Joseph Zubretsky
Analyst · Piper Jaffray. Please go ahead
Thank you, Ryan, and thank you all for joining us this morning. This quarter's results reflect a significant transition we are undertaking here at Molina. The disappointing contract losses in New Mexico and Florida, and the related goodwill impairment charges, the continued expenses for restructuring and the cash up adjustments related to the poor performing marketplace business are all legacy issues that we believe are now behind us. The performance of the core business however, which we define as a Medicaid and Medicare was respectable and when viewed on a run rate and full year basis provide a solid baseline from which to achieve our margin recovery and sustainability plan. We are squarely focused on improving our operating margins and creating an earnings profile that is less volatile and more sustainable. Only when we have accomplished this, we'll be able to reap the full benefits of this franchise, with its strong revenue base, across well diversified geographies and product lines. This morning, I will be discussing the sustainability of our revenue base, the key operating and financial results from the fourth quarter and the full-year and connecting them to our 2018 preliminary guidance, and to the vision that I provided at a presentation to investors last month. First, with respect to the disappointing news related to the re-procurement of our Florida Medicaid contract, we are taking urgent and focused actions to secure this revenue base. Today, we operate in 8 of 11 regions throughout Florida, serving approximately 350,000 Medicaid members, with $1.5 billion of annualized revenue. The entire state is currently up for re-procurement, effective January 1, 2019. As we announced last week, we have been selected to negotiate to the award of a managed care contract in only one region of the state, that region, Region 11 comprises Miami-Dade at Monroe County, where we currently serve 59,000 Medicaid members. This outcome posted significant challenges, as a first step, we will do our best to secure contract at Region 11. Beyond that we will pursue the various protested appeals as appropriate. In New Mexico, we were surprised last month that the state chose not to invite us into the next round of the re-procurement process. Our New Mexico health plan has a long history of offering high quality service to our members. Upon review of the procurement materials made available, we have concluded that our re-procurement loss was primarily based on the rating factor in the bid and not the service aspect of the bid. With that back in mind, we are currently working to the appeals process in an effort to retain this business. That said, if the current decisions regarding our Medicaid participation in either Florida or New Mexico stand, they would have a significant negative impact to the company's revenue. Although our Florida and New Mexico health plans have been unprofitable in 2017, to say that their loss is therefore not challenging, would ignore the more significant issue. The lost opportunity of returning those health plans to profitability is of serious concern. Our plan with respect to Florida and New Mexico is as follows. First, it is critical that we manage our 2018 operations in both states to achieve our 2018 plan. We will launch the appropriate protested appeals necessary to ensure that we have exhausted every avenue available to us for retaining these contracts. If the outcome of these RFPs proves to be unsuccessful, we will transition our operations in an orderly fashion and in a financially responsible way and then we will adjust our cost structure accordingly to mitigate any percentage margin impact on the consolidated enterprise. The long-term headwind therefore is not against our target margin percentage, but against the absolute value of operating profit we can achieve. We are particularly sensitive to this situation, as we prepare for two other near terms re-procurements, Texas and Washington where we will compete vigorously to win. We have always taken major steps to improve our RFP response process to better articulate and present the Molina value proposition. First, we have marshaled more internal and external resources to support both efforts. We have engaged a broader and deeper array of very senior subject matter experts, clinical, operational, regulatory and financials. We have infused more local market knowledge into the process and we have retained outside experts in Medicaid procurement to pre-score our proposals and conduct marked reviews. While this may sound like we are blocking and tackling, it is precisely these technical qualities that are the foundation for successful bid. The combination of a well-executed proposal leverage with our deep community ties and long history of quality servicing in these states and our two recent wins in Washington give us confidence in successful outcomes. Now turning back to our earnings, we reported a net loss for the quarter of $4.59 per diluted share and $9.07 for the full year. Looking more deeply into these unacceptable headline numbers, I would like to call out three important dimensions of our fourth quarter and full year performance. First, we incurred $342 million for the quarter and $704 million for the full year of impairment and restructuring cost. Second, we experienced poor marketplace performance as demonstrated by a quarterly medical care ratio of 102.1% for the fourth quarter and 88.1% for the full year. Our product that should run at 78% or below based on 2017 pricing. Finally, looking over the entire year and stripping away a number of legacy items, we were able to develop a clear view of the underlying earnings base of our core business. I would characterize that underlying earnings base as stable. Allow me to spend a little more time in each of these dimensions. First, the impairment charges were the result of the unfortunate combination of expensive legacy acquisitions giving rise to significant intangible assets and the unsuccessful re-procurements relating to those same geographies. Relatedly, the restructuring charges were the result of the company growing its cost structure beyond its profit capability and this lack of discipline has now been corrected with improved monitoring and control. Second, with respect to the marketplace, we have taken significant actions to improve performance in 2018, as well as to reduce our overall exposure to this business. Specifically, we had implemented premium increases averaging 59% effective January 1, 2018. Those premium increases included a 20% increase for the absence of federal funding of CSR subsidies and a further 39% increase for medical cost trend anti-selection risk, demographics and a variety of other rating factors. These price increases along with our market exists in Utah and Wisconsin have resulted in substantially lower membership. So in response to our marketplace challenges, we have increased premium rate significantly, eliminated our exposure to uncertainties around CSR funding and reconciliation and priced up with the full expectation we will reduce our overall membership. Finally, the fourth quarter performance in our core business was respectable. Our medical care ratio excluding marketplace, declined 210 basis points to 88.8% when compared to the third quarter of 2017, reflecting decrease inpatient utilization as compared to the third quarter. This improvement was achieved despite an increase in flu related cost estimated to be $20 million. Looking at 2017 on a full year basis, it is important to remember that our medical care ratio of 90.6% is burdened by substantial unfavorable out of period or nonrecurring items. These include approximately $150 million of unfavorable prior period claims development and another $90 million of unfavorable marketplace items, most notably the lack of CSR reimbursement in the fourth quarter. Absent these items, our medical care ratio for 2017 would have been approximately 89.3%. In that context, I would like to provide some commentary on our core business portfolio. Looking at our core business by product line for the full year 2017, TANF represented approximately 40% of our total Medicaid revenue and had a medical care ratio of 92%, which was above our 2017 target of approximately 90%. Improving profitability for this product will require more effective utilization controls and care management, particularly with respect to High-Risk Pregnancy, reducing unit costs of high cost providers and more effective rate efficacy. Our Aged, Blind and Disabled product represents approximately 37% of our total Medicaid revenue, and had a medical care ratio of 94.7% for the full year. As oppose to our 2017 target of approximately 91%. Keys to improving ABD performance include, improved care management in coordination of services for high acuity populations focusing on the integration of behavioral and physical health services, targeting high risk members for care management intervention and more comprehensive documentation of medical conditions and improved management of community and other long-term care services for members in this product line. Expansion represented 23% of our total Medicaid revenue and at a medical care ratio of 84.9%, which was above our 2017 target of approximately 83%. Expansion continues to contribute favorably to our overall profitability and was responsible for approximately 40% of our total Medicaid medical margin for 2017. While premiums and margins for expansion have been declining in recent years, the rating environment appears to have stabilized. States generally look at rate adequacy holistically across all of Medicaid. Strategically this product may be an important companion product to our marketplace business as certain states contemplate merging the two markets. In 2017, Medicare and MMP combined generated approximately $2 billion of revenue, and had a medical care ratio of 88.4%, which was below our 2017 target of approximately 92%. These products are important because they present opportunities for the integration of care, on an even more comprehensive basis that is the case with many of our ABD members. The MMD [ph] plans in particular provide the opportunity to demonstrate that all aspects of care behavioral health, physical health, and long-term care services can be delivered more efficiently through managed care. As I presented to investor last month, we have a very well diversified geographic portfolio, the majority of which is already operating at our target margin level, and the minority of which is profitable, but below target and the remainder unprofitable. Moving from a product line our company to a geographic view, I have the following commentary. Of our four largest health plans that generated over $2 billion annually in core business premium revenue, three California, Ohio, and Washington operated at medical care ratios that were at least 200 basis points below our consolidated core medical care ratio of 91%. Texas is the fourth of our health plans with core business revenue over $2 billion has a heavy concentration of members receiving long-term care services, which explain why its core medical care ratio of 92% exceeds the company's overall average. These plans are operating at target margins have long tenured and experience management teams, excellent product diversification mix and excellent standings in the respective states. Although it is midsized I would also include Michigan on this list of well performing plans. Our underperforming plans Florida, New Mexico, Puerto Rico, and Illinois are under intense review for performance improvement, irrespective of their re-procurement status. New Mexico's performance improved in the last half of 2017, and is projected to be the marginally profitable in 2018. Florida's issue largely stem from aggressive marketplace membership growth in 2016 and 2017, that combined with Medicaid challenges over taxed many core operations. With its reduced marketplace profile in 2018, combined with our improvement initiatives already in flight this business should improve. Puerto Rico's performance, and that of the entire Island was impacted by the hurricane as utilization abated dramatically and then bounced back. In the back half of the year performance stabilized, and to note the entire Island will be re-procured this spring. In Illinois we had significant unfavorable prior period development due to a variety of issues. In 2018, with a new state wide contract we will start the year with a slight premium revenue increase. We are working toward rebuilding relationships with the providers in the central part of the state, as we reenter those areas at the beginning of the year. Our fourth quarter SG&A ratio of 7.4% represented a 20 basis point decline from the third quarter, and was 60 basis points lower than the full year ratio of 8%. This improvement reflects the actions taken in 2017. The tighter controls in productivity standards that we've implemented will ensure that our costs stay in line with our revenue base. And we expect to continue to find additional savings above the $235 million we have already announced. Moving on to the subject of capital management, enhancing our balance sheet and staying capital disciplined are also key parts of our plan. We took a number of steps in this regards during the fourth quarter. We strengthened our liability for medical claims, marketplace CSR and risk adjustment. In December, we repurchased the portion of our 2044 convertible debt in exchange for equity. This transaction enabled us to lower our total debt to capital ratio by approximately 5 percentage points, while also allowing us to release for general purposes approximately $157 million of restricted cash. Finally, we entered into a bridge loan that will provide funding in the event that our $550 million face value of convertible notes, due in February 2020 are presented to us. While we think it is unlikely that those note will be presented to us in the near future, we concluded that it was important to may gain this risk. Our total debt ratio remains too high, and we will continue to delever and improve our overall capital structure to achieve our target. I turn now to the preliminary 2018 guidance. We describe this guidance as preliminary because of the inherent uncertainty around achievement and timing of our numerous profit improvement initiatives. While these initiatives extend across the various dimensions of managed care fundamentals that I described to investors last month, many are in the early stages of development and implementation, and therefore not included in guidance. Therefore, our guidance should be viewed as preliminary estimate of what we expect to achieve until we see the profit improvement from these in flight initiatives manifest themselves in the earnings stream. Once we have the benefit of first quarter earnings, and further insight into the execution of our profit improvement initiatives, we will be able to update you with the firmer view of our guidance. To provide for an appropriate amount of execution risk, our preliminary guidance has therefore been developed with appropriately conservative views of medical cost baseline in 2017, medical cost trend for 2018, potential rate increases and retained amounts of revenue at risk, and the turnaround of the marketplace business until we can observe the achievement on the margins implicit in our 2018 pricing. With that said, our preliminary guidance is as follows, for 2018 on a preliminary basis, we expect earnings per diluted share to be in the range of $3 to $3.50 on a GAAP basis. We expect premium revenue to decrease from $18.9 billion to approximately $17.5 billion. The vast majority of this decrease is driven by lower marketplace enrollment, which is only partially offset by higher premium rates. Our preliminary guidance anticipates that marketplace membership will begin the year at approximately 450,000 members from 815,000 at December 31st and decline to approximately 300,000 members by the end of 2018. We expect our 2018 medical care ratio to be approximately 89% compared to the 90.6% medical care ratio, we reported for 2017. Although, our preliminary guidance takes a cautious view of the medical cost improvement in 2018, we expect our 2018 performance to benefit from an absence of the unfavorable prior period claim development we experienced in 2017. That unfavorable prior period claim development in 2017 amounted to $150 million. We expect to manage our administrative cost ratio to approximately 7.3% for all of 2018. This reflects the full year run rate value of the $235 million of savings that we announced last month as part of our restricting efforts. We will update you with a firmer view of our 2018 preliminary guidance on our first quarter earnings call and at our Investor Day. I have also spoken about the need to bring additional talent into our company, while we have many talented leaders at Molina the regress demands of our turn around require that we continue to assess our talent needs across the company and expand our leadership team. Mark Caim [ph] our new Executive Vice President of Strategic Planning, Corporate Development and Transformation, will be the chief architect of our continued restructuring and will lead the analysis of the business portfolio and work to unlock value in all of our major vendor and ancillary cost contracts. Mark's years of recent experienced with [indiscernible] where he performed similar activities will surely create a significant amount of value. I would also like to announce the hiring of Pam Sedmak, Executive Vice President of Health Plan Operations. Pam will be responsible for health plan operations, turning around the underperformers, solidifying our re-procurement efforts and executing on margin recovery and sustainability plan across the fundamentals of managed care. Pam has a long and successful career of managed care particularly in her role as President and CEO for Aetna Medicaid where she oversaw 17 health plans, whose Medicaid business achieved over $9.5 billion in premium revenue. Most recently, Pam was a Senior Advisor at McKinsey & Company servicing clients in the healthcare servicing space. In closing, I am excited about 2018, and I look forward to providing more details on our longer term strategic plans during our Investor Day on May 31st in New York. With that, I will turn the call over to Joe White for more detail on the financials.