Form 8-K MOLINA HEALTHCARE, INC. For: Sep 17

September 17, 2021 10:51 AM EDT

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Investor Day 2021 Sustaining Profitable Growth September 17, 2021


 
2 Sustaining Profitable Growth Topic Speaker 8:30am Welcome and Logistics – Ron Kurtz 8:35am Sustaining Profitable Growth – Joe Zubretsky 9:30am Compelling Financial Profile – Mark Keim 10:00am – 10:45am Executive Q&A – Joe Zubretsky – Mark Keim


 
3 Cautionary Statement Safe Harbor Statement under the Private Securities Litigation Reform Act of 1995: This presentation and the accompanying oral remarks include forward-looking statements regarding, without limitation, the Company’s 2021 guidance, its 2022 premium revenue and revenue growth strategy, its long-term financial targets and margin outlook, the COVID pandemic, COVID risk sharing corridors, future RFPs and re-procurements, mergers and acquisitions, Medicaid redeterminations, and the Company’s general business plans. The Company intends such forward-looking statements to be covered by the safe harbor provisions for forward looking statements contained in the Private Securities Litigation Reform Act of 1995. Readers and listeners are cautioned not to place undue reliance on any forward- looking statements as forward-looking statements are not guarantees of future performance, and the Company’s actual results may differ materially due to numerous known and unknown risks and uncertainties. Those risks and uncertainties are discussed under Item 1A in the section entitled “Risk Factors” in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020, and also in the Company’s quarterly reports, current reports, and other reports and filings with the Securities and Exchange Commission, or SEC. These reports can be accessed under the investor relations tab of the Company’s website or on the SEC’s website at www.sec.gov. All forward looking statements in this presentation represent management’s judgment as of September 17, 2021, and, except as otherwise required by law, the Company disclaims any obligation to update any forward-looking statements to conform the statement to actual results or changes in its expectations..


 
4 Sustaining Profitable Growth Joe Zubretsky President and Chief Executive Officer


 
5 Sustaining Profitable Growth Long-Term Financial Targets The Profitable Growth Playbook Attractive Government Managed Care Market Value Creation Dynamics Winning Leadership ModelOur Value Creating Franchise


 
6 Long-Term Financial Targets


 
7 Total Growth Long-Term Premium Revenue Growth Strong organic growth opportunities off of 2022 outlook, complemented by disciplined acquisition strategy Organic Acquisitions Total 8% - 10% ~5% 13% - 15% Organic Growth Weighted Total Medicare Marketplace 8% - 10% 5% - 8% 11% - 13% 8% - 10%Medicaid


 
8 Medical Care Ratio Adj. G&A Ratio Pre-Tax Margin Long-Term Margin Outlook Continued margin management will drive net income growth 87% - 88% <7% 4% - 5% Medical Care Ratio Weighted Total Medicare Marketplace 87% - 88% 78% - 80% 87% - 88% 88% - 89%Medicaid Pre-Tax Margin


 
9 Total Company Long-Term Outlook Strong revenue and earnings growth off of 2022 outlook, enhanced by operating leverage and share repurchases Premium Revenue Growth 13% - 15% Hedge to Margins / Operating Leverage 0% - 1% Net Income Growth 13% - 16% Share Repurchases ~2% EPS Growth 15% - 18%


 
10 Investment Thesis Strong growth, sustained margins and disciplined capital management form the core of shareholder return Legacy and new market opportunities Double digit revenue growth Attractive margins and operating leverage Capital efficiency and cashflow generation High return capital deployment Proven management team


 
11 Our Value Creating Franchise


 
12 Franchise Leading pure-play, government-sponsored managed care company with breadth and scale 155 Ranking >$27B Total Revenue 2021E 4.7M Members 2Q21 18 States 2021 3 Products Medicaid, Medicare and Marketplace


 
13 Mission We improve the health and lives of our members by delivering high-quality health care Members Government Agencies Employees Shareholders Our mission is balanced among all those we serve Molina provides access to high-quality government sponsored healthcare


 
14 Transformation Our transformation has driven strong growth in revenue, EPS and shareholder return Total Revenue Adj. EPS Margin Sustainability 2019 $16.8B $11.57 (11%) (1%) Stock Price Margin Recovery 2017 2018 $19.9B ($8.72) $18.9B $11.74 (5%) nm $77 Growth 2021 Guidance >$27.0B >$13.25 >60% >15% ~$260 ~240%


 
15 Portfolio Geographically diversified government-services portfolio with strong segment synergies 6-10% >10%5% or less Percent of Total Premium Revenue >$26B ‘21 Premium Guidance 12% Medicare 11% Marketplace 77% Medicaid Synergistic Medicare and Marketplace Segments Complement Medicaid Strong Incumbent in 18 States With No State Greater than 20% of Portfolio Revenue


 
16 Portfolio Synergies Synergistic product segments provide member continuity and leverage common capabilities F e d e ra l P o v e rt y L e v e l 400 - 250 - 138 - 100 - 150 - MA-PD DualsMedicaid Marketplace (low subsidy) Marketplace Target (max subsidies) MA-PD Target (low-income) <65 >65 Continuity for “age ins” Mobility as income levels change Age


 
17 Market Share Upside Opportunity National franchise with significant local market opportunity in all segments Average State Market Share National Market Share ~20% - 30% ~9% ~6% ~20% - 40% ~9% ~15% - 50% Medicaid #4 Nationally ~6% Medicare Duals #6 Nationally ~3% Marketplace #6 Nationally ~5% Sources: Health Management Associates, State-reported data, CMS and Decision Resources Group Molina Top Competitors


 
18 Attractive Government Managed Care Market


 
19 The Government Managed Care Market Our addressable markets exceed $1T in spend with high growth $461B 64M Members Members Spend $470B 29M SpendMembers 16M $105B Sources: CMS Medicaid Actuarial Report, NHE, KFF, HHS and Urban Institute Spend 8% ’22 – ’25 CAGR 13% ’22 – ’25 CAGR 5% ’22 – ’25 CAGR MarketplaceManaged MedicareManaged Medicaid 2022 2022


 
20 Political / Regulatory Environment Political and regulatory environment provides favorable conditions for all segments Medicaid Medicare Marketplace Executive Orders Revoked Medicaid work requirements PHE continues telehealth flexibility increasing access Agencies halt sale of limited duration/non-ACA compliant plans Legislation ARP provides FMAP incentives for remaining states to expand Medicaid Sequestration extends through 2021, boosting premiums ACA premium subsidies increase for 2021 and 2022 Regulation Rating rules tighten actuarial soundness requirements for quality withholds CMS direct contracting opportunities NBPP helps Medicaid enrollees transition easily to Marketplace after the PHE ends


 
21 Medicaid Rate Environment Core rates are expected to remain actuarially sound with many COVID risk sharing corridors expiring • COVID risk sharing corridors in many states through 2021 • Corridors expected to end with PHE • Corridors already expired in CA, NY, SC, and MI for 2022 fiscal years • Prospective rate setting in return to traditional methodology • Clear visibility on 2022 rates for 25% of premium revenue • Rates reflect pre-COVID baseline trended forward and are actuarily sound Core Rates COVID Risk Sharing Corridors


 
22 r rrr r Medicaid Enrollment During and After the COVID-19 Pandemic, July 16, 2021| Manatt Health Strategies, LLCMedicaid Enrollment During and After the COVID-19 Pandemic, July 16, 2021| Manatt Health Strategies, LLC 0 5 20M 65 80M 60M 55 85 75 -4% 45 -1 8% 0% 5 -3 1 35 9 3 25 4% 7 40M 15 2005 20151990 1995 2000 2010 2020 22 Recession Economic Recovery Trends Unemployment Real GDP Growth Medicaid enrollment increases with economic downturns, continually growing without returning to previous levels Total Medicaid Enrollment Sources: CMS, BLS, MACPAC and KFF Recession Recession Recession


 
23 The Profitable Growth Playbook Medicaid / Medicare / Marketplace / M&A / Margin Profile


 
24 Medicaid


 
25 Strategic InitiativesOrganic Premium Revenue Opportunity Medicaid Long-Term Organic Growth Long-term organic growth rate of 8%-10% driven by current footprint and strategic initiatives 1 Increase market share 2 Grow with potential expansion states 3 Pursue carve-in opportunities 4 Win new RFP states 4% - 6% 8% - 10% ~4%


 
26 Increase Market Share Retain existing contracts and focus on fundamental operating tactics to drive significant market share opportunity Service Area Market Shares 11-15%6-10%5% or less >15% – Engage membership redeterminations proactively – Engage providers to drive membership – Increase auto assignment through improved quality scores – Drive voluntary enrollment through community presence and awareness 1% Increase in Service Area Market Share ~$1.6B 2025 Revenue Opportunity Actions


 
27 Expansion Opportunity Grow with Potential Expansion States Opportunity in five incumbent states represents ~3 million additional Medicaid managed care lives Potential Medicaid Expansion states Source: KFF, state filings and Company estimates Medicaid Foot-Print ~7% Weighted State Avg Market Share ~$1B 2025 Revenue Opportunity $12B Expansion Revenue Opportunity


 
28 ~$7B in Carve-in Opportunities Pursue Carve-in Opportunities Numerous pending LTSS and BH carve-in opportunities as states leverage managed care efficiency Actions – Pursue announced carve-in programs – Advocate for additional carve-in programs – Leverage Molina’s leading capabilities and $4B LTSS platform LTSS BH ~15% Service Area Market Share ~$1B 2025 Revenue Opportunity California Utah Kentucky Michigan Sources: CMS and Company estimates California South Carolina


 
29 New State RFP Pipeline New state procurement opportunities total ~$95 billion in annual premium revenue by 2025 2025 Premium Revenue Opportunity Arizona Louisiana Rhode IslandMinnesota ~$15B2022 North Carolina PennsylvaniaMaineFloridaArizona ~$30B2025 Georgia Delaware IowaIndiana TennesseeMissouri Oklahoma ~$25B2023 New MexicoNebraskaKansas New Hampshire W. VirginiaGeorgia ~$25B2024 Indiana


 
30 Key Criteria 2025 total RFP opportunity ~$95B Pursue subset of opportunities ~40% Projected competitive win rate ~50% Projected market share ~20% 2025 Molina revenue opportunity ~$4B Prioritizing Opportunities Significant RFP opportunities drive incremental long-term revenue growth 1 Size and duration of contract 2 Strength of incumbents 3 Number of awardees 4 Access to high-quality low-cost network 5 Rational rate environment Sizing the Opportunity


 
31 – Award covers beneficiaries through TANF, CHIP and Medicaid expansion programs – Four-year contract term with potential two- year extension – Future opportunities in LTSS and ABD – Strong ground game and innovative differentiation drove success Nevada RFP Win Recently announced Nevada RFP award demonstrates continued success in new states 0 ~20% Estimated State Market Share >$400M Projected 2022 Revenue ~630,000 Members Statewide 2022 Premium Revenue Expectation On August 17th, Molina announced award of new state Medicaid contract in Nevada


 
32 Medicare


 
33 Organic Premium Revenue Opportunity Strategic Initiatives Medicare Long-Term Growth Long-term organic growth rate of 11%-13% driven by current footprint and strategic initiatives 2 Penetrate Medicaid service areas 3 Introduce low-income MA-PD product 1 Increase D-SNP market share in current Medicare service areas 4% - 6% 11% - 13% ~7%


 
34 Increase D-SNP Market Shares in Current Medicare Service Areas Fundamental operating tactics drive significant market share opportunity – Expand direct sales channels – Deepen targeted broker relationships – Develop key provider relationships – Improve retention through member engagement Duals Service Area Market Share 11-15%6-10%5% or less >15% Actions ~$250M 2025 Revenue Opportunity 1% Increase in Service Area Market Share


 
35 Penetrate Medicaid Service Areas D-SNP penetration of remaining Medicaid footprint provides significant opportunity ~3% New County Target Market Share ~$200M 2025 Revenue Opportunity 56 new counties filed for 2022 ~500 Counties Without D-SNP States with under-penetrated Medicaid service areas Medicaid Footprint Penetration of Medicaid Footprint


 
36 National Managed Medicare Market Actions Introduce Low-Income MA-PD Products Low-income MA-PD products double Molina’s market opportunity in Medicare Sources: CMS and Company estimates ~20% ~55% Duals MA-PD ~25% Low- Income MA-PD ~$470B 2022 Premium Revenue ~$215B Target Market ~$700M 2025 Revenue Opportunity ~2% Service Area Share of Medicaid Footprint – Introduce low-income MAPD in current Medicaid footprint – Target Marketplace and Medicaid age-ins – Leverage existing direct sales and broker networks


 
37 Marketplace


 
38 Strong 2021 Market Growth Increased subsidies through ARP drove strong growth in 2021 with future growth rate expected to moderate 57% 55% 11.4M 11.4M ~15M 2019 2020 2022 59% Source: CMS, Urban Institute and HHS 15-17M 2021 Bronze Silver Market Dynamics – More members are now eligible for zero-dollar silver plans – Subsidy eligible population expanded through elimination of 400% FPL “cliff” – Special enrollment period extended window for additional sign-ups – Continuation of higher subsidies beyond 2022 currently under legislative review


 
39 Strategic InitiativesOrganic Premium Revenue Opportunity Marketplace Long-Term Growth As a smaller complement to Molina’s core Medicaid franchise, Marketplace margin discipline will be prioritized over volume 0% - 3% 5% - 8% ~5% 3 Penetrate Medicaid service areas 2 Prioritize margin discipline 1 Focus on highly subsidized population


 
40 Penetrate Medicaid Service Areas Marketplace penetration of remaining Medicaid footprint provides significant revenue opportunity, balanced with margin discipline States with under-penetrated Medicaid service areas Medicaid Footprint Penetration of Medicaid Footprint 14% Average Service Area Market Share ~$1.5B 2025 Revenue Opportunity 59 new counties filed for 2022 >750 Counties Without Marketplace


 
41 M&A


 
42 Our M&A Platform M&A is a key element of our long-term premium growth outlook 3 M&A generally more accretive than new procurement economics 4 Previously announced purchase prices are highly capital efficient 1 Ample excess cash flow to deploy for acquisitions 2 No need to access equity markets 6 Expert integration teams 5 Underperforming properties yield “sweat equity” accretion


 
43 Acquisition History Five transactions totaling ~$8 billion of run-rate revenue sequenced for manageable integration A n n o u n c e d C lo s e d YourCare Health Plan Magellan Complete Care 2019 2020 2021 Passport Health Plan Affinity Health Plan Cigna Texas Medicaid YourCare Health Plan Passport Health Plan Magellan Complete Care Affinity Health Plan Cigna Texas Medicaid 2022


 
44 Margin Profile


 
45 Adjusted G&A Ratio Margin Management Performance Strong MCR and G&A management programs continue to drive attractive margins Medical Care Ratio 91.4 % 88.4 % 88.1 % 90.6 % ~89% ~87% ~80% ~88% Medicaid Medicare Marketplace Total Company 2017 2021 Ex Net Effect of COVID 8.0 % ~7.0% 2017 2021


 
46 Operating Focus – Implemented state-of-the-art medical economics platform – Centralized utilization management – Enhanced high acuity care management – Created Centers of Excellence for Behavioral, Rx and LTSS – Focused on core technology, automation and quality Medical Cost Management Numerous capabilities to drive medical cost efficiencies, with focus on high acuity populations Risk Adjustment Care Management AnalyticsNetwork Pharmacy Utilization Management QualityPayment Integrity


 
47 Optimal Operating Platform Fully integrated blend of proprietary and best-of-breed partners provides winning combination Internal – Care management – Provider contracting – Quality – Community engagement – Pricing and rating Hybrid – Utilization management – Transaction services – Risk adjustment Outsourced – Pharmacy – IT infrastructure Differentiated Capabilities Commodity


 
48 Winning Leadership Model


 
49 Proven Operating Model While fairly traditional, our operating model and management process are executed with rigor and discipline Organizational Design Management Process Operating Model How We Operate – Flat organizational structure – Empowered local decision making – Simplified matrix – Appropriate delegated authority – Manage by the numbers


 
50 Executive Team Proven industry-leading team with over 20 decades of experience. Operating Council acts as a virtual COO Operating Council Chief of Staff Ron Kurtz President & CEO Joe Zubretsky Marketplace & CMO Jason Dees External Affairs Carolyn Ingram General Counsel Jeff Barlow CFO Mark Keim Health Plans Marc Russo Health Plan Services Jim Woys Human Resources Larry Anderson


 
51 Value Creation Dynamics


 
52 Organic Acquisitions Enterprise Value Creation Dynamics Highly efficient capital generation and deployment model creates significant value – Strong market growth trends – Numerous strategic initiatives – Capitalized at <10% of revenue – Low volatility – Numerous pipeline opportunities – Announced acquisitions at attractive valuations – Turnaround opportunities drive strong EPS accretion – Cost structure yields significant operating leverage – High conversion of net income to cash flow – Attractive capital redeployment opportunities 8% - 10% revenue growth ~60% levered ROE ~5% revenue growth ~20% levered ROE 13% - 15% revenue growth 15% - 18% EPS growth


 
53 Investment Thesis Strong growth, sustained margins and disciplined capital management form the core of shareholder return Legacy and new market opportunities Double digit revenue growth Attractive margins and operating leverage Capital efficiency and cashflow generation High return capital deployment Proven management team


 
54 Compelling Financial Profile Mark Keim Chief Financial Officer


 
55 Compelling Financial Profile Strong Capital Foundation G&A Expense Management Attractive Acquisition Metrics 2022 and Long-term Outlooks 2021 GuidanceCapital Deployment Discipline


 
56 Strong Capital Foundation Strong balance sheet provides foundation for stability and growth 2Q21 Credit Stats Reserve Strength Current Acquisition Capacity Parent Company Cash ~$400M Debt Capacity ~$1B Total Deployable Capital ~$1.4B Reserves at 6/30/21 $2.9B Days in Claims Payable 48 Days Net Debt to EBITDA Ratio 1.7x Net Debt / Capitalization ~43% Revolver Capacity $1B Recurring Parent Cash Flow Dividends to Parent ~$700M Incremental Debt Capacity >$700M Annual Cash Flow Capacity >$1.4B


 
57 Capital Deployment Discipline Capital deployed to highest return opportunities Accretive Acquisitions – Robust pipeline – Disciplined approach – Strategic fit, operational synergies and EPS accretion – Organic growth is the highest priority – Most efficient use of capital to grow – All lines of business are high growth Re-invest in Business Return to Shareholders – Convertible debt retired – Share repurchases EPS Accretion


 
58 Capital Deployment History Demonstrated record of capital management enhances shareholder value $1.0B $1.0B 2018 2019 $2.2B 2020 2021F $1.2B Stock / Convertible Repurchase M&A Organic Growth Long-Term Target Allocation // 100% ~25% ~50% ~25% Capital deployed for:


 
59 Attractive Acquisition Metrics Announced acquisitions at attractive valuations drive strong EPS accretion Target Acquired Revenue ($ M) Purchase Price Run Rate EPS Impact Announced Price ($ M) % of Revenue (Including Capital) YourCare Health Plan $300 $40 21% $0.20 Magellan Complete Care $2,900 $820 28% $1.75 Passport Health Plan $2,000 $66 11% $0.35 Affinity Health Plan $1,600 $380 28% $0.60 Cigna’s Texas Medicaid $1,000 $60 15% $0.50 Total $7,800 $1,366 22% >$3.00


 
60 Acquisition Pipeline Acquisition pipeline remains robust with many remaining opportunities Strategic Fit and Synergies Large franchise opportunities Bolt on plans Turnaround opportunities ~300 Government Health Plans Near-Term Target List 1 Numerous acquisition opportunities remain 4 Long-term revenue guidance requires additional ~$5B of acquired revenue in 2025 3 Managed care plans, not services or provider assets 2 Turnarounds provide attractive economics


 
61 Expense Management Leveraging the Base Building Capabilities G&A Expense Management Continued expense management and positive operating leverage fund investments while reducing G&A ratio – Automation and process redesign – Digitization – Outsourcing – Centralization to Center of Excellence – Transparency and discipline – Member and provider experience – New business development – M&A integration – Medical economics and data analytics – Population health 50% Variable 50% Fixed + -


 
62 Embedded Earnings Power Full-Year 2021 Guidance Reiterating adjusted EPS of no less than $13.25 on higher revenue and underlying earnings power offset by higher expected net effect of COVID Total Revenue >$27 B Premium Revenue >$26 B Adjusted EPS no less than $13.25 Full Year 2021E Net Effect of COVID ~$3.00 Medicare Risk Scores $1.00 Acquisitions at Portfolio Margin $2.00 Total ~$6.00 Guidance


 
63 Initial 2022 Premium Revenue Outlook 2022 premium revenue growth outlook of 12% before Marketplace enrollment changes and additional strategic initiatives / acquisitions 2021 Premium Revenue Current Footprint CI and Affinity Acquisitions 2022 Premium Revenue >$26B $2.3B $1.0B ~$29B Nevada RFP Win Redetermination ($0.5B)$0.4B Organic Growth


 
64 Medicaid Redetermination Several factors are expected to drive a soft landing and 2022 revenue impact of ~$0.5B and another ~$0.8B in 2023 Timing Duration Eligibility CMS suggests PHE “likely” extended through 2021 year-end. Several states have already set their own timeline With practical limitations of redetermining 80M members, CMS has now extended to maximum of one year Precedent and COVID outlook suggest retention of many members gained through lapse in redetermination 750,000 Members gained organically since beginning of pandemic 375,000 Estimated 50% of members retained FY 2021 FY 2022 FY Member Months Implied Revenue ~6.7M ~$2.4B ~8.2M ~$2.9B FY 2023 ~4.5M ~$1.6B One year


 
65 Long-Term Premium Revenue Growth Balanced growth driven by significant organic growth opportunities and disciplined acquisition strategy ~14% CAGR After Impact of Redetermination 2022 2025 ~$29B ~$42B Strategic Initiatives Acquisitions ~$4B ~$5B 4% - 6% CAGR ~5% CAGR ~4% CAGR ~$5B Current Footprint ~($0.8B) 2023 Redetermination


 
66 Current Footprint Eligibles + Yield Strategic Initiatives Long-Term Organic Growth Rate 2025 Revenue Opportunity Discounted Outcome 3-Year Implied CAGR off of 2022 Medicaid 4% ~$7.6B 40% - 60% 4% - 6% 8% - 10% Medicare 7% ~$1.2B 40% - 60% 4% - 6% 11% - 13% Marketplace 5% ~$1.5B 0% - 20% 0% - 3% 5% - 8% Weighted Total ~4% ~$10.3B ~$5B 4% - 6% 8% - 10% Long-Term Organic Premium Revenue Growth Model Targeted organic growth rates driven by identified strategic initiatives


 
67 Total Company Long-Term Outlook Strong revenue and earnings growth off of 2022 outlook, enhanced by operating leverage and share repurchases Premium Revenue Growth 13% - 15% Hedge to Margins / Operating Leverage 0% - 1% Net Income Growth 13% - 16% Share Repurchases ~2% EPS Growth 15% - 18%


 
68 Executive Q&A


 
69 Reconciliation of Non-GAAP Financial Measures Adjustments represent additions and deductions to GAAP net income as indicated in the table below, which include the non-cash impact of amortization of acquired intangible assets, acquisition-related expenses, and the impact of certain expenses and other items that management believes are not indicative of longer-term business trends and operations. Management’s opinions on business trends and operations can change, so the adjustments included in the table may not be consistent from period to period. 2017 2018 2019 2021 Guidance Net income per diluted share (9.07)$ 10.61$ 11.47$ 11.65$ Adjustments: Acquisition-related expenses - - - 1.13 Amortization of intangible assets 0.55 0.32 0.27 0.81 Loss (gain) on debt repayment - 0.33 (0.24) - Other (1) - 0.91 0.10 0.16 Subtotal, adjustments 0.55 1.56 0.13 2.10 Income tax effect (0.20) (0.43) (0.03) (0.50) Adjustments, net of tax 0.35 1.13 0.10 1.60 Adjusted net income per diluted share (8.72)$ 11.74$ 11.57$ 13.25$ (1): 2018 includes restructuring costs and loss on sales of subsidiaries, net of gain. 2019 includes restructuring costs. 2021 Guidance includes change in premium deficiency reserves, loss on sale of property, and restructuring costs.


 


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