AGL

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Transcript Summary

Agilon Health delivered strong Q1 2026 results, surpassing guidance across revenue, medical margin, and adjusted EBITDA. The quarter was defined by the successful deployment of an enhanced data pipeline covering 85% of members, which significantly improved risk score visibility and led to a raised full-year estimate of 1.5% for risk adjustment. Management also announced the appointment of Tim O'Rourke as the new CEO. Key drivers included disciplined payer contracting, better-than-expected ACO REACH results due to CMS fraud adjustments, and a new $200 million full-risk contract. Clinical programs, particularly for congestive heart failure, are showing measurable success in early detection, and the company is expanding these pathways to COPD and dementia. While medical cost trends were booked at a conservative 7.4% for the quarter, management observed favorable development from late 2025. Analysts questioned the transition to the 2027 Lead model and the sustainability of margin expansion. Management remained bullish, citing minimal exposure to unlinked chart reviews and a strong foundation for future growth. The company’s focus remains on operational discipline and profitability through physician partnerships rather than rapid geographic expansion in the near term.

5-year share-count history (top 10 holders by peak, incl. exited) + price

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agilon health: Reverse stock splits and legal blitz mask VIE-driven insolvency risks

Full Earnings Call Transcript — Q1 • 2026-05-06

Operator: Hello, everyone. Thank you for joining us, and welcome to agilon health First Quarter 2026 Earnings Call. After today's prepared remarks, we will host a question-and-answer session. [Operator Instructions] I will now hand the conference over to Evan Smith, Senior Vice President, Investor Relations. Please go ahead.
Evan Smith: Thank you, operator. Good afternoon, and welcome to the call. With me are Executive Chairman, Ron Williams; and our CFO, Jeff Schwaneke. Following our prepared remarks, we will conduct a Q&A session. Before we begin, I would like to remind you that our remarks and responses to questions may include forward-looking statements. Actual results may differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with our business. These risks and uncertainties are discussed in our SEC filings. Please note that we assume no obligation to update any forward-looking statements. Additionally, certain financial measures we will discuss in this call are non-GAAP financial measures. Non-GAAP measures are supplemental and not substitute for GAAP results. However, we believe that providing these non-GAAP measures helps investors gain a better and more complete understanding of our financial results and are consistent with how management views our financial results. A reconciliation of these non-GAAP financial measures to the most comparable GAAP measures is available in the earnings press release and Form 8-K filed with the SEC today. And with that, let me turn the call over to Ron.
Ronald Williams: Thank you, Evan, and good afternoon, everyone. In 2026, we remain focused on disciplined execution and building a durable foundation for sustainable long-term performance. We are advancing the same strategy and mission, empowering best-in-class physicians through long-term partnerships to deliver high-quality, cost-effective patient care that delivers value for all of our stakeholders. In 2025, we made meaningful progress across all of our initiatives, which has translated into strong first quarter performance and increased expectations for our full year 2026 outlook. As we announced last week, we are excited to welcome Tim O'Rourke as our new CEO beginning tomorrow, May 7. Tim brings significant experience across the payer and provider space with a deep understanding of what is needed to succeed in value-based care. Tim is fully committed to furthering our mission and strategy to continue driving improvement in agilon's performance for all of our stakeholders. In the first quarter, we delivered results that were above our expectations. Our performance demonstrates operational discipline, the strength of our long-term physician partnerships, and early benefits from the strategic decisions we made last year. Operationally, we are building upon several key initiatives you've heard me discuss before, the enhanced data pipeline and improved actuarial visibility enabling earlier identification and validation of trends, continued advancement of our clinical and quality programs with our congestive heart failure program now scaled broadly across the network, and ongoing execution of disciplined payer contracting and operating expense optimization focused on profitability and sustainability. Each of these efforts are designed to improve predictability and alignment with our physician partners, reduce variability, and support durable margin expansion over time. With the enhanced data pipeline, we now have more timely direct payer data feeds with validated and highly correlated member level clinical and claims data as well as member level risk scores on approximately 85% of our members. The increased visibility and alignment of our financial and operational data enable us to more quickly identify and drive improvements. As Jeff will discuss in more detail, this has enabled us to increase our revenue and adjusted EBITDA expectations in part due to better progress on the validation of our burden of illness initiatives. Going forward, we will continue to enhance the data pipeline to support clinically actionable insights as well as improved network design and care model innovation. In combination with our physician reviewers, we are integrating generative AI-based insights directly into clinical workflows to drive more informed physician decision-making at the point of care, and we are seeing encouraging results. This capability is helping physicians intervene at the most appropriate points of care earlier. We are continuing to increase our focus on high-risk patients, an increasingly important focus for all constituents in the Medicare space. We have grown the richness of our member level data and are now aligning it better with PCP actions. This is helping physicians improve the quality of their intervention with higher-risk patients, identifying gaps in care, and leveraging industry standard guideline-directed clinical pathways. Greater access to timely and high integrity data has also improved the quality of our forecasting as demonstrated in the ongoing development of our 2025 cost trends. We have favorable medical cost trend development from the second half of 2025 and are seeing slight moderation within patient census so far in 2026. With that said, given it is early in the year, we believe it remains prudent to maintain our net cost trend outlook of approximately 7% for full year 2026. Our full risk Total Care Model is delivering clinical and quality outcomes and driving strong patient and PCP Net Promoter Scores while demonstrating the ability to effectively manage utilization and medical cost trend. Next, let me discuss clinical and quality programs, focusing primarily on our clinical execution, which is a core driver for our model. As a reminder, the congestive heart failure or CHF program remains the most mature pathway deployed across 90% of our markets. Let me start with why this program is important to patients. Approximately 40% to 50% of patients nationally are diagnosed at the time of first admission to the hospital. That means missed opportunities for earlier detection, leading to less-than-ideal care and unnecessary hospital costs. The second thing we know about heart failure is that less than 10% of patients are actually on the right therapies. Through a proactive and guideline-directed approach, our physician partners have been able to shift CHF diagnosis to earlier in the care continuum, with inpatient first diagnosis rates improving from approximately 25% to less than 5%. So less than 5% of heart failure diagnoses are now in the inpatient setting. Additionally, we are expanding our pharmacy integrated management approach for heart failure patients across the network and observing positive trends in guideline-directed therapy rates, which we expect to improve functional outcomes for patients and prevent downstream complications of disease that lead to admissions. Current results reflect the combination of our early detection and diagnosis supported by in-office or increased access to diagnostics, structured and physician-supported clinical protocols and ongoing patient engagement, including virtual pharmacy support. These pathways are increasingly informed by AI-driven risk stratification and early detection models, enabling more proactive intervention with this high-risk population. We plan to utilize this evidence-based approach by rapidly scaling COPD and broader lung health pathways through 2026. The initial focus for these programs will be earlier identification of COPD, expanded lung cancer screenings and increased use of advanced diagnostics by our physician groups, each of which is designed to drive earlier intervention, improve treatment adherence or prevent avoidable complications and hospitalizations. In addition, we are seeing good engagement as we continue to roll out the dementia program in conjunction with our physician partners. Increased health care costs and the burden on caregivers is being driven by the approximately 50% of dementia patients across the broad population that go undiagnosed, increasing both health care costs and the burden on caregivers. We are working with partners to deploy enhanced caregiver models, structured early-stage pathways and virtual diagnostics. Moving to our quality and stars performance. agilon stars' performance is a result of a highly integrated quality operating model that combines data infrastructure, physician engagement and payer alignment. Operationally, quality performance starts with our ability to identify care gaps early and deliver actionable insights directly to our physician partners. Because we are working closely with our physician partners, quality measures are embedded into their everyday clinical workflows. Our partners and their care teams have clear visibility into their performance and the actions needed to efficiently close care gaps for their patients. Looking ahead, we expect to see continued opportunity to expand our performance through deeper data integration and earlier intervention, leveraging analytics to identify patients at risk of missing key quality measures earlier in the measurement year. Ultimately, our approach is about building durable infrastructure that supports physicians in delivering high-quality care that is aligned with the key objectives of the Medicare Advantage program while ensuring performance is accurately measured and rewarded. Now let me move on to ACO REACH. As evidenced in the quarter's results, we continue to demonstrate the strength of our model and the ability to deliver superior performance across both Medicare fee-for-service programs and Medicare Advantage. In addition, we are pleased that CMS took a pragmatic approach to addressing fraudulent claims related to urinary catheter and suspect skin substitute claims for 2025. Finally, we have finalized 2026 payer contracts, which Jeff will discuss in a moment. We are beginning our 2027 payer contracting process where we plan to take the same disciplined and partnership-oriented approach with our payers, focused on shared profitability and durable margin expansion. In closing, we have had a strong start to 2026 and feel good about the progress we are making. We are seeing it across all areas that matter: Payer contract, burden of illness, clinical and quality initiatives and cost discipline. First, the work we have done with our physician partners around burden of illness initiatives and clinical pathways is starting to show up more clearly in our clinical results and financial performance. Second, our AI-enabled technology platform and enhanced data capabilities deployed in very close proximity to the physician are allowing us to identify opportunities earlier, act faster, and manage performance with greater precision. We are beginning to see the benefits of AI more deeply into both physician and operational workflows. Third, the discipline we applied, particularly around payer contracting and cost structure is starting to come through. We are raising our outlook for financial performance this year due to the early impact of these initiatives and remain confident in the long-term strength of our unique partnership model. With that, I will turn the call over to Jeff to go through the financials.
Jeffrey Schwaneke: Thank you, Ron, and good afternoon. As Ron mentioned, we are very pleased that we exceeded our guidance for the first quarter and are increasing our expectations for the full year. The positive results and increase to our full year guidance were driven by the strategic actions we took throughout 2025 and the continued strong work of our physician partners across the country. These include the significant improvement in our data visibility and estimation process, execution of our clinical and quality programs across our network, cost management, and disciplined payer contracting, all of which were focused on improving our operations and creating a strong foundation for durable and predictable performance this year and beyond. During our call today, I will cover 3 key areas of our financials. First, I will discuss our financial performance for the first quarter. Second, I will provide an update on cost and macroeconomic trends, including the recently announced final rate notice for 2027. And finally, I will discuss our second quarter and revised full year 2026 outlook, along with key assumptions we have made. Moving to our financial performance for the first quarter of 2026. We exceeded the top end of our guidance range for total revenue, medical margin, and adjusted EBITDA. The performance in the quarter was driven by higher-than-expected revenue from risk adjustment and additional full risk contract with a new payer in an existing market and strong performance in ACO REACH. Starting with membership. Medicare Advantage membership at the end of the quarter was 426,000 compared to 491,000 in Q1 2025. Our ACO REACH membership for Q1 was 110,000 members compared to 114,000 in the same period of 2025. As a reminder, Medicare Advantage membership was affected by our measured approach to growth, previously disclosed market exits, which were finalized as of January 1, 2026, and payer exits in certain markets, which were a result of our disciplined and profitability-focused contracting efforts. Additionally, a subset of our members are under care coordination fees. These contracts are primarily net neutral to agilon health with financial opportunity based upon strong quality and cost performance. Next, revenue for the first quarter was approximately $1.42 billion compared to $1.53 billion in the same period of 2025. Our year-over-year revenue decrease is driven by the membership decline I just mentioned, partially offset by more constructive rates for 2026 from both the CMS benchmark and favorable payer contracting benefits as well as increased revenue from higher estimated risk scores from our previous expectations. Revenue for the first quarter was higher than our expectations, driven by the execution of an additional full risk contract in an existing market and the estimated benefit of higher-than-expected risk scores. Using the enhanced data pipeline for a meaningful portion of our membership, we calculated member level risk scores for the mid-year data period. This enhanced data is based on claims data as well as MAO4 and MMR data that our payer partners receive from CMS. These data files are both claims and plan submitted encounters that are accepted for risk adjustment. As a reminder, we did not have this increased visibility into member level clinical and claims data as well as member level risk scores until the pipeline went live at the end of the first quarter of 2025. Our revised estimate for the increase in risk scores over 2025 for the full year is now 1.5%, which is above our previous estimate of 0.4% for the full year 2026, both net of the V28 impact. This was driven by the improvement in our data and forecasting capabilities as well as the operational process improvements we put in place over the past 18 months. Moving on to medical expense. The cost trends for the second half of 2025 continue to develop favorably, further demonstrating our ability to effectively manage medical costs. The full year 2025 cost trend is now estimated at 6.2%, down from the 6.5% we estimated when we reported our 2025 full year results. The favorable development for 2025 medical expense was offset by additional reserves related to Part D costs for 2025, which, as a reminder, are recorded net in premium revenue. Given the lack of data for 2025 Part D costs, we continue to take a prudent approach to Part D reserving as we won't get final reconciliations of the cost typically until the third quarter of this year. Given we have limited paid claims visibility for the first quarter of 2026, we recorded a cost trend of 7.4% for the quarter. I would note that based on our census data, cost trends remain in line with what has been mentioned nationally by our payer partners and others. However, given our limited paid claims visibility early in the year, we took what we believe is a conservative approach in the quarter. Medical margin for the first quarter was $149 million compared to $128 million in the first quarter of 2025, which exceeded the high end of guidance. This was driven by higher revenue, as I previously discussed, and lower overall medical expenses in the quarter. ACO REACH adjusted EBITDA for the first quarter was $27 million and ahead of our expectations by approximately $5 million. The favorable performance was primarily driven by CMS' removal of fraudulent urinary catheter and suspect skin substitute costs from our 2025 performance and the corresponding benchmark changes. Adjusted EBITDA was $54 million as compared to $21 million in the same period of the prior year. The favorable overall performance reflects higher medical margin, OpEx discipline, and the favorable ACO REACH performance I previously highlighted. As Ron mentioned, ACO REACH results underscore our confidence in our model and the potential for driving continued value creation as we look forward to the advancement of both the MSSP and CMS lead model in 2027. On the balance sheet, we ended the quarter with $303 million in cash and marketable securities and $47 million of off-balance sheet cash held by our ACO entities. Year-end cash position is still expected to be at least $125 million. Last, we executed a reverse stock split at the end of the quarter. Additional details can be found on our Investor website. Now moving to guidance. We are revising our full year 2026 guide to reflect the strength of the first quarter results, including better-than-expected revenue associated with higher estimated risk scores for the year and the first quarter performance in ACO REACH. In addition, as previously mentioned, it also includes a new full risk contract signed in Q1 2026 in an existing market with a new payer. Our confidence remains rooted in the same key tenets we have previously outlined, including operating execution across clinical and quality programs, improved data visibility and forecasting capabilities related to the enhanced data pipeline, payer contracting improvements, which emphasize profitability for both medical margin and cash flow and a conservative cost trend assumption supported by factors previously mentioned. Utilizing the midpoint of guidance ranges provided within our earnings release, we now expect revenue of approximately $5.7 billion, medical margin of approximately $375 million in 2026 and adjusted EBITDA of approximately $25 million. As I indicated, while the second half of 2025 saw favorable claims development, we continue to be prudent in our reserving and are maintaining our full year net cost trend outlook of 7%. Focusing on the second quarter and utilizing the midpoint of guidance ranges, we expect revenue of $1.45 billion, medical margin of $123 million and adjusted EBITDA of $20 million. I will close by saying that we are very pleased with our first quarter's performance, including delivering strong positive adjusted EBITDA. The enhanced data and reserving model is improving our visibility to claims and revenue trends. We have executed on our strategic transformation and continue to drive improved performance across all aspects of the business. As Ron mentioned, we also remain optimistic about our runway for continued improvement beyond 2026 based on the continued execution across our initiatives and the final 2027 rate notice. With respect to the final rate notice for 2027, we believe our starting point across our markets is in line with the 5.33% effective growth rate CMS noted with additional opportunities based on our BOI, quality, and contracting efforts. Based on our model and review across the business, we believe we have minimal exposure to unlinked chart reviews and with respect to the 1.12% normalization factor, I will remind everyone that we have been able to more than offset the V28 hurdle over the past couple of years. Further supporting our potential will be continued discipline around payer contracting, implementation of programs to lower overall medical costs, and further driving operating efficiencies. The team will remain focused on minimizing risk related to Part D, emphasizing our quality initiatives, and balancing payer priorities with our own profitability. And last, we believe CMS continues to demonstrate their support for full risk value-based care models focused on clinical and quality programs that drive improved outcomes, reduce costs, and enhance member satisfaction. And therefore, we remain optimistic about the potential for agilon. With that, operator, let's move to the Q&A portion of the call.
Operator: [Operator Instructions] Your first question comes from the line of Jailendra Singh with Truist Securities.
Jailendra Singh: I want to ask about ACO REACH EBITDA, kind of nice number there, $26.5 million. But you guys are maintaining the guidance for full year is $25 million to $30 million now for the full year. Why are you guys not expecting any further contribution for that business for the rest of the year?
Jeffrey Schwaneke: Yes. Thanks, Jailendra. The real -- the $5 million benefit that we saw, we just really increased that in the guide for the year for the REACH program, but the $5 million benefit that we saw in the quarter was really related to 2025 performance, and it was associated with the suspect skin substitutes and the urinary catheters. And so CMS decided to back those out of the costs for 2025, and so we got a pickup there. And so that's really what you're seeing. And it's a little early in the year for us to think about, I would say, REACH performance and adjusting that at this point in time, right?
Jailendra Singh: And then my follow-up, you guys talked about AI helping you to capture some more efficiencies in the provider operational workflow and admin stuff there. The efficiencies you're seeing, the gains you're seeing right now, should we think of those like incremental to the OpEx benefit of $35 million you guys have talked about for 2026? Or is that already reflected in your guidance? Just trying to understand the opportunity there.
Jeffrey Schwaneke: Yes. Two things. I would say, I would bifurcate the AI programs. One is OpEx efficiencies. The other one would probably impact more of, I would say, above the line, right? So more of medical costs and revenue. So we mentioned the AI-driven risk stratification. I mean that's really looking at medical costs, we use AI in our suspecting algorithms as well. So that's on the revenue side. And so I guess what I would say is probably limited early impact on the OpEx line, more significant on both the revenue and medical cost line. And as you know, we operate in an environment where you're working on things today, but the value shows up much, much later in the health care environment, right?
Operator: Your next question comes from the line of Matthew Shea with Needham.
Matthew Shea: Nice to hear about the scaling clinical programs. I guess maybe I just want to put some finer points around those. I think at a conference a couple of months ago, you guys have talked about that by the end of Q2, you had expected to get 50% to 70% plus of markets live on dementia and COPD pathways. Is that still the right way to think about the rollout? And then on the financial side, could you remind us how long it takes to generate outcomes from these programs? Like does scaling COPD and dementia add benefit to 2026 profitability? Or should we look at that as more of a 2027 benefit?
Jeffrey Schwaneke: Yes. I would say, yes, on the COPD and dementia rollout. And yes, again, on your second question of would it add value to 2026? However, it has to show up in the claims. And obviously, that takes time, right? But I would say, yes. And scaling, if you think about, we initiated the heart failure program a year ago. It's our most mature program, and we are obviously seeing the benefit of that today. And I think in the prepared remarks, you heard a lot of statistics about how it's really improving the lives of our members. And so we have seen the outcomes of that. And I think we're pretty excited about rolling out the other programs and continuing to focus on other clinical programs as we think about member care going forward.
Ronald Williams: Yes. Probably the only comment I would make is how our physicians feel about being actively engaged in these clinical pathways. They see this as really part of the reason they went to medical school was to help improve the quality of people's lives. And the ability to earlier identify these conditions to get people on the right therapies, not only avoid perhaps unnecessary hospitalization, but most importantly, improves the lives of the patients. And they really feel very positive about that.
Matthew Shea: And then maybe to follow-up on that point about provider engagement and working with them. A couple of months ago, you guys have been vocal about maybe some governance changes and that at a physician group level, you're being more aggressive in terms of how you manage networks and sort of going market by market and tightening up that governance. Would love to just have you guys maybe unpack that a little bit. What ultimately are you doing or implementing? And any way to think about what sort of inning we're in with that tightening of the governance and when we might start to see some results from that?
Ronald Williams: Thank you, Matthew. I think the focus we've had is really working with the payers and basically saying to our payers that we're not going to pay them for the privilege of doing business with them, that our physicians are doing a great job of improving quality, which is reflected in the stars rating that we've often talked about. Our focus has really been working collaboratively with the physicians to articulate to the payer community the value that we can create for them, the value we can create for their patients. So it really hasn't been about the governance of the groups themselves. It's about how we work together to participate and actively develop the kind of contractual negotiating results we've seen this year.
Operator: Your next question comes from the line of George Hill with Deutsche Bank.
George Hill: Just, Jeff, I was wondering if you could talk about your conversations with your ACO REACH clients' customers right now about how they're thinking about the lead program for next year? Like are you expecting to see the same level of participation? Do you guys expect that your economics are going to look the same? And kind of would just be very -- given the contribution that ACO REACH has made to the business, I'd be interested to hear how those conversations are going or standing going forward.
Jeffrey Schwaneke: Yes. Yes. I mean, obviously, the details of the lead program just came out. So we're in the process of, I would say, analyzing all that information and really determining which path is best from either a lead or MSSP program. I think the good news for us is that we participated in MSSP and obviously, the REACH program and have been very successful. And so I guess as we think about it, we think we can be successful in both programs moving forward, and they will be positive contributors to our financial performance in 2027 and beyond. So it's a little early, but we're certainly having conversations, and we're running all the calculations to figure out which path is best to go down.
George Hill: And Jeff, if I can have a quick follow-up. I guess just as you think about kind of the improvement in the guidance in fiscal '26, just from talking to some of the plans, do you feel like the results in fiscal '26 are something that can be built on for 2027? Or what I'm worrying about is to what degree do you think the business faces a reset as you go into contracting for '27 and bids for '27 -- membership bids for '27? Just interested in how you're thinking about sustainability.
Jeffrey Schwaneke: Yeah. No, I would certainly say it's a foundation that can be built on. I mean that's what we've been focused on over the last 18 months is really driving towards profitability. We will take that same lens as we think about contract negotiations for 2027, which we are in active discussions at this point in time for all the reasons that Ron just previously mentioned. So I do think it's a solid foundation for us to build off of.
Operator: Your next question comes from the line of Stephen Baxter with Wells Fargo.
Stephen Baxter: I just wanted to make sure that we understand all the sources of medical margin upside in the quarter versus your guidance. I think you sized the full year expected benefit from the higher risk scores at the 1% level. I think that on a quarterly basis is something like $14 million or $15 million of additional medical margin. When we look at the balance of the peak, which I think was closer to $35 million, again, trying to make sure we have all the pieces there. I guess you had a benefit from PYD, but you're also saying your booking cost trend to guidance levels versus kind of modeling any kind of improvement. So yes, first, maybe we could clarify that. And then I have a question as a follow-up.
Jeffrey Schwaneke: Yes. Maybe I'll start with just for Q1, bridging you to maybe the guide mid for a medical margin perspective. So the variance is roughly $26 million compared to the guide mid, and there's a couple of things in there. You're right, the risk adjustment update. Think of that as $50 million for the full year. Obviously, we would get half of that. And so there's a piece that's associated with the risk adjustment update. And then we mentioned the new contract. So the new contract, although it has -- I would say, we've modeled it as breakeven margin for the year, obviously, Q1, if you lay out the seasonality of our business, there would be margin on that contract in the first quarter. So those are the 2 things that are impacting medical margin in Q1 as you think about the midpoint of the guidance we previously provided.
Stephen Baxter: And then just in terms of the 2027 payer contracting objectives, I would love to just hear a little bit more of an expansion of like what are the things that have sort of been fully accomplished in terms of what you're able to do for 2026? I'm thinking like it sounds like Part D risk is something you've made a lot of progress on, but maybe things like percentage of premium are more of an opportunity prospective. I guess how would you kind of characterize the opportunity set on payer contracting versus what you've been able to do so far?
Jeffrey Schwaneke: Yes, certainly. I don't think our perspective has changed as far as the items that we are seeking. You're right, percent of premium is obviously one of the ones at the top of the list. Continued reduction of Part D exposure, we were very successful over the last couple of years. This year, less than 15% exposure on Part D. We'd certainly like to see that go down even more. But we have reduced the magnitude of the risk to where it's manageable. But certainly, we are -- that is on the list. The other thing is capture corridors or carving out things that are outside of our control like supplemental benefits. But all of those same levers that we were talking about a year ago are the same things that we're focused on for 2027. And again, I think it's just early in our contracting cycle. We're having very productive conversations with the payers. They're very supportive of our model. And so we'll have to play that out as the year goes on.
Operator: Your next question comes from the line of Daniel Grosslight with Citigroup.
Luismario Higuera: Hello, this is Luis on for Daniel. You said last quarter that there was $15 million of new geography entry expenses. I know some of those are for current providers, but you also said that some would be -- some of that guidance is embedded for new possible investments for additional growth. Can you provide an update on that, if possible?
Jeffrey Schwaneke: Yes. Yes. I think you maybe talking the geo entry that was in the guide maybe for the full year. I think that's what you're talking about. I would say those costs are just generally in line with what we expected in the first quarter. Nothing really out of the ordinary there.
Luismario Higuera: And one more follow-up for me is, are you able to break up the 7.4% cost trend embedded in guidance? Is there any particular categories that are expected to drive much of that? And what would give you comfort to revise that down maybe for?
Jeffrey Schwaneke: Say that again, that first part, you kind of cut out there.
Luismario Higuera: Sorry. Are you able to break out the 7.4% cost trend embedded in guidance? Like, I mean, are there any particular categories that are expected to drive like much of that trend?
Jeffrey Schwaneke: Yes. I would say the 7.4% was just to clarify, that's what we recorded in the first quarter. For the full year, our guidance is 7% net. And we have limited paid claims visibility as we sit here today in the first quarter. But what we do have, I would say, continues the theme of Part B, Part D escalated Part B costs and inpatient costs. That's where we continue to see the cost escalation. That's been a common theme over the last year. So it's, I would say, consistent. But again, we're setting on limited data here for the first quarter.
Operator: Your next question comes from the line of Amir Farahani with Evercore.
Amir Farahani: You previously discussed roughly 50 bps of tailwind from improved payer bids. I guess how is that tracking year-to-date? And also with the '27 bidding season around the corner, I would love to hear what you guys are hearing from your payer partners in terms of benefit design, premiums, et cetera. And I would appreciate your view on how that's translating into potential impact for next year.
Ronald Williams: Yes. Maybe I'll do the payer part. The messages that we're hearing in their communications is continuing to have a very strong focus on margin improvement. And so we would expect that their bids, their product positioning, everything is about restoring themselves to what they view as a reasonable level of margin, which we think is good for us.
Jeffrey Schwaneke: Yes. And the second piece you talked about was the benefit of the payer contracting. I think the number we quoted in the initial guide was roughly $127 million for the full year. And when we talked about that on the guide, that was done. Those contracts were executed. So that benefit is absolutely flowing through in the first quarter.
Amir Farahani: In terms of the -- maybe one follow-up question on the group MA mix, maybe you can give an update in terms of where that stands today. We've heard from several payers that have flagged that there is recovery in the MA margin in the group business in '26. I guess are you seeing structurally better economics in your book? And is that upside captured in the guide?
Jeffrey Schwaneke: Yes. I guess what I'd say, our group mix roughly hasn't changed from last year, very consistent. And obviously, when we think about negotiations with payer contracts, it's all members. And so the number that we quoted in our initial guide would be inclusive of that.
Operator: Your next question comes from the line of Jack Slevin with Jefferies.
Jack Slevin: Congrats on the quarter. Maybe to start, just to clean up a little bit of what I heard as far as that upside in the quarter, maybe piggybacking on Stephen's comment or question, just to be super clear, there was no PYD that you recognized in the first quarter. Is that the way to understand it? And maybe to add on that, just heard about the favorable development. Would love to hear a little bit about what that may have looked like on that development that you saw in the second half of '25. Was it just not a continuation of some of the outlier cases you had at the end of 3Q? Any incremental color would be really helpful.
Jeffrey Schwaneke: Yes. Yes, certainly. So the prior year development, that's a number that you can find in the filing in the 10-Q and the medical cost roll forward is roughly $12 million for the quarter related to 2025 dates of service. And you are correct, effectively, there was really no flow-through because during the quarter, we added additional reserves to Part D. And as you know, we have limited information on Part D costs, and we had 30% of our members had that risk in 2025. And so we just took the opportunity to bolster those reserves because we really don't get final reconciliation until the third quarter of this year. So you are correct that there was really no benefit from the prior year development. And remember, Part D is in revenue for us. So you had a good news from last year in the medical expense line, and that was offset by a reduction in revenue, which really represents the Part D.
Jack Slevin: And then just as a follow-up on some of the 2027 commentary. Jeff, I think you had said on the last quarter that even with sort of looking at the advance notice, considering what you guys have been able to do on burden of illness, you guys felt like you could possibly expand margins or felt confident about expanding margins in '27. I guess, obviously, the numbers have changed here and gotten more positive. Has anything else really changed as we think about where you were a few months ago as far as confidence for '27 or how you're thinking about that equation on the core side of the business?
Jeffrey Schwaneke: Yes. I mean I would say the only thing that I would point to that changes is obviously our performance this quarter with respect to the risk adjustment, right? So I would say now we have more confidence on a going-forward basis. This year, for example, we said we were going to outperform the final year of V28. Now we have more confidence that it's going to be even higher than that. So I guess that gives us more confidence going forward in 2027 and beyond that we can offset, for example, the risk normalization, the normalization factor of 1.12. Again, we've commented that in the prepared remarks that we don't believe we have any material exposure to sources of diagnosis given the design of our model being closely aligned with the primary care physicians. And so as we think about the growth rate for 2027, we're really zeroing in on that 5.33%.
Operator: Your next question comes from the line of Ryan Langston with TD Cowen.
Ryan Langston: Appreciate all the commentary here. On the new risk contract with the new payer, I guess what was attractive about that contract? Like I get it's in an existing market. Are those generally members maybe you had before the switch to this payer's plans? Or is this a new member cohort? And are you able to provide what the pickup in the guidance was from this contract? If you already said it, I'm sorry, just a lot of numbers flying around.
Jeffrey Schwaneke: Yes, yes. No, certainly. It's in a market with an existing physician group. And I think from our perspective, it is a new payer contract. So it's a new contract with a payer. And as we think about that, and I just mentioned earlier that we modeled that at roughly -- it's roughly $200 million in revenue. We've modeled it at roughly breakeven margin for the year. And I think for us, it's really an opportunity for a multi-year improvement in margin, and we think we can deliver that. I mean it's not uncommon for us to have year zero conservatively modeled at breakeven margin.
Operator: Your next question comes from the line of Craig Jones with Bank of America.
Craig Jones: So you mentioned pretty much no impact from the unlinked chart reviews that we're going to see in 2027. But it seems like CMS is pretty Gung ho on continuing to kind of level the playing field. So as you look forward, maybe '28 or even further out there, what about -- what kind of impact would you see from linked chart reviews and maybe health risk assessments? And is there any other kind of low-hanging fruit you see that CMS could go after?
Ronald Williams: Well, look, I think that we feel good about where we are for the reason that we have 100% chart review, physicians see every patient, physicians -- the charts are audited very carefully. It doesn't mean we won't have some issues, but it means that we're much more rigorous than we think some of the other plans have been in terms of how they have coded historically. So I think that we can expect CMS will continue to try to spend the taxpayer's dollar wisely. And our focus on making certain it's linked to real care that's delivered to real patients, we think, is the best thing we can do.
Operator: Your next question comes from the line of Michael Ha with Baird.
Michael Ha: So regarding the lead model, I guess, as you run your calculations to determine which path to go down, how are you contemplating the eventual -- that AI inferred risk adjustment model that's being phased into the lead program? How much visibility do you actually have into how this AI model might impact risk adjustment?
Jeffrey Schwaneke: Yes, Michael, there's not a lot of details on that right now, right? So I think it's hard to obviously model in something where there's really no details about how that's going to work. And we'll just have to play that out as we get visibility to whatever that model is.
Michael Ha: And then I think last quarter, you mentioned the opportunity to possibly more than double payer incentive contributions in '26, which I think was $25 million for '25, your '26 guide conservatively assumed the same, which presented, I think, an area of upside. So I was wondering how is that tracking so far through '26? How much of that path from $25 million to potentially north of $50 million might you already have visibility into? And I just would love to understand like what it takes to get from $25 million to possibly double that this year.
Jeffrey Schwaneke: Yes. I guess what I'd say you're correct that the opportunity has doubled. I think that just shows the importance of quality across the board, specifically for payers. And so the opportunity for us to earn additional dollars is there. What we said as part of the guide is we have a similar level of performance in '26 guide, assuming we performed at the same level of '25. We don't have any -- I mean, it's super early, right? We don't really have any data on that yet. So we're just going to have to wait until time goes on throughout the year. But we feel pretty confident that we are delivering superior quality to our payer partners and our members.
Operator: Your next question comes from the line of Ryan Daniels with William Blair.
Ryan Daniels: I'll keep it to just one. Given the operational improvements you're seeing, the clinical pathways, the better data feeds, when does the company consider going back on the offensive a bit, kind of growing the member base, maybe going out and reinvigorating the new partner pipeline, especially as there's a clear demand from payers to continue to expand these partnerships?
Ronald Williams: Yes. I think one thing that sometimes gets missed is the fact that our partners are deeply embedded in these communities. They've been there for years. They have large commercial panels. And every month, people turn 65 and enter Medicare Advantage. So there is some degree of embedded growth. It's nowhere near like opening a new market, but it means that you don't suffer attrition typically as a result of not expanding in a meaningful way. And also, some of the groups do, in fact, add new physicians, they bring them in. So I would say the focus right now is on in-market growth, in market execution. The time will come when we will turn our attention to other things, but that time is not here yet.
Operator: We have reached the end of the Q&A session. I will now turn the call back to Ron Williams for closing remarks.
Ronald Williams: Yes. I want to thank everyone who joined us this evening. Since stepping in as Executive Chair 8 months ago, I've really worked very closely with the leadership team. We've been highly focused on increasing the sense of urgency, heightened the focus on the key priorities that are focused on really, really driving improved performance for our members, for our primary care partners and for payers. And I think that while we believe that the environment remains dynamic, we are confident that the actions we have taken will deepen the existing strengths of our partnership model. We think it's a very unique model because of the proximity to the physician. It gives us an ability to make certain that the suspects and things that we determine are resulting in real clinical interventions. And we think that is extremely important to patients and please be important to CMS. I want to close really by welcoming Tim O'Rourke, our new CEO. I am thrilled to have Tim join us today. He brings the right balance of understanding the payer, understanding the provider and understanding the importance of primary care physicians bring to our unique delivery model. So I want to close by thanking Tim for joining us. And I have to say he did extensive due diligence, which was most impressive on making a decision that we feel very good about having him part of our team. Our employees have really worked very hard to get us where we are, and I want to give a special thank you to everyone in agilon who helped us achieve the results we are reporting today. Thank you all.
Operator: This concludes today's call. Thank you for attending. You may now disconnect.