Alignment Healthcare (ALHC) Q3 2026 earnings call transcript

Good afternoon, and thank you for joining us on our third quarter earnings conference call. For the third quarter 2026, health plan membership of $301,200 represented growth of 31% year-over-year and drove overall revenue of approximately $1.4 billion, a 37% increase year-over-year. Adjusted gross profit of $142 million represented an adjusted MBR of 89.5%, a 240 basis point increase year-over-year.

Meanwhile, adjusted SG&A of $120 million represented an SG&A ratio of 8.9%, which improved by 70 basis points year over year. Taken together, adjusted EBITDA was $22 million within the range of our guidance. I want to spend a few minutes on the headwinds that emerged this quarter and the actions we have taken in response. As part of our broader scaling initiatives, we began a comprehensive claim system migration last year designed to improve our payment speed, auto adjudication rates, and payment integrity capabilities. During this transitional period, we experienced greater volatility in claims processing.

As this volatility normalized, we identified a notable increase in aggressive provider appeal and disputes in our paid claims data, which resulted in higher cost trends.

Separately, during the quarter, we saw pockets of higher costs in areas such as catastrophic cases and skilled nursing, which also pressured medical expenses. To address the headwinds we experienced, we acted swiftly over the past several months to build out a more robust payment integrity function, including industry standard prepay claims edits and more rigorous post-pay review. Additionally, we have moved quickly to manage and deploy our clinical resources more effectively and are making targeted investments to ensure our clinical best practices and operating rigor are applied systematically across our markets to reduce the variability in member outcomes. We are confident that the actions we are taking to scale our clinical programs will enable us to achieve the level of clinical effectiveness that we are accustomed to.

We are pleased with the progress we have made across our multiple initiatives and saw institutional acute cost trends stabilized as we closed out September and entered October. Furthermore, we've experienced positive momentum across other cost categories. Despite our progress, we're taking a prudent approach to the increased trend seen in Q3 and assume that higher costs in the third quarter will continue to weigh on our results for the remainder of the year. Given this position, we lowered our annual guidance to no less than adjusted gross profit of $575 million and adjusted EBITDA of $100 million.

I want to emphasize that the guidance we have provided today is a guidance that we are confident in delivering. Furthermore, we have thoroughly reviewed each market to identify the issues that impacted our financial performance this year and mobilize quickly with plans to address them. Our revised outlook reflects both a prudent posture toward the cost pressures we are seeing today and a disciplined approach to forecasting the balance of the year. Our focus is now on execution, delivering against the commitments we are making today, and positioning ourselves well for 2027.

As we enter 2027, we feel well positioned to achieve our top-line growth target of at least 20% given the early results of this AEP. Importantly, we bid prudently, reconciled those assumptions in the bids to the trends we are seeing today, and have made adjustments in areas we saw room for improvement. At this time, we have a firm grasp of the underlying market dynamics we faced in 26 and the actions required to address them.

Taken together, we believe we will strike the right balance between growth and margins for 2027. We will share our thoughts in greater detail following AEP results in January. I'd like to take a moment to address our star ratings for payment year 2028 which reflects performance for 2025 dates of service we maintain a four-star or higher rating and six of our seven eligible plans demonstrating our ability to deliver strong stars performance across much of our portfolio at the same time our California HMO contract earned a 3.5 star rating which is below our expectations the shortfall in our California HMO contract was primarily driven by misses on several triple weighted measures particularly in Haas and Part B as well as higher than expected industry cut points we have already identified data and workflow opportunities within our stars infrastructure and initiated actions across our enterprise to drive better and more consistent stars performance we have conducted more provider and member engagement initiatives to improve performance and survey measures address data issues that impacted gap closure in Part D and accelerated our progress in HEDIS gap closures to further strengthen our position in these metrics these changes are in place and operationalized for the 2026 performance cycle in conclusion we continue to demonstrate profitable growth and are addressing the challenges that impacted our performance this year we have taken decisive action in those areas and our revised outlook reflects a prudent view of the cost pressures we're seeing today.

At the same time, we continue to invest in capabilities and operational changes that are important to support our next phase of growth. Over the past couple of years, we have evolved our leadership, processes, and technology architecture to support greater scale. We are already seeing benefits from some of these changes. This includes greater visibility and control over inpatient utilization to our partnerships with the providers to de-delegate institutional acute UM functions. We also continue to seek opportunities to assert more control over our pre-service UM for outpatient and professional costs where appropriate. Additionally, our clinical model remains a core strength of our business and primary driver of our unit cost advantages. The investment in claims processes, clinical operations, and STARS infrastructure build on that foundation.

With that, I'll turn the call over to Jim to further discuss our financial results and outlook. Jim?

Thanks, John. I'll dive into our third quarter results. For the quarter ended September 2026, health plan membership of 301,200 increased 31% year-over-year, supported by strong member additions and high retention in our existing membership base. This drove revenue of approximately $1.4 billion in the quarter, representing approximately 37% growth year-over-year. Third quarter adjusted gross profit of $142 million represented an adjusted MBR of 89.5%, approximately 100 basis points above the implied midpoint of our third quarter guidance and an increase of approximately 240 basis points year over year. Approximately half of the year over year increase in MBR was driven by changes in Part B seasonality and additional clinical model investments, consistent with the comments we made on the Q2 call.

As John mentioned earlier, we also observed a notable increase in provider-led appeals and disputes in the quarter, along with elevated costs within our skilled nursing and catastrophic case categories. These components drove the remaining increase in MBR.

Turning to operating expenses, our adjusted SG&A was $120 million, an increase of 27% year over year. As a percentage of revenue, adjusted SG&A of 8.9% improved 70 basis points year over year and outperformed the midpoint of our guidance range by approximately 90 basis points. We delivered this result even as we made incremental investments in our business previously mentioned in Q2 call and John's commentary today.

Additionally, included in the quarter was a benefit from lower incentive compensation and cools, given our year-to-date performance against targets. Taken together, third quarter adjusted EBITDA of $22 million produced an adjusted EBITDA margin of 1.6%.

Moving on to cash flow and the balance sheet. We generated $158 million in operating cash flow during the first nine months of the year, and our liquidity profile remains strong. We concluded the quarter with $743 million in cash, cash equivalents, and short-term investments. Overall, our reserves remain well-positioned in both current and prior years, and we are confident our cash flow generation will continue to support our growth going forward.

Lastly, our funded leverage ratio at the end of Q3 was 2.4 times our trailing 12-month seeded off. Moving to our guidance. For the fourth quarter, we expect health plan membership to be no less than 305,000 members, revenue of no less than $1.32 billion, adjusted gross profit of no less than $104 million, and adjusted EBITDA of no less than negative $28 million.

For the full year 2026, we expect revenue of no less than $5.25 billion, adjusted gross profit of no less than $575 million, and adjusted EBITDA of no less than $100 million. Our fourth quarter adjusted gross profit guidance of at least $104 million implies an MBR of 92.1%. In our guidance, we have assumed a continuation of the elevated medical claims expense we experienced in Q3 with no contemplation of the stabilizing trends we observed in both September and October.

Furthermore, while we are not including any benefits from the initiatives currently in progress, the cost of these initiatives are fully burdened in our guidance. Lastly, on seasonality, our revised guide continues to embed an assumption for increased costs relative to typical medical expense and Part B seasonality. Additionally, we are assuming a continuation of the higher costs we experienced in the third quarter related to elevated appeals and disputes activity, along with increased costs in certain categories.

On SG&A, we expect higher expenses during the fourth quarter associated with growth-related costs and marketing expenses related to AEP consistent with our past experience. In closing, our updated outlook reflects prudence in our positioning as we address the pressures we discussed today, as well as the seasonal factors typical of the fourth quarter. We expect the actions we have taken this quarter to provide visibility and control and support improved performance as we position ourselves for 2027.

With that, let's open the call to questions. Operator?

Yeah, Matt. FACETS is the industry-leading claims adjudication application. We migrated off to something that we thought was subscale. One of the benefits of this is we felt that we needed better auto adjudication rates so we could pay our providers faster. We needed to make sure that we had kind of state-of-the-art payment integrity programs. to offset the AI initiatives from a lot of the larger providers.

And anybody that's gone through one of these conversions knows it's a messy process. I'm actually pretty happy with where we ended up in terms of getting through most of this in July. And so we're three months past that now. And I feel very happy about where we are from a stability point of view. but really what happened is we saw volatility in our paid claims and we started seeing that in July and once we realized we had a lot more appeals and disputes coming through we had to react on that and I'm happy to say that the the amount of appeals has dropped off significantly in August September and October as Jim said in spite of that kind of stabilization we're still taking a very prudent approach toward the rest of the year and I feel I feel good about where we are in that regard I feel good about where we are with our reserves and and and that that the main that reserves And that the main issue on facets Great.

And once we saw that, we made all the requisite changes and got all of that through in terms of getting paid claims stabilized, but that created the higher trend really starting in July. And we start seeing that, and, you know, the actually trends is starting to actually tail off a little bit in August, September, and October.

But, again, we're just being extra careful to make sure that we're kind of assuming that trend continues into Q4, despite the fact that I think some of the trends are already starting to stabilize.

You got it.

Yeah, hey, Joaquin.

Yeah, it's a good question. We did a deep dive, as you might expect, on the assumptions that we made into the bids. we kind of compared that to the trends that we anticipate and the mitigation efforts that we have in place for the balance of this year which just to underscore we did not factor into the guidance and the result of that is we made some changes with respect to certain networks we made some changes with respect to how fast we're going to grow certain products or not grow certain products specifically. But overall, we feel good about where we are in 2027. We feel good about finding, again, that balance between growth and margin expansion.

I think we've been pretty good at that over the years, and we'll get back to that same cadence. And you can imagine, we did a a pretty thorough dive as to how much we should grow and how we're positioned relative to competitors in PlanFinder. And again, I think we feel pretty good with solid profitable growth at that 20% level.

Well, I think with respect to us, we have so much membership in the California H number. That's something that we're looking at, obviously.

And I'm not going to comment too much on the tactics associated with that, but more so focused on really getting to the root issues in STARS and really what I think is going on is we still got six out of seven, you know, four-star and above. We've got three, you know, four-and-a-half-star plans just to remind everybody. But those are still being well run, really, because we're smaller in those markets. California has gotten so big that, you know, we just have to, you know, continue to invest in automation.

We have to continue investing and really incentivizing our provider partners and our IPAs to work with us and focus on stars more and better.

But that's kind of where we're zeroing in on. It's like we might have some kind of crosswalk types of tactics, but we've got to get to the root issues. We've got to get to the root it and fix it. Just to remind everybody, when we started the company, we bought a plan that was three and a half stars. It dropped to three. This was way before we had anything to do with it. We're still the only company to get from three stars to four and a half stars. And the way we did that was underscore the fact that stars is not a functional department. Stars is a cultural requirement. And we have so many new people here.

We're growing so big with new people, new leadership. That's something that we're going to be underscoring yet again, is this is something that everybody in the company has to focus on, serving that senior, and we'll get this fixed. That I can promise you.

Yeah, and John, I'll take this one, and then John Cato can fast follow. But just in terms of developing our Q4 guidance, we did want to reflect the cost trends that we identified in the call and put ourselves in a position where we could deliver on the revised expectation. And obviously, you're seeing some prudence in that. So in our guide, we're assuming a couple things, and we're not assuming a couple things. So that's important to understand from the jumping off point. In our guide, we're assuming that we're continuing the higher appeals and disputes at what I would describe a peak rate. So putting some prudence in the appeals and disputes expectation. And as John mentioned, John Cale mentioned, that's already starting to come down.

We also are assuming a continuation of the SNF length of stay issues that we've talked about, but also CAT cases kind of continuing.

And as we exited Q3, we saw both of these things kind of moderate. What we are not assuming is any favorability from payment integrity or payment accuracy activity. So that's not in the assumption. We're not doing any returns from the clinical investments that we call NIQ2. So in that, we're kind of making sure that we can deliver and not baking in any of the, what we think is going to be run rate benefits for 2027.

And then finally, we just put an extra layer of conservatism on it. So the question, and maybe I'll push this over to John Taylor, is is that the right starting point for 2027?

Yeah, John, I would strongly advise not to use the Q4 MLR as an annualized starting point for 2027. That would be, I think, a mistake. you know we have a lot of initiatives going on and again just took a took a made a decision that you know this is a bit of a reset and we're going to do the reset let's just make sure we can you know convey confidence to the street as to you know what we can achieve and I think there's potential for upside and And, you know, we're going to be focusing on that. And that would be my suggestion for you without getting into 27 guidance.

Yeah, that's a great question. Just to underscore one piece of detail, the margins associated with that CSNIP membership, even in-year for this year, has been pretty good. that's a big deal. And so really I think the points that we highlighted with respect to appeals, disputes, revenue cycle, aggressiveness of providers, a couple of outpatient kinds of costs were the drivers. The mix issue is not something that we think contributed to this.

Having said that, for 27, I think you're going to see a balanced, more balanced on HMO products. I think there are still some pockets that we think CSNIP makes sense for us.

But, yeah, I mean, that was the first thing I looked at is, you know, as part of this mix, and it's actually performing quite well in year.

Does that answer, John, your question?

Yep.

I think the one thing that we would say that was present in Q3 as well, in terms of a little bit extra burden that was in the baseline was just Part D, which adds a little bit of an uptick in the NBR in the fourth quarter. That's just structural and kind of how the bids work out in the risk quarters, et cetera. And we did have a little extra layer of investment in the clinical side. So that is, if you're doing it year over year, you have to kind of apply that same factor. So then you do sequentially. You've got, I would call it a pretty full run rate of these costs that we described, the appeals and disputes, the CAT cases, and the SNF, kind of pushing into Q4.

And what we're really doing is saying it's a bit one-sided, which is we are putting a full count for what we think the trend could be without any offsets that we've already been actioning and actually starting to see some results. Payment Integrity is a perfect example of that. So we are being prudent on that, but that's how the bill came about, Justin.

Yeah, just, and I'd add to Jim's comments, really, the operative word from our point of view is prudence. You know, we really looked at, you know, the Q3 numbers. We saw an uptick in those appeals and disputes. You know, those are, in our world, called adjustments with respect to claims payment. We've seen a positive trend with those coming back down starting in August, September, and October, stabilizing. We see ADK stabilizing.

We have initiatives with respect to cat case management, sniff length of stay management. All of the blocking and the tackling is implemented. But really, we just like, let's just be super prudent and not assume any of that's going to start being reflected until we actually get the paid claims in place.

Yeah, but for a little bit of incentive comp that we mentioned on Q3, it's tracking exactly as to what our expectations were in terms of quarter over 12. We were 120 in Q3 and 132, I believe, in Q4. So it actually does pick up, Justin.

We said it would track according to plan. So maybe we'd be in a high 120s in Q3, I think was our guide, our original guide.

And it's picking up to 132. So we really haven't made any material changes. And in fact, we've been investing in the SG&A areas because we want to position ourselves for 2027. We called that out in Q2. There was going to be a little extra investment made in Q3 and Q4.

Thanks, Justin.

yeah so so um with respect to uh gates of service 2026 payment 29 obviously it's a bit early to comment on that but i will give you some input that we feel good about our HEDIS gap closure initiatives. We feel good about our Part D data issues that got cleaned up.

And just really as a reminder, even heading into Plan Preview 2 just a couple of months ago, and I was feeling, you know, optimistic just because we had such a good CAP score come in. and we really got a little bit blindsided with Haas. And so that's still one area that is a little bit elusive for us, which really caused me to pause about 26, you know in aggregate But a lot of the changes in operations I comfortable with But you know give us a little bit more time you know and obviously I think CAPS and HAAS is going to be more and more important.

I think our Part D is going to be strong this year in terms of dates of service. With respect to, I think, your third question, You've got to remind me what the second one was. But, yeah, I mean, I think we're going to look at this like we always do, finding the right balance between growth and margin.

I will say that the kind of the confidence I have with our ex-California markets and our operationalizing of those markets, I feel good about. I think we have a handle on the issues. We have a handle on utilization. and we have so much growth in those areas that the embedded earnings is going to start to, I don't know, steer the right way with us in those ex-California markets that would allow us to grow there.

And I think there's still more room for us in California to still get decent growth. I don't think we need to slow down growth in California, maybe a little bit, particularly given where everybody else is. and so we'll make the right decisions with respect to benefit design. We're pretty good at that.

Oh, okay. Yeah, yeah, let me let us get back to you on that one, please because the the mitigation initiatives is is pretty material And I Underscore two areas one is embedded earnings You know a lot of the the investments that we made in obviously 26 and the C snips I think is going to start paying off. It's going to help bridge some of that gap with respect to stars and then an MRA I think we are as we have shared with you in the past pretty conservative as it relates to risk adjustment and I think that there's lots of opportunity for us you know we took a very I would just say conservative approach philosophically to coding we did not want to be dependent on that but I think it's also fair to say we can do a better job, and we're doing just, I think when we're starting to dive into that, we've determined there's lots of opportunity for us on risk adjustment.

And so we'll be in a position to share a lot of that with you when we give you this kind of the full plan. We expect to do that after the Q4 call.

The answer is it has not. The brokers are fine. The brokers are just, we have such a strong set of relationships with them built over the last 12 years. We've earned their respect. We do what we say. They have confidence in us.

And we feel really good about 2027 AEP. I mean, really good. And I'd say the right products in the right markets with the right margins. I mean, I'm very happy about that. You know, just to note a couple of things that we've announced, you know, we've added some pretty important provider partners this year. Hogue Memorial is a premier delivery system in Orange County in our backyard.

And so we've got a very, very good win-win contract with them. And then our expansion in L. A. with Estrana. and so I feel really good about that. There are certain, there's a couple of other markets with certain products we're going to probably de-emphasize heading into 27 and even with that I feel good about the growth. But yeah and even the providers, particularly the one Regis mentioned, you know, are going to work with us because they have confidence in us that we'll get this thing corrected that is a very good question and and so the next logic was okay well how do you think about the growth in 27 how do you think that'll impact your bids and your product strategy in 28 I think we've contemplated that and I think we're going to be fine and I think it's really going to be you know what does the margin profile look like in California with respect to benefit design relative to how much we grow ex-California.

I think that's what we'll start looking at, you know, as we head into 28.

Yeah. The whole point of this, everybody, is to get this care model everywhere in this country. It's a good care model, and we needed to do this. We needed to scale. We needed to put these processes in place and to automate more of what we do so that we can get this model in more states. And I feel good about where we are and what we've done so far heading into 27. We're going to be entering San Antonio and Charlotte.

Again, that was a bit prudent on our part that we could have added additional states. We chose not to in 27. In 28, we're working very diligently to add a couple of states. and the whole point of this is what we've been talking about is to scale this model. And I think that you're going to be happy with what we end up with. We're going to get back to this kind of beat and raise cadence.

Just everything's going to be bigger and much more reliable. But we've got to get through this kind of transformative phase.

Yeah, you got it, Michael.

Well, in this, in the quarter, we definitely saw some elevation, and you can kind of think about that in terms of the NBR 120 basis points that we called out. And we are seeing it stabilized, and I would say that probably exiting the quarter below the peak of the quarter. But in our guidance for Q4, we are certainly predicting or guiding towards that maintaining at essentially peak level just in an effort to be proved.

So the trend level we think is going to come down over time clearly as we go into 2027 based on the actions we're taking. And that's things like payment integrity initiatives, the clinical model initiatives that we talked about, and just getting sharper in some of these spots, cat case management, et cetera.

But for the next three months, we're just being prudent. We do think that this will get back to normal in 2027 in terms of our typical trend.

No, it's a good question, Jonathan. We're putting more boots on the ground in the markets. that's that's the kind of the short answer you know I again to reiterate what I said earlier you know we have to just get back to the fact that this is a cultural requirement it's not a functional department this is like everybody in the entire company needs to believe in serving that senior as best we can partnering with the providers as best we can and so you know it stems from the top from the board to me I'm going to be sitting on this daily I've got great leadership in place now to sit on it daily and it really is numerators and denominators for every single measure that we track daily and I think we just got away from that and so we got to put more bodies in in the markets have more consistency around how we close these gap code closures and engage the providers, particularly in California, much more tightly.

And those are the things we've invested in. Those are embedded in the guidance numbers.

Yeah, Scott, it's a great question. We do well in the C-SNPs, you know, and, you know, a concern I had heading into this year, I thought we bid appropriately, but, you know, was, you know, were we going to get, you know, negative trend there worse than we budgeted? And what's interesting is I think we're pretty much spot on in terms of contemplated margin for the C-SNP in year for 2026. and and so I think you can expect us in 27 to have a good growth in CSNIP in selected markets I think you're going to see more HMO growth you know more traditional HMO growth you know if you look at the plan finder I think you'll find that our benefits were pretty good relative to our competition and that speaks to our confidence in all the different initiatives we're working on And I just can't emphasize the importance of kind of getting through this kind of claim system conversion.

That was a big deal. It took a huge effort. We started it like three years ago. We went live last July. We're 17, 16 months into it now. And so that part of it is starting to work. And I would say one area that is going to be a huge opportunity for us is just the payment integrity part. Shout out to our team working on that. They're doing a great job.

And it's going to be more and more important as you hear the providers deploying more sophisticated AI tools. We had to go through this in order to get to our long-term growth objectives. and so getting that kind of stabilized is going to bring into focus everything that, you know, we've been so proud of in terms of visibility and control.

So with respect to the competitive dynamic, yeah, I mean, I think things are going to, you know, going to get tougher. I think in 27, you know, we don't have another year of V28, And so I think you're going to get some good lift in that regard.

I'm not sure you're going to get rewarded, the industry's going to get rewarded for any kind of large or huge revenue benchmark increases. But I think in that new world, I think we win still. I really do. I think we just get all these transformative changes in place. Biggest one is the facets conversion. Very proud of the team. They worked their, you know, what's off on that. And shout out to that team as well.

So anyways, I don't know if I answered your question, Scott.

That's the best question so far. So we deemed about two years ago that it was strategically important that we build a core competency of doing the UM work.

And, you know, we still have this kind of shared risk delegated model in California. And so what that means is we've delegated UM to our IPAs. and the UM is really two parts there's the inpatient acute institutional determinations and then there's the what we would call pre-service and that's really the outpatient and the professional and and and what strategically we decided was we could not be in a place where we were entirely dependent upon the global cap providers right Because you could see that with V28 there going to be a lot of margin pressure because the revenue is going down. And so in that world, we were accustomed to is that the providers, you know, they're global cap, want more money, and they're going to squeeze our margins.

So we had to move away from that and move away from that kind of dependence. And so what we did was we started to de-delegate the IPAs and the medical groups for the acute inpatient part of the UN. And we've done a very good job with that. And again, shout out to the team for working so hard to develop that competency.

And we're about 80% through our process. So the key thing we've done is do that in a way that is aligning with the providers. Because if we do better, they do better. And so that's a key, key thing. The area that there are more opportunities for us, and we've alluded to this, is in the pre-service. If we go outside of California, there's going to be less dependency on IPAs that are going to take any kind of downside risk, whether it be shared risk or global cap. And so our ability to do pre-service and to integrate more care navigation, okay, into our processes for pre-service is going to do huge amounts of improvement for us, I think, on MLR, particularly on outpatient and professional spend.

And the way we want to do it is we want to use that capability to route people to the right high-performing providers it's not a matter of denying care our denial rates are very low it's about getting them to the right care the right timely provider in a timely basis that is going to be the next frontier and we need to do that very carefully with our IPAs in California and we need to execute that very quickly ex-California and I think that would be a big opportunity for us and I think then what we will have is the ability to operationalize our networks as we expand throughout the country whether it's fee-for-service we can make that work whether it's shared risk we can make that work and I got nothing against global cap.

Global cap works as long as we have durability to that rate. That can work. And so the whole idea of this is to be able to enter any market with any kind of contracting with providers, overlay our clinical model, and then get the same reliable growth that we've experienced for the first, you know, whatever, five years of being public and 12 years of being a company. Great question.

The answer to both is I need to get back to you as a follow-up. Those are good questions. I don't have the degree of visibility I would have liked for the 2026 states of service, which is our measurement year, really, because you're talking about 24 dates of service. I'm hunting that down. I know that the work that we're doing now for 26 states of service is a lot of work around town halls. I think we've touched over, I think the last number I saw was like 70,000 members in some capacity.

So it's obviously a concerted effort, but I need to follow up with you on that one.

Yeah, it's another good question. Yeah, it's a concern for providers, but I will say our market management team has done a very good job. We're collaborating with all of them, like all of them. You know, they get it. And I think there's upside opportunity. Remember, this isn't going to affect them until 2028. And so there's a lot of work that we can do, you know, now and through 2027 in terms of trend vendor initiatives. and I think there's opportunities for inpatient acute candidly I think there's lots of opportunity for you know the way get just getting back to basics of how we did the cat case management with them there's incentive strategies being put in place with respect to stars because part part of the Part of it is the alignment or misalignment is because of the IPAs on some of these STARS issues.

So we've got to get them more aligned with us to see what they can do to help us with respect to transitions of care initiatives and access to care and timeliness of care. Those kinds of things, again, in California are delegated to a lot of the IPAs. So it's like we're aligned to solve the problem together. and there's other levers, not the least of which is risk adjustment, by the way, that they're very, very collaborative in working with us on, you know, ensuring that we capture encounters in a more timely way, et cetera.

So I think it's kind of in this category of not let any, you know, crisis go to waste. It's allowed us to really have very constructive dialogues with the IPAs, and it's forcing us to get even more and more aligned with them. And again, I think our market management team has done an excellent job in that regard.

Thanks, John.

Yeah, very good question. The Q3 reserve position, let's start with the statement that we made in the script, which was, we feel very good about our reserves. As we migrated through this claims transformation, there was a lot of volatility. And as a result, it was more difficult to predict how the runout for date to service 25 was going to play out. And so in Q2, we said we're going to be prudent and make sure we bolster our reserves for those dates of service in 2025 and prior. That's that prior year. So we did that in Q2. Q3, we're flat.

And I would say that we feel actually very well positioned at this juncture. We're essentially at 99% run out on those days of service. And very little new day claims coming in the door.

What's continuing to help us is we're getting payment integrity recoveries still coming through. So I feel good about the 25 reserves. And so you're right. We are kind of migrating or managing through the claims transition, but the reserve position, again, that's quite good at this point.

and we haven't changed any of our investments that we call out on Q2. In fact, we've been investing back in the business on a variety of initiatives, but we're absolutely sticking to our Gonzalo's clinical and SG&A investments. Those are in our Q3 numbers and in our Q4 guidance.

But that, obviously, when it comes in, it's still, then it's going to start running.

Hey, Jess, can you repeat that, please?

No, no. What we did, what we had to do was we looked at the bids, right? The bids were obviously done in, you know, April, May, June. They're submitted in June.

And what I mean, you know, recalibrate is, you know, how far were our MLR assumptions for each product in each market? And were those numbers, you know, were they consistent with our current trend and more specifically our current trend that we think is going to lead into 2027. You know, we're sharing with you guys a very prudent, you know, kind of Q4 guide.

I'll just reiterate, I would not, you know, peg Q4 MLR and I would not annualize that for next year. And so we haven't done that either. And so we're factoring in all the different initiatives that we're going through. and then you know I had to look at that in in like on a product by product and market by market specific basis and and so what we concluded in certain markets for example we kind of said you know this doesn't make sense this what was assumed in the bid didn't actually it was consistent with you know what our current trends are and so we made the decision while they may be a product we're not going to grow that product just as an example I obviously can't speak to which products and which markets but that's an example another example is a okay another market was do we have the right engaged network right and in the conclusion was not really and so we had to move and grow with a different network in that market this is another example okay and a third on the other side of the equation is we I think were too conservative with respect to our assumptions in the 27 bid and so we then double down on growth assumptions in that market and so it's the only way you can do this is in a detailed product by product market by market review and when you kind of tally all those puts and takes up we still pretty comfortable about the 20% growth that we're telling you guys and and you know that's probably as much as I can get into without getting into 27 guidance you know but but you know again just to underscore don't don't don't annualize q4 trend or or MLR got it that's helpful and then just a quick follow-up I know you gave some color on the the expanded network relationships, but just interested if you could offer some color on the new physician relationships you're announcing for 27.

Yeah, yeah, no, it's a good question. I would say the common theme with all of these different providers is a commitment to quality health care. And I know that sounds a little Pollyanna, but really I think that's what they like about us. They know we're going to do the right thing. They're obviously not happy with the three and a half, but we're going to work together to get that solved so much so that they're also willing to expand geographically with us. And the key to the whole thing is long-term. We're not doing this just for the short term. We own and take accountability for STARS for 28 payment. We're going to get that fixed. It's very, very serious.

I take it very personally, actually. And our leadership team is fully on board. And what's equally important is the providers on their leadership team is collaborating with us. They know they have input and a say in how they drive our stars. And so we've got to do that better together. And that's really the approach that we've taken. The whole name Alignment Healthcare was building alignment with the providers for the benefit of the beneficiary. That's the whole reason for this.

And I think it's a wake-up call for everybody. you know, and, you know, we've had nine years of four stars or above, and if anything, that's what I'm taking away from this. It is a wake-up call. We've got to get back to basics, and it's, you know, there's urgency in all of it. So, we'll get there.