter? Does that $15 million kind of capture all of the -- what onetime stops. So you've got the negative $6 million for the quarter and then $15 million of what we'd consider onetime. So is $9 million a fairly clean quarter in terms of how to think about it?

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Michael H. Shapiro, Option Care Health, Inc. - CFO [5]

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Yes, you're thinking about it right, Dave. We -- one of the first things we wanted to do is get caught up, which, again, as I mentioned, gives us a chip to play as we engage with our procurement partners. So getting caught up gives us a better platform from which to collaborate with them. So you should definitely think about the catch-up as more of a onetime item in nature.

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David Samuel MacDonald, SunTrust Robinson Humphrey, Inc., Research Division - MD [6]

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Okay. And then just 2 last questions. The first one you just touched on. Look, it's obviously a little bit more difficult to have a constructive conversation with your vendors when you owe them money. So can you talked a little bit about the goodwill that you think that, that creates and the opportunity to kind of drive that into a more positive relationship? And then secondly, when you look at the kind of best of both initiatives, I was wondering if you could highlight a couple of areas where BIOS was candidly outperforming, and some of the things that BIOS was doing that will be integrated into the best practices.

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [7]

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Yes, Dave, it's John. So let me start with the vendor platform and really, what we've done with procurement. As you outlined, the ability to get caught up and to really have a platform to then start having more concrete conversations, it was an imperative out of the blocks. And as Mike had outlined, that was front and center, something that we look to do. It has created the opportunity for us to sit down with many of the key vendors to start to look at, not only taking the best contract, but start thinking about how we use our scale as a competitive advantage, and more importantly, how we can make certain that we are maximizing the opportunities that are there. So the first order of magnitude was around taking best contracts and applying that into the procurement. And as we get through that, we're now starting to move into thinking about what renegotiation and realignment can be around those key vendors.

As for the best-of-both question. Yes, I'm really excited about the way the teams are working together. Honestly, it's in so many ways, better than expected. When you add 2 organizations that were competitors against each other day-to-day in the marketplace, you're always a little bit leery around bringing them together. And I would tell you, the team has responded very well through that.

Some of the things that we took as real best practices from the BioScrip side. Look, they're focused around driving growth on an organic basis and focusing around the entire organization looking at the opportunities to sell from the seat to be focused around driving the top line is something that we have embedded across the organization. With Harriet Booker as the -- as Chief Operating Officer, there are some best practices within the way that the BioScrip team was leading their operations that we have started to pull through. And some of it is to, in various ways, eliminate some of the bureaucracy that we had as an Option Care organization and being a little bit more nimble and responsive to the needs of the market based on that. And so pleased with the progress to date on both of those. And I'm really pleased with the team's willingness to be open-minded and really look at how do we take the best and take a 1 plus 1 and make it greater than 2.

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David Samuel MacDonald, SunTrust Robinson Humphrey, Inc., Research Division - MD [8]

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And guys, just last question. In your prepared remarks, I want to make sure I get this number right. I think you said as part of the field sales harmonization, 45% of folks are focused on a new territory. Can you just give us a sense of once this kind of settles down and everyone's in their seat and it sounds like that's largely done, how big an expansion of the footprint you're able to attack from a sales standpoint given the increased resources that you have with the combined company?

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [9]

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Yes, so -- and yes, to just put a period on that. So 45% of our field sales organization have some new structure. So some of them have some new accounts within their existing territory, and others have, with re-chalking of the districts, have new territories in which they are covering. And so we knew that was going to be disruptive. But as I think we had talked about before, there was a significant amount of overlap. And you had situations where we would have resources in the same hospital or resources calling on the same referral sources. And so it really gives us an opportunity to reset that and realign the resources. In general, we believe that we can get about a 15% or 20% expansion in our coverage with the realignment of those resources.

Now we're not going to embed a resource into every hospital. We're going to go through a criteria of establishing the size of the hospital, the number of beds, the number of discharges in the way that we align those resources. But we really believe that there's an opportunity as we start to build and grow this forward, that our frequency and reach will expand in that, let's call it, 15% to 20% range.

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Operator [10]

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(Operator Instructions) Our next question comes from Brooks O'Neil with Lake Street Capital.

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Brooks Gregory O'Neil, Lake Street Capital Markets, LLC, Research Division - Senior Research Analyst [11]

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It's nice to start with a new company and a new structure and new team, so I'm excited for you. I have a couple questions. I guess, the first one, historically, guys, adjusted EBITDA margin has been a key topic for BioScrip investors. I recognize all the moving parts, and I thought maybe we should start there and just talk a little bit about refreshing people's memory about why your adjusted EBITDA margins are lower than the historical BioScrip margins. And was wondering if you can make any attempt to kind of talk about year-over-year comparisons on each side of your business, specifically. Are you seeing margin expansion or contraction on the Option Care side, on the BioScrip side and recognize that, that's going to be less and less sort of relevant going forward, but I'm just curious where we're starting today.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [12]

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Sure. You bet, Brooks. Thanks for the question. So again, one of the distinct differences as we tried to articulate over the last few months since announcing the merger, is there is a difference in the revenue book and basis for the organizations. On the legacy Option Care side, again, we've invested in a portfolio of limited distribution therapies which are somewhat finite in terms of the patient population. Again many times, these are orphan populations or smaller patient cohorts. We find these to be attractive complementary therapies, that they're a more efficient therapy class to collaborate with biopharma as they bring these to market. They do admittedly have a lower margin profile, again, because we're bearing the exorbitant cost of the therapy in our revenue. So whereas these are efficient therapies to treat, strategically, they're very complementary for our chronic therapy portfolio. They do have a negative impact on the gross margin rate. Still attractive gross margin dollars, but from a rate perspective, that has had a lowering effect on our EBITDA margin overall.

When you really normalize for the limited distribution and high cost of chronic therapies, the EBITDA margins are relatively comparable from the start. On the -- in response to some of John's comments, we've made a number of investments in technology and infrastructure. On our side, we are seeing EBITDA expansion. But again, Brooks, the further we get into the integration, it becomes much more challenging to really talk to EBITDA margins on either side. But the bottom line is, again, back to why we're excited about the merger and integrating these 2 organizations is the tremendous cost synergy opportunity, which, frankly, the best way to articulate that is by demonstrating to you the EBITDA margin expansion over the next several quarters.

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Brooks Gregory O'Neil, Lake Street Capital Markets, LLC, Research Division - Senior Research Analyst [13]

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Absolutely. I get that totally so I appreciate all that color. I have 2 more, just quick ones. One, there was quite a bit of commentary or discussion during the quarter about pressures relative to IVIG. Can you just give us an update on sort of your perspective of where you're at in the cycle? Or with that particular therapy.

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [14]

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Yes. Brooks, thanks, it's John. We feel that we're in a really strong position in the relationships that we have across multiple manufacturers and providers of the product. So yes, it is tight. Yes, there are constraints within the supply lines associated with that. But we've been pretty nimble in our ability to manage that effectively. And we do have -- where clinically appropriate, we do have alternatives that we can provide to patients and to prescribers in the marketplace. So we operate with a center of excellence that really focuses around managing that patient population effectively. We work proactively with our referral sources and the prescribing physicians to really get a best match of product to the patient based on availability and clinical efficacy. So we really believe that, that gives a strength for us as an organization. And it's something we're going to continue to work closely as we move forward with our procurement and developing those deep relationships with the vendor partners to make certain that we have access to products and services.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [15]

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And Brooks, it's Mike. The one thing I'd add is this is an area where scale absolutely matters. You've been following the IG market for years. You know that this is an environment where it's subject to product disruption and shortages from time to time. And given our procurement strategy, which is to primarily procure these with direct relationships through manufacturers. With the scale that we have, and again, now that we're caught up and we have more amicable relationships, this gives us the strength to weather some of those disruptions, probably a little bit better than many in this space.

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Brooks Gregory O'Neil, Lake Street Capital Markets, LLC, Research Division - Senior Research Analyst [16]

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Yes, that's great. I totally get that. Last question, obviously, there was some commentary or Medicare-related legislation this week. I'm just curious that my sense is, clearly, the CMS is still reluctant to give you guys full and fair reimbursement for infusion services. Curious if you have any commentary about where you stand now and where you think this is going to ultimately play out going forward.

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [17]

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Yes, Brooks. Yes, a lot of commentary this week. And if anything, CMS just reaffirmed what has been their historic position around an infusion day and the way that they're looking to reimburse home infusion. We didn't -- we weren't caught by surprise on that. We expected that, that was going to be their position given that, that has been their message up to this point. We are continuing to vigorously fight this. I mean we are in partnership with NHIA, continue to look at all alternatives to do that. We do not believe that the current structure and reimbursement scheme is fair in the value that we're able to deliver through that process. And so we're looking at all available ways to influence, and then more importantly, to get a better outcome on that from the lawsuit that has been filed against HHS and CMS, all the way to working with members of Congress to get better legislation that's more definitive with its language around that.

So we'll continue to fight the fight on this because we believe we're on the right side of the argument. We offer high quality, appropriate cost care in a setting in which patients want to be served. And quite frankly, we believe that CMS and the beneficiaries would benefit in lowering cost and better outcomes. So we will continue to fight that fight.

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Brooks Gregory O'Neil, Lake Street Capital Markets, LLC, Research Division - Senior Research Analyst [18]

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Cool, I get that. I just want to clarify. I think -- I mean, my own sense is it's all upside from here. There's absolutely no downside in the current posture from CMS, right?

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [19]

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Correct. At this point in time, we have -- there's nothing in our numbers that would -- that we have put for the upside on that. So anything that would move in a favorable way, would be something that would be upside for us.

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Operator [20]

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And our next question is from Brian Tanquilut with Jefferies.

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Jason Michael Plagman, Jefferies LLC, Research Division - VP [21]

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It's Jason Plagman on for Brian. Just wanted to ask if the numbers and the growth and synergy targets you laid out in proxy. Any material changes from those so far now that you're a couple of months into the integration. Just wondering if anything has changed from your thoughts prior to the deal closing.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [22]

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Jason, it's Mike. No, again, as we mentioned, obviously, it's early innings but very encouraged with the progress over the last couple of months. As we've tried to convey a high degree of confidence in at least $60 million of net synergies, and I'd characterize our confidence as high or higher than when we closed the merger. So good first -- as John mentioned, it's early. There's a lot ahead of us. There's some complexity over the next 18 to 24 months, but encouraging progress thus far.

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Jason Michael Plagman, Jefferies LLC, Research Division - VP [23]

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Great. And then just wondering what reaction you've heard since the deal closed from your clients and your referral sources, given how they're viewing the combined organization and their ability to partner with the combined organization.

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [24]

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Yes, David, (sic) [Jason], it's John. I think in general, it has been positively received. In many instances, the breadth of the product portfolio that now we can bring the clinical expertise that is available when you look at the combined organization and what we can bring to the equation as well as, as we have talked before about taking the best of both around the efficiencies and effective way to onboard patients and bring that ahead. So in general, I'd say it's been very positively received. The reach we have when you look at the national platform is something that is extremely helpful. And in many of those situations, especially with some of the major academic medical centers or where you have medical tourism, if you want to think of it that way, patients that are traveling from large distances to receive care at one of the settings, our ability to help with that transition no matter where that patient may reside is also a benefit that we can bring given the size and scale of our platform.

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Operator [25]

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And our last question comes from the line of Mike Petusky with Barrington Research.

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Michael John Petusky, Barrington Research Associates, Inc., Research Division - MD & Senior Investment Analyst [26]

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So I guess when you guys -- just looking ahead, when you guys do give guidance, have you guys sort of dialed in yet how -- is it full year? Is it quarterly? Is it going to be sort of revenue, adjusted EBITDA? Is there going to be more to it. Have you guys thought about how the cadence of -- I guess, the cadence or the coverage of the guidance and then the important metrics you want to provide?

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Michael H. Shapiro, Option Care Health, Inc. - CFO [27]

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Yes, Mike, it's Mike. We're still refining that. I think we're generally going to provide annual expectations. Naturally, we'll be providing revenue and an adjusted EBITDA. How far beyond that we go, we're still refining. But we'll provide annual guidance on our fourth quarter call on Q1.

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Michael John Petusky, Barrington Research Associates, Inc., Research Division - MD & Senior Investment Analyst [28]

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Okay. Great. And then just in terms of synergies, and I know it's super early. But as you sort of get a few quarters into the integration efforts. I mean will you guys provide sort of a quantification or just items that, hey, we've now checked off this issue or this issue? Have you guys thought about how you're going to sort of communicate that either quantitatively or just, I guess, qualitatively?

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Michael H. Shapiro, Option Care Health, Inc. - CFO [29]

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Yes. We're absolutely committed to providing updates on...

(technical Difficulties]

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Operator [30]

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Excuse me, this is the operator. I apologize that there will be a slight delay in today's conference. Please hold and the conference will resume shortly. Thank you for your patience.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [31]

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Hey, Mike?

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Operator [32]

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Please begin.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [33]

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Apologies for that. We had a telecommunications challenge.

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Michael John Petusky, Barrington Research Associates, Inc., Research Division - MD & Senior Investment Analyst [34]

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No problem. Sometimes, I ask questions that may make executives want to hang up, but they normally don't go all the way and do that.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [35]

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That was not the case. Yes.

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Michael John Petusky, Barrington Research Associates, Inc., Research Division - MD & Senior Investment Analyst [36]

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Yes. I'd just asked along the lines of synergy updates and if you're going to provide quantification of that or just items that you've checked off.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [37]

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Yes, my apologies, again. Yes, we're committed to providing updates. Again, as we get further away from the merger date, it becomes a little bit more difficult to quantify, but we're absolutely going to provide updates on our progress. Again, how granular are we getting in the dollars, again, the best way to show evidence of the synergy is through meaningful EBITDA margin expansion, and so we'll do our best to provide you with feedback on our progress.

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Michael John Petusky, Barrington Research Associates, Inc., Research Division - MD & Senior Investment Analyst [38]

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Okay. And then just last one, and I may have missed this. You may have spoken to this earlier. But other than debt paydown, which is obviously a big deal in terms of whatever free cash you guys generate. What other capital allocation priorities do you see? I mean with 96% or 97% coverage, whatever you guys have, I mean, is M&A actually something that you guys need to look at. Or could you just speak to, besides debt paydown capital allocation priorities?

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [39]

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Yes. So this is John. I think as we're looking at the priorities, as you say, at this point in time, adding additional pharmacies is not necessarily on the top of our list. We've got a lot to do with integration of what we have and making certain that we maximize the value there. We certainly want to make our priorities around looking for near adjacencies that may make sense. We have, as we had outlined before, we have some CapEx that we're going to need to deploy for bringing everything up to the same high standards and making certain that we, as an organization, are leveraging that technology platform across all of the facilities as we move ahead. So there is some use of the dollars within that, that we would say. But I would say, from a priority perspective, certainly we -- having cash on the balance sheet and really making certain that we get through the integration is, first and foremost, including the CapEx associated with that. And then I'd say, we're always looking for opportunities for near adjacencies that could be complementary to what we do in the business.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [40]

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But nonetheless, Mike, again, just to reaffirm some of the comments we made, that it's early, but the -- our confidence in the free cash flow potential of this enterprise is as strong as ever. And we think that, that's a key tenet of the merger. And as John said, I think, near term, it's let's fund the integration, make sure we've got adequate liquidity and we'll look at the different alternatives down the road.

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Operator [41]

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And our next question is from Richard Close from Canaccord Genuity.

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Richard Collamer Close, Canaccord Genuity Corp., Research Division - MD & Senior Analyst [42]

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Great. Congratulations on the merger. I jumped on the call late -- a little late here. But just curious if there's anything to call out in the fourth quarter. I understand you're not giving guidance. But is there anything we should think about with the fourth quarter in terms of our modeling efforts.

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Michael H. Shapiro, Option Care Health, Inc. - CFO [43]

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Yes, Richard, as you mentioned, we're just not in a position to be providing any specific guidance. I think some of the subjective comments we've made is, obviously, we're encouraged having gotten to the later stages of the commercial integration, which, again, getting that -- most of that disruption behind us is encouraging. Obviously, we're in full swing on pursuing the synergies across both the procurement effort as well as driving the spending savings. So again, encouraged by the near term. And again, as John mentioned, a critical, critical priority is at the commercial organization, driving the top line acceleration. So again, beyond that, there's not a lot that we can provide around thoughts on how to model out the fourth quarter.

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Richard Collamer Close, Canaccord Genuity Corp., Research Division - MD & Senior Analyst [44]

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Okay. And then maybe bigger picture, obviously, you're still in the early days here. But any thoughts with respect to what you think the long-term growth and maybe aspirational margin targets are for the company?

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Michael H. Shapiro, Option Care Health, Inc. - CFO [45]

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Yes. I mean the way we think about it. Again, we think that the near term, driving the synergies, that will manifest in a meaningful expansion on the EBITDA margin. And then again, as we've articulated, our expectations going forward, we see this enterprise as one that with top line in the mid-single digits delivering 2 to 3x bottom line earnings leverage is something that, frankly, we think is a realistic expectation. And so over time, we think that, that leads this enterprise into an EBITDA margin in the high single digits with very strong cash flow potential.

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Operator [46]

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And I'm not showing any further questions. So I'll now turn the call back over to John Rademacher for closing remarks.

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John C. Rademacher, Option Care Health, Inc. - CEO, President & Director [47]

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Yes. Thanks, Bridget. Thank you, everyone, for joining us this morning. As I hope you hear from our commentary, we are really excited about the progress that we've made and, more importantly, about the potential that the business has as we look forward.

So with that, we'll look forward to providing further updates as we get into fourth quarter earnings released in the first quarter. And so thanks, everyone, for your time and participation this morning. And hope everyone has a great day. Take care.

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Operator [48]

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Ladies and gentlemen, this does conclude the program. You may now disconnect.