DocGo Aktie

Good afternoon. My name is Sarah Conrad, and I'm on the GS Healthcare Services team here. Today, I am joined by DocGo and CEO, Lee Bienstock. We just -- for those who are a little less familiar with the story, can you give a high-level overview of the business today and how we're thinking about the core value proposition?

Absolutely, Sarah. It's great to be here with you. So for those less familiar with DocGo, essentially, we deliver health care literally. We go into patients' homes and deliver health care. We provide virtual care services, remote care services, and we also have a very large medical transportation business where we go and take patients from one care setting to the next.

So that's essentially what our company is there to do. We're going to meet patients where they are or bring patients to where they need to get to. And we do that at great scale. Last year, we transported 700,000 patients, and we also visited about 150,000 patients in the home and did over 1 million telehealth visits. So we're really excited. We're meeting patients where they are. And we think when you meet patients where they are, you have better health outcomes, you have better health outcomes. Obviously, it's great for the patient, it's great for the system, and we think we'll do well in that way.

Yes. So the company has gone through a bit of transition over the last couple of years. You've moved away from your COVID and migrant-related work. Can you talk about the main pieces of the business today and how investors should think about like what the normalized business should look like from here?

Absolutely. So you mentioned it. I mean, the company went public in 2021. At that time, we were a medical transportation company. We've been doing medical transportation now for over 10 years. When the company went public, we were doing about $100 million of transportation revenue in that year, this year, we'll do over $200 million. So we've doubled the medical transportation business in that time.

And at the time, we were doing a lot of COVID work and over the last number of years doing work relating to the migrant crisis in New York. And so the company was doing a lot of work with emergency response, right, us being an ambulance company at heart, a medical transportation company at heart. We were mobile and dynamic in that way, and that was what was needed to respond to some of these emergencies.

But really, the goal of the company has evolved into meeting patients where they are in an evergreen way, tackling their health and their chronic conditions in an evergreen proactive way, and that's where the company has evolved. In Q1 of this year, that was the first quarter in years where the company did not have any COVID revenue or migrant-related revenue, we're providing medical care to the migrants that were being bused in New York. We didn't have any of that type of revenue. We had about $76 million of revenue in Q1 of this year, all of which was comprised of our medical transportation revenue and the care anywhere portfolio, as I say, bringing care to where it's needed. So that was an exciting moment for us with the sort of first quarter and people got a chance and investors got a chance to see the business for the components that are evergreen and proactive in providing care where it's needed, and that was a big, big model for us.

Yes. So let's move on to medical transportation. This is your largest, most established vertical. Can you talk a little bit about the utilization environment there? What's driving growth today and also just the competitive environment within medical transportation?

Yes. So medical transportation has gotten a lot of excitement recently. And we were talking about one of our peer companies, I'd say, AMR just went public a couple of months ago, and we're cheering them on as well, of course. So I think really, medical transportation is evolving. Patients need to get to the care facilities and care settings that they need to get to receive efficient care. As I mentioned, we've been doing it for over a decade now. And the real genesis for us to bring innovation to the space was really, how can we use technology to become more efficient, how can we use technology to help the system.

And that's basically what we set out to build over the last 10, 11 years. We built a platform that's embedded within Epic, where a discharge nurse can literally click a button, and just like Uber, see exactly when the ambulance is going to arrive to pick up the patient. That is a really magical experience for discharge nurse.

If you think back, it used to be when you ordered ambulance for medical transportation, call the first company on the list, hey, Can you come pick up my patient now? Great. We'll be there in an hour. You don't really know they're going to be there in an hour. In 20 minutes, are they going to be there in 40 minutes? Maybe they weren't available to pick up the patient. You call the second one on the list. Now with us, we have our platform. It's directly embedded within Epic, and they click a button and they can see exactly when we're arriving.

And the other piece is we've approached the market in a very different way. We're not -- we're contracting with major hospital systems to provide medical transportation for their entire population. And this is a big aspect because you can imagine if a hospital calls up an ambulance company and said, hey, can you come pick up a patient? They didn't have such great insurance, maybe they're busy. They didn't have any insurance. Maybe they're not available. But for us, we help the hospital system manage the patient -- we contract in a way that we align incentives so that we can help them manage the patient flow. And that has been a big, big sort of breath of fresh air to the customers we work with. We work with some hospital systems like New York City Health and Hospitals, Mount Sinai, Jefferson. We work with mainline health. We work with Methodist. We work with a lot of great hospital systems that use our software, Northwell, and we help them manage that patient flow. And that integration between software and services is very unique. I think that's a winning strategy.

We can talk more about it, but there's a lot of companies out there that are just doing the software, but they can't provide you with the services or their antiquated companies providing services, but they don't have the technology. And that's kind of our unique value proposition as we bring both to bear, both the platform and the services, all integrated into 1 seamless experience for the facility and the patients.

Yes. So you mentioned you take all types of payers. We've had a couple of changes in the market recently with the HIC subsidies expiring, Medicaid challenges with SVT payments. Can you talk a little bit about how your payer mix has shifted over the last year or so?

Yes. So for us, really, we contract first and foremost, either with the insurance companies directly or with the hospital systems. I'll tell you that the -- there's a lot of strain on the system right now. Hospital systems are definitely worried about expenses, reimbursement rates that they're going to be getting. Certainly, we believe there's going to be a lot of what makes fewer population on some of the Medicaid plans.

And so as a result, what patients are going to end up in the hospital. The question is do they have Medicaid? Or do they not have Medicaid? Do they have insurance or they not have insurance? The hospitals are going to have to grapple with how they're going to provide services for those patients.

And so that's really why we exist. We're there to help them either mitigate that. We try to keep patients out of the hospital, right, when they don't need to be there and I'll tell a personal story in a second. And of course, if the patient does need to be there and need to be transported out upon discharge, we help them do that efficiently. So I think to be more and more efficient. One of the -- is really CMS' goal to reward outcomes and the upfront reimbursements are so low, you have no choice but to use technology to drive down the cost. Otherwise, you won't be successful.

So it's pretty clear what the industry and what CMS is trying to do. They're trying to incentivize providers like us and hospital systems and insurance companies that we work with to drive the cost down, to improve outcomes and to reward companies and providers for doing that. We've all had experiences where we've gone to the doctor, taking this child to the hospital, and there's just test after test, providers get rewarded, the sicker and sicker you get, the more and more times they visit hospital, the more and more time they visit a doctor's office. And the system has to change to where actually companies like mine, companies like ours are successful, the healthier the patient is.

That's what CMS, I believe, is trying to do. We sit at the intersection of that. And I think you're going to see more and more of that come down, come down the pike here. I think also in some cases, you're going to see pressure on rates, but in some cases, you're going to see higher incentives. I think CMS is really pushing more preventative care. They're increasing the G-codes on preventative care. They're improving reimbursements on proactive screenings and things of that nature, all with an effort to improve outcomes, which will ultimately drive down the total cost of care. So that's really kind of the piece of the strategy we're focused on.

Yes. So I guess sticking on medical transportation just for a little bit. So what do you think customers are prioritizing when they're selecting their vendors? And then what do you think is driving your ability to continue to take share in this market?

So I think, first and foremost, the customers we work with are prioritizing the transparency of the service delivery. When are we going to be there? How often do we arrive on time? How quickly can we move the patients and free up the bed for the next patient. That's the key. So for example, when we're ordered, when medical transportation is ordered through us, alerts go out across the hospital. The housekeeping team is notified. Now it's time to go and make up the room for the next patient. The intake team is notified, hey, the bed is freed up for the next patient. Discharge nurse does exactly when to get the patient ready because they know exactly when we're going to be arriving.

So that transparency understanding each piece of the service delivery is very, very valuable to the hospital system, and that's what the tech platform enables them to do. I also think the quality of the service is very, very important. And so they choose us based on that. They typically don't choose us based on price. We're not going to be the lowest cost provider. We're there to provide medical transportation to the entire patient population that they serve often times that requires the hospital system to invest alongside us, right? I mean, part of the issue has been that all the ambulance companies happen to be busy when a patient that doesn't have insurance or has, let's say, low reimbursement insurance, needs to be transported. We'll be there to take that patient. We want to provide great care and great access for all, but then the incentives have to be in line between the facility and the provider.

So a lot of cases, we have a program where we call like a dedicated fleet, where our ambulances are dedicated to that facility. And will transport any of the patients they need to transport and we'll bill insurance if we're able to collect our daily minimum, the hospital system doesn't owe us anything, if we're able -- if we're not able to collect, then the hospital pitches in the shortfall. And that aligns incentives.

The other way we align incentives is we'll tell the hospital when we're going to arrive to pick up the patient. We show up there and the patient is not ready. We just have to wait around. Everybody loses, the patient loses, the hospital loses and we lose we couldn't be the only ones to lose in that scenario. We're just waiting for the patient to be ready.

So that's the key, aligning all the incentives where the hospital system knows they can have reliable, great quality, transparent transportation and patient flow. We know that when we show up, the patient is going to be ready. So we could be really efficient and transport as many patients as we can throughout that shift throughout that day. And then, of course, the patient benefits in a great way when there's great quality, predictable transportation to get them where they need to be. That's what we've set up. That's why we think we're going to be very successful.

Great hearing about those partnerships and relationships that you have. I want to pivot to the recent acquisition of SteadyMD, which had a really strong first quarter. Can you talk a little bit about how this business is operating post acquisition? And how we should think about the pipeline of new logos and existing logos from here?

Yes. So we're very excited. We have a very talented team that's joined the company in SteadyMD. They had a record quarter Q1. They're on a really great trajectory for the rest of this year. They continue to sign incredible customers and partners in the pharmacy space, in the digital wellness space. And I think we're very excited.

The piece that is very foundational. This idea of going to deliver care in the home, we don't send a doctor. We don't send an MD to the home. We don't send a nurse practitioner or physician assistant into the home. There's just too much drive time, there's too much time in between the patient interactions.

So what we do, which is very unique, is we'll send the medical assistant or an LPN into the home. They are hands, eyes and ears in the home, that's able to vaccinate a patient, that's able to take a swab, take a lab sample, take a screening and remotely, virtually is the higher order clinician. And that's the SteadyMD network.

So we've really -- through this acquisition, we've done 2 things: a, we've brought a great virtual care practice, 50 state into the company. And we've created this network where now SteadyMD clinicians are overseeing the DocGo visits in the home. And that 400, 500, 600 clinician network is enabling us to scale the in-the-home visits way faster.

So that's why we're so excited about this. And we think, look, you have to be able to provide care in every modality, virtually, remotely and in-person. And there are so many companies that could do it virtually, but they can't be in-person or companies that could be in person like the doctor's office, but they don't do the digital or remote well. We are building the competency to do all of it, under 1 clinical practice.

And so when the telehealth visit will do, we'll do a telehealth visit. When we need to be with the patient hands on, we have the ability to do that as well. We can't take a blood sample through a Zoom call, through a virtual visit. We can't give a patient of vaccination through a screen. But we can do a lot of things virtually. And so that's the wonderful aspect of what we're building. We're building this Care Anywhere platform, where we can be with the patient when it's needed. We can be virtual when it's efficient. We can be remote, so we're monitoring the patient throughout their daily lives, and we can intervene and be proactive in the moment in real time. That is very unique at the scale we're doing it. It's a very big vision. And it's really, frankly, what's needed for the health care system because if -- the health care system keeps going the way it's going, where we spent 19% of GDP. I'm sure a lot of people are talking about this throughout the conference.

Patients are just getting sicker and sicker. And rewarding providers like ours for treating patients that just keep getting sicker and sicker, really frankly, makes no sense. That's what CMS is really pushing. We applaud them for that and rewarding folks like us for the healthier the patients get, the less they're bouncing back to the hospital is really where the system needs to go to be -- to save the system, frankly, from total collapse.

Yes. We talked about -- a little bit about the flywheel demand with the SteadyMD acquisition. So as we think about the demand trajectory and also the margin profile, like how should we think about this integrating into the company and driving additional efficiencies.

Yes. So that is the big aspect, that integration where the SteadyMD clinical practice group. So before we acquired SteadyMD, we had our own clinical practice group and then, of course, SteadyMD came with the clinical practice group. So now we've integrated the clinical practice group into 1 clinical practice group serving all the patients we see, whether they be SteadyMD patients, DocGo patients or any of the patients that we see. And again, marrying the SteadyMD network to the clinician and the home when DocGo sends a clinician at home. That's what's going to be driving the efficiency.

So we think that's going to improve the margins, a big aspect of the company is we've been investing into the ability to bring a doctor's office into a patient's living room. That's what we've been investing into. It's cost us money. Obviously, it's contributing to the EBITDA loss, but we think that opportunity is just such a big opportunity, but we also realize that we have to improve the margins as we go, if we want to be effective and viable. And so SteadyMD allows us to improve the margins as we go, allows us to see the patients in the home, but also to serve other customers with virtual visits, and that integration, integrating the clinical practice groups and then integrating the competencies, DocGo's ability to go in the home, SteadyMD's ability to be virtual. Now it's all under 1 roof, and we can be very, very efficient going forward.

Yes. And just double clicking one more time in the SteadyMD. So there's been a little bit of focus on like some of the current logos like the online pharmacies for waitlists. But can you talk about are there any other types of customers that you want to call out or like additional logos that you would want to expand into that you think are a big opportunity?

Yes. So you mentioned online pharmacy. That's obviously a big with the GLP-1 adoption. That's been a big driver for the company, and we've been at the forefront of that. I also think something that has not been talked about a lot is -- well, everyone is talking about AI, but everyone is talking about AI as sort of like a replacement or maybe to be more efficient.

We actually think the clinician with AI is going to be very, very powerful. So I'll give you an example, we work with a customer today. Dermatology AI company where you can upload a picture of, let's say, a skin condition or you can engage with AI in a chat. But ultimately, if there's some diagnosis needed or there's some higher-level interaction that's needed where a patient actually wants to speak to a clinician, we can unlock that.

So I think it's going to -- our clinicians that are making sure that the AI is making the right diagnosis. It's our clinicians are going to be sort of an off ramp for when a patient actually does want to speak to a human clinician. And I think you're going to see a lot of marrying between the 2. Today, a clinician still has to review that dermatology assessment. And so we're working with a lot of the AI companies to bring the clinical practice to whatever tools they're trying to build to make the health care system more efficient.

Okay. So now we walked through a lot of the pieces of the business. I want to ask about the underlying demand trends you're seeing across the portfolio in the second quarter. We've heard from some of our hospital companies, one last week who said, surgical volumes were down and potentially flagged a weaker demand environment. So I guess just is there any color that you can give us on demand trends throughout the second quarter so far?

Yes. So we actually -- we don't play with those higher order surgical procedures. Actually, if we're doing our job well, surgical procedures will go down and sort of higher, more acute interventions will go down. And that's really, frankly, what the health care system needs.

Now of course, hospitals play a vital role. If a patient truly needs that more acute surgical procedure than we want to be there to be able to maybe coordinate the transportation or to provide the follow-up care in the home to make sure that it's healing properly and so forth, we do all of that.

So I think the demand trends we're seeing is really around the consumerization of health care. I think a lot of the wearable companies are going to get more and more into health care. I think they are doing a wonderful job with some of the diagnostics they're able to do with the wearables, but then if they truly want to take the next leap into sort of a medical device, they're going to need a clinical practice and setting up a clinical practice is not so easy to do, certainly to do it in all 50 states is not so easy to do. And so we're finding a lot of demand there, where you have the consumerization of health care and those digital health companies that want to offer actual medical advice, medical services, to their members, to their subscribers, we unlock that for them. So we're seeing a lot of growth there.

I think we're also seeing a lot of growth again from the payer side, where they're trying to improve their MLR. They're trying to drive down cost. They're trying to reduce hospital readmissions. They're trying to improve their HEDIS quality score ratings. And the only way to really do that, there's a lot of ways to do that, but the big way to do that is -- drifting that are unattached, that are going without the care -- we're helping them address that. So we're seeing a big tailwind there for sure.

And so we're continuing to widen the scope that we're providing in the home. We're trying to meet patients before they end up in a hospitalization. We're trying to meet patients within that 30-day readmit window so that we can see them in the home. Maybe redress that incision site, maybe make sure that they don't bounce back to the hospital. We work with a very large payer in California, where they've been giving us the late score patients, length of stay acuity, chronic condition patients on a scale of 1 to 10. They've been giving us, I think on average 9.2 out of 10. So these are the highest acuity patients. Our patient population they've been giving us has been bouncing back to the emergency department 60% less. So because, again, we're following up with their care plans in the home. So I think this idea of meeting patients where they are is playing out and the payers that -- the majority of the customers we have on the payers, I want to expand with us this year.

Okay? So maybe all the demand is just shifting out of those acute settings. So you've outlined a path to profitability this year. So how should we think about the key drivers and what the puts and takes are going to be?

Yes. So this is a big, big aspect for the company. We shared on our last earnings call that we plan to breakeven in the back half of the year. And it's really a factor of 3, obviously, key components. The first is on a quarterly revenue basis, we want to achieve the $80 million to $85 million. We feel like that's the critical need, the sort of watermark that we need to get to on the revenue side in order to have the scale that we need.

And so in Q1, I mentioned we did about $76 million of revenue. So we feel like we're quite close to that. And of course, I mentioned a lot of the growth that we're seeing throughout the company. And so that is sort of within reach, if you will. So that revenue base, that's one component of it, that $80 million to $85 million of quarterly revenue.

Then on the gross margin side, we feel like we need to be in the 34% to 35%. In Q1, we are at 31.6% adjusted gross margin. So we feel like, again, we have about 200 or 300 basis points to -- 200 to 400 basis points to go there. That's going to be driven by being more and more efficient in our delivery, reducing overtime hours for staff, reducing shift bonuses, being much more efficient again in the field, the medical assistant and the licensed practical nurses alongside the SteadyMD clinicians and driving that gross margin up.

And as the mobile health portfolio takes more and more of the revenue component that will drive margins up with it. So as an example, our mobile phlebotomy offering has about 55% gross margins, our remote patient monitoring practice has about 60% gross margin. So as those continue to grow and become a bigger component of the revenue base, it will also take gross margins with it.

And then we need to cut about $4 million to $5 million of SG&A spend per quarter. We did a very large reduction in force recently, so we took some costs out of the business, and we're continuing to work with the vendors that we work with to sort of pare back some of the spending there, and we think that we can get that done.

Okay. So that was some really good detail there on mix versus scale versus operating efficiency. As we think about '27 and beyond, once we're past that breakeven point, what do you think are the biggest levers going forward?

Yes. I think it's going to continue to be on -- from a growth perspective, it's going to continue to be the Care Anywhere platform. I think we're going to continue to have very nice growth in those components. We think the Care Anywhere platform, again, the virtual care, the care in the home, the mobile app, the more patient monitoring aspects, will grow about 30% to 40% year-on-year. Again, medical transportation less. And so as that grows, that will be a continuing lever for that.

I think we'll also continue to expand with the payers we work with. Right now, we work with a number of wonderful fantastic name brand payers. I know some of them will be at the conference. And so we work with those payers. And we think over time, we're going to be thoughtful about it. There are a lot of markets that those payers want us to go to.

So I shared -- and it's always -- I think you said it's a balance there, right? So we have a payer that we work with in California. We recently expanded with them to Kentucky, New Mexico. There's other states we can stand with them. And so I think it's -- but we also want to make -- be mindful of new markets, require new investment, which require perhaps strain on the EBITDA. So we're being very thoughtful about that. We're expanding to new states in a very measured way. And we think we're expanding to states in a way where we can do it profitably quickly.

We announced a couple of weeks ago that we just launched mobile phlebotomy services in Southern Florida, actually, this neck of the woods. And we did that in partnership with one of the major labs, and we did it in a way where we were able to scale the staff cheaply and quickly and the demand was already there for us. We didn't have to generate it. So we think we're going to be profitable very quickly in that endeavor here in Southern Florida. And so that's the way we're kind of be scaling the business.

Yes. So we touched a little bit on the CMS access model a little earlier. I'd love to go more in depth into both CMS access, but also are there any other CMS or regulatory proposals that we should be aware of as it relates to your business?

Yes. So the access model was a big program that CMS launched. Essentially, what that model is trying to incentivize is a much lower upfront, basically, reimbursement for a preventative care. And if you're successful in achieving health outcomes, which I'll give me examples of, then you get sort of incentive payments and bonus payments. And that was a big move by CMS. They put out an RFP. I think a lot of companies responded to it. They ultimately ended up choosing 150 to participate. We are one of the 150 that was selected. And I think time will tell. We will launch in a measured way where patients can be enrolled into our practice as part of the ACCESS program, and we will provide preventative care exactly like we're doing today and try to drive outcomes. And so I think we will see more programs like that from CMS. I think that's the only real solution.

I think part of the aspect that people in health care don't talk enough about is in order to improve health outcomes, most of the time, you need a long-term view, right? Patients that have chronic conditions, it takes time to impact their health outcomes. It takes time to improve their condition. And our system is set up in a very short-term way. I may have 1 insurance provider this year. And next year, I might change my insurance provider. I might work for a company where I have 1 insurance and then I go and work for another company, it has a different insurance.

So how can a insurance company actually invest to make me healthier, try so hard this year to maybe perhaps help me if I'm struggling with a chronic condition, only to see me go to another health insurance company if I were to change roles or change jobs, change insurance companies? And so that's the problem the system has. The only one that can solve that is CMS. And so I think that is CMS' responsibility, and I think they're going to continue to look there, all the conversations that we have around this from people that are in that orbit, advising in that space are telling us that CMS is pushing more and more to develop programs that are incentivizing that because otherwise, the health care system is completely doomed.

Even for us, we're a self-insured employer on the health side. And we try so hard to help our employees, our team members that perhaps are high utilizers and have chronic conditions. And look, we feel more responsibility to try to help them, even if they are to go to move on to another company and have another insurance provider, but we see it. You have to have a long-term view to impact someone's health. But the insurance industry and the health care industry is set up for short-term incentives. And so that has to be solved.

Everybody is talking about all these things with AI and everything else, you can invest in anything you want. If it does not improve health outcomes over a period of time where you could actually make a return on that investment, which is how we're set up, which is the way it should be, right? I'm going to work so hard to make a patient healthier only to see them go to another provider or go to another insurance company. And that insurance company is going to get all the benefit of all the investment I made into that patient, then that has to change. So I think that's the types of programs you're seeing, the HEDIS quality scale is a big part of that, where insurance providers are incentivized to improve outcomes and have higher star ratings. I think it's about something like 40% of the plans, improvement in their reimbursement rate if they would -- and they're missing out on that. And 5% is a meaningful premium reimbursement to get from CMS uplift. So I think that's where the system is going. It has to go that way. The only one that could actually push incentives like that is CMS and I know from the ACCESS program as an example, they're really looking towards that.

Okay. I've got 1 quick housekeeping modeling question. So fuel costs have been a big area of focus with the conflict in the Middle East. They weighed on earnings in the first quarter. But it seems like costs have come down. Is there any updated framing you can give us? And how we should be thinking about that into the second quarter and the rest of the year?

Yes, it's funny. So obviously, we have -- I should have mentioned at the onset, we deliver health care. How do we do it? We have 1,000 vehicles. We have 4,000 clinicians in the field, all meeting patients where they are, taking patients where they need to get to. And last year, we were bragging that we drove like 11.5 million miles. And the team was -- we were talking about it and I said, hey, guys, actually, we should be bragging about how few -- how much fewer miles we can drive. And so that's part of the efficiency. If we didn't have our tech platform, I'm sure we'd be driving a lot more.

But as part of that, we purchased about 270,000 gallons of gasoline each quarter. It's pretty significant. And so about -- for every dollar increase at the pump, we see about a 35% -- a 35 basis point margin hit. So for every dollar, again, 35 basis point margin hit. Our biggest component in the business is really the vehicles and labor, not the gas. But we'd love it if the gas prices went lower, but it's about -- for every dollar, it's about 35 basis points. Sometimes people think like it would end up impacting our business more. It will be a headwind for us in Q2, we saw much higher -- we're seeing much higher gas prices in Q2, we think that will persist. But then we think hopefully debates in the back half of the year, which will help on the gross margin side.

The other piece that we're doing in order to offset things we can control, like gas prices, is to invest in the things that we can control like automating a lot of the aspects of the business. So we -- I mentioned on our last earnings call, we have an efficiency portfolio that includes a lot of automation -- in the business. So for example, on our prebilling -- annual prebilling function where we would go in and see a preauthorization to see if the patient has insurance, we're going to be able to collect, notify the hospital system of that. And now we're using AI to do that as an example. We were using a lot of human capital to coordinate patient schedules, visits, rescheduling, confirming appointments and now we're using AI more and more to do that.

So we are going to do the best we can to procure the gas for cheapest possible way, but understanding we can't control the price. But we are absolutely like, we're sleeves rolled up on the aspects of the business that we can control, investing in automation so that we can improve the margins, which is a big facet of what we're doing to get to breakeven in the back half of the year.

Yes. And so how should we think about cash flow and capital needs over the medium term? And how should we think about capital allocation given where we are today?

Yes. So first and foremost, I've been resolute. In terms of the capital allocation, we're going to continue to fund the growth of the business and fund the capabilities of the business. And we think that there's a lot of opportunity for us in the pipeline that we have in the business and the existing customer base we have.

As I mentioned, we have the majority of our health plans are looking to expand with us this year. So that's really, first and foremost, for the capital allocation priority will sit. And then I think we have ability to access capital. We have ability -- we have a line of credit today that we're looking to slightly modify and have access to capital to help fund the growth of the business going forward.

Okay. And we've got about 2 minutes left. So I just want to go over what do you think investors are most misunderstanding about the DocGo business today?

Good ones there, and thank you for asking that. So again, sometimes people look at our stock chart and said, lee, what am I missing? A $300 million health care services and technology company going and meeting patients where they are, which is, again, one of the other pieces we didn't talk about is the federal government is also earmarking about $50 billion to help improve access to patients. You're doing all this. You have great scale. You have 1,000 vehicles, 4,000 clinicians. You're operating across all 50 states. What are we missing when we look at the stock chart?

So I think we've -- over the last couple of years have really been digesting the comps from COVID and the migrant. Like I said, I think Q1 was the first quarter where we didn't have any of that. But in Q1 of last year, we had about $35 million of migrant revenues, providing services to the humanitarian crisis in Europe relating to the migrants.

So when you look year-over-year, right, the business is growing or is it not? Again, when you take out the migrant revenues, it is, but when you see it in sort of on that screening process, those year-over-year comps have been tough for us. So that continues. I think we'll have some of that in Q2, but as we go throughout the year, that will abate. And I also think, again, I think people are looking at really where we're investing into and seeing -- they want to see the progress in the health care and the address Care Anywhere program. I think we are showing that. We certainly showed that with all the volumes being up in Q1. We'll continue to show that as we go throughout the year here. And then as we hit that profitability threshold, I think we're going to be celebrating that.

Yes. So we're super excited to watch the rest of the story from here and reaching breakeven profitability. Thank you so much for the time and attending our conference today.

Thanks, Sarah. Appreciate it. Thank you to the Goldman team.

Good afternoon, ladies and gentlemen, and welcome to the DocGo First Quarter Earnings Conference Call. [Operator Instructions] This call is being recorded on Monday, May 11, 2026.

I would now like to turn the conference over to Mike Cole, Vice President of Investor Relations. Please go ahead.

Thank you, operator. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call other than statements of historical fact are forward-looking statements.

The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expectations.

Forward-looking statements are inherently subject to substantial risks, uncertainties and assumptions, many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements.

These risks, uncertainties and assumptions include, but are not limited to, those discussed in risk factors and elsewhere in DocGo's annual report on Form 10-K, quarterly reports on Form 10-Q, our earnings release for this quarter and other reports and statements filed by DocGo with the SEC to which your attention is directed. Actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward-looking statements.

In addition, today's call contains references to non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are included in our earnings release and the current report on Form 8-K that includes our earnings release, which is posted on our website, docgo.com as well as filed with the SEC.

The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time. We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law.

At this time, it is now my pleasure to turn the call over to Mr. Lee Bienstock, CEO of DocGo. Lee, please go ahead.

Thank you, Mike, and thank you all for joining us today. We reported a strong top line of $75.6 million in revenue during the first quarter with an adjusted EBITDA loss of $10.2 million. Additionally, we increased our 2026 revenue guidance from a range of $290 million to $310 million to $300 million to $315 million, while leaving our 2026 adjusted EBITDA guidance unchanged at a loss of $5 million to $10 million.

I would like to take a few minutes and break down the revenue and profitability aspects individually. First, a major driver of our strong revenue performance and increased revenue guidance is our virtual care offering, SteadyMD. We noted this upward trend in our last earnings call, and we are pleased to share that this trend has accelerated.

During the first quarter, SteadyMD generated in excess of $9 million in revenue, beating the previous high set in the fourth quarter of last year by roughly $1 million and completed approximately 1.1 million total visits and lab orders during the period, up 38% when compared to last year.

SteadyMD recently entered into a new contract with a leading online pharmacy to provide virtual care services for weight loss prescriptions and a broad scope of general clinical services, which will fuel continued growth. Second, our mobile phlebotomy offering is performing exceptionally well.

While their revenue base is smaller, we are now projecting as much as 75% growth for this business in 2026, which is well above our previous expectation, and we anticipate our rate of home visits to increase from 600 per day currently to 900 per day by the end of 2026. We've opened new territories in Upstate New York and Pennsylvania to meet demand for our services, and we are planning to launch services in Florida, which is a new state for us.

We are expanding our use of technology as well, working with a major national lab to integrate our order intake into their applications to allow doctors to order home visits directly through the lab systems and deploying AI automation for order intake and customer service to help increase our margins. And third, we have signed recent new contracts and expansions with payers and providers for our care gap closure, PCP and transition of care services.

We have now surpassed 1.6 million lives assigned to us for care gap services since inception, and we've increased the number of visits completed 46% year-over-year. Also of note, we have begun an aggressive pace of onboarding for PCP and longitudinal care services, and our panel now has over 1,000 patients, the vast majority of which were enrolled in Q1. Our goal is for this business line to break even in late 2026, dramatically lessening the investment level that has been required to launch and grow this business over the last few years. Regarding our medical transportation business, we have recently had several significant renewals in addition to some smaller wins, further solidifying the long-term revenue profile of this business segment.

We renewed our contract with one major New York hospital system for an additional year and renewed our contract with another major New York health system for 2 additional years and added their Staten Island facilities. We signed a contract to provide service for a long-term acute care hospital in Chattanooga, Tennessee, signed contracts to provide medical transportation with several hospice facilities in Wisconsin and signed a new nonemergency patient transport services contract for the Great Western Hospitals NHS Foundation Trust in the United Kingdom.

In addition to what we have factored into our updated revenue guidance, our business development pipeline remains strong and supportive of continued growth with multiple opportunities for medical transportation growth, both in the U.S. and especially in our U.K. operations. Consistent with our approach, we will update guidance accordingly if and when contracts are entered into.

Collectively, we cannot be more pleased with the near-term revenue growth opportunities for our consolidated business. Now I'd like to shift gears and break down the gross margin and SG&A lines to provide some color behind our decision to increase revenue expectations while keeping our adjusted EBITDA guidance unchanged. We experienced labor inefficiencies as a result of SteadyMD's exceptional growth.

As I mentioned previously, we had high expectations for this business in 2026, and those lofty expectations are being exceeded. Their dramatic growth required us to pay increased incentives to our current clinicians to cover shifts while we worked to bridge a hiring gap. As a result, this negatively impacted our consolidated gross margin by approximately 60 basis points.

During the first quarter, we leveraged DocGo's recruiting expertise to increase SteadyMD's clinical workforce by over 45%, and we expect this added workforce to help meet pent-up demand for SteadyMD services in the second half of the year. In addition, we saw a significant increase in fuel costs in March, driven by the war in the Middle East.

We estimate that every $1 increase at the pump cost us about 35 basis points of consolidated gross margin. Our average price paid in March was $3.69 compared to an average cost of $2.93 per gallon in January and February. Average fuel costs in Q2 to date have remained at this elevated level, which we expect to be a continued drag on gross margin over the near term, unlike the temporary narrowing of SteadyMD's margins I just described, which has already corrected in the second quarter so far.

And last, if we adjust our operating expenses to exclude depreciation, stock-based compensation and other nonrecurring items, we saw a decrease from $35.7 million in the fourth quarter of last year to $34.1 million in the first quarter of this year. We feel this is the most accurate representation of how our cost-cutting efforts are working their way through our financials.

There is undoubtedly a lag in this process, and we are just starting to see the impact from many of the cost cuts made late last year. Our expectation is that we will see an acceleration in this improvement in the coming quarters based on steps that have already been taken and additional cuts already underway in the second quarter.

In sum, we saw margin headwinds driven by the geopolitical tensions influencing fuel prices and the aggressive pace of operational expansion that was beyond our initial expectations. We believe that these margin constraints are temporary in nature and not reflective of our long-term profitability profile. Our top line is strong and getting even stronger.

We achieved record volumes across all major business lines in the first quarter, with U.S. Medical Transportation increasing 17%, health care in the home increasing 46%, mobile phlebotomy increasing 8%, cardiac and remote patient monitoring increasing 13% and virtual care and lab orders increasing 37% year-over-year. Before handing it to Norm, I would also like to briefly address the strategic alternatives process that was announced on March 16 of this year.

While I'm obviously limited in what I can say, the company's evaluation of strategic alternatives remains ongoing. While there can be no assurance that this process will result in DocGo pursuing any particular transaction or other strategic outcome, we will share further developments as appropriate.

Now I will hand it over to Norm to review the financial details.

Thank you, Lee, and good afternoon. Total revenue for the first quarter of 2026 was $75.6 million compared to $96 million in the first quarter of 2025. The year-over-year revenue decline was entirely due to the wind down of migrant-related projects.

Removing migrant-related revenues, we saw a revenue increase of 24% year-over-year in Q1. Now this was partially due to the recent acquisition of SteadyMD, which added $9.5 million in revenues in Q1 of this year. Removing the impact of both the migrant-related revenues in the 2025 period and the SteadyMD revenues in the 2026 period and revenues still increased by about 8% year-over-year.

Medical transportation services revenue increased to $51.9 million in Q1 of 2026 from $50.8 million in transport revenues that we recorded in the first quarter of 2025 and were the highest quarterly transport revenues in DocGo's history. Revenues were driven higher by gains in both large and small U.S. markets with some of the strongest growth in markets like New York, Texas and Tennessee.

We continue to see increasing demand across most of our markets. Mobile Health revenue for the first quarter of 2026 was $23.6 million, down from $45.2 million in the first quarter of last year, driven again by the wind down of migrant revenues. Non-migrant mobile health revenues more than doubled, driven by increases in care gap closures, remote patient monitoring and mobile phlebotomy and by the inclusion of revenues from SteadyMD, which we acquired during the fourth quarter of 2025.

Removing the impact of SteadyMD, Mobile Health revenues still increased by about 38% year-over-year. Adjusted EBITDA for the first quarter of 2026 was a negative $10.2 million compared to an adjusted EBITDA of negative $3.9 million in the first quarter of 2025. The adjusted gross margin, which removes the impact of depreciation and amortization and is the measure of margins that we track most closely, was 31.6% in the first quarter of 2026 compared to 32.1% in the first quarter of 2025.

However, looking at only the revenues from business lines that were active in both periods, thereby removing Migrant revenues of $35 million and gross profits of $12.3 million from the first quarter of 2025 and removing SteadyMD revenues of $9.5 million and gross profits of $2.8 million from the first quarter of 2026, the adjusted gross margins of the underlying business would have been 31.9% in Q1 of 2026, up about 1.5 points from 30.4% in last year's first quarter.

During the first quarter of 2026, adjusted gross margins for the Medical Transportation segment were 31.9% compared to 30.8% in Q1 of 2025. Medical Transportation gross margins are still being restrained by higher-than-planned effective hourly wages for field labor. However, we took solid strides toward increasing our field headcount in the first quarter of 2026, and we saw the overtime rate decline in the first quarter of 2026, closer to the sub-10% overtime rates we saw in the first half of 2024.

Transport gross margins were also impacted by increased fuel costs, as Lee described earlier. Mobile Health segment adjusted gross margin was 31% versus 30.8% in the first quarter of 2025. SteadyMD gross margins were several points lower than normal, reflecting the aggressive hiring in the first quarter to catch up to the increased demand from large customers.

This factor, which is expected to reverse itself starting in Q2, was offset by greater relative contributions from higher-margin service lines within mobile health, such as remote patient monitoring and mobile phlebotomy. While revenue came in well above expectations and gross margins were generally in line, operating expenses came in higher than anticipated.

This is due to the need to ramp up the hiring, onboarding and training of mobile health clinical staff to meet customer demand as well as the fact that our cost-cutting decisions regarding vendor spending and corporate headcount made in late Q4 and into 2026 won't meaningfully impact our income statement until the second quarter.

With SteadyMD's recent hiring push behind us, our continued cost-cutting efforts in Q1 and additional savings from the efficiency portfolio initiative that we discussed on last quarter's call and that are anticipated to have a positive impact on our second half 2026 results, we continue to expect sequential declines in SG&A in dollar terms as we go throughout the year.

As of March 31, 2026, our total cash and cash equivalents, including restricted cash and investments, came to $59.9 million, down from $68.3 million at the end of 2025. Our cash balance at quarter end was lower than we had expected due to the delay in collecting migrant-related accounts receivable owed by New York City's Department of Housing Preservation and Development, which we had expected to see during the first quarter.

However, on April 1, the first day of the second quarter, we received approximately $8 million in these receivables, and we are working on collecting the remainder of these receivables. With some further, albeit smaller operating losses in Q2 of 2026 and several growth-related initiatives requiring working capital, we would expect further declines in cash in the near term.

This could create some working capital pressure, which is expected to ease in the second half of the year, in line with our planned return to profitability. Turning to 2026 for the rest of 2026. As Lee mentioned in his comments earlier, and as we pointed out in our press release, we have updated and increased our revenue guidance for the year based upon what we have seen in the first 4-plus months of the year and the positive volume trends across most of our business lines.

We now see full year revenues in the range of $310 million to $315 million, up from the range of $290 million to $300 million that we shared in mid-March and higher than our initial guidance of $280 million to $300 million. Now this does not include any revenues from migrant-related projects and would represent a 19% to 25% growth over 2025's base revenues.

We continue to anticipate a full year adjusted EBITDA loss in the range of $5 million to $10 million, which is unchanged from our previous guidance. At this point, I'd like to turn the call back over to the operator for the question-and-answer session. Operator, please proceed.

[Operator Instructions] With that, your first question comes from the line of Ryan MacDonald with Needham.

This is Matt Shea on for Ryan. Maybe starting with the SteadyMD business. Nice to see the momentum continuing from last quarter, especially with the new win. Lee, maybe just double-click on this segment. What kind of pipeline are you seeing for new logos versus growth with existing logos?

And are you seeing most of this demand from online pharmacies for weight loss or any other customer types worth calling out? And then, Norm, maybe when thinking about the top line guidance, it seems like majority was driven by the SteadyMD weight loss customers, but curious if you can put any finer points on that.

Absolutely. Matt, great to hear from you. Really appreciate the question. And on the part of the question relating to the growth and the pipeline of what we're seeing in SteadyMD, as I mentioned in our prepared remarks, we're very, very encouraged and excited about the growth prospects there.

I think the growth is coming from really both avenues, our existing customer base. We continue to grow our capacity and grow our volumes with our existing customer base that we've been working with now for quite some time. And we have been adding new logos pretty consistently over the course of the end of last year and as we head into this year, which is also fueling further growth.

And the big push we made really in the first quarter of this year was to ramp the hiring in order to meet this growth and meet the demand. In terms of the types of customers we're working with, we're really working with -- you mentioned it, the online pharmacies. I mentioned one that we're expanding with quickly. Digital health companies, wellness companies, digital wearable companies as well are all partnering with us as well as your typical labs that you might expect as well.

So really seeing growth from across that space. Yes, it's weight loss, but it's also general wellness trend as well as sort of the consumerization of health care is really pushing growth for us there. So we're really, really excited about it. The SteadyMD team is a great, great team, a great addition. And as we go through the year here, some of the growth is also going to come from DocGo's in-home visits.

We really want to drive SteadyMD's telehealth capacity to be a key component of overseeing prescribing treatment planning the visits that are happening in the home with our mobile health clinicians. That's a big, big area of integration for us as we go throughout the year here and will help us also expand our margins for those in-home visits.

So we're really seeing it across the board, really great addition to the team, really fits nicely into the future of health care, care anywhere vision that we're pursuing, and we couldn't be more excited. Norm?

Matt, in terms of the top line, I think you're referring to the guidance that we've given where we're going to a range of $300 million to $315 million, so let's say a midpoint of $307.5 million and you compare that to where we were before, which is $290 million to $300 million. So let's take a $295 million midpoint.

So we essentially are adding $12 million to the guidance. There are a couple of ways of looking at it. Number one, I would say that when I look at our quarterly results for Q1, the number that we did, which was about $75.5 million, $75.6 million is probably about anywhere from $3 million to $4 million ahead of where we thought we would be. So that gets us off to a good start.

But when you break it down by the different business entities, so the $12 million or so increase in guidance for the top line midpoint to midpoint, I'd say about $8 million to $9 million of that is probably related to SteadyMD. We necessarily projected it in a somewhat conservative way, right? We only had the company for about a month or 2 at the time that we made our last guidance, we gave our last guidance, and it's pleasantly surprised us with volumes with that volume growth, as Lee has mentioned.

But that's only one part of it. The transport business is performing very well. We had a thesis that we've talked about on this call a couple of times, wherein if we had -- we knew we had the demand, we looked at the number of calls and trips that we couldn't take because we didn't have enough personnel. And we knew that if we would add to our headcount, we would add to our field labor that, that would translate into more volume.

And that's worked. So, so far, that part is definitely working. So if you think about it that way, then that definitely adds to the growth as well or at least it validates the transport growth we expected. And then you have some of our smaller business lines within mobile health like the mobile phlebotomy business and the CRMS business, remote patient monitoring business, which grew like 20% year-over-year in the first quarter.

So again, I would say that the majority of the increase relates to SteadyMD, but we're seeing some solid volume growth, as Lee mentioned in his prepared comments, really across all of our business lines.

Okay. That's great color. I appreciate that from both of you. And then maybe touching on another area that sounded really strong this quarter, again, with being the payer and the care gap closure business, nice to see lives there crossing the, call it, 1.5 million mark. Maybe just first, it's a very dynamic year for the payers.

Any changes in terms of how they're looking to use you for these care gap closures or any services they want you to prioritize more maybe than what had been prioritized in the past? And then second, I think earlier this year at our conference, you had sort of talked about a pipeline of 2 to 4 more incremental payers that you could sign on in the first half of this year.

I wasn't sure from your prepared remarks if you had brought 1 or 2 on maybe this quarter, but maybe just update us on that thinking there, if that's still the right way to think about the incremental payers you're bringing on in the first half and maybe where you're at on that so far?

Absolutely. I'm glad you mentioned that. So in terms of what the payers are looking for us to do, I think it's pretty consistent with what we've been seeing as we've built this out really over the last 18 to 24 months, which is really absolutely the care gap service, care gap closure, particularly for patients that are falling through the cracks, drifting, unattached, that continues to be a big need in the market, really no change there, and we've been ramping up our ability and growing -- really growing our volumes year-over-year as we go throughout building up that business.

I think the other piece that we're really seeing is when we go visit the care gap -- the open care gap patients, we are seeing that a lot of them are just also unattached or don't know who their primary care provider is and a very large percentage, the majority of which that don't have a PCP are opting for us to become their PCP. So those are the services really that we're adding on top of the care gap closure services, and we've continued to do that.

We saw in the first quarter, it was pretty interesting when we go to see the patients in their homes for care gap and also for PCP services, we're seeing that 60% of the patients we go and visit have 2 or more chronic conditions. And a big percentage of them have 3 or more chronic conditions. 20% of them have social needs or risks that are impacting their health outcomes. We also see that 42% of the patients had chronic conditions that had never before been documented.

So these are big drivers for the health plans, and we're able to uncover this, that we're able to meet patients where they're at. And so -- and that goes along with our 50% plus readmission reduction that we're seeing with our longitudinal care patients that we've been working with. So we're really seeing great impact on health outcomes. We're really starting to provide more longitudinal care in addition to the care gap services.

And uncovering chronic conditions that had been undocumented before is a big, big benefit to the health plan and of course, to the patient. So that's really what the plans are using us for. That's what we're -- that's the data and the insight that we're providing back to them, and it's proving out to be very, very valuable. And of course, we think we'll be successful and continue to grow the company as we provide more and more value.

The majority of all of the plans that we work with have told us that they would like to expand with us over the coming year. So again, that's really given us a lot of excitement and optimism and enthusiasm for what we're doing there. On the new logos, I know you mentioned that, Matt, on the new logos, we'll announce them as it makes sense, but we're absolutely on pace to add 2 to 4 new logos in the first half of this year.

And the next question comes from the line of Pito Chickering with Deutsche Bank.

This is Kieran Ryan on for Pito. Appreciate all the color that you gave there. I guess just stepping back, could you maybe just help us just understand kind of the puts and takes around the reiteration of the EBITDA guidance just as far as kind of how the tailwinds from the really strong outperformance on revenues and with SteadyMD.

Maybe offset by some incremental headwinds on kind of the labor cost and transportation and with SteadyMD and then on the fuel side. Just how should we think about that all kind of balancing out towards the reiterated range?

It sort of answered the question itself, Kieran. But what's happening is we feel we have some really good momentum on the revenue side as evidenced by the fact that we outperformed our number for Q1 and we raised the guidance for the full year. And the reason why we left the overall EBITDA guidance the same even with a higher revenue expectation is for those reasons that you mentioned, right?

There'll be a little bit of pressure on gross margins in the transport piece in Q2 because of fuel prices. Lee mentioned that our average gas price was about $3.69 per gallon in March, up from that $2.93 in January and February. That number is currently running at about $4. We don't think that, that's going to last really beyond the second quarter, but that's something that we have to take into account. Granted, we're not as leveraged to fuel prices maybe as we were in the past when we were only an ambulance company.

But it still will have an impact and could have an impact for us of maybe 1/3 of a point to 0.5 point in gross margin, which will obviously have an impact on -- will offset some of the gain that we would have from having higher margins than were originally projecting. On the operating expense side, so some of the stuff that Lee mentioned relates to SteadyMD.

I did say in my comments that our -- there's been a lag in our cost cutting or in the way that, that sort of flows its way through to our income statement. So we expect to pick up some benefit there in Q2, but we're starting at a somewhat higher point. So we just want to build in a little bit of conservatism as far as that goes as well if operating expenses continue to run a little bit hot compared to where we expected things.

Got it. That's helpful. And then I think you had said if we adjust both SteadyMD and the migrant revenues in 1Q '25, mobile health growth was 38% in the quarter. And I see you're kind of grouping some business lines in together, Health Care at Any Address, which seems to account for the most of the dollars in mobile health.

Can you just help us kind of understand what -- which business lines are driving the most growth on a dollar basis ex SteadyMD because there's obviously some really strong percentage growth rates there that are all contributing, but just so we can understand that a bit better.

Yes. So I think on a dollar basis, you're seeing our patient monitoring business have really strong growth year-over-year, also really strong profitability profile as well in that growth. You also see growth in the health care in the home business, our care gap in primary care continues to grow year-over-year, and you're seeing growth in our mobile phlebotomy offering as well.

So those are the 3 pieces. And then, of course, SteadyMD, which you mentioned. So those are really the pieces that are growing the fastest. They're starting to integrate with one another, SteadyMD overseeing the DocGo visits in the home, utilizing phlebotomists for the care gap visits in the home, utilizing patient monitoring for patients where it makes sense when we go and visit them in the home.

And so that care at any address health care anywhere portfolio, we're really excited to see that growing and one playing and feeding the other is sort of a vision that we have as we go to provide care virtually in person and remotely. And that's the piece that's growing the fastest at the company right now.

And the next question comes from the line of Richard Close with Canaccord Genuity.

Yes. Maybe just a follow-up to that last question and some of the earlier questions. But just with respect to SteadyMD first, I think coming out of the fourth quarter, you had said something that's like a $25 million to $30 million business and call it, in 2026. So I guess based on the comments on the guidance, is, call it, $34 million to $39 million a good number for SteadyMD now for '26? Why don't we start there?

Yes. Richard, I appreciate it. So I think, as Norm mentioned, SteadyMD did about $9.5 million in the quarter for Q1. Now we do tend to see Q1 and Q4 as the highest levels for SteadyMD sort of as you go in those winter months as you close out the year and start the year.

But as you're mentioning, that $9.5 million kind of puts them at that $36 million run rate for the year, but understanding that the middle months of the year tend to be a little bit lower on the volume. Now that being said, we are bringing on additional customers. We are onboarding additional customers that will potentially smooth that out as we go throughout the year. But that's basically, as you mentioned, that's the pace they're on as we exit Q1.

Okay. And then just to be clear, with respect to the, call it, $23.6 million for mobile health, you have the $9.5 million for SteadyMD. There's like absolutely no migrant in any of those numbers or the mobile health for the quarter. That's completely gone, correct?

That's correct.

Okay. And then maybe back to the question right before me in terms of -- so if we looked at like remote monitoring, if we ex out the mobile SteadyMD from the $23.6 million of total mobile, is remote monitoring the biggest chunk of what's remaining in there?

It's the biggest -- Richard, it's the biggest single one. It was a little bit more than $4 million, I'd say, $4.1 million in the quarter. But to give you an idea, the clinical staffing business was about $3.8 million, $3.7 million, $3.8 million. So it was a close second.

But yes, it is actually the biggest one, operating at a margin for the quarter of over 60%. Natural margin is probably a little bit lower than that, but it's solidly over 50%. So that really helps the overall margin picture for Mobile Health.

Okay. And we're throwing around a bunch of terms here, but clinical staffing is care gap closure and PCP and that's correct?

So the clinical staffing is basically our portion of the business where we support mobile clinics and clinical staffing for our health care partners. So it's essentially programs that we run on behalf of clinical groups like the -- we have groups like radiology groups and so forth that we run staffed clinics for.

It's a legacy government medical services business that we bought in, I think, back in 2022.

Okay. So remote monitoring is $4.1 million, you got staffing at $3.8 million, and then it would be care gap closure or the home, health care in the home and then mobile phlebotomy.

Correct. Yes. And the health care in the home, we -- again, the mobile phlebotomy is one of the service offerings that we do in the home, right? So primary care, care gap closure, mobile phlebotomy. In those scenarios, we're sending a clinician into the home. That's sort of the care in the home service line. We're calling out mobile phlebotomy because it's one of the fastest-growing components of that care in the home business.

So a big growth and a lot of those off of relatively small, but continued progress there. With respect to fuel prices, when you say you would expect some relief there, just maybe on transport, how much is the fixed rate programs versus the lease rate programs as a percentage? How is that trending? And do you get any relief on fuel on those agreements? Or how do we think about that?

On the leased-hour arrangements?

Yes.

No, I don't think there's anything that's built in there. I mean we were talking about it here over the last few weeks. In general, whether it's on the headcount side or the fuel side, we really need to go back on some of our contracts and try to work in some sort of automatic indexed cost adjustment, but it doesn't exist on the vast majority of our contracts.

Where this plays out is that from a lease hour perspective versus fee-for-service, then we kind of look at it and say the fewer trips we have, the better because we're not using up the fuel. But other than that, that's not something really that's under our control.

Okay. Okay. And then with respect to the cost savings in this -- they're kicking in the second quarter. When do you get like the full sort of the full positive impact from the cost cutting? Is that like midway through the third quarter or actually here in the second quarter?

I would say the full impact would probably be sometime in the third quarter. And I say that thinking about the sort of list we have of the very specific cost-cutting measures. Richard, part of the reason why we saw higher expenses than we would have expected in -- we initially expected in Q1 is typically, what will happen is we will swap out one vendor for another vendor.

That's lower priced or we will just stop working with a vendor. But it's the kind of thing where you've got a list of vendors and you've got these cost savings that are identified and executed, but there's a lag because I might have a contract with that vendor that goes through the end of March, even though I told them in January that we're not using their services anymore or I told them back in December, I'm not using their services anymore.

And it's the same thing with some of the personnel. As we sort of shift into more of the corporate layer here, where we're trying to take some cost out. What ends up happening is that we'll have situations where someone is told, hey, look, we've identified this position for elimination, but we need you to stick around for another 30 days or 60 days. It sort of gets you into that next quarter.

And that's why that ends up happening. So knowing what we have executed so far in Q2, and what we have on the calendar to execute between now and the end of Q2, I would say that we're not going to get the full benefit of all of those things during this quarter. But by third quarter, we should get almost all of it.

Obviously, in Q4, we'll have whatever took place at the end of Q2 and Q3 hitting the P&L. So if things flow through the way we anticipate and without other things coming up that would cause us to add to our headcount or to take on other vendors that we don't currently have, we would expect that sequential decline in operating expenses as we go into Q2, 3 and 4.

Okay. And then good job on collecting. I guess you said $8 million April 1 or something like that.

Yes. [indiscernible] mix.

Okay. How much is still out there? And what's the thought process on when that comes in?

Yes. So from HPD, which is the one that we talked about Housing Preservation and Development, there's about, I guess, $13 million left. We are in the process of communicating with them, sending them, in some cases, the very same information that we sent them last time, in some cases, sending it a different way.

There's a formal process by which we would go through that. They have now laid out for us exactly what it is that is "missing" in order for us to get paid on those items. And we're gathering that information and are sending it over. I'm going to say -- I mean, look, I look in their payment system, I think there's probably another $1 million or so that will come in maybe in the next couple of weeks. But beyond that, we would expect it to come in over the balance of 2026.

One thing that we have learned, even though we have now collected 97% of that contract is that it gets really, really difficult to predict the exact timing of when those payments are going to be made. And so we try to err on the side of being conservative. I will point out, when we talk about migrant revenues on the other hand, so there's HPD, but there's also New York City Health and Hospitals, the HERC program that we talked about, all that's been collected, and that was collected on a very timely basis in terms of the stuff that we billed as we came to the last days of those programs in late 2025.

So I don't think there's anything material that's outstanding on any of those contracts as we sit here, that was all brought in during Q1. So it's really that $13 million or so that's sort of sitting out there that we are working very, very hard to collect.

And the next question comes from the line of David Larsen with BTIG.

This is Jenny Shen on for Dave. I just wanted to ask more about the weight management program or business within SteadyMD. I think you mentioned in the prepared remarks a new partnership or contract with an online pharmacy.

Can you just speak more about that? Are you partnering with the pharmacy that offers the branded medications? Or are they offering the compounds? And how does that revenue sharing work?

Yes. So on the revenue, we charge a per visit rate. There's no revenue sharing. It's just we charge our contracted rate, as you mentioned, Jenny.

In terms of your part of the question relating to the weight loss medication, we're working with the branded weight loss medications, the pharmacies that are offering those branded weight loss options and we are the clinical visit as part of that prescription as part of that prescribing process.

So that's really what's driving that growth there. Of course, we're seeing, obviously, in the marketplace, a big tailwind and growth in that space, and we are participating in that.

Okay. Perfect. And then can you remind us how much of revenue do you expect the payer business to contribute in 2026? And how much is SteadyMD do you think?

Absolutely. So as we mentioned, we updated the guidance to $300 million to $315 million for the year. And we expect, again, as we shared on the last earnings call, we expect about $85 million to $100 million to come from the Mobile Health segment and then about $210 million to come, $215 million to come from the Medical Transportation segment for the remainder of the year.

SteadyMD, as was mentioned, I think Richard asked about it specifically. Again, SteadyMD exited Q1 at a $9.5 million quarter. And so they're contributing roughly that $35 million, $36 million as we go throughout the year in our projections.

And that concludes your question-and-answer session. I would like to turn it back to Lee Bienstock for closing remarks.

Thank you so much. Appreciate everybody joining us and looking forward to speaking with you again soon. Have a great evening.

Thank you. Ladies and gentlemen, this concludes today's conference call. Thank you all for joining. You may now disconnect.

Good afternoon, ladies and gentlemen, and welcome to the DocGo Fourth Quarter and Full Year 2025 Earnings Call. [Operator Instructions] This call is being recorded on March 16, 2026. I would now like to turn the conference over to Mr. Mike Cole, Vice President, Investor Relations. Please go ahead.

Thank you, operator. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call other than statements of historical fact, are forward-looking statements. The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expectations.

Forward-looking statements are inherently subject to substantial risks, uncertainties and assumptions, many of which are beyond our control, and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements. These risks, uncertainties and assumptions include, but are not limited to, those discussed in Risk Factors and elsewhere in DocGo's annual report on Form 10-K, quarterly reports on Form 10-Q, our earnings release for this quarter and other reports and statements filed by co with the SEC to which your attention is direct.

Actual outcomes and results or timing of results or outcomes may differ materially from what is expressed or implied in these forward-looking statements. In addition, today's call contains references to non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are included in the earnings release and the current report on Form 8-K that included in which is posted on our website ao.com as well as filed with the SEC. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time.

We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law. At this time, it is now my pleasure to turn the call over to Mr. Lee Bienstock, CEO of DocGo. Lee, please go ahead.

Thank you, Mike, and thank you all for joining us. Today, we announced a strong close to the year, reporting $74.9 million in fourth quarter revenue and an adjusted EBITDA loss of $11.6 million. While our revenue exceeded expectations and enabled us to beat the top end of our revenue guidance, our adjusted EBITDA loss was slightly greater than expected largely due to costs associated with the final wind-down of our migrant related programs in the fourth quarter, which we do not expect to recur going forward.

Additionally, on the back of new customer expansions and improved hiring rates, we are increasing 2026 revenue guidance to $290 million to $310 million compared to our previous guidance of $280 million to $300 million and when combined with our cost efficiency initiatives, we are now expecting an adjusted EBITDA loss of $5 million to $10 million compared to our previously projected adjusted EBITDA loss of $15 million to $25 million.

I'd like to take a few minutes and cover the details driving this improved outlook. First, we are seeing an absolutely stellar performance from our virtual care offering, SteadyMD. During the fourth quarter, StudyMD exceeded $8 million in revenue for the first time in its history, beating the previous quarterly high by approximately $1 million. As we did not acquire SteadyMD until late October, we recorded $6.1 million in DCO's fourth quarter results. At the same time, StudyMD's full year-over-year gross margins improved from approximately 30% to 37% and with the dental gains expected in 2026.

Our integration efforts remain on track, and we are aiming to consolidate provider networks so that steady and de clinicians will be able to provide care for patients across Taco's mobile health offerings by the end of the second quarter. For the full year 2025, StudyMD exceeded 4 million patient interactions consisting of approximately 3 million lab orders and 1 million synchronous and asynchronous telehealth visits. That compares to approximately 2.5 million patient interactions in 2024, which consisted of approximately 2 million lab orders and 500,000 synchronous and asynchronous telehealth visits.

The fourth quarter performance was exceptional, and we anticipate this strong growth to continue, driven by the recent announcement of major customer expansions to meet the needs of our customers' branded GLP-1 weight loss programs. Second, we are seeing considerable improvement in our hiring rates to support strong demand in our Medical Transportation segment, allowing us to outsource fewer rides and recognize the associated revenue. I want to be clear, we still have considerable work to do, but we have filled 206 ENT and paramedic roles out of the 546 that were opened at the end of last quarter.

In Q4, we saw overtime rates in this segment in the teens above our target in the mid-single digits. We are seeing this overtime rate gradually decline as hiring continues to improve, which we expect will provide some additional margin improvement potential as we progress through the year. I am extremely enthusiastic about the progress we are making to bring the doctor's office into the patient's living room and the continued strength in key metrics across our business. For example, when we compare our Q4 2025 metrics to Q4 2024, medical transportation trips increased 11%. Health care and the home visits were up 113%, mobile phlebotomy visits were up 16%, remote patients monitored increased 16%, and telehealth and lab orders were up 50%.

We also continued expanding our care gap closure programs with 1 of our top 10 national insurance payer customers to provide annual preventative exams in the state of Kentucky, which is expected to launch later this month. We are working with this payer across California, in New Mexico and now Kentucky. For our care gap closure program as a whole, we saw a 12% sequential gain in the number of assigned lives increasing from 1.3 million last quarter to over 1.45 million currently.

As we grow our business with insurance payers, we continue to refine our approach to care delivery in a manner that drives efficiency and maintains our exceptionally high customer satisfaction rate which was measured at an NPS score of 92% as of March 1. To that end, we're planning to leverage SteadyMD's clinical network to provide the virtual portions of our visits starting in Q2 and we continue expanding our use of genic AI and workflow automation for administrative and patient support functions. While we will continue to invest in this business, we expect that level of investment to decline considerably as early markets mature and become more self-sustaining, reducing the cash outlay in 2026.

Our goal is to grow this business, which we believe has significant future strategic value in an efficient manner that both minimizes investment and supports our goal of achieving profitability in the second half of 2026. Our remote patient monitoring business was another bright spot during the fourth quarter, generating record revenue of $4 million and $830,000 in adjusted EBITDA for the period. This performance was driven by a 16% increase in the number of patients monitored when compared to the same period in 2024 with strong growth in our virtual care management offering.

We are seeing substantial margin gains in this business as greater economies of scale are achieved and we expect continued improvements in profitability over the balance of 2026. Additionally, we launched our efficiency innovation portfolio in Q4. This is a collection of more than a dozen projects designed to increase efficiency and create more operating leverage in our P&L. These projects span our medical transportation, mobile health and corporate segments and are anticipated to deliver approximately $5 million to $6 million of savings in 2026 and approximately $20 million to $24 million of savings in '27 when we experienced the full annual benefit of these projects.

Central to this work is our use of technology, which has always been a focus and key differentiator for DocGo. We've already incorporated a genic patient outreach into our proprietary Dara ordering and routing platform, and we introduced automation into our prebilling function to increase efficiency. We're planning to expand these initiatives and bring others online in the coming months. I look forward to sharing more about these efforts on future calls.

We shared in our earnings release earlier today that DocGo has initiated a process to explore a range of strategic alternatives designed to maximize shareholder value. We make no assurance that this process will yield positive results or that any transaction may be identified or undertaken.

Finally, I'm often asked when DocGo will achieve profitability, and I always say it's a confluence of 3 key components: our top line revenue, our gross margin and our SG&A. With regards to revenue, we continue to see strong demand for our services and top line growth across our volume metrics. Our gross margin is improving due to our progress in hiring and reducing our overtime costs, and we expect our SG&A to improve as our efficiency innovation portfolio projects take shape and make a real impact. At this time, I will now hand it over to Norm to review the financials. Norm, please go ahead.

Thank you, Lee, and good afternoon. Total revenue for the fourth quarter of 2025 was $74.9 million compared to $120.8 million in the fourth quarter of 2024. The year-over-year revenue decline was entirely due to the wind down of migrant related projects. Removing migrant-related revenues in both periods, we saw a revenue increase of 11% year-over-year in Q4. For the full year, total revenue amounted to $322.2 million in 2025 compared to $616 million in 2024. Medical Transportation services revenue increased to $50.2 million in Q4 of 2025 from $49.1 million in transport revenues that we recorded in the fourth quarter of 2024. Revenues were driven higher by gains in both large and small U.S. markets with some of the strongest growth in markets like New York, Texas and Tennessee.

Mobile Health revenue for the fourth quarter of 2025 was $24.8 million, down from $71.8 million in the fourth quarter of last year, driven by the wind-down of migrant revenues. Included in this year's amount was approximately $7.4 million in migrant related revenues. Nonmigrant global health revenues increased by 47%, driven by increases in care gap closures, remote patient monitoring and mobile phlebotomy and by the inclusion of 2 months of revenues from SteadyMD, which we acquired on October 20.

Adjusted EBITDA for the fourth quarter of 2025 was a loss of $11.3 million compared to adjusted EBITDA of $1.1 million in the fourth quarter of 2024. For the full year, the adjusted EBITDA loss was $28.6 million in 2025 compared to adjusted EBITDA of $60 million in 2024. The adjusted gross margin, which removes the impact of depreciation and amortization and is the measure of margins that we track most closely was 32.5% in the fourth quarter of 2025 compared to 33.5% in the fourth quarter of 2024.

During the fourth quarter of 2025, adjusted gross margins for the medical transportation segment were 32.8% compared to 30.1% in Q4 of 2024, and the highest gross margins that we've seen in that segment since Q1 of 2024. Despite these improvements, medical transportation gross margins are still being restrained by higher-than-planned effective hourly wages for field labor. As we pointed out on the last call, our transportation business has been running at the highest utilization rates that we've seen leading to higher overtime rates.

Over time, accounted for about 13% of hourly wages in Q4 and has been running between 11% and 13% for the past several quarters. However, we took solid strides toward increasing our field headcount in the fourth quarter of 2025, and we would expect the overtime rate to trend lower in 2026, closer to the sub 10% overtime rates that we saw in the first half of 2024. This should provide a lift to transportation gross margins in 2026.

Mobile Health segment adjusted gross margin was 31.8% versus 35.9% in the fourth quarter of 2024. As we completed the wind down of migrant related programs, we experienced significantly lower gross margins in that area, which were below 20% for the quarter. We expect that Mobile Health segment gross margins will improve in 2026 in the absence of these wind down costs and with greater relative contributions from higher-margin service lines such as remote patient monitoring, mobile phlebotomy and virtual care.

There were several nonrecurring noncash items that had a large impact on our GAAP results this quarter, so I'd like to spend some time reviewing them. Within the operating expense category, we incurred noncash charges due to the write-down of intangible assets and goodwill. The write-downs were driven by the persistent gap between the carrying value of our assets and our market cap. We began this process in the third quarter when we wrote down the goodwill and intangible assets relating to our clinical staffing business. Even after these write-downs, entering Q4, there was still a significant amount of goodwill and intangible assets on our balance sheet, primarily due to the acquisitions we have completed over the past 4 years.

Throughout the fourth quarter, our market capitalization remained well below our net asset value requiring us to consider adjusting the valuation of all of our intangible assets and goodwill in an attempt to narrow this gap in accordance with ASC 350 and ASC 360. At year-end, we have now written down all the intangible assets and goodwill to 0. This resulted in a total goodwill impairment of $49.5 million and an impairment of intangible assets of an additional $22.6 million in the fourth quarter.

Along these lines, within the other expense category, we impaired the entire carrying value of an equity investment into a health care company we made in previous years, which had an impact of $5 million in other expense. It is important to note that these write-downs are all accounting driven and noncash in nature. In no way do they reflect the change in the company's outlook regarding the future prospects or profitability of any of these underlying business lines?

At year-end, our total cash and cash equivalents, including restricted cash and investments was $68.3 million, down from $95.2 million at September 30, 2025. The largest factor in the decline in cash was the acquisition of SteadyMD in October. We paid $12.5 million in cash for SteadyMD and incurred additional transaction-related costs of approximately $1.5 million. Our cash balance at year-end was lower than we had expected due to the delay in collecting migrant related accounts receivable owed by New York City's Department of Housing Preservation and development, which we had expected to see during the fourth quarter, coupled with an ongoing operating loss. With further operating losses expected during the first half of 2026 and several growth-related initiatives requiring working capital, we would expect further declines in cash in the near term, creating potential working capital pressure during 2026.

To mitigate this, we are highly focused on reducing cash utilization and operating costs, particularly at the corporate level. We're also working with our current credit line provider to remedy issues related to certain financial covenants, which may increase borrowing costs while providing us with greater flexibility. Turning to 2026. As Lee mentioned in his comments earlier, and as we pointed out in our press release, we have updated and increased our guidance for 2026, based upon what we've seen in the first 2-plus months of the year and the positive volume trends across most of our business lines.

We now see full year revenues in the range of $290 million to $310 million, up from the range of $280 million to $300 million that we had shared back in November. This does not include any revenues from migrant-related projects and represents a 15% to 23% growth over 2025 space revenues. We anticipate a full year adjusted EBITDA loss in the range of $5 million to $10 million compared to our prior guidance of a loss of $15 million to $25 million. In addition to the increased revenue outlook, we have several cost-cutting initiatives underway that we are addressing with the efficiency innovation portfolio efforts that Lee previously outlined, which we believe can accelerate our pathway to profitability.

We continue to expect to achieve profitability on an adjusted EBITDA basis in the back half of this year. At this point, I'd like to turn the call back to the operator for Q&A. Operator, please proceed.

[Operator Instructions] And your first question comes from the line of Pito Chickering from Deutsche Bank.

I guess just to lead off here. You talked about doing your formal process a lot of strategic alternative. Just can you give us any color on sort of what the process entails, and any color on is going so far?

Peter, absolutely. Thanks for the question. So we've engaged an investment bank to run a formal process with the goal of maximizing shareholder value. We can't share more at this time as we're in the process. But of course, as things progress, if they do progress, we'll share more at that time.

Okay. I figured as much, but if I look ahead to ask here. Can you about the improvement in the 2006 guidance in both revenue and EBITDA from upside from SteadyMD or improvements in mobile health or transportation or SG&A? Just any color because you raised revenues by $10 million and adjusted EBITDA by $10 million to $15 million.

Yes, absolutely. Thanks for that question as well, Pito. So we're seeing increased volumes in -- particularly in our Medical Transportation segment, where we've also made progress on EMS staffing. Those are the 2 key components really for the increased revenue outlook of about $10 million. We are seeing additional upside in SteadyMD and those, I would say, are the primary drivers of our increased guidance. Both volumes in SteadyMD are up significantly as well as our ability to fulfill the volumes that we've seen in the Medical Transportation segment with additional hiring that we've been successful with we still have some additional room to run on the staffing.

That's going to be a continued focus for us on the EMS side. But that's really been the driving factor of the revenue guide increase. On the EBITDA side, it really is a factor of, a, the revenue increase provides most -- more gross profit dollars. We're also seeing gross margin improve with reduced overtime that Norm pointed out. And so we see gross margin improving as we start the year here and as we progress because we've been able to staff more efficiently and drive that overtime rate down. And then again, we're also very focused on reducing SG&A by another 10% to 15% from recent levels with some of these efficiency innovation portfolio items that we've already kicked off.

These are areas where we're working to automate many of the functions in billing, in dispatch where we can utilize perhaps fewer staff members but leverage automation to make us more efficient. And we've already kicked that off. I mentioned [ 3 ] billing is an area where we've already made that automation process improvement and there's going to be other areas as we progress throughout the year here as we use technology to become more and more efficient and take costs out of the business. That's what's really driving the EBITDA improvement, the EBITDA outlook improvement. Norm, anything to add?

Yes. I mean I would just say that when we look at the gross margin, the exit rate of gross margin, in the fourth quarter. So we showed it was around 32.5%, 33% on a blended adjusted basis. But in reality, 1 of the things -- exactly a couple of things that were holding us back in the fourth quarter that have already improved here in the first 2, 2.5 months of the year. Number 1 is on the transport side. So as Lee mentioned, there's the overtime rate, which is -- it can't be overstated in terms of the impact, that having a higher overtime rate has on your overall gross margins, it raises your effective hourly rate. If we look at the fourth quarter, the effective hourly rate for field labor was probably the highest that we've seen. And it has since moderated along the lines of having our overtime rate come down like 13% closer to the 10% area that we had seen in the first half of 2024.

So that's 1 driver. The other part of it is when we look at the mobile health revenue or the Mobile Health gross margins, so on its way out, the migrant revenue came in at a much, much lower gross margin level than it had. It's traditionally been running in the 35% to 38% gross margin range. Then in the third quarter of last year, it ran in maybe the high or mid-20s and then under 20% and it's a little bit of a stranded cost thing, but it's more a matter of just sort of having people on staff until the end of the year.

Some of those projects ended midway through the month of December. And you're left with a little bit of cost. Those costs are all gone. There's not going to be any of it in Q1 along with those revenues. So when we think of the exit rate and then we think what we had pegged the gross margin at our original guidance, especially in the first half of the year, we think we're running at a level at somewhat above that.

Okay. Excellent. And then last question here. You talked about sort of free cash flow pros potentially negotiated covenants here. Can you just sort quantify what free cash flow generation or free cash flow declines will be sort of during 2026. And any color on how we start in the year. And just to be very clear, does that include or not include collections in the rest of the migraine business?

Okay. So a little bit to unpack there, so we'll do it in order. I mean the first thing to point out, and we did talk about it here in our prepared comments, our cash balance at year-end was lower than what we had pegged it to be. And that's simply because there's about $20 million of those migrant receivables. The last piece of it, we've collected 97% of everything up until now. That did not come in during the fourth quarter, that still has not come in yet in the first quarter. I believe that a good chunk of that is imminent. By that, I mean I still think that some of it is going to come in during the first quarter, even though it was only about a couple of weeks ago.

So it's pretty imminent and the rest will come in in the second quarter, maybe in the third quarter, but we expect to collect all of it. So when I look out a few months, I wouldn't expect there to be any net difference. But yes, that's $20 million of receivables or $20 million of cash that I would have expected when we last spoke in November of last year that I would have expected to have had in the door and in the bank by the end of the year. So that's 1 factor. But again, getting to your other question, very clearly, it doesn't change -- our outlook hasn't changed as to the ultimate collectability of that money. I'm just looking at a cash balance is somewhat lower than it had been before.

We do have working capital requirements. As Lee mentioned, we're bringing on a lot of new people on the EMT side. So you bring on EMT, you start to pay them, you get them out in the field, working on the truck, they do more volumes. And then those are typically paid within 80 to 90 days. So you've got a little bit of your typical growth working capital needs there as well. So that's really what we're talking about.

As far as the vendor -- the line of credit is concerned. So we have your typical, I'll say, EBITDA covenant or adjusted EBITDA covenant, and it's no secret. We've been running it at an EBITDA negative level for a good few quarters. So that's one of those things that we need to work through with them. We're in the process of working with our credit line provider in terms of how they interpret that and those kinds of adjustments to make sure that, that line of credit remains available to us. We have not tapped down on it since we -- drawn down on it since we paid it back in August of last year. But it would be nice to know it's there. Certainly nice to was there. So that's a big part of it.

As far as -- I want to avoid I think I learned my lesson, I want to avoid like looking into the crystal ball and talk about exactly how much cash will be there at what date. But just to give you an idea of the trend, as we mentioned, I think the next couple of quarters where we expect some negative EBITDA, at least in Q1 and Q2 and into Q3, that will probably result in a somewhat lower cash balance. But again, it depends on the timing of that -- of the payment of the remaining migrant receivables. When they come in, that will cover up the loss. And technically, that could keep us at a somewhat flat level.

So all of it really depends on the timing of that and the timing of some of the payments that we make. But then as we get towards the back part of the year, and we're looking at relatively small EBITDA losses or even positive EBITDA numbers as we get to the back end of the year, then we should see a sort of a plateauing of that particular cash balance.

And your next question comes from the line of Ryan MacDonald from Needham & Company.

Maybe, Lee, just on the payer business first. Obviously, some great momentum there in terms of covered lives that you continue to grow there, the expansion into Kentucky as well. And I think earlier this year, at our conference, you were talking about sort of a pipeline of 2 to 4 more incremental payers that you could sign on within the first half of this year. Just any update on sort of what that pipeline looks like and if that's being factored into even the increased top line outlook, if at all, that you set today.

Absolutely, Ryan. Thanks for the question. Great to hear from you. So the forecast that we have, the forecast that we shared today is consistent to what we shared in our previous call. We continue to see momentum in this business. The number of visits is up significantly as we mentioned, the number of lives and patients that are being referred to us by the payers is up, and we continue to balance scaling that business with also obviously, the investment we're making in that business. And that's the key factor there.

I think the reason why I was excited to share the expansion into a new state by a payer we're already working with in 2 other states is just that is a great harbinger for us that the value we're providing to our partners is there. They're looking to us to expand and provide that value to additional patients in other states. And that is a good indicator to us that, of course, patients and the partners we're working with are deeply valuing the services we're providing. And so that makes us very, very excited. And of course, we see it every day when we go visit patients and see the impact we're making.

So that's the momentum we're seeing. We're really focused on making sure that we're growing efficiently, that we're continuing to scale while balancing the investment we're making in this business so that we could achieve really critical mass in the markets -- the markets we're in and be very selective about whatever markets we expand to primarily with existing customers of ours. So that's the focus. I think you'll see us visit in the patient's homes, about 200,000 patients this year across our mobile lab and care in the home business. Care Gap, transitional care management, primary care is another big focus of ours where we're seeing good progress.

We always endeavored when we entered this business to not only close care gaps, but provide longitudinal preventative care. That's when you can really impact the cost of care, improve health outcomes, and so we're seeing great progress there as well. So that's what the forecast consists of as, of course, if we sign additional contracts, we'll announce those and then adjust accordingly as we go throughout the year.

Excellent. Appreciate it. Obviously, there's a lot of moving parts at the gross margin level this year with some of the migrant revenues coming off, a reduction in overtime rates, also sort of shifting SteadyMD to -- or integrating it to the point where you can start doing more of the mobile health visits through that platform in the second quarter. Can you just kind of give us a sense of sort of implied in the forecast, where you're thinking in terms of gross margins at each segment level on the overall level as you're thinking about the 2026 guide?

Sure. So, at the risk of sounding redundant like everybody else in the world, we do expect sequential gross margin gains as we go through the year. That's the first thing I'll point out. But I think that might -- whether that plays out or whether we end up doing better in the first and second quarter and a little bit less in the third and fourth quarter compared to where we are. But on a full year basis, we would expect the blended gross -- the consolidated blended gross margin to come in right about 33%. So that will be a little bit of a pickup.

On the transport side, where we're currently running at about last quarter, our adjusted gross margin was, I think it was 32.8%. I would always be clear about it. There's a certain limit to where gross margins go. I think that once we get to a point where we would have gross margins on the transport side of 34.5% to 35%, can probably, probably end up seeing that scale back a little bit. So I would say that on the transport side, that number is going to be hopefully somewhat higher than -- a little bit north of 33%.

As we go through the full year, and I can point to certain markets where we're certainly expecting a turnaround and there are 1 or 2 markets that are currently holding us back that we've already seen better improvement or some improvement in Q1. So that's the transport side. And then Mobile Health, a lot of it is going to come down to mix. We have a group of -- obviously, the health plan provider, the care in the home business is a much relatively lower margin than what we see otherwise.

But then the mobile phlebotomy business comes in at a high-margin SteadyMD comes in at a pretty high margin, but we've talked about how they've had to rapidly expand. So you might even see a period of time where SteadyMD margins are taking a little bit of a step back, along with some growth that's above plan. But then you have your relocation monitoring business, which is chugging along, which is increasing both on a year-over-year and sequential basis and the margin is hanging in there and it's north of 50%.

So we would like to see mobile health margins get back to, let's say, a 35% blended basis blended level for the year, and that would sort of get you that 33% for the full year.

And your next question comes from the line of David Larsen from BTIG.

Can you talk about for the 2026 guide, the different sort of revenue components in the past, you've kind of disclosed it like by division, transport, municipalities, health systems, payers or also by like RPM, virtual primary care -- any of those sort of sort of details by division would be very helpful. Absolutely, Dave. Thanks for the question.

So I think if we take the midpoint of our updated guidance, call it, $300 million as the midpoint, we're expecting now that transport is going to come in somewhere around $215 million. We think there's some additional upside there if we continue to make progress on the staffing. And on the Mobile Health side continues to be in that $85 million to $88 million of projected revenue. In the Mobile Health side, if you remember, it consists of no population health, municipal revenue doesn't include any micro revenue, of course, for 2026? And also we continue to point out that if we'll do municipal or population health revenue, we're going to report on that as sort of separate item.

So it really does consist on the mobile health side of our study and, of course, acquisition, which is a virtual care side, the care and the home portfolio that I was describing, the mobile labs, the Care gap, the primary care and the patient monitoring, along with some of the staff clinics that we do. That's really the component pieces. I would say that we've shared in previous calls that SteadyMD is sort of in the $25 million to $30 million range.

As Norm pointed out, we think there's upside to that plan, given the progress that we're making now that we've spent more time with that business having acquired in October, and we're continuing to integrate and infuse them into the company and all the opportunities that the company is seeing and so I would say that's sort of the mix. You have that SteadyMD and acquisition that is coming really into full bloom as we integrate it and that Mobile Health collection of businesses is in the $85 million to $88 million of revenue, of which -- none of that is migrant or municipal or population health in nature?

That's very helpful. And then can you talk about the cross-selling effort? Like I would imagine from a health plan perspective, cargo closures, that's enormously helpful. How frequently would you be able to add in like promote patient monitoring? And then, okay, you assign a primary care doctor or you have a mobile lab service. Like can you talk about the cross-sell and upsell growth potential?

That's a great question. I'm so glad you asked it because that's often something that I think is really an untapped opportunity for us. I think we've done some of it, and I can give some examples in a minute. But I think that, that remains a very big opportunity for the company, 1 that we've made some progress on, but there's clearly more opportunity that we can leverage as we really refine our portfolio of services. I think 2025 was a year where we've established a great portfolio of services on the mobile health and medical transportation side. It's very clear what our value is. Patients love it and now we can start to think about how do we cross-sell and provide those services to patients on a broader basis, particularly because our 2 main customer segments are really the 2 customer segments you want to have in health care.

We work directly with large health systems and hospitals and then the payers. And so we're excited about being at the center of that between the payers and the hospitals, which is really where the vast majority of touch points and really cost is coming from in the system that we're contracting with and partnered with in that space. So I'll give you a few examples. I mean, one area that we're really enthused about is our ability to take a care gap patient and turn them into a preventative primary longitudinal care patient. So we go and we may close a care gap for a diabetes patient or do a screening of some sort.

And we find that many of those patients do not have a primary care provider or know who that primary care provider is and over 70% of the time would opt for us to be that primary care provider. So we're starting to add that aspect of our services as we go into care gap and then primary care. The other piece I'll just flag also you mentioned the mobile labs. We're working with some of the hottest consumer health care companies in the space, the wearable space, where they're now offering lab orders and they're integrating your lab results into their consumer apps, for their wearables. And right now, they're driving patients to patient service centers, but we have partnerships with a lot of the labs, perhaps we can go to the homes of those patients as an upsell as a more convenience than driving them to the patient center.

So going into the home and providing mobile ads as an example. And we continue to think that the opportunity that we have where we're bedside at discharge is a very key moment in a patient's journey. When the patient is being discharged by the hospital on our EMS teams are there transporting the patients, and we're bedside at discharge. We continue to think that, that is a crucial moment in the health care journey. And so what can we do to bridge the discharge from the hospital to the home. We think we have a big role to play in that as we continue to build out the capabilities and continue to work with our amazing partners.

So those are some of the areas that we are absolutely excited about it, and that's why I'm giving such a long detailed answer about it because I think it's an additional area of opportunity that is in front of the company as we go forward here.

And your last question comes from the line of Sarah James from Cantor Fitzgerald.

I appreciate the commentary that you've made so far on some of the moving pieces in '26 with migrant costs being concluded in '25 and the improvement you've already seen year-to-date in EMS labor. But wondering if you could put that all together with what you're planning on the SG&A efficiency side and give us a view of how we should think about EBITDA cadence throughout the year.

So I guess based on what you're doing on the G&A side, is it like a ratable improvement for the year? Should the year be really back-end loaded? Or how should we think about that?

Yes. Thanks, Norman, for the question. I think as Norm mentioned, I think we see most of the EBITDA -- the adjusted EBITDA projection, the loss focused on the first half of the year. And as we turn the corner into the second half of the year, we turn to profitability. I think the big components really are in reducing corporate expenses both on the headcount side as well as some of the vendors that we work with on the corporate side. I mean we've already undertaken a lot of that work. And so that is a factor. And then on the efficiency side, the charge I've really given to the team is to find a way to make us more efficient, use technology, automate, standardize processes at the company where the patient and the customer doesn't feel it.

They don't know that we're being more efficient. The service levels that they've come to love, remain as high as ever, the patient's experience that the patients absolutely love. I mentioned the Net Promoter Score of 92 stay as delightful of a patient experience that you can have in a patient's home when they're in need of health care to maintain that high bar, but at the same time, remove cost and the way to do that is to use technology into automate. And so I mentioned an example of the pre-billing process today or in the past, I should say, we had our dispatchers, and we had members of our team doing the pre-billing component to ensure, of course, that the patient had insurance that we were going to be able to collect, as an example, on the medical transportation trip.

Now we're working to automate that. And we feel like we have build something that can automate that process and then, of course, free up our people to do other work or perhaps allow us to be just as efficient and productive perhaps with fewer people. And that really is a driving function. And so -- we're really looking at areas where we are using human labor today, but it can be automated, it can be standardized and that are -- those are the areas that we're using technology to build out.

Another great example I've been using is when we first started engaging with the patient list that the payers are providing us for care gap services, we were making phone calls for all those patients, myself included. I did a bunch of those calls, and got quite good, I might add, but engaging with the patients. But now we're automating a large portion of it. We're automating a large portion of it with text, we're automating a large portion of it with agentic-AI, and we're doing more with fewer resources.

And so those are really the areas we're focused on. We are very enthused by the progress we're seeing. That agentic-AI, patient engagement solution is already live. It's been running for months now. That automation of the pre-billing is set to go live. We've been testing it for months now. And so these are the areas that we're really going to push forward on to drive efficiency and ultimately remove cost from the business that we know is crucial. And so that is really where we set out. We really worked on it towards the end of last year, and we're starting to see it come to fruition as we kicked off 2026.

Your next question comes from the line of David Grossman from Stifel.

Maybe you could help us better understand kind of your expectations for the cadence of mobile growth as 26 progresses. And maybe if you could, in your response, maybe help us better understand what visibility you have today and what the pipeline may look like, including how do you leverage the success you're having with this 1 particular payer and care gap closure into marketing that to some of the other payers?

Absolutely. Thanks, David, for the question. So as we mentioned on our last call, we really -- we're really taking the approach to set guidance based on what we have today, the contracts we have today, the [ sets ] we have today, the volumes we have today, and then of course, if we're able to add to that with new contracts, new expansions, additional staff, then we would update as we went along. And so we're taking that same approach this quarter. This is based on the staff we have today. We mentioned how much progress we're making on the staffing. There's still more progress to be made. This includes the contracts we have today. It doesn't include any sort of wins that are projected to come but rather what we already have in-house today.

So that in terms of visibility, in terms of that part of your question, this is the full visibility that we have. It's the contracts that we have with the staff we have today. Of course, things can happen, but this is what we have in the mix of the business right now with the customers we already have. So that's the key component. I think we really project that the mobile health business will grow as we go throughout the year. There is no 1 quarter where we hit some inflection point. It really is going to be a linear build on the mobile health side, because as I mentioned, it's including all the contracts we already have today. I think what you're seeing on the mobile health side is about a 40% year-over-year growth from 2025 to 2026. Now of course, that does include a full year of stead EMV revenues, which we acquired, as we mentioned in October. If you exclude study MD from both periods, we have about 10% to 15% year-over-year growth as well.

So what we're going to be focused on this year is integrating study and b, utilizing them across the DocGo platform so that we're utilizing studying these clinician base to oversee the visits that are happening in the patient's homes with our mobile health clinicians in the homes. And then, of course, enabling them to grow as well. But that's basically what we see is a linear growth on mobile health as we go throughout the year. Of course, if we were to win a new contract that would maybe introduce a step function into the growth rate, but it's based on what we have today is sort of the visibility aspect to your question.

Okay. Great. And just a quick one for you, Norm. So I think you said you expect to get another chunk of cash from HPD at some point, perhaps even before the end of the month. Any sense of what the gating items are to getting paid at this point? Or has it just been typical administrative kind of delays in getting the final payments. Any sense for whether or not there's any risk to the $20 million. I think in your press release, you said you expect to get fully paid, but I just thought I'd just ask the question.

Yes. And sure, David. It's a good question. And just to set the table, we're in touch with them on a pretty frequent basis. I have a counterpart there, there's about half a dozen people here who are in touch with their counterparts. I speak to them weekly. So what has been going on is that as the administration has sort of transitioned , first of all, people have been a little bit busy. But beyond that, they're going through an audit, not just for our payable to -- not just the payable to us, but really for everything that HPD has done with all the different vendors that they have and they're going to even they brought in a, I'll say 1 of the big 4 accounting firms that was and consulting firms that was doing an audit for them across the board.

And looking at the stuff that they already paid, looking at the stuff that was already opened, kind of routine type of process, but I would say that, that payment was held hostage, if you will, by that particular audit that really dragged on for quite a few months. That audit has been wrapped up. The findings are now being put together on paper. And that's why I think that we should find out really within days of what they are going to pay us in an initial wave of funding. And then, of course, if there's some stuff where they require additional information, all of which we have, we would provide that and continue that process going.

So -- and that was the big gating item there really was getting that audit done that took at least, I would say, 2 to 3 months maybe more to get complete.

And there are no further questions at this time. I will now hand the call back to Mr. Lee Bienstock for any closing remarks.

Wonderful. Thank you so much for everyone joining us today, and we're looking forward to speaking with you again soon. Take care.

And this concludes today's call. Thank you for participating. You may all disconnect.

Good day. And welcome to the IAccess Alpha Virtual Best Ideas Winter Investment Conference 2025 The next presenting company is DocGo Inc. [Operator Instructions] I'd now like to turn the floor over to today's host, Mr. Lee Bienstock, CEO of DocGo Inc. Sir, the floor is yours.

Thank you so much. It's great to be with you today at the Best Ideas Conference and to talk about DocGo, our mobile health care company, where we bring medical care to where it's needed, when it's needed. And that's really our great idea.

Our best idea is creating a world-class medical company that delivers mobile health care, medical care to where it's needed, when it's needed. And we believe that when you meet patients where they are, you have great outcomes. And better outcomes lead to better health and better health leads to less strain on the entire health care system, something that is desperately needed in our country and for our health care system. So we're excited to share how we do that with you today. I'll make sure we leave some time at the end for questions, and we'll get into it.

So as I mentioned, our thesis, is we are building a leading provider of tech-driven mobile care. We have a foundational expanding medical transportation business where essentially we've built an Uber-like experience for medical transportation, where we bring patients to the care setting that they need or bring them home from the hospital. We have a rapidly growing care in the home business. All of it is run off our proprietary tech backbone that we built purpose-built for delivering care in this way. We have a strong balance sheet and the resources to support our growth in the years to come.

And of course, anyone working in the health care space has a massive expanding TAM. But as I'll share later in the presentation, CMS, Centers for Medicare and Medicaid and other key players in the ecosystem are predicting a huge growth in the amount of care being delivered in the home.

So here's what we do in a nutshell. We have three service lines. As I mentioned, we have a medical transportation, a division. It's a tech-powered state-of-the-art platform with our own fleet. Our own skilled EMS professionals providing medical transportation and management. I'll talk more about it, but our tech platform is integrated with Epic. It works into the patient flow of the hospital systems we work with. We work with premier hospital systems like Mount Sinai, Jefferson, North Well, New York City Health and Hospitals, Mainline Health and they utilize our technology to help coordinate the patient flow, discharge in medical transportation.

We have a rapidly growing mobile health care division, where we use the same tech backbone to deliver care in a patient's living room, and we're building out the capabilities to bring a doctor's office, the capabilities of the doctor's office to the patient's living room. When we're not with patients, we have a growing remote patient monitoring business, where today, we monitor over 50,000 patients, primarily in the cardiac space that have implantable loop recorders and pacemakers, and we're reviewing those transmissions of data continuously on a daily basis to make sure that their conditions are not precipitating and we're intervening when necessary.

And all told, we have thousands of clinical staff providing these services in over -- almost 1,000 mobile vehicles in 31 states and the U.K. and our clinical practice, we have a 50-state virtual practice where we can provide virtual care to anyone across the country. We've served over 10 million patients since we started, so we've been scaling, we've been doing this at great scale now for many years.

And most importantly, the patients love it. Patients love it when you meet them where they are and engage with them on their terms, in their preferred setting, and it's a really tech-forward experience and patients love it. And that is the most important -- most important aspect. And when patients love it, they're more likely to engage in their health and you're more likely to have better health outcomes, and that's what everybody wants. That's really the platform we're building here on the medical transportation side.

We have a great roster of customers on the mobile health care side. We're working with the payers, the health insurance companies that are identifying patients that have gaps in care that need care brought to them. And they're providing us with those list of patients, and our team is engaging and going and seeing those patients day in, day out. We expect to provide medical transportation for about 700,000 patients this year. Provide care in the home, mobile lab, care gap closure, primary care to over 150,000 patients.

And as I mentioned, we monitor over 50,000 patients today. So great scale across our service lines, all the goal to bring care to where you are. That's our best idea. Who knew if you meet patients where they are on their terms, just like any other industry, if you deliver great care to where they are when they need it, you're going to have great results. And that's why we're so excited to continue to build out.

This has been the financial profile of the company. I like putting this slide right upfront, so people can get a sense. I mentioned the scale of the volume of visits and patient engagement that we're -- that we're delivering today. And here's what the business has looked like over the years. And you'll notice a couple of elements here.

Number one is you see the growth of our medical transportation business. Now 5 years ago, we did less than $100 million of revenue in that business. This year, we guided to about $200 million -- $200 million plus. And you'll also notice our work with our payers and providers, those list of patients that the payers and providers are working with us to bring care to their members that have open gaps in care, need care to help keep them out of the hospital or the condition -- the chronic condition from precipitating getting even worse, and that's the light blue bar that you see being built out there.

And we issued guidance, which I'll get into a little bit more, we issued guidance for next year on our last earnings call to between $280 million to $300 million of revenue. So we're essentially tripling the base business of the company over the past 5 years or so. We're really, really proud of that.

All the while, you'll notice the gray bar, we were instrumental in responding to the COVID crisis, right? We're a mobile health care company, which was incredibly valuable during the pandemic. We've been providing services to the migrants and asylum seekers that were arriving in our home state of New York here. And that's the gray bar that you see there. The company experienced revenue and deployment in a significant way around those crises and emergency responses, and that's where you see that gray bar, which again, sort of overshadows the great growth in the base business that we've been experiencing over the past number of years. And so that's why we like to talk about that upfront.

Oftentimes, investors will ask me, well, what happened with the revenue last year or the year before, and that's where you see the COVID revenue and the migrant revenue that we're breaking out and showing the base business revenues and the growth there. And I think it's important for us to talk about that at the onset. So people can see the growth profile of the company and all its component pieces. And we're very proud of it.

So as I mentioned, we had our earnings call last month, and here are some highlights from our Q3 call. Our total revenue for the company was about $71 million in revenue, $70.8 million in revenue. Our adjusted gross margin was 33%. We had an adjusted EBITDA loss of about $7.2 million. Again, we'll talk about where some of that investment is going, but that investment that you see here is going into building out the capabilities of bringing the doctor's office to a patient's living room. And continuing to invest in the growth and infrastructure of the company.

Mobile health revenue is about $20 million. Medical Transportation revenue is about $50 million, breaking those pieces out. And our Medical Transportation adjusted gross margin was 31.7%. The company doesn't have any debt on its balance sheet, our outstanding amount on our line of credit is sitting at zero. We've paid that all back and total cash on the balance sheet is $95.2 million. So we have a really healthy balance sheet. We've managed it well.

We continue to have a growing business that we invest in the capabilities of the company and some really great traction. I announced also on our last earnings call that we achieved record volumes across all our major business lines with medical transportation, U.S. Medical Transportation growing by 2.5%, our care gap closure in transitional care business growing 320% year-over-year, our mobile phlebotomy business growing 11% year-over-year, our remote patient monitoring business growing 6% year-over-year and when comparing to third quarter of this year, third quarter of last year.

So we really see volumes up. That's how we know we're absolutely on the right path, and patients are loving it. Health plans are benefiting from it. Hospital systems are benefiting from it. Most importantly, patients are benefiting from it. And we're really, really excited about the growth plans of the company and all the capabilities we're bringing out and the financial health of the company.

And this really is the problem we're solving. Chronic disease is a massive issue in the U.S. health care landscape. The CDC, again, there was a great article in the CDC estimated that 90% of the nation's $4.5 trillion in annual health care spend is relating to people with chronic illness. If we can help people with diabetes, with heart failure, with chronic kidney failure, we can help those patients manage their diseases, stay out of the hospital, lead healthier lives. We're going to help this massive issue in the U.S. health care system. And that's exactly the type of solutions that we are building out is to be able to address and help treat chronic conditions key patients out of the hospital and ultimately provide preventative proactive care, and this is a huge need in the U.S. health care landscape.

We'll dig in a little bit more on mobile health. As I mentioned, we're projected to visit over 150,000 patients in their home this year. We work with the payers and providers that have patients that are part of their member base or patients that they're trying to reach. And for whatever reason, they're not getting the care they need. Maybe they need a diabetic retinal scan, they have diabetes, and we have to make sure that they're not at risk for vision impairment. Maybe they have osteoporosis and they need a bone density scan, maybe they're at risk of colon cancer. We need to do a colon cancer screening. They have vaccinations that they haven't received.

They have received an annual wellness visit. And so we go to the home and those are the exact services that we deliver. We deliver over 40 different care gaps in the home, building out the capabilities to do that. That's what our company is all about. And we've been making great, great progress there. And like I said, we'll visit 150,000 patients in their home this year.

The payers we work with, that list is growing. I'd like to share that a couple of years ago, we were working with one payer. They gave us a list of about 70,000 patients that were in need of these services. And now we work with payers you see here listed, over a half dozen payers that have given us 1.3 million patients, list of patients that are in need of those care gap closure and primary care services Molina, Health First and an Empire Health Plan, L.A. Care, Elevance, Emblem, all customers, all working with us in partnership to reach patients that have open gaps in care and needs preventative care.

And if we close those gaps in care, the health plan save money because the patients are healthier, they're not landing in the hospital. The health plans get a higher quality rating because their members are getting the care they need and all of that drives savings and better performance for these health plans. So we are targeting the very aspect of what the health plans are struggling with right now, which is ballooning costs. And patients with chronic conditions, ending up in the hospital. And we are absolutely going and treating those patients, helping them close those gaps in care.

As I mentioned, this is a very, very big market, as you can imagine, 30% of the PCP market is expected to shift into nontraditional providers according to Bain. And again, CMS is projecting a huge percentage of care to find its way into the home because oftentimes, that's the best setting for some of this care, and we're right at the nexus of that.

Here's how we do it. This idea, this great idea, this best idea is an old idea. The doctor he used to come to your home, but it was inefficient, there was too much drive time. We frankly have a scarcity of physicians in this country and advanced practice providers and so how do we do what we do?

We've built a tech platform that allows us to send certified medical assistance, licensed practical nurses, phlebotomists into the home. They are the ones that are driving from home to home. They're the ones that are getting the patient visit set up. They're the ones that are hands, eyes and ears in the patient's home. And they are overseen synchronously by that very scarce advanced practice provider, that licensed medical physician, that physician's assistant, that nurse practitioner overseeing and directing the visit and they're able to tell the clinician that's in the home. They want to see inside the ear, nose and throat. They want to take a swab. They want to administer a vaccine.

The remote clinical staff is the one prescribing treatment planning and diagnosing and the clinician in the home is the one that's the hands, eyes and ears hands on with that patient. And that's exactly the platform that we've built. It is tech forward, and that allows us to essentially put that old idea back into play. Spending the capabilities of a clinician into a patient's home. And we're very excited about this. Patients absolutely love it.

And again, it's very tech forward and again, meeting patients where they are. And this is the platform we built out. In order to help us accelerate that platform, the expansion of that platform, the scale of that platform, we need more and more advanced practice providers. And so you may have seen about 6 weeks ago, we made an acquisition where we acquired a company called SteadyMD, that has been operating for 9 years. They'll do about $25 million of revenue this year.

And they have hundreds of advanced practice providers, providing clinical care, virtual care, telemedicine across 50 states today, and we feel like that network of clinicians overlaid with our field deployment, those mobile health care clinicians in the field paired with the SteadyMD platform is going to help us go faster, is going to help us be more efficient. Allowing us to use those hundreds of telehealth based providers that SteadyMD has to garner up to 10% gross margin improvement on our deployment. We're very, very excited about this, and they have a world-class platform.

This is what we offer in the home. We talked about it, mobile phlebotomy, care gap closure, transitional care management, urgent care, primary care, all in the patient's home or via telehealth. And again, we're one of the largest scale providers of this. And meeting patients where they are, again, is the profound idea.

As I touched on it, sometimes patients need to go to the hospital, sometimes patients need to be taken from one care setting to the next, and we have one of the preeminent medical transportation platforms in the industry, also a multibillion-dollar market. And we partner with the hospital systems in this case. So on the mobile health care side, we are partnering with the health insurance companies. And on the medical transportation side, we're partnering with the health systems, the hospitals themselves.

Here's a list of the wonderful customers we have there, enterprise-grade agreements and deployments with the hospital systems, and we provide efficient, reliable, tech-forward medical transportation, that is integrated with Epic, which I'll get into in a moment. And we're deploying this in multiple markets across the U.S. and the hospital systems utilize our tech platform that's integrated with Epic to manage the patient flow.

Now on that tech platform, we built our proprietary mobile health and medical transportation platform that allows a discharging nurse to click a button in a patient's chart, and see exactly when that ambulance is going to arrive to pick up that patient. And housekeeping knows when to get that bed made up for the next patient.

And intake knows that, that bed is now free to give to the next patient. And all of it is integrated seamlessly and discharging their snow is, okay, the ambulance is going to arrive in 20 minutes. I need to get the patient ready. So that when we arrive, we're not waiting around the patients ready to be taken. So that efficient patient flow and workflow is incredibly valuable when you infuse technology into the process, and that's what we've been building now for 10 years.

And as I mentioned, hospital systems love it. Household systems like Mount Sinai and New York City Health and Hospitals and Jefferson are all utilizing this tech platform and our crews in the field. And loved ones know exactly when they're -- when the patient is arriving home because they get a link and just like any other tech platform today, you see exactly when the service is being -- is arriving or when the goods are being delivered.

And in our case, they could see exactly when the patient is going to be arriving at the next destination, all seamlessly integrated. And this is a huge competitive advantage for us that we've been building and investing into for many years now. It's HIPAA compliant, it's SOC2 and ISO 27001 certified. And so we're very, very, very proud of what we're building out here.

As I mentioned, our volumes are all up. We're very excited about that progress and that traction we're seeing. I talked about the patients that are assigned to us for care gap and transitional care management, about 70,000 patients couple of years ago to well over 1 million today, that's grown 142% compounded over the course of that span. The number of visits we're completing up 90% over the course of 2024 to the projections we have for 2026.

Number of CCP visits. Again, all these volumes up in a big way because these are absolutely important aspects of the health care delivery system that patients need, and we're bringing it to them when they need it. We have a great team. Folks on the call may know Dr. Klasko, who is the former CEO and President of the Jefferson Health System, joined as the Chair of our Board. It's great that I'm here with you.

I serve as the CEO, and we have a great leadership team that has deep expertise in EMS, in mobile health care, in the hospital settings and so forth, and we're working really hard day in, day out to serve patients, to serve more and more patients to help our partners be successful and we believe that we make patients healthier and our partners like health insurance companies and hospitals more successful. Our company will be very successful alongside that. So here's really what our competitive advantage is.

We put all the pieces together to be able to deliver a seamless experience in a patient's home. And so the patient sees and gets to feel the experience of us having our own proprietary tech platform with our own staff, with our own fleet, with our own lab license, with our own clinical practice group with our own managed care credentials, all combined so that we can provide a comprehensive great experience of high-quality medical care in a patient's home.

And putting all these pieces together is not easy and it takes time, takes effort, takes brainpower, takes skill, takes execution, and that's exactly what we've been doing over the number of years here. And we now have the ability to deliver exactly what I'm just describing because of our vertical integration. There's so many companies out there that are selling software, but the hospital systems or the insurance companies, they need the personnel to actually use it.

There's so many companies out there that are antiquated. They may have the ambulances or the personnel or the brick-and-mortar doctor's office -- but they're not -- they don't have the tech platform to really deliver the services and the way that we're doing it. We're so unique in that way. We've built the software and the tech platform, but we don't just leverage that. We utilize that paired with our own clinical staff to be able to deliver care where it's needed.

Okay. I'm going to leave some time for questions here. We think we're very unique in the space. You may have recognized some of these names from Amwell to Teladoc to Uber Health, but we're putting all these services comprehensively in a way together that allows us to deliver a pretty seamless unique experience that, frankly, is unmatched in the industry.

How are we going to grow the company? We think about that day in, day out. First off, I shared some of the customers we're working with. We have strong long-term relationships with leading health systems, payers and providers, exactly the people in the health care industry that you want to be partnered up with if you want to impact change, if you want to grow. And they have lots of needs and we have lots of the capabilities that they need. And so there's a lot of opportunity, frankly, with the customers we have already today.

We are very focused on reducing hospitalization. That's what cost the system a lot of money. That's the most expensive care setting. Is when you're in the hospital. And so we have programs specifically designed to keep you out of the hospital. Hospitals play a vital role when you need to be there, you need to be there and they absolutely provide a necessary role in the ecosystem.

But oftentimes, you don't need to be in the hospital or if we can keep you from going to the hospital by preventing precipitating condition or helping you manage your chronic condition better, that's what we're all about. And so that's the role we play. We have a growing virtual care management platform, payer programs. We have a robust pipeline of new customers that we'll be looking to bring on, hopefully in the next years to come. And we're very excited about that. And we've also shown propensity and ability to execute on strategic M&A.

As I mentioned, we acquired SteadyMD about 6 weeks ago. We've been adept at acquiring companies and adding those capabilities and helping us scale faster with M&A, and we have a disciplined M&A approach, but we have a robust M&A pipeline that we'll continue to explore in the coming months and years.

The key takeaways, and we'll leave some time for questions here. We have a strong balance sheet to support our growth. We have a defensive competitive advantage from our tech and our vertical integration, the software and the services, all integrated into one platform, turnkey, we have a unique value proposition. We want to succeed when the patient is healthier. We want to succeed when the patient is cared for in their home. We want to succeed when we're efficient in moving patients from one care setting to the next with the medical transportation platform that we have.

And when patients are healthier and our partners are winning, that's when we win, that's a great recipe, and we're very excited about our role in that. And we're building a recurring revenue base with highly attractive customers. Yes, we helped during the pandemic. Yes, we helped during the migrant and the asylum seeker crisis. But all the while, at the same time, we've been growing our base business. We've been growing out our capabilities. We've been growing out our tech platform to really set us up for the years to come and to help a lot of people. And we're a mission-driven company. Our goal is to keep patients out of the hospital. Make them healthier. And if we're successful in doing that, our company is going to be successful.

And of course, there's just an enormous TAM out there for us to effectuate that growth and for us to effectuate that better patient outcome. And this is what it's all about. The lithium is just so much better than the waiting room. How many of us have been on the right-hand side of the photo, with our children, and our loved ones? And if we can give people perhaps a different experience in their home, with the same quality of care, we feel like that is a profound idea. You may say, a best idea keeping with the spirit of this conference. And so we're so excited about that, and that's exactly what we're building here at DocGo.

Okay. So let's take a look, left some time for some Q&A. Excellent. So I have a bunch of questions here. I'll try to get to them all.

First question we have up is, how is SteadyMD acquisition improving margins and capacity across your in-home visit model?

So that is a very important piece. As I mentioned, we have two aspects to make that home visit possible. First, we have the field resources that are going from home to home from care setting to care setting. And that is, of course, what the company has always done well. We have, again, that huge fleet, a huge workforce that's trained to go into the patient's home.

But at the same time, they're overseen by the advanced provider. A licensed clinician and the MD, the NP, the PA. And so that is exactly what SteadyMD is bringing to DocGo. They have a network of hundreds of these advanced practice providers. And they're also serving other customers. So that when they're not seeing a DocGo patient, they're seeing another telehealth visit from their roster of impressive customers. And so that allows us to maximally utilize every minute of that advanced provider today and make us much more efficient and then, of course, bring that capacity to us to help us scale in the markets we're in and help us scale to the markets that we're being asked to go to.

For example, we work with a payer today, in California that recently asked us to expand to New Mexico, which we just started serving patients in New Mexico over the last few weeks. And so SteadyMD will help us expand to new markets as we work with our payers, we love that. right? The payers we're working with are happy, they're benefiting. The patients are benefiting. They ask us to go to new states. SteadyMD already has a 50-state clinical network that we're going to leverage for expansion there as well.

Let's take a look at a few other questions. What does your pipeline look like for new quality and gap closure programs heading into 2026?

So that's a really great question because I think it touches on two very important aspects. So the first is -- we -- as I mentioned, we have a growing number of patient lists that are being provided to us by the payers we already work with, and we think there's enormous opportunity there for us to continue to expand with the payers we're already working with in the markets we're already working with. We're also going to be looking to add new payers in the markets we're already in, adding density and the more density we add, the more efficient we get, the more efficient we get, the better the margins improve.

And so we're working on building that out in the markets we're in today. We will expand to new markets that will typically happen with an existing payer we're already working with, and they are partnering with us to scale to a new market. So we're never going to go to a new market and hope to get volume or hope to get customers. Typically, our expansion strategy to new markets is because we already have a customer that's taking us to that new market, if you will. And that's going to continue to be our ethos going into next year.

And so I think it's going to be a mix between, frankly, expanding in the markets we're already in, getting greater density, getting greater efficiency and then expanding to some new markets with our existing customer base or with a large anchor customer that wants us to enter into that market with the same capabilities and service lines that we offer today.

The reason why I also wanted to focus on this question as well, is because I mentioned the guidance that we gave for next year, the $280 million to $300 million of revenue for next year. That takes into account the customers we already have today. It does not take into account any new customers that we may sign any new markets we may go into any new deployments that we may undertake any additional M&A activities, we may pursue next year.

All of that would be additive to the guidance that we issued on our last earnings call. So that's why it's very important. I'm glad thank you whoever submitted that question, it's a great one because I think it touches on our growth strategy on how we expand, but also touches on how we came to the guidance that we issued on our last earnings call

And so that puts us at time. Really appreciate it. We're here. We're really excited about what we're doing. We're going out and serving patients. We engage the investor community. Appreciate you hosting us today. If you have questions, absolutely reach out to us and watch as we grow in the space. We're going to be delivering care to where patients are when they need it, and when we do that, we help them lead healthier lives, manage their chronic conditions. And ultimately, we think we're going to be very successful doing that.

That concludes DocGo Inc.'s presentation. You may now disconnect, and please consult the conference agenda for the next presenting company.

Good afternoon, ladies and gentlemen, and welcome to the DocGo Third Quarter Earnings Conference Call. [Operator Instructions] This call is being recorded on Monday, November 10, 2025. I would now like to turn the conference call over to Mr. Mike Cole, Vice President, Investor Relations. Please go ahead.

Thank you, operator. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call other than statements of historical fact are forward-looking statements. The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expectations.

Forward-looking statements are inherently subject to substantial risks, uncertainties and assumptions, many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements. These risks, uncertainties and assumptions include, but are not limited to, those discussed in risk factors and elsewhere in DocGo's annual report on Form 10-K, quarterly reports on Form 10-Q, our earnings release for this quarter and other reports and statements filed by DocGo with the SEC to which your attention is directed. Actual outcomes and results or timing of results or outcomes may differ materially from what is expressed or implied by these forward-looking statements.

In addition, today's call contains references to non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are included in our earnings release on the current report on Form 8-K that includes our earnings release, which is posted on our website, docgo.com as well as filed with the SEC. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time.

We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law.

At this time, it is now my pleasure to turn the call over to Mr. Lee Bienstock, CEO of DocGo. Lee, please go ahead.

Thank you, Mike, and thank you all for joining us today. 2025 has been an important year of transition for DocGo, and I would like to start our call by sharing 4 key headlines from the quarter before sharing more specifics about our performance.

First, we experienced record volumes across all of our base business offerings in the quarter. Our strategy to build a robust evergreen health care business is coming to fruition. Second, we continue to have a strong balance sheet with cash we intend to use to fund our growth and capitalize on the opportunities in front of us. Third, we are extremely excited about our acquisition of SteadyMD and how their 50-state virtual care network and over 500 advanced practice providers will allow us to scale more efficiently.

And fourth, today, we announced 2026 guidance of $280 million to $300 million in revenue and a full year 2026 adjusted EBITDA loss of $15 million to $25 million, with the majority of this adjusted EBITDA loss expected to be realized in the first half of the year. Our 2026 revenue guidance represents 12% to 20% year-over-year base business growth. Any potential acquisitions or new contract wins would be incremental to that amount, and we would provide updates on 2026 guidance as needed. At the top end of our revenue guidance range for 2026, we would expect to exit the year on an adjusted EBITDA positive run rate.

We have a bold vision of building a company that brings the capabilities of a doctor's office into a patient's living room. I am excited about our investment to build these capabilities, which I believe is a small price to pay for the promise of something that has transformational potential, both for our company and our industry. Before I cover the individual business verticals, I want to emphasize that each of our service lines with the exception of our Care Gap Closure and Primary Care offerings is EBITDA -- is adjusted EBITDA positive on a contribution basis. I think it's important to highlight this because their value can be masked by the impact of corporate overhead costs at our current scale and the investment we are making in the capabilities I just referenced.

Now I'll touch on our Medical Transportation and Payer Provider Mobile Health verticals. Our flagship Medical Transportation business achieved record volumes in Q3, driven by numerous long-term contracts with strong visibility and an enviable roster of customers, including Jefferson Health, Mount Sinai, New York City Health and Hospitals, HCA Tristar, the NHS in the U.K. and others. We expect this business will generate more than $200 million of revenue in 2025, making this a strong foundational asset.

As we add additional scale and ramp staffing in this segment over the next 2 to 3 years, we anticipate that we can further improve the adjusted EBITDA contribution margin to approximately 12%. We continue to see incredibly strong demand for our services with opportunities to grow revenue within our existing customer base. Several of our large health system customers use our total transportation solution, which includes our proprietary software, dedicated ambulances, EMS crews and staff to manage their transfer center operations. Our Epic integrated technology platform creates efficiency, transparency and provides a single source of truth for transportation management across vendors.

In this capacity, we often have the ability to select whether to assign a trip to one of our ambulances or select a different transportation vendor if we don't have an available unit staffed to run the trip. We estimate that over the last 12 months, we have assigned over 26,000 trips to other companies, many of which could have been run by our fleet if we had available service level capacity. We have accelerated our talent acquisition efforts and are looking to hire hundreds of additional EMS staff as soon as it is practical to create the capacity and better capitalize on this embedded demand from our current customers. We expect that these targeted additional hires will enable us to capture millions of dollars of additional top line revenue on our existing contracts in 2026.

In summary, our transportation business serves a vital market need, is profitable on a stand-alone basis and is a valuable foundational asset.

Moving on. I would like to cover our Payer and Provider vertical, which is expected to generate approximately $50 million of revenue in 2025, which includes a contribution of approximately $5 million from the SteadyMD acquisition in mid-October and is expected to grow to $85 million next year. This vertical includes services such as Care Gap Closure, Primary and Preventative Care, Telehealth, Remote Patient Monitoring, Mobile Phlebotomy and other Payer and Provider services.

One of our core offerings in this vertical is our remote patient monitoring business, which has made considerable progress over the last year. Remote patient monitoring is operating at an annual run rate of approximately $15 million with a greater than 10% adjusted EBITDA contribution margin, which is expected to continue trending higher in 2026. We've signed 13 new contracts or expansions this year on the back of strong demand and have 8 additional proposals submitted or in contracting. We are excited to keep developing this capability in a space that typically commands high multiples.

An area of our Payer and Provider vertical that is taking longer than anticipated to ramp but still holds great promise for us is our primary care services. We had originally budgeted approximately $5 million to $10 million of revenue from primary care in 2025. We are seeing progress here and just received a substantial list from a major health plan to offer these services to 10,000 members, which will launch in Q4 and ramp in early 2026.

Also within our Payer and Provider vertical, our Care Gap Closure and Transitions of Care business more than quadrupled when we compare Q3 2025 to Q3 2024. While our investment in product development, training and technology to build our capabilities was substantial in 2025, we expect that rate of investment to decline considerably in 2026, which will help contribute to our goal of achieving profitability.

As we work to drive our Care Gap and Primary Care business to profitability as soon as possible, I want to underscore why we are making this strategic investment to build these capabilities. DocGo's ability to leverage a tech-enabled clinical workforce to reach difficult populations with chronic conditions delivers meaningful value to our Payer and Provider customers. Our solutions help keep people healthier and in their homes and have the potential to significantly lower health systems costs.

Considering the convergence of increasing costs, flat reimbursement levels, facility overcrowding and ongoing operational challenges facing health care today, we believe DocGo's offering is positioned to drive substantial value and represents a significant opportunity for our company. While this Payer and Provider business takes considerable time to develop, we have made significant inroads over the last 2 years, and we believe it has high growth potential. As I shared on our last earnings call, we are already working with 2 of the top 10 national payers and are in active discussions with both of these customers to expand those contracts. Additionally, we are in the process of contracting with 2 more of the top 10 national payers and have an additional 10 pending proposals in our business development pipeline.

I wanted to illustrate the potential of these relationships by highlighting the growth trajectory of one of our major Payer customers over time. In 2023, our first year working with a major California health plan, we performed 789 total patient visits. In 2024, that number grew by nearly 65% to 1,293. In 2025, it is expected to grow another 250% and reach 4,500. And in 2026, it's expected to grow another 280% and reach over 17,000 visits based on existing plans. This same customer started with a single transition of care program, added Care Gap Closure and has recently added Longitudinal Care services as well.

In summary, it takes time for these relationships to ramp, but they can accelerate quickly as our customers appreciate the value we can deliver. As I mentioned, we also considerably expanded our capabilities with our acquisition of virtual care provider, SteadyMD, last month. We believe we got a very attractive deal for our shareholders with the way we structured this transaction and the value it brings. For those of you who didn't have the opportunity to dial into our webcast last month, which is posted on our Investor Relations website, SteadyMD offers a 50-state virtual clinician workforce, clinical operations and world-class technology that powers real-time matching between patient needs and clinical expertise.

The company provides virtual care for top consumer health care and digital wellness brands, including 2 Fortune 10 customers. SteadyMD maintains a roster of over 500 clinicians, is expected to service over 3 million patients in 2025 and is projected to generate approximately $25 million in revenue this year. SteadyMD's scaled network of virtual providers is expected to enable DocGo to achieve more efficient delivery of patient care by pairing DocGo's mobile health clinicians in the field with SteadyMD's clinical network over time.

We are enthusiastic about this acquisition for numerous reasons. First, it provides us with a 50-state virtual care footprint, which significantly expands our clinical capacity and positions us to extend our offering to both payers and providers. Second, we have long believed that pairing our last mile clinical delivery capabilities with virtual care has the potential to unlock the power and potential of telehealth and creates an optimal end-to-end solution. We look forward to the potential synergies this creates, and we'll look to both amplify our existing offerings and potentially launch new services next year. Lastly, we see strong opportunities for cross-pollinization between the 2 exceptional customer bases that both DocGo and SteadyMD have built, and we look forward to exploring those as well.

We continue to believe that DocGo has a unique ability to acquire traditional health care assets where we can overlay our technology, mobile health capabilities and extensive customer base to drive additional value. There are a wide variety of health care companies out there that see DocGo's last mile health care delivery capabilities as a missing piece, making us a very attractive partner, and we plan to remain active on the M&A front.

In sum, 2025 has been a transitional year as we move beyond emergency response contracts and increasingly focused on executing DocGo's evolution to a provider of long-term integrated technology-driven health care solutions that meet the needs of our customers today and tomorrow. I couldn't be more proud of the progress we are making as we are positioned for strong growth in each of our key verticals. We expect the investment in our early-stage business lines to gradually abate over the course of 2026. We have made a strategic acquisition in SteadyMD that expands our footprint, adds accretive capabilities and a roster of blue-chip customers that we can continue building upon.

Additionally, we continue to grow our pipeline of new business and look for potential acquisition opportunities, both of which can help us gain critical mass, achieve profitability and create additional shareholder value in the coming years. Our future is bright and valuable. We have the right products and services to address critical needs in our health care industry, have built differentiated technology and capabilities and have business lines such as Medical Transportation and Remote Patient Monitoring that are already firmly EBITDA positive, and we have the balance sheet to see our vision of bringing the doctor's office to the living room a reality.

At this time, I will hand it over to Norm to cover the financials. Norm, please go ahead.

Thank you, Lee, and good afternoon. Total revenue for the third quarter of 2025 was $70.8 million compared to $138.7 million in the third quarter of 2024. The year-over-year revenue decline was entirely due to the sunset of migrant-related projects. Excluding revenue from migrant-related programs, revenue increased by 8% to $62.4 million in Q3 of 2025 from $58 million in Q3 of 2024.

Medical Transportation services revenue increased to $50.1 million in Q3 of 2025 from $48 million in transport revenues that we recorded in the third quarter of 2024. Revenues were driven higher by gains in nearly all of our U.S. markets with some of the strongest growth in Texas and Tennessee. Mobile Health revenue for the third quarter of 2025 was $20.7 million, down from $90.7 million in the third quarter of last year, driven by the wind down of migrant services. Included in this year's amount was approximately $8 million in migrant-related revenues. Non-migrant Mobile Health revenues increased by more than 20% year-over-year, driven by increases in Care Gap Closures, Remote Patient Monitoring and Mobile Phlebotomy.

Adjusted EBITDA for the third quarter of 2025 was a loss of $7.1 million compared to adjusted EBITDA of $17.9 million in the third quarter of 2024. The adjusted gross margin, which removes the impact of depreciation and amortization and several one-off items and is the measure of margins that we track most closely, was 33% in the third quarter of 2025 compared to 36% in the third quarter of 2024. During the third quarter of 2025, adjusted gross margins for the Medical Transportation segment were 31.7% compared to 30.7% in Q3 of 2024 and the highest gross margins we've seen in this segment since Q1 of 2024.

During the third quarter, our transportation business ran at the highest utilization rates that we've seen. Given these utilization rates, it will be critical for us to expand our field labor team, which we would expect to lead to higher revenues and improved gross margins for Transport in 2026. Mobile Health segment adjusted gross margin was 36.2% versus 38.8% in the third quarter of 2024, but up from adjusted gross margins of 32.5% in the second quarter of 2025. We expect to continue replacing migrant-related revenues with relatively higher-margin service lines, such as remote patient monitoring and mobile phlebotomy.

On both the cost of goods sold and an operating cost basis, we continue to make significant investments in our Care Gap Closure business. We estimate that the adjusted gross margin for Mobile Health would have been above 40% in Q3 of 2025, excluding the Care Gap Closure business.

There were also some nonrecurring items that had a large impact on our GAAP results this quarter, so I'd like to briefly review them. Within the cost of goods sold area, we incurred increased insurance costs in the amount of approximately $5.2 million. These largely consisted of additional premium owed for workers' compensation coverage back in 2022 and 2023, driven largely by an increased migrant program-related employee base and the settlement of a large auto insurance claim for an incident in 2022 in the since discontinued California transport market. Also, within the operating expense category, we incurred noncash charges due to the write-down of various intangible assets and goodwill. These charges totaled $16.7 million in the quarter.

During the third quarter, we made further progress on strengthening our balance sheet by paying off the outstanding amounts under our line of credit, removing $30 million in debt from our balance sheet. We continue to collect our older, larger invoices, which allowed us to generate approximately $1.7 million in operating cash flow for the quarter despite our operating losses. Through the first 9 months of 2025, we have generated nearly $45 million in cash flow from operations.

As of September 30, 2025, our total cash and cash equivalents, including restricted cash and investments, was $95.2 million, down from $107.3 million at the beginning of the year. However, having paid down the entire outstanding balance on our credit line during Q3, our cash position net of debt is well above our net position as of the beginning of this year. Our balance sheet is now debt-free for the first time since late 2023.

Our accounts receivable continued to decrease, particularly for migrant-related receivables. At quarter end, we had approximately $37 million in accounts receivable from the various migrant programs, which represented a little more than 1/3 of our total company ARR. This compares to $54 million in migrant program-related ARR at the end of Q2, $120 million at the end of Q1 and $150 million at the end of 2024, which at the time represented approximately 71% of the company total. We've now collected about 96% of all of our migrant-related receivables from the inception of those programs until today, and we remain confident that we will collect all remaining outstanding amounts.

Now that we've improved our cash balance and paid off our credit line debt, we are well positioned to carry the company through this ongoing transitionary period. Over these final 7 weeks or so of 2025, we will focus intently on collecting the remainder of the migrant-related receivables. Assuming that these amounts are collected during the fourth quarter, we would expect our cash balances at year-end to be higher than they were at the end of Q3 after adjusting for the SteadyMD acquisition. We expect to exit 2026 at about $65 million of cash, which we expect will be the low point, subject, of course, to buybacks or any additional acquisitions.

Finally, as we head here into the home stretch of 2025, we'd like to discuss our outlook for the full year and offer a preliminary view on 2026. For full year 2025, we now expect revenues in the range of $315 million to $320 million. Of that amount, about $68 million to $70 million relates to migrant projects, so the base revenue should come in at about $250 million. For adjusted EBITDA, we see the full year 2025 loss in the range of $25 million to $28 million. For 2026, we see revenues in the range of $280 million to $300 million, which would represent a 12% to 20% growth over 2025 base revenues.

We anticipate a full year adjusted EBITDA loss of somewhere between $15 million and $25 million. However, at the top end of this revenue guidance range for 2026, we would expect to exit the year on an adjusted EBITDA positive run rate. On a sequential basis, looking at 2026, we expect revenues to increase and for the EBITDA performance to improve over each of the 4 quarters of the year.

At this point, I'd like to turn the call back over to the operator for questions and answers. Operator, please proceed.

[Operator Instructions]

And your first question comes from Pito Chickering from Scotiabank.

Looking at the implied margins for the fourth quarter, look to be sort of -- I think it looks like negative 13%. Can you help bridge us versus margins we saw in the third quarter of down 10%. How much came from SteadyMD acquisition versus core ops, just bridging the 3Q to 4Q margins?

So there wasn't anything in Q3 on SteadyMD. SteadyMD showed up in October. So you're going to get most of the quarter is SteadyMD. We think that number should be somewhere around $5 million in -- a little bit more than $5 million in revenue for the quarter. And I would say slightly EBITDA negative for that period. So it really shouldn't have a material impact. It's going to have an impact on the margin percentage. But otherwise, it's not going to have much of an impact. We will have lower -- we will have basically no revenue from -- or a very small revenue number from the migrant-related revenue. So that's also going to have an impact on the margin a little bit.

Okay. And then for 2026 EBITDA guidance, the implied margins there for next year are negative 10%. Yet we're exiting fourth quarter at sort of negative 13% margin. Can you sort of walk us through kind of how that improves throughout the year? And what should we be modeling in the first half of your EBITDA versus the back half of your EBITDA?

Yes, sure. So there are a couple of areas where we think we'll do a little bit better in terms of our model. First of all, on the gross margin percentage. So it's interesting to note that the Q3 adjusted gross margin, as we walked through, worked out to about 33%. That's higher than what we did in Q1 or Q2 of this year, and we think that it's something of a proxy for where we go in the next few quarters going forward. There are some projects that we have, especially on the transport side that we think will raise the gross margin a little bit. But realistically, those will probably have more of an impact in the second, third and fourth quarter of next year than here in the fourth quarter of 2025 or the first quarter of 2026. So there's a little bit of room over there as well.

And then on the operating expense side, so we continue to work hard at trying to reduce our SG&A. And as we were able to take a couple of million dollars out per quarter in SG&A, that should also have an impact towards the back half of next year. And then there's a scale. So our expectation, Pito, is that whatever we see in terms of revenue in Q1 will be the low point of 2026. It will go up then the way we model it out into Q2, into Q3, into Q4. And consequently, the EBITDA loss or profitability will improve every quarter as we go Q1, 2, 3 and 4. So we think that, that's going to have the impact.

So going to your second question, as far as the breakdown, the -- I would say the bulk of the expectation for a negative EBITDA number is going to come in the first half of the year. It's clearly going to be skewed towards the first half of the year in terms of those losses. And then you get a much smaller loss in the third quarter and maybe even perhaps we think a positive number in the fourth quarter.

Okay. And then last question for me. Looking at for 2026 revenue guidance, how much do you assume for migrants for next year? And how should we be modeling transport versus Mobile Health next year?

Absolutely, Pito. This is Lee. So in terms of migrant-related revenues for 2026, we don't expect any migrant-related revenues for 2026. So that number will be 0 for next year. In terms of the breakdown for the guide, it's important to note that the guide really is -- current guidance is based on the baseline of the business as we see it today. Any new contract wins or M&A would be in addition to the number we're sharing tonight. The breakdown is about 2/3 Transport, 1/3 Mobile Health. That's essentially the way to look at it.

And your next question comes from Sarah James from Cantor.

I wanted to dig a little bit more into the Payer-Provider revenue growth. So you guys obviously have a very strong pipeline there. It sounds like when you step up from $50 million in '25 to $85 million in '26, am I right in annualizing the SteadyMD impact to be $15 million of that and then you'd have $20 million from organic growth? And then what kind of deal closure assumptions does that include for the pipeline that you talked about with possibly expanding your existing 2 national payers or adding in 2 others?

Absolutely, Sarah. Thanks for the question. So first off, the $85 million for Payer and Provider for next year includes about $25 million from the SteadyMD acquisition. That's the run rate the business is on. Of course, we announced that acquisition a few weeks ago. So we're in the process of integrating it. So we have a $25 million of the $85 million as SteadyMD contribution for next year and the remaining would be the $60 million from our current Payer and Provider baseline business.

To answer your question specifically, I'm glad you asked it, it does not include any deal closures or additional M&A or contribution from our pipeline. We're looking at the contracts we currently have today. We're looking at the geographies we currently operate in today, the list of patients that have been provided to us so far and our current customer set and basing our guidance for next year off of that, both for Payer and Provider and the Transportation portions of the business.

Great. And can you help us understand what does it look like when you expand the Payer-Provider contracts going from Transition of Care to Care Gap Closure to Longitudinal? What are the orders of magnitude of revenue that, that could impact or the way it could change your margin profile for that segment?

Absolutely. So as you mentioned, Sarah, mostly our Payer and Provider contracts typically start with either Care Gap Closure services where the payers provide us with a list of patients that have open care gaps. They haven't been seen. This could be diabetic retinal exams, bone density scans, annual wellness visits, vaccinations. And then we go and engage those patients, we meet them where they are, and we help close out those care gaps. And these are chronically ill patients. They're typically patients that are costing the health plans a lot of money. And so the health plans are heavily incentivized to make sure they're reaching these patients. And if they don't, their quality scores for their plan are negatively impacted. And then, of course, patients end up landing in the hospital. That costs the payers lots of money.

So they're providing us with a list of patients. These are the patients that have open gaps in care, and we're going to see them. So they either start with Care Gap Closure or Transitional Care Management. And so as the patient is being discharged from the hospital, they've already been hospitalized or they visited the emergency room, they're leaving the hospital. We work with them to make sure that their transition of care to the next setting could be their home, could be another facility. We make sure that their discharge plan is well taken care of and that we're redressing the incision site, titrating meds, making sure we're checking their vital that their transition of care is well taken care of and they don't end up back in the hospital. That's where our services typically start with the payers.

What we're also finding is a lot of these patients need primary care services and preventative care. And so as I mentioned, we're in the process of expanding the relationships we have into primary care and preventative care, more longitudinal care. So instead of going to serve a care gap closure visit or transitional care, we're providing the long-term care and the preventative care and the primary care for that patient. And that's typically step 2 in that process.

And then you can see scenarios where we enroll those patients in Remote Patient Monitoring, as I mentioned. And so really, developing the patients in the care they need, meeting them where they are, closing care gaps to start and then making sure they have the proper primary and preventative care. That's how the progression of those contracts typically take. And then the lists get larger, the patient needs get bigger and more varied, and then we're there to sort of expand into those payer contracts as they see really the impact of our work and how better off their patients are with our services.

I know we've shared -- and I want to share one more piece here, which is with a lot of the health plans we work with, one example we gave, which I gave in the prepared remarks, we've helped reduce their ED readmission rate by over 50% for the patients in that transitional care management program. So the payers are seeing real benefit, and they're continuing to give us more and more work. And so that's what we're basing our guidance on is the contracts we currently have and the ability to expand with our current customer set. Any new additions from the pipeline or M&A or any significant contract wins would be in addition to the guidance we're giving tonight.

And your next question comes from Ryan MacDonald from Needham.

Maybe to start on the transportation side. So it's great to hear about the heightened levels of utilization and sort of that being a signal for incremental investment to scale the team. But how do you balance sort of supply/demand in terms of what you're seeing so that as you continue to scale the team that you have enough demand to sort of utilize those teams in an optimal way so it's not becoming sort of margin dilutive?

Absolutely, Ryan. Thanks for the question. So I thought it was important for us to mention how many trips we're currently outsourcing or handing off to other vendors. And so we looked at that number over the last 12 months. It's added up to about 26,000 trips. So that's really the number we're using as sort of the embedded demand we have and the contracts we have and how much staff and supply we need in order to meet that demand. And that's really the number we're working off of. Of course, new contract wins, we'd have to hire more, but that's the number we're working off of.

And we've been able to quantify those trips in all of our markets and then the corresponding level of staff that we would need in order to satisfy those trips and not outsource them. And so that's what we're basing our entire hiring plan around. If you add those up, those 26,000 trips across all of our markets, it looks like we have to hire about another 700 to 800 staff. Now I'll tell you, we've made progress on that over the past number of weeks here, but we're continuing to ramp that up pretty intensively right now. We have big work streams going within the company to make sure that we're both retaining the great staff we have and attracting new team members to join so that we can scale those efforts. But it's really based off of the number of trips that we're already outsourcing from the embedded demand we have from our contracts.

Helpful color there. And then maybe as a follow-up, obviously, great to hear about the continued scaling and growth in the remote patient monitoring business, 13 contracts this year, 8 more proposals. Can you just talk about what some of the core areas and sort of care areas that you're focused in with remote? And really, the genesis of the question is a bit is, obviously, the recent news about United rolling back RPM, except for, I think, chronic heart failure and hypertension during pregnancy. Just kind of curious what you're hearing in the market of does that sort of create a knock-on effect at all for other payers in the market?

Yes, Ryan, I'm so glad you mentioned that. So actually, our core offering in remote patient monitoring is really in the cardiology space. So you mentioned chronic heart failure and other insurance companies rolling back coverage to just cardiology and heart disease. That actually would bode well for us. We have a deep expertise in cardiology and implantable cardiac devices like loop recorders, pacemakers and so forth. So that's really our specialty, and that's the area where we're investing in.

So that's the focus of our remote patient monitoring efforts is these devices that are transmitting data, particularly for heart failure and other cardiology-related chronic conditions. We have been expanding since from that into other specialties like diabetes and others, but the core focus of our group right now is in cardiology.

And your next question comes from David Larsen from BTIG.

This is Jenny Shen, on for David. First, I just wanted to ask about your current view of the hospital and hospital spending environment as a whole. We've spoken to some hospital executives who've said some of the uncertainty in the market, including around things like ACA and Medicaid have caused them to be more cautious with their budgets, and they're expecting there could be pressure on volumes and spending. Have you had or heard any of that sentiment with your customers so far, but it looks like volumes are strong. Just any thoughts on hospital customer sentiment on spending?

Absolutely, Jenny. It's great to hear from you, and it's a great question. So look, I think it's still early to tell what really the impacts will be from any new legislation. But you can certainly see an area where perhaps there's more Americans that are underinsured or uninsured and they end up in hospitals, emergency rooms and really straining capacity. And then, of course, perhaps those hospitals won't be able to recoup reimbursement from underinsured or uninsured patients. So it's definitely a concern.

We spend a lot of time with hospital executives, and I speak to hospital system CEOs very regularly. And I think our core focus is on how we can save them money and be more efficient. That's really always been our focus. We feel like we can help them manage their patient flow, make sure patients are not staying an extra night in the hospital if they don't need to because they couldn't get the medical transportation coordinated. We help with that. Our platform specifically is designed for that. And so we feel like we've gotten receptivity from hospital systems very recently to that.

And then, of course, on the payer and provider side, our whole goal, again, whether it be with hospital systems or payers is we want to help lower their costs and their utilization. And so that transitional care management program I described, when a patient is getting discharged, that is a critical moment in patient engagement. They're leaving the hospital. And so we're there bedside often, scheduling follow-up appointment, making sure that we're going to go and see them perhaps in their home to make sure their discharge planning is being taken care of. That is very valuable, and that will help patients stay out of the hospital. And that helps hospitals because hospitals get penalized if patients bounce back within a 30-day window. And so we're helping keep patients from doing that. And it helps the payers because, again, patients are most costly when they're in the hospital.

So again, we really are excited by what we're building here. We think it is very timely. We think it's incredibly strategic to the health care ecosystem. And really, it's all designed on trying to save the system money, the hospital's money and the payers' money and that we think will be successful with that.

Yes, Jenny, what I would add to that is that I can say anecdotally that in the last 6 months or a year, we've had conversations with hospital systems that we've been in the ambulance business for quite some time, but there are some big hospital systems we've spoken to that we had not really spoken to prior to, let's say, the last 6 or 12 months who are now thinking about precisely that, outsourcing the management of the flow of patients into and out of their facilities, something that they had always done on their own. It's always been a pain point to them, and now they really have to think about being more efficient and getting it off their plate. So we're having -- we have opportunities that I don't think even existed a couple of years ago.

That sounds great. And then for a quick follow-up. Have you seen any impact from the government shutdown? Has that impacted any municipal decision-making at all?

Yes, absolutely. So we've shared over the past several earnings calls, we've actually emphasized less our work in the population government space. So we've really been focused on the hospital systems, the payers, the providers. SteadyMD is now customer set, it's going to get more and more of our attention, time and resources. And so that's really where our big focus is.

And again, I think honestly, it's very early to tell any impact from some of this legislation or policy changes. We don't see it yet. And frankly, a lot of the policy changes kick in later on down the road next year or the year after. So we're really heads down. We think our value prop speaks to whatever environment the health care system or policy may be, whatever situation the health care system may be in or whatever policy that there may be an effect because, again, we're there to help save the system money, save hospital systems money, help CMS save money, help our insurance partners save money. And that's really our goal, and we think that will be germane and relevant no matter what going forward here.

And your last question comes from Mike Latimore from Northland Capital.

This is Aditya, on behalf of Mike Latimore. Could you give some color on how are the bookings in the third quarter? And how much did they grow sequentially?

For which business?

Like overall, yes.

I mean we saw sequential growth in almost all of our businesses. In Transport, we would see, let's say, in the U.S., and we look at it in terms of the number of trips that we carried. So we saw like a mid-single-digit sequential growth in trip count, which for a quarter-over-quarter number, that's very, very good. We're happy with that. Obviously, our Payer and Provider business lines all showed some growth during the quarter. I think every one of those business lines showed a higher revenue number for Q3 than for Q4.

So in fact, when we look towards 2026, if we would simply take the Q3 results and annualize them, that would already put us in pretty good shape as far as the guidance that we gave. So we definitely saw a pickup in volumes. And I think we mentioned in the release or elsewhere that we did see record volumes. Now granted it wasn't blowing away our previous records, but we did see higher volumes across all of those business lines in Q3 than we had ever seen.

Got it. And how much cash do you expect to have at the end of the year?

So just using the end of Q3 as a baseline, we had $95 million when you take cash and the restricted cash as well or $73 million, if you just look at the unrestricted cash. We would expect that number to go up net by a few million dollars, assuming that as we expect, we will collect on the remainder of the large migrant-related invoices that are out there, that would be enough to cover any kind of operating loss, and we should be able to squeeze out some operating cash flow on that basis. So we would expect that the number will go up a little bit by the end of Q4.

As we've shared, we think that, that number from there starts to go down at the end of Q1, at the end of Q2 before picking up in the back half of the year. But we feel that we would exit 2026 at a number that's about $65 million or higher.

And there are no further questions at this time. I would now like to turn the call back over to Mr. Lee Bienstock. Please continue.

Thank you, and thank you all for joining us today. Be well.

Ladies and gentlemen, this concludes your conference call for today. We thank you very much for your participation. You may now disconnect. Have a great day.

Greetings, and welcome to the DocGo acquisition of SteadyMD. [Operator Instructions] As a reminder, this conference call is being recorded. I would now like to turn the conference over to your host, Mike Cole. Thank you. You may begin.

Thank you, operator, and thank you all for joining the call today. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call other than statements of historical fact are forward-looking statements.

The words will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expectations.

Forward-looking statements are inherently subject to substantial risks, uncertainties and assumptions, many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements.

These risks, uncertainties and assumptions include, but are not limited to, the risk that the cost savings and synergies from the transaction may not be fully realized or may take longer than anticipated to be realized, disruption to the parties' businesses as a result of the transaction and associated integration activities, reputational risk and potential adverse reactions of SteadyMD or DocGo customers, employees, vendors, contractors or other business partners, including those resulting from the announcement or completion of the transaction, the extent to which SteadyMD's business will perform consistent with management's expectations and projections, accuracy of projections and those other risks discussed in our risk factors and elsewhere in DocGo's annual report on Form 10-K, quarterly reports on Form 10-Q, Form 8-K disclosing this transaction and other reports and statements filed by DocGo with the SEC to which your attention is directed.

Actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward-looking statements. In addition, today's call contains certain financial forecasts related to SteadyMD and the transaction. These projections have not been audited and should not be relied on as being necessarily indicative of future results.

The assumptions and estimates underlying the prospective financial information are inherently uncertain and subject to a wide variety of significant business, economic and competitive risks and uncertainties that could cause actual results to differ materially from those contained in this presentation. Accordingly, there can be no assurance that the prospective results are indicative of future performance of SteadyMD or that actual results, including on a combined basis with DocGo will not differ materially from those included in this presentation.

Disclosure of the prospective financial information on this call should not be regarded as a representation by any person that the results contained in this prospective financial information will be achieved. The information contained in this call is accurate as of only the date discussed. Investors should not assume that statements will remain relevant and operative at a later time.

We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law.

At this time, I will now turn the call over to Lee Bienstock, CEO of DocGo. Lee, please go ahead.

Thank you, Mike, and thank you all for joining us today. I'm Lee Bienstock, CEO of DocGo, and we are excited to share more about our announcement that DocGo has acquired SteadyMD. And today, joining me to help us do that is Guy Friedman, CEO and Co-Founder of SteadyMD.

Thanks, Lee. Hi, everyone. I'm Guy Friedman, the CEO and Co-Founder of SteadyMD, and we're excited to join the DocGo team and build a fantastic business together.

Likewise, thanks so much, Guy. So those that are new to the DocGo story, DocGo is a leading provider of tech-enabled mobile health care. We provide services across 31 U.S. states and the U.K. today with a fleet of over 900 mobile health vehicles powered by our proprietary tech platform and our heroes in the field, our over 3,000 clinical staff that are out providing care to where patients need it, when they need it every day.

Since 2015, we've served over 10 million patients and our patients absolutely love the services we provide. We have over 92 patient Net Promoter Score. We have multiple service lines. We provide world-class medical transportation and medical transportation management powered by our tech platform and our state-of-the-art fleet as well as the thousands of EMS professionals that I mentioned that are out every day providing exceptional medical transportation and medical transportation management. This year, we expect to transport over 750,000 patients.

We provide in-home medical care with an innovative approach, which I'll talk more about that uses upskilled clinicians to provide care in the comfort of a patient's home, office or community setting. And this year, we expect to provide and visit over 150,000 patients and provide care in their homes as well as mobile lab. We also provide remote patient monitoring with an empowered care team that provides continuous insight and monitoring on patients' health, driving smarter patient care plans and stronger patient engagement and this year, we expect to monitor over 50,000 patients, and we do that with an incredible roster of partners and customers ranging from Mount Sinai to Jefferson to Northwell to Molina and LA Care, the NHS in the U.K. and more, and now we're excited to add a 50-state tech-enabled telehealth platform in SteadyMD.

So how do we do what we do? How do we bring care into the home of patients at scale. And it really comes down to our innovative hybrid care delivery model, where we utilize mobile health clinicians that are LPNs or RNs, licensed practical nurses or RNs who travel to patients' homes and patients' locations with specialized equipment. They are the hands, eyes and ears in the patient's home where they are, and we pair them with physicians, PAs and NPs that oversee the clinical visit virtually, synchronously, directing the LPN in the home to provide back real-time diagnostics screenings and other data so that the patient can receive a comprehensive visit, a high-quality visit in their home. It's this innovative approach that allows us to scale this model efficiently.

I like to say the doctor coming to visit you is a 100-year-old idea. The doctor used to go visit their patients in the home, but it was just inefficient. There was a lot of drive time in between, and everyone knows we just don't have enough advanced practice providers in this country to meet the demand, and so in order to leverage that scarce resource maximally, we have them oversee virtually our LPNs in the field with our tech platform, and so SteadyMD is really going to help us scale this, by providing, we'll talk more about it, the hundreds of advanced practice providers in the telehealth platform that will allow us to scale this mobile health care delivery across the country and the U.K. Guy, maybe talk a little bit more about SteadyMD and the incredible platform that you and the team have built.

Yes. Thanks, Lee. Appreciate that. So yes, SteadyMD was founded 9 years ago in 2016. Originally, our business model was in the virtual primary care space, selling direct to consumers. In early 2020, we pivoted to our current business model. Today, as the slide shows, we power some of the largest digital health companies in the world from the Fortune 100 to the most innovative startups doing cutting-edge digital health and caring for patients in new and unique ways.

So the way our business works is digital health companies integrate with our platform, and we power their offerings with our 50-state clinician network, which is comprised of hundreds of NPs, PAs, MDs and other specialists, built a robust technology platform with great APIs, a custom EMR and online clinic, spent a lot of time and energy building custom scheduling, workforce management and other operational technology to make this all run.

In the past year, we've had very solid growth. We've seen approximately 3 million patients spanning from lab orders to urgent care visits and long-term care in a lot of different digital health verticals. So we're excited to join the team and keep building this and building upon the work we've done so far.

It's incredible, and to see the roster of customers that you have and the scale that you've been able to achieve with the team and the quality of the product and the platform is just incredible, and we think together, we have a really incredible foundation to build tremendous mobile health and virtual care management platform.

Now I wanted to spend some time for us to touch on the synergies that both of us are going to bring and achieve together, how DocGo is going to benefit SteadyMD and how SteadyMD is going to benefit DocGo. So I mean, first, how SteadyMD benefits DocGo, we talked about it. SteadyMD's 50-state virtual provider network is going to really help augment DocGo's in-home care delivery, and the use of SteadyMD's hundreds of telehealth-based providers is going to potentially garner up to 10% of a gross margin improvement for our in-home visits, and SteadyMD is going to help us more quickly launch into new geographies with their existing scale and their existing presence, and we think the ability to cross-sell B2B telehealth services to our partners and customers is going to be a big opportunity as well.

So we really feel that SteadyMD is going to bring a lot to the DocGo platform and allow us to scale faster and more efficiently. Guy, maybe touch on what DocGo is going to help bring to the SteadyMD platform and ecosystem.

Yes, absolutely. I mean it's always been kind of a dream in the industry to combine virtual care and in-person care, both are extremely complex businesses. If we can offer a combined offering to both our sets of customers, it's truly an end-to-end solution, and that has a tremendous potential for growth and the ability to care for more patients in a better way nationwide.

So it's really an end-to-end solution where we can augment our clients and our partners with in-home care and all the services DocGo provides, and I think with DocGo's support, we'll be able to offer all the rest of the infrastructure DocGo has built to our partners as well. So it's really an amazing combination. I think it's going to be a revolutionary progress moving forward.

No question, and I want to kind of illustrate that a little bit more deeply here on how SteadyMD's telehealth platform is really going to accelerate DocGo's service offerings. So first off, we think SteadyMD is going to help advance the growth of our quality and gap closure programs, our world-class quality and gap closure programs, as I mentioned, by bringing SteadyMD's already existing 50-state virtual care platform that's going to seamlessly integrate into our mobile health care deployments, allowing us to scale in the markets we're in, allowing us to scale to new markets and expand our home visit capacity is going to be tremendous.

Not only that, SteadyMD has big scale in lab order approvals, and obviously, DocGo has a fast-growing in-home phlebotomy, in-home lab business, and so SteadyMD's providers are going to be helping order diagnostics. They already help order diagnostics for major lab companies and employers, and of course, we can layer in DocGo's capabilities to that to provide in-home mobile lab and in-home phlebotomy, and as I mentioned, DocGo's mobile phlebotomy fulfill specimen collections in the home. So that pairs very nicely with SteadyMD's platform that's already providing order diagnostics for major, major lab companies.

And then, of course, we've talked about it at DocGo. We've shared primary care is a big focus of ours, primary care, preventative care in the home, helping keep patients healthier and out of the hospital. That starts with great preventative primary care, and so SteadyMD's providers are going to significantly increase the capacity for our primary care patients and DocGo's in-home services are really going to augment SteadyMD's primary care practice. So that combination is going to allow us to bring primary care to even more patients much, much more quickly, and so many of the patients that we go and see to provide care gap closure programs and care gap services, so many of them don't have a primary care provider or haven't seen one in over a year, and we know there's a primary care provider shortage in this country.

And so the ability to pair these two platforms together is going to help address that and the need is absolutely there and the need is great. Now how do we do this? One of the big components of really this integration are the two world-class proprietary health tech platforms that we're both bringing to the table, and DocGo's platform helps optimize mobile health resources in the field to provide maximum utilization with the right vehicle, the right clinician at the right time, at the right location, all at scale, scale I talked about. and SteadyMD's platform that optimizes the clinical resource utilization, the right clinician for the right patient at the right time via telehealth at scale.

So this is a profound combination of tech platforms that help do and accomplish essentially the same thing in the field and remotely, and pairing those two together are going to allow us to be incredibly efficient and allow us to scale to much, much greater capacity, and so both platforms are purpose-built to create efficiency in last mile care delivery, and that is going to be a tremendous benefit to our customers, to our partners, to our patients by combining these two tech platforms, and we're very, very excited about that.

So how did we structure the transaction? DocGo acquired SteadyMD for a purchase price of up to $25 million, which involves an upfront payment and a contingent payment, and DocGo funded the transaction through our existing cash on the balance sheet. Any contingent earn-out payment will be paid in either cash or stock at DocGo's election, and SteadyMD is expected to generate approximately $25 million of revenue in 2025 and is expected to be EBITDA positive in 2026, and I already talked about all the synergies and overlap and efficiency that both platforms are going to hopefully achieve together.

Our mission has always been to bring high-quality care to where it's needed, when it's needed, helping patients lead healthier lives and stay out of the hospital. Where we are needed, we go, and now with SteadyMD, we'll be able to go farther more efficiently faster, and I couldn't be more excited about our future.

Now we'll hand the call back to the operator for Q&A. Thank you.

[Operator Instructions]

Our first question comes from Michael Latimore with Northland Capital Markets.

Great. Congrats on the news. Very exciting. Just curious if you guys have worked together in the past with any customers? How did you know each other?

Michael, absolutely, thanks for the question. So SteadyMD has been on our radar for quite some time. Actually, when we first started providing in-home services, we had looked at the marketplace for some potential partners to power the telehealth portion overseeing and directing the mobile health clinician in the home, and at the time, we had looked at some of SteadyMD's competitors, and they didn't have the capabilities or frankly, the quality that we needed. And we thought, well, maybe perhaps we'll build out this capability in-house.

As we started to scale, we realize we want to go faster. There's an opportunity for us to be a lot more efficient. And so we started looking at utilizing and leveraging a partner again and SteadyMD rose right to the top of that list. The ability to scale to all 50 states, they're already licensed and servicing patients via telehealth and have customers with patients in all 50 states. And we realized pretty quickly that, yes, there's a partnership opportunity here, but there's a much bigger opportunity for us to integrate more deeply, for us to cross-sell and provide our various different solutions to our different customer bases. And so we started to get very excited about the ability to combine both businesses, and that's when we really started heading down that path.

And so that's really what we're excited to do. And we've been looking at this portion of the market. We've tested with it. And we think that SteadyMD far and away has the best quality, the best leadership team, the best tech platform that will help pair in real time, the telehealth provider, the virtual care provider, the advanced practice provider with our mobile health clinician in the field, and we feel very, very excited to merge the 2 platforms together, and we think that it's going to be very accretive both to the top line and the bottom line.

Yes, makes sense. The 10% gross margin lift, was that for Mobile Health overall, the Mobile Health segment or a subsegment of Mobile?

That's right. It's for the Mobile Health segment, really specifically targeted at our in-home business. So the ability to pair SteadyMD's advanced practice provider with DocGo's mobile health clinician in the field. Really, the advanced practice provider overseeing the mobile health clinician in the home is the most expensive component of our in-home visit, and it's actually one of the most difficult portions of the visit to fulfill with the advanced practice provider.

And so we want to get a lot more efficient with the advanced practice provider utilization because it is the most expensive component, and that's exactly what SteadyMD is bringing to us. And so that paired with our mobile health logistics platform and the mobile health deployment, the LPNs in the field is going to bring us that gross margin improvement.

The other thing that we've been talking about is, as you know, we acquired a mobile phlebotomy company earlier in the year as well. And so we're also looking at leveraging our fleet of mobile phlebotomists to do some of the care gap and some of the care gap closure program work in the home. They can't do all of the services we provide. I mean that's one of our big competitive advantages.

We provide over 40 different clinical offerings in the home. Some of them a mobile phlebotomist can do, and so we're looking to leverage them as well, which will also drive a gross margin improvement for some of the, call it, more entry-level care gap closure visits in the home, and then we're also going to pair that with SteadyMD.

So what you see us doing here is really putting the pieces in place to be very efficient in the field, using the right clinician for the right patient need in the field, paired with the right clinician for the right patient need virtually, and as we start to put those pieces together, we're going to get scale, which is SteadyMD is significantly bringing to us and efficiency, and that's really the power of what we're doing here and what we're announcing.

We're getting scale and efficiency on the advanced practice provider on the virtual side, and we've been obviously making investment on the mobile health clinician in the field. And the pairing of that is really the big opportunity here, and we're excited about it.

Our next question comes from Ryan Langston with TD Cowen.

On the cross-selling point, I guess what is the overlap of the two books of business kind of currently look like? I'm just trying to get a sense of the overall opportunity maybe just currently to cross-sell those services between the two businesses.

Absolutely. Absolutely. Thanks, Ryan. So first off, on the existing sort of customer overlap, I think the big area there is really with the labs that we both work with. So we have a deep integration with one of the large major labs. SteadyMD works closely with another major lab that we work with less. So we think we're going to be able to really scale our lab business pretty significantly by working together, bringing some of the lab customers we have, SteadyMD is going to bring some of the lab customers they have. And so we're going to be able to build out that infrastructure and that scale.

And then I think there's actually a big opportunity to cross-sell customers that we don't have that SteadyMD has and to cross-sell the SteadyMD customers, but also cross-sell the DocGo customers that SteadyMD doesn't have. So we're looking forward to that. I think SteadyMD works with essentially direct-to-consumer B2C providers, wellness companies, a lot of health tech start-ups, and they have a huge roster of customers, some really, really impressive names.

We're very excited to work with together with them, and then I think we really bring the enterprise hospital systems and payer partners that they don't have. So there's a big opportunity here, I think, to work with the already existing customer base we both have that overlaps, but we're also very excited to be introduced to a new customer base and then the same. So I think there's opportunity for both.

Cool. And then just last for me. I'm sorry if I missed it. I know you did mention some gross margin lift, but maybe just run through the growth profile of this company, maybe in terms of just revenue or a long-term algorithm, just how we should think about it maybe over the next couple of years? And maybe just a little bit more on how you think you can sort of leverage maybe existing G&A at both SteadyMD and DocGo over the next couple of years with that revenue growth.

Of course. So on the G&A side, I think we've already -- we've done a lot of work upfront on this, a lot of work upfront. We mentioned in our press release that Alvarez & Marsal was retained, and they helped us look at some of the overlap on the G&A side, some of the synergy side, they made great pairing with us to look at some opportunities there. So of course, on the G&A side, when it comes to compliance, human resources, finance, payroll, benefits, we're already identifying some really great overlap and synergies that just naturally comes from an acquisition like this. And then I was touching on the synergies really in the patient care delivery. I mean that's where there's huge synergies as we go to market together in the home and virtually.

So we've sort of identified both gross margin and G&A synergies as part of this, and we've had some really great minds helping us think through all of that, and we have a really solid plan going forward. In terms of the growth profile, we'll share a lot more about sort of the financial profile of the combination, what it does for our guidance going forward for the rest of this year and into next year. We plan on sharing a lot more details about that on our earnings call coming up here in the beginning of November. So we'll dive a lot more into that.

But we definitely think there's an opportunity for us to accelerate the growth trajectory of SteadyMD. It's a very impressive company. They have an incredible roster of customers. The solution is best in breed, and then we think that we can layer on both our resources and our infrastructure to help them scale even more. So that's what we're looking at doing. They have a very strong growth profile, and we think we could supercharge that.

Our next question comes from Ryan MacDonald with Needham & Company.

This is Matt Shea on for Ryan. Congratulations on the deal here, guys. Nice to see how SteadyMD can accelerate a variety of your service offerings, but maybe relative to the payer business, was the deal in part from an increased level of demand or patients being assigned to DocGo and SteadyMD is needed to help service that demand? Or how should we think about this potentially accelerating the payer and care gap business?

Yes, Matt, that is spot on. Great to hear from you, Matt. So absolutely. I think on the payer side, that's a big -- everyone knows that's been following our company, we have a big opportunity there. We're going to see patients that don't have good access to care that have mobility issues. We're going into their home. We're closing care gaps. We're helping provide preventative care, keeping patients out of the hospital where they're most costly. I mean that's a big opportunity for our company. We've been investing into that.

We have a world-class solution. Patients absolutely love it. I mentioned we have a 92 Net Promoter Score on that. And so we want to be able to scale it. I think there's really two aspects to this. One is new geographies, and we're going to be very thoughtful about that. But SteadyMD has a 50-state presence, and so that can allow us to scale a little bit more quickly to new geographies.

We'll always continue to expand to new geographies consistent with our profile where we have an anchor customer there. And so as an example, we work with a payer today in one of our markets, and they asked us to expand to New Mexico, which we had announced. And so this will help us expand there a lot more efficiently, a lot more quickly. But of course, we also have that anchor customer to come with it. And again, care gap closure services for that expansion. So there's no question about it there.

I'll also mention on the PCP side. So a lot of the patients that we go and see, I mean, 1 in 4 Americans doesn't have a primary care provider, doesn't know who it is. And so there's a big opportunity there. Actually, a big percentage of the patients we go see don't know who their primary care provider is or haven't seen a primary care provider. So we are continuing to invest in the capabilities to provide great primary care, which we feel ultimately improves patient outcomes, which is going to be a huge value, obviously, to patients, but also to the payers and the ecosystem at large.

So SteadyMD has a deep history in providing PCP services. SteadyMD has a deep history in providing preventative care, urgent care. And so we're going to leverage their expertise in that space and allow us to go a lot more quickly into PCP. We recently had one of our payers tell us that they plan to give us list of patients, 10,000 patients that are in need of PCP services.

So we have the opportunity there. We want to scale into it. It will take us time to scale into that when you're talking about those types of numbers, but this will help us absolutely give us a head start on that with SteadyMD.

Okay. Great. That's helpful. And then on the synergies on the cost side, exciting to see that 10% gross margin improvement. How should we think about the time line or maybe the pace of that expansion?

Yes. I think that our plan is to integrate pretty quickly here, really to effectuate everything that we shared on this webcast. I think we're really looking to have everything in place sort of that integration happen over the course of the rest of this year and into Q1 and really hitting stride sort of in that Q2 through the remainder of the year.

So I think that's really our time line here. I think we're on a, call it, 3- to 6-month time line to really integrate and effectuate all of the synergies that we have planned here, and again, I think we have a really robust and well thought-out plan as part of this acquisition. I'm really proud of really all the work that's gone in ahead of this. We were very thoughtful about it, and we really enlisted world-class advisers, and so I think over the course of sort of 3 to 6 months, you'll start to see integrations, but pretty quickly here, we're going to be looking to leverage the virtual platform of SteadyMD to help us expand, and so -- and then I think you'll start to see the synergies start coming into place at the beginning half of next year.

Our next question comes from John Pinney with Canaccord Genuity.

John Pinney on for Richard Close. Congrats on the acquisition. So I guess, can you go into what like the revenue model is for SteadyMD currently? Is it mostly like visit revenue? Is there some like recurring revenue based access to the tech platform? Or just any commentary you can provide there?

Yes, absolutely. So I mentioned -- so SteadyMD, they provide telehealth visits and also lab visits. To give you a sense, on the telehealth side, they did -- they're expecting about $900,000 -- over $900,000 this year and there are 2 million lab visits. On the pricing side, I think pricing varies. It depends on the services that they're providing.

SteadyMD really prides itself, and we were very impressed by this. They engage deeply with their customers. They try to understand exactly what their needs are, and they put together sort of a specific program for them. But I think the way to sum it up, typically, it involves a monthly fee along with a per visit fee or an hourly fee depending on the clinical services. And there are -- they also have monthly minimums, which is very smart and it sort of protects them, which we like to see. So many of SteadyMD's customers are deeply integrated with them. That's another big component of it with their platform. And sort of the SteadyMD platform in that regard provides recurring monthly revenue for us. So we're excited about that.

We think they've gone to market very intelligently. They run their business very well. They're looking at providing tremendous value and also ensuring that their company is protected. So we are very impressed by that, and we think sort of a very, very good model, which aligns incentives with the customers and also the company, which is -- and patients, which is something we always want to see.

I always say all three have to win. The company has to win, the customer has to win and the patient has to win, probably most importantly, and then we'll be successful. Their contracting and model very much is in line with that.

All right. Great. And I guess one more quick one. So for -- on the press release, you said like there's $20 million revenue like expected through September 30 and then $25 million for all of 2025. Is there anything to call out for like the implied sort of softer fourth quarter? Or is that just kind of some conservatism or anything to call out there?

Yes. Great question, John. So I think our goal was to really kind of give a view in the press release of sort of what SteadyMD has done so far up to this point in the year. We're going to give a lot more sort of color and specificity on the earnings call. And that call is in say, a few weeks here in the beginning of November, we'll announce the date pretty shortly. So I think we'll talk a lot more about what the expected revenue contribution is going to be for SteadyMD for this year, the remainder of this year. I mean the year is almost done, but the remainder of this year and then into next year. But we didn't want to put out a specific number.

So we said basically a little over $25 million for the remainder of the year, but we'll adjust that, and we'll update that with a sharper pencil and give more specificity on it on the earnings call coming up.

Our next question comes from David Larsen with BTIG.

Congratulations on the transaction. Can you talk a little bit more about the margin profile of SteadyMD? Just generally speaking, how is like the gross margin? Is it a tech company? Or is it more a provider business?

Of course. So SteadyMD is sort of cut from the same cloth as us. It's a tech platform that also provides the clinicians. So to me, I think that really is the future of health care. And I know, David, we've talked about that a lot. I think that the companies that are going to win both provide the technology, but then also sort of the boots on the ground or the virtual providers to pair with it.

I think so many of the customers we speak to people are trying to sell them software. And the software is great, but you also have to have the workforce to utilize that software to actually implement clinical offerings. And so we really feel that, that is a key component of our strategy. I mean we leverage technology. We purpose-built it ourselves, which we've done at DocGo. SteadyMD has done that on their platform. And so -- but they also provide the clinicians that go with it. And we're going to continue to invest that way. I see some questions in the queue here relating to technology and AI, which I'll touch on.

But essentially, that's our big sort of strategic vision is that we want to have a tech platform enabled by the clinicians that utilize it and are providing care and providing that to our customers, and that's a big competitive advantage for us. I think the addition in terms of margin specifically, I think the addition of SteadyMD is going to help us achieve our gross margin objective of 40% plus for the mobile health business.

I think SteadyMD's current gross margins are in line with that. And I think, again, we talked about on this call, but I think SteadyMD is going to help us elevate the gross margin of DocGo's current health care in the home business, right? So it's twofold, right? I think it's going to help us achieve our gross margin objectives on the in-home visits. And then, of course, their gross margins in line with this 40% plus mobile health gross margin goal.

So really, it's about -- this is about efficiency. It's about high utilization of the advanced practice providers overseeing the mobile health clinicians in the home. And then it's also about us bringing the mobile health clinicians to the SteadyMD platform so that they can offer the ability to go see patients in their homes or where they are to the SteadyMD customer base. And once we scale that, we're going to see some good gross margin accretion here.

Okay. Great. And then just one more quick one. Can you talk about the difference between the telehealth tech that SteadyMD has versus what DocGo did or did not have previously? Because it was my understanding that there was some virtual care capabilities that DocGo had, basically, the nurses in the home could be overseen by a physician. Just -- or did you not have the telehealth capability previously?

Yes. Great question, David. So yes, I mean -- but our platform has always been about pairing the mobile health clinician in the field with the advanced practice provider via telehealth. Some of the visits were telehealth only. And yes, we did utilize telehealth synchronously with overseeing the visits, but nowhere near the scale that SteadyMD is operating at today with the hundreds of advanced practice provider clinicians that they have trained and onboarded on the platform.

I also think SteadyMD's platform is really akin to what we built on the mobile side, right? So David, you know well, our mobile health platform is about pairing essentially the right clinician in the field with the right vehicle with the right diagnostics for the right patient need, optimizing their routing, the logistics, clustering the patients in a way that we can be very efficient in the field.

We didn't have the platform similar to SteadyMD that does that on the virtual provider side. So the right clinician for the right patient need under the right program that they have with their customers, all scheduled in a way that is incredibly efficient, and so the way I view it is SteadyMD has their current customer base. It's generating revenue. They're providing those services to their customers. And any gaps in their schedule currently, we can absolutely fill those with our in-home visits paired up. And then ultimately, they're going to help us scale and bring on more capacity to meet our needs as well.

So their platform really does what our platform does for mobile health clinicians. They do it on the virtual side. And we think that their platform, not only with the scale of their platform, but their platform is going to help us be more efficient pairing synchronously the virtual provider with the mobile health provider in the field. And we're very excited about the opportunity to integrate their technology with our platform.

So really it's going to be a very differentiated platform where we are optimizing the resources in the field, at the same time, we're optimizing the resources virtually. I think that's going to be very unique, probably very, very, very differentiated. I don't know anyone else that's doing that right now. So it's going to be very powerful.

Our next question comes from Aidan Conniff with Stifel.

Congrats on the transaction. You have Aidan on for David Grossman. My first question was just around the seasonality, if there is any in the SteadyMD business. I know your guys' payer business has a little bit of seasonality as payers look to close kind of these scores towards the end of the year. So just wondering if there's any seasonality in SteadyMD's.

Yes. I think Inherently, in health care, there'll always be some seasonality around flu season. I think it's actually pretty similar to what we see with the end of year push and sort of the Q1 of the year, sort of those winter months. I think we see an uptick in volumes. We see it on our medical transportation side. We see it on our care in the home side, and we think actually that once we start layering in SteadyMD into the care gap business, we see payers really do a sprint towards the end of the year to try to close out as many care gaps for patients as possible.

So we've been gearing up for Q4. This is going to help us in Q4 somewhat. I mean there'll be some time to integrate here. But we think over time, the back half of the year, as we integrate SteadyMD, absolutely for next year, we're going to see increased volumes because we see the payers really sprinting towards the back end of the year, and we probably will anticipate that with SteadyMD as well once we integrate them and once we bring them on.

Okay. And then just one clarification. For SteadyMD, are the clinicians W-2ed or 1099?

Yes. So it's a mix depending on the services that they're providing and how many hours they're working for us. So I would say it's a mix.

There are no further audio questions. Are there any web questions?

Thank you, Rob. I do see a number of questions in here. We'll take as many as we can. I think a lot of them we've covered, but I want to take a few here. So there's a question, as I mentioned in the chat relating to AI.

Is DocGo utilizing leveraging AI and other emerging technologies to improve scalability?

So absolutely, we are. We're infusing AI in a number of different areas. One of the most exciting areas that we're infusing with AI is in our patient engagement and outreach portion of our deployment. So those that know our business, the payers give us lists of patients that are in need of care. They have open care gaps. They have chronic conditions, and we reach out to those patients and schedule visits to go to their home and close out these care gaps and provide preventative care.

We've been leveraging AI tremendously in that effort. So for example, when we confirm an appointment, we schedule an appointment, if patients have a question of what to expect during that appointment, AI is answering all of -- a lot of those questions and rescheduling and scheduling patient visits, and we're starting to use it more and more on the outreach towards those patients to schedule and be very efficient there.

We're also utilizing it in other facets of the business when it comes to routing, I mentioned scheduling. So we're making it very efficient on the operations of the business, leveraging AI, and that scheduling platform that I mentioned, we built that in-house. So we're excited about that. And over time, it's something that we can extend to our customer base. And we're also looking at ways to predict whether a patient is going to show up or whether they're going to be there when we arrive at their home.

So as we do more and more visits, we're doing thousands and thousands of visits to the home. And of course, now it's SteadyMD, really over 1 million virtual visits. We want to make sure that the time still works for the patient. We don't want to show up at their house and not to be there. And so we're building models to predict patient no-shows, cancellations. And so that's a big facet as well that we're looking at to, again, get us even more efficient and make sure that when we show up at a patient's home, they're there, they're ready for us, and we're there to provide great care and the timing works. So we're building some technology around that as well.

So at our core, we're a tech company. We're going to push into that space to make us even more efficient to provide patients with great service and then really leverage our clinical staff to make them more efficient in providing patient care, and that's a big, big area for us. So really appreciate that question.

We have a question in here. How does this transaction fit into DocGo's broader M&A strategy?

So the focus for our M&A strategy is to add to our capability set. That's our core goal. I mean with companies who have built world-class platforms, that's a criteria. On the mobile health side, we're seeing companies that we -- we're seeking companies where I think we can layer on their last mile mobile health capabilities to add to ours and leverage our tech stack to create value and very similar in line with the SteadyMD acquisition.

We didn't talk about it as much on this call, but we're very proud of the platform we have on the medical transportation side. We have one of the world-class medical transportation platforms as well as our crews in the field. So on the medical transportation side, we're also seeking opportunities to increase scale in our existing geographies and maybe expand the footprint. But as I mentioned, we're always looking where expansion into new markets comes with an anchor client on the medical transportation and mobile health side. That's always a crucial component to us. All that is staying the same.

Okay. We have a lot of questions here. We'll try to get to as many as we can. There's a question in here about will you operate on two platforms? Or will you integrate into one? Will you expand into the rest of the world? And how soon would that be? That's a great question.

We are ambitious. Thank you for that question. So our plan is to really integrate the two platforms, as I mentioned, over the next 3 to 6 months here, and again, patients won't feel that integration on the operational side, but on the efficiency side, they will on the quality side, they will. So we're very excited about that.

To the world, I'm not sure we have that ambition just yet. I think the U.S. is a huge market that offers a lot of opportunity in and of itself, and so as I mentioned, we'll expand to new geographies with anchor customers, but also really use SteadyMD to get more efficient in the geographies we operate in.

When it comes to the rest of the world outside the U.S., those that know us well know that we operate a great, great business in the U.K. We have 600 health care heroes out in the U.K. providing services up and down the U.K. And so I think over time, this is absolutely an opportunity for us to leverage telehealth and virtual into what we're doing over there. But of course, that will come with the necessary regulatory steps and the necessary compliance steps, and we'll look into that when the time is right. But thanks for that question. Absolutely, we're looking to expand, and we're excited about it.

Okay. I think we have time for one more question. Let's see. A lot of these we've covered in earlier remarks. Actually, a lot of the questions can be summed up really with this one, which we spoke about, how does SteadyMD's telehealth platform specifically complement DocGo's existing mobile health business?

And we touched on it, almost a lot of the questions are really oriented around this. So that's actually a good summary as we close out this call. I think, again, the magic of our platform has always been our ability to pair a mobile health clinician in the home with a virtual advanced practice provider overseeing the visit through telehealth connection. And so the advanced practice provider is the most expensive component of the delivery model. And as I've been talking about, SteadyMD will allow us to maximize the utilization of the advanced practice provider.

So this increased utilization and 50-state coverage it's going to allow us to, as I mentioned, drive up our gross margin while also scaling to new geographies, again, just more expeditiously and profitably. So short answer, efficiency and scale. That's really what you're hearing from us here today.

So really appreciate everyone joining the call. We're very excited. Guy and Yarone, the founders of SteadyMD along with the SteadyMD team are joining the DocGo family. They are incredible operators. They're innovators in the space. They're very well regarded, and we're just excited to welcome their team and their platform and their capabilities to ours, and I'm very excited for the future.

So with that, I'll hand it back to the operator and looking forward to speaking to everybody in the coming weeks and months and looking forward to people joining our earnings call at the beginning of November and looking forward to building this future together. Thank you so much.

This concludes today's conference. You may disconnect your lines at this time, and we thank you for your participation.

All right. Thank you all for joining us. I'm Chris Brustuen, Managing Director in the New York office for the healthcare team of Morgan Stanley. I'm going to start off with a disclosure. For important disclosures, please see the Morgan Stanley research disclosure website at www.morganstanley.com/researchdisclosures. If you have any questions, please reach out to your Morgan Stanley sales representative. Lee, thank you for being here today. We appreciate you attending our conference. Before I jump into questions, any opening remarks before I jump in.

Yes. First off, Chris, thanks for having us. 23rd Annual Morgan Stanley Healthcare Conference. It's great to be here with you. I know you and I spend a lot of time together. We talk about the industry, talk about what's going on in the space, talk about the innovation. So it's great to be doing a fireside panel with you. Yes, I think it's a very interesting time for the healthcare industry. We're certainly at the vanguard of some of the trends that are happening with home-based care, the ability to provide accessible care to patients that are flowing through cracks. I think there's a lot of change coming with some of the new legislation, some changes to Medicaid, obviously, that people are talking about, some changes to rural healthcare. So we're really participating in a lot of those evolutions, and I'm excited to talk to you about what we're seeing in the space.

Thank you. So my first question is on mobile health. That segment is experiencing significant growth in recent years. Can you spend a little bit of time talking about what services you provide in that segment? What types of customers you're seeing there?

Absolutely. So for those who don't know our story that well, DocGo is a medical transportation and mobile health provider. I'm sure we'll talk about medical transportation. We've been doing that for 10 years. We're a big innovator in the space, and we basically created an Uber-like experience for medical transportation which I know we'll talk about. And then once we realized that we had this incredible logistics platform, coordination platform that we were using for medical transportation, few years ago we started applying that to mobile health. And the mobile health segment has been growing very quickly for us, particularly our work with the payers and providers.

So we contract directly with insurance companies and providers to coordinate care and provide care to their unengaged, high-utilizing members that are costing their plans a lot of money. And so what the plans do is they give us a list of all these members and our patient engagement team is getting incredibly sophisticated on how we engage these unengaged members and then we not only provide the platform, but we also provide the care in the home and we go to the home and we close care gaps and provide primary care services to these very underserved, high utilizing, have multiple chronic condition patients and the plans are loving that.

We started doing that about 18 months ago, 2 years ago. We had 1 plan give us a list of 2,000 members. I'll never forget the day, it was December 2, and they said, can you go see these 2,000 members before the end of the year? I'm like you do realize there's 28 days left to the year and some of which are New Year's Eve and Christmas and we did. We mobilized quickly. That's really one of our calling cards, and we used the infrastructure we had on the medical transportation business and of course, on the mobile health space, and we made some great progress there. Today, fast forward from that 1 payer that gave us a list of 2,000 patients, we have over half a dozen very large payers that have given us almost a list of 1 million patients that we're going and engaging with, primarily in the Tri-state New York area and in California. And so we've been engaging these patients. We're doing thousands upon thousands of home visits and we're closing multiple gaps per visit.

On average, we close almost 2 gaps per visit. We've had some visits where we closed 6 gaps in 1 single visit. And so that breadth of service, the number of things that we can provide. And by the way, care gaps are things like a diabetic retinal exam for patients that have diabetes and are at risk of vision impairment. It's a bone density screen for osteoporosis patients at a risk of falling and breaking their bones. It's an annual wellness visit, it's vaccination. Lots of critical care and preventative care that patients need, critical services that patients need, but you can't provide it with telehealth alone, and that's where we come in. So we've been seeing a lot of growth there. We're very excited about what we're doing. The patients are absolutely loving it, and we're looking to expand pretty aggressively.

Thank you. It's impressive. So I want to spend some time on the tech stack. Can you spend a minute just giving a little bit of an overview on the front-end, back-end tech stack that you developed? And then you think of EHR integration with Epic, Athena, that impact on referrals and any enhanced functionality you get from that?

Yes. I think the tech stack is the critical component of this. The idea of providing medical care in your home is like as old as time. I mean I -- everyone remembers that Norman Rockwell painting hanging in their pediatrician's office with the doctor visiting the patient and you're standing in a cold waiting room as a kid, waiting to get those vaccines. Everyone has that memory. So the idea is an old one. I think the only way to do it efficiently to go to the home is essentially the industry and doctors realize I can't be driving from house to house. These very, very scarce resources of physicians we have today, we don't have anywhere near enough of the physicians we need. And now technology is going to solve some of that in the coming years. But 1 in 4 Americans doesn't even have a primary care provider.

We don't have enough doctors and they certainly can't be driving from location to location. And so what we did is we took the tech stack that we built and we enabled LPNs, which are licensed practical nurses, medical assistants, they're the ones that are going from home to home. They're the ones that are driving. There's more of them. We can train them. And then the primary care provider or the nurse practitioner or the PA, these advanced practice providers are the one directing the hands, eyes and ears in the home, which is that LPN. And that's the tech platform that we've built. In addition, the coordination platform that we built, I mentioned sort of Uber for ambulances, we've built a platform where a discharging nurse at a hospital can literally click a button within Epic, which you mentioned, and they can see when that ambulance is going to arrive to pick up that patient that's being discharged from the hospital, perhaps going to a skilled nursing facility or to home or the next care facility.

So the tech stack that we built essentially is integrated with Epic, it feels like all the consumer on the front end, you asked about the front end, it feels like a consumer front end, directly from the patient's chart. You can click a button, you can order medical transportation, you can order all of our mobile health services. How did we get integrated with Epic, company of our size, particularly when we were starting out. We have a close partnership with Jefferson in the Pennsylvania, New Jersey area, and they're a very large customer and partner of Epic. And so they asked Epic to integrate with us. Today, Jefferson is using it. Lots of large hospital systems are using our integration with Epic with our platform directly built in. On the front end, it looks super simple, just like ordering any other service we do today on our mobile phones or from our desktops.

On the back end, what other companies are doing, I think, in the delivery space is like child play compared to what we're doing, right? We have to make sure that we have the right level of care, the right ambulance, advanced life support, basic life support, is the patient on oxygen. We have to know the right vehicle with the right clinician with the right licensure for the right patient need, all coordinated together, and that's what our back end is doing. And so when that discharge nurse clicks that button, he or she sees exactly what time we're going to arrive. Why does that matter really because then they know when that bed is going to be freed up for the next patient. And that's everything to hospital systems that are trying to manage patient flow. And so when that button is clicked, the housekeeping staff knows to come and get that bed ready for the next patient, intake knows when that bed is going to be made ready for the next patient. And of course, the discharge team knows when to get the patient ready when we're arriving. And that coordination and symphony that happens with the tech stack is extremely differentiated.

Thank you for that. So I want to spend some time on the recurring revenue, revenue visibility topic. How should we think about recurring revenue opportunity within the business? And then your line of sight regarding revenue visibility. So is it primarily in the transport services side? Or is it on mobile health as well?

It's on both. I'll start with the transportation side. We typically sign contracts there from 3 to 5 years. Those are the length of our contracts. They're incredibly sticky contracts. We're embedding our software within their workflows. We're providing the crews that are transporting and dedicated to the hospital system. That's our model. So it's been very sticky. I mentioned Jefferson. We've been working with them since 2017 as an example, Northwell as an example. We've been working with them since 2018. So you see these contracts, we've been working with a lot of our big great partners for almost a decade in that space. And we very, very rarely -- oftentimes, it's at our choice when we decide to move crew and personnel around to orient around some of our customers. But we tend to keep those customers for a very long time.

They're very happy. We're very, very proud of that on the medical transportation space, and we're going to continue to expand that. On the mobile health space, I think the answer candidly is twofold, right? I know, Chris, you know our business well. We historically have done a lot of work with municipal governments, right? And people that know our story know a lot of that work that we've been responding to crises and pandemics, asylum seeker, migrant healthcare, and a lot of that was episodic in nature, and it was very much intended to help in the crisis and God willing that crisis is over and then you move on to the next thing. If we do a good job, the crisis ends. If we do a good job, the emergency is over.

And so that was more episodic in nature. I think over the last 2 years since I took the helm of the company, we've been moving the company towards more evergreen opportunities, population health style opportunities. And for example, the programs I mentioned with the payers that I described. The payers are always going to have a percentage of their population that are special needs, that are drifting, that are immobile and have accessibility issues, and we think that space is just very, very large. And indeed, the payers we've been working with have talked to us about expanding to new states, have talked to us about expanding their footprint with what they're doing with us in the states we already launched with them and those are evergreen in nature as an example. So those are really the partnerships that we've been signing, the deals we've been signing over the last 1.5 years, and then we feel like they have a very long runway.

Thank you. So how do you think about the labor and inflationary environment that we're in? Any adjustments that you can make to staffing or automated processes that are addressing this area for you?

Yes. Staffing is a big component of our business. We're not just a technology platform, which is a big differentiator for us, and obviously, that scales. But we also provide the staff and I can tell you that's a big, big competitive advantage. There's -- I speak to hospital system CEOs, health plan CEOs, and they say, if I have to see just another person that's trying to sell me a software platform. We provide the software platform and the boots on the ground. That is a big component of our business. And so we have a very talented engineering team on the corporate side. But on the field side, we have thousands of EMTs, paramedics, nurses, advanced practice providers that are in the field, as I say, they're the heroes in the story, active in the field going to serve patients every day.

Right now, at the company, we have just about 800 open roles that we're looking to fill right now because we're trying to expand our -- the contracts we have and the scope of the work. And it's a challenge on the hiring side, which I'll talk about. But on the inflationary side, other than -- we don't have a lot of inflationary pressures on the business. All the vehicles that we have, we either own them already or that we procure new, we have a very favorable credit facility that we utilize to procure the vehicles. Actually, on the fuel side, prices have actually come down we've seen. We drove 8.8 million miles. So we use gas, electricity, things of that nature.

Last year, we drove 8.8 million miles. So frankly, on the fuel side, that's come down a bit. On the people side, as I mentioned, we're actively working very, very -- very, very quickly to try to hire all these open roles that we have for our expansion. And so we're working on that. I think we are consistently the premier place to work in this space. If you look on Indeed and Glassdoor, we have the highest ratings in the industry. We provide great training capability to the staff. They get to elevate their career and progress their career within our company going from an EMT to a paramedic to our mobile health business. And so we've been working to make our company the great culture that it has and also to attract the great talent because we need to scale our workforce and able to hit our very ambitious plans.

I have to think the payer opportunity is pretty significant. So can you talk a little bit about care gap closures that you hit on a little bit, chronic care management. When you think about these conversations around kind of dual eligibles, Medicaid, is there an opportunity in Medicare Advantage as well? Can you just spend a little time about the overall payer opportunity?

Yes. So we tend to work with the payers that are providing managed care, managed Medicaid, Medicare Advantage, you mentioned the D-SNP population, the dual special needs population. And so those are the list of patients that the plans are providing to us, particularly, again, the ones that are unengaged that are costing them a lot of money and not getting the care that they need. We're actually seeing enormous uptick in the D-SNP population. That population tends to engage at a rate of 300% to 500% more than the traditional population we've been engaging with and that's for a lot of reasons, right? They tend to be lower income, so they tend to have less access to great care. They tend to be ambulatory in nature. They need to -- they have mobility and access issues. Some of them are elderly, and so we check a lot of those boxes. We come to those patients' homes. We provide the care in those homes.

They don't have to worry about coordinating transportation. They don't have to worry about managing the schedule of various different appointments that they have. We come to their home and provide a lot of that. So -- and the plans are very focused on that population right now. So we see a lot of great confluence of variables happening. One, the plans are very focused on this population because they cost them a lot of money. Engagement rates for us are really high with this particular population, and we solve a very critical need. So we are continuing to add resources to provide comprehensive services, chronic care management, preventative care, primary care in the home for these populations. Anybody, because I should say anybody that's at risk for their patient population, these value-based care, which we feel is where the industry needs to go.

Any time a provider is being incentivized to provide more tests, to provide more screens, that's a bad scenario because the patient is just getting more and more sick care, if you will, more and more tests, more and more visits. We actually think the entire system should be rewarded for how healthy the patients are and how few visits they need or how less often they land in the hospital. We want to be successful when the patients are actually healthy at their home and not visiting the hospital unless they truly need to. And we want to align there. And so any of the plans that are trying to keep patients out of the hospital, any of the hospital systems that are trying to keep certain populations out of the hospital, particularly with the 30-day readmits, we're aligned with those plans very well because we're going to the home, we're providing care for patients that are unengaged, unattached, chronically ill and that are not getting the medical care that they need.

And as a result, they're landing in the hospital every other month, they're costing the system a lot of money, and that's where we come in. So any of these managed care plans, value-based organizations, we do very well with.

So shifting to M&A. Can you talk a little bit about the opportunity within M&A, particularly in the mobile health segment, but maybe across the business, are there specific areas of focus when you think about strategic expansion for the business?

Yes. I think for us, it's always going to come down to added capabilities that the plans particularly are asking us for and added geographies. That's 1 area where we look at. So added capabilities relating to the tech stack, added capabilities relating to the service delivery and, of course, new geographies that we're not in today. Today, we provide services in 30 states. But of course, there's lots of different parts of the country that are still well underserved that we can go and make a difference. And so that's what we look at on the M&A side. It has to be complementary to what we're doing. It has to make us scale faster so we can get the density faster so that we can increase margins over time.

That's really what we're looking to do on the mobile health M&A side. We see a lot of opportunities. I know, Chris, you and I talk about this a lot. There's an inflection point in healthcare right now where some of the smaller operators are having a hard time because they don't have the scale and the density, particularly in the mobile health space. So we're seeing a lot of opportunities. I think healthcare is on sale right now, frankly, with a lot of the smaller operators having a hard time because they don't have the density. For us, we're lucky because when we deploy a mobile health contract or a mobile health deployment, we're launching out of the same base and same infrastructure that we have on the medical transportation side.

If you go visit our base in Ridgewood Queens here, you're going to see 100 ambulances coming in and out, and you're going to see dozens of mobile health and mobile X-ray and mobile clinic vans going in and out of that same infrastructure. And so a lot of the mobile health providers that don't have that medical transportation infrastructure, which we're very unique in that regard. When they don't have that, scaling is much more difficult than it is for us. It's a different investment thesis for them. So we think that bringing them into the fold can potentially help us scale and get more density there.

On the medical transportation side, we've been very successful there. People may have seen -- we mentioned -- we acquired a smaller medical transportation company. Usually, medical transportation has a very long tail distribution. It's a very localized segment. We only have a very small percentage of it. We think it's a $10 billion market on the medicine transportation side. We have a very small percentage of that. So there's an opportunity for us to acquire perhaps smaller, less-scaled medical transportation operators and bring them into our fold where we have our self-funded insurance plans. We self-insure all of our ambulances. We self-insure all of our staff. And so we can bring them in and they can gain those efficiencies.

Obviously, they can gain efficiencies from the tech stack, which very few, if not any, medical transportation providers have. So we feel like we can bring them in and make them more profitable as they join our scaled infrastructure on the medical transportation side. So we're looking to do that as well.

So when we think about capital allocation, it kind of ties back to the M&A conversation, but how should we think about prioritizing different pockets of capital allocation? So M&A, share repurchases, increased hiring. Can you spend a little time on that?

Yes. I think number 1 is going to be making sure we have the resources and spending on the organic growth. You mentioned the staff. We train our staff. We invest very heavily in training our staff. So we mentioned that we brought on a very large medical transportation contract here in New York last month. I think, started in July. So about 6 weeks ago, we brought on a very -- we had to staff up and we had to train that staff to be able to provide an exceptional service to that customer. So we invest into that. Every mobile health clinician that goes into a patient's home, we have a high bar on that. We require that they have 80 hours of training before we let them go into a patient's home and provide services. It's a large breadth of number of services that we provide.

So we're going to continue to invest in our operations, invest in our people, invest in our training, invest in our scale organically. We talked about M&A, and we think there's going to be some good accretive opportunities that we're going to look at there. So growth, growth, growth, both organic and inorganic. And then you mentioned some of the other capital allocation we've done, we've repurchased shares. We've repurchased shares. I think we have purchased just about $25 million to $30 million worth of share repurchases that we've done off our balance sheet. And then we also recently -- we mentioned on our last earnings call, we paid down, we had a $30 million outstanding balance on our line of credit. We paid that down to 0.

So the company has 0, no outstanding large balance on the debt side, we paid the credit facility down to 0. So we've been very judicious in using our balance sheet. And then we have -- again, we shared on our last earnings call, over $100 million of cash on the balance sheet. So we feel like we're in a good position here. We feel like we have the resources we need to effectuate and implement our plans on the growth side. We've been using the capital from our balance sheet to pay down our debt. Again, we paid that credit line down to 0. We repurchased shares. So we feel like we're in a really good spot to implement our plans and return value to shareholders.

So talking about the RFP process for a minute. How has that been able to expand as you scale? Are you targeting larger contracts now? How has that kind of progression been and kind of the breadth of services you mentioned before, too?

Yes. I think when we used to talk about the RFP process, it was very focused on the municipal side, particularly on the government procurement side. I talked about historically, we were submitting about 100 RFPs a year, which was 3x we were doing before we really started focusing on that space. I think we're submitting more proposals than that today, except it's just a wider range of recipients of those proposals, not just municipal customers that might be down to maybe, call it, 30 or so a year on that side of the business. And then we've more than replaced what we were doing on the municipal side with many proposals to hospital systems and payers, everything we've been talking about during this conversation.

So on our last call, I announced that we're already in contract with 2 of the top 10 largest national payers. We are in active talks with 2 more of the top 10 largest payers. And we have 35 proposals out to payers all across the country there. And then on our medical transportation side, and other provider side, we have probably another 100-plus proposals out. So we're doing more proposals and submitting more proposals than we ever had, and it's been to a more diversified, wider audience of recipients than just the municipal side. We really feel like on the municipal side, we want to be a lot more focused on evergreen opportunities, less crisis response, less emergency management, like I had talked about, and more evergreen longitudinal population health style programs.

So as an example, I've shared, we're looking to provide services to our veterans, right? Health screening services, health prevention and fit for duty readiness screenings for our heroes in the military. That's evergreen, that's going to be there for a long period of time. Population health to underserved communities, perhaps with a mobile vaccination program we just launched in Southern California targeting populations that don't have good access to vaccine. Again, that's a longitudinal multiyear effort, and those are the types of municipal programs we're going to be bidding on.

So shifting to market expansion. You've entered several new markets in the last 12 months. Can you discuss a little bit about how you assess the new markets that you're going to enter into and what you're looking for kind of what that target market kind of somewhat looks like from a playbook perspective?

Yes. So I think first and foremost, we want to expand into the markets where our customers are pushing us to expand into. So we don't go to a new market and hang a shingle and then try to sign up some business there. We always expand to new markets when we have an anchor tenant, an anchor customer, if you will. That's usually a hospital system. As an example, we recently expanded to Dallas, Fort Worth metro area. We expanded there with Methodist, which is a very large hospital system. And now we're looking to expand to other hospital systems within that area. So very often, when we are expanding -- not often all the time when we're expanding to new geographies, it's because we have an anchor customer that's pushing us there.

I think you'll see us expand to states. We have plans to expand to about a half a dozen new states over the next year or so. And really, those states are -- we're going to expand to, are the ones that our health plan partners and our hospital system partners are pushing us to expand to. So we're very successful with a health plan in California. They may want us to expand to other states where they need our help, and those would be the states that we look to expand to.

I didn't grasp that you have the visibility as you're entering into each of these -- from those partnerships. That's helpful. Can you talk a little bit about the go-to-market strategy for each of the customer segments. So when we think of government payers, the hospitals, events, what's the sales cycle like for each of these, if they're different?

Yes. Well, the sales cycle is long. The sales cycle often is anywhere from 6 to 18 months, depending on the, I would say, on the new customer side. I think the sales cycle will be shorter absolutely for the customers we're already working with. So as we were just discussing, we're already working with a large health plan in California. It only makes sense that they would expand us. And I think it would be quicker, and we're -- those processes are going much faster to expand to new states with those existing customers. That's much faster than the 6- to 18-month cycle I was just describing. But for the new very large, again, we're not taking a few extra ambulance trips because we're working with a nursing home here or we're working.

We tend to -- not tend, we work with the large health systems and the large payers. And we take over their entire transfer center, their entire medical transportation, nurse center, if you will, operations, the software is integrated. So those sales cycles tend to be a little bit longer. They also tend to be a lot stickier as well. And so that's what it looks like. I think universally, what's the pitch? What's the value prop? It's pretty simple. We help keep patients out of the hospital. Health plans really want that because that's where patients are the most expensive. Hospital systems don't want you getting readmitted within that 30-day post discharge window because that means that perhaps you're bouncing back to the hospital because you have an infection or you didn't get the proper care the first time so they're getting dinged on their quality scores, Oftentimes they're not even getting reimbursed for that second readmit within that 30-day window.

So the hospital systems, again, don't want you being readmitted. And so we have transition-to-care programs with hospital systems. And so everybody in the value chain wants to help keep patients out of the hospital. Patients also obviously don't want to end up in the hospital. So everybody wins when the patients that need to be in the hospital are there and the patients that we can prevent from going to the hospital are being cared for at home and healthier. People often forget, it costs $3 million on average to bring a new hospital bed online, so to speak, to build a new hospital bed cost $3 million. So hospital systems want to better and more efficiently manage the beds they do have than spend the CapEx on building new hospital beds.

They want the right patients in those beds and the patients that can be prevented from going to the hospital, everybody is incentivized to keep those patients out of the hospital, and that's really how we're targeting our pitch over that 6- to 18-month sales cycle.

I'm going to ask another one, and then I'll open up if any questions from the audience as well. For mobile health, given the growth in that segment, can you discuss a little bit about where you see that market going? How you're creating value for your channel partners, the hospitals, municipalities, payers across that?

Yes. I think on the mobile health side, A lot of it is keeping patients out of the hospital, which I just discussed. And I think oftentimes, the health plans that we're working with, there's a big quality component to what I was just discussing. So as an example, you mentioned the Medicare Advantage plans that we work with. They get what's called the HEDIS quality star rating. Every health plan, every MA plan gets a quality score. That quality score impacts how much premium and reimbursement that, that plan gets. And then also when participants are signing up for their MA plan, they see the score. They see the quality score right in the portal. It's obviously the plans that have the higher quality scores get more enrollment, they get better premiums, the winners win and the losers lose.

It's actually the way the system should work. And so that's where the care gap closure comes in. How do you increase the quality score, what makes a good quality health plan? A good quality health plan is a health plan that's providing care to all its members. A good quality health plan is a health plan that their members like and that the members are satisfied. A good quality health plan is a health plan that's managing their costs appropriately. That's what makes for a good quality health plan. And so all the care gaps that we provide, they're specifically targeted at the HEDIS quality score matrix and helping the plans improve that quality score.

And a big component of the quality score is how satisfied the customer is, how satisfied the patient is. And our net promoter scores, our patient net promoter scores are 90-plus, which is like unheard of in the space. So we help check that box as well. So that's really the value to the health plan is helping them increase the quality of their health plan by providing care to members that are going unengaged, by providing the care gaps and closing those care gaps, so their quality scores go up, as their quality scores go up, more members choose them. As the enrollments increase, obviously, the health of the plans increase. And so that's the virtuous cycle that we're participating in.

Any questions from the audience? All right. Moving to my next one on medical transport. Can you discuss a little bit about that market opportunity and in particular, the partnerships that you have? You mentioned Jefferson before, Northwell, HCA. How do you think -- how big do you think this market opportunity is and the growth opportunity there, too?

Yes. So estimates on the market size, it's a $10 billion market on the medical transportation side, I shared that we expect to do around $225 million with the medical transportation this year as part of our guidance. So we have $225-ish million of this $10 billion market. I mentioned it's actually a very fragmented market. It's a very local market. We feel like we have the ability to be 1 of the few large nationally scaled, multistate medical transportation providers. And there's a lot of goodness that comes from that scale. The cost can be invested across the platform. So our -- we talked about our tech stack. That tech stack is used by all of our markets across all the states that we operate in. We talked about the training. We talked about the recruitment process. Again, standardized systems that get used across the entire system.

We move vehicles around. When we have more demand in 1 city or state than another, we'll move ambulances around. So that ability to scale is going to be very valuable in this space. And I think over time, you're going to see the space consolidate a bit. And I think we're in a very good position to participate in that. And there's a lot of great enhancements that come when we're able to bring a smaller medical transportation provider onto our platform using our tech, using our infrastructure, using our logistics capabilities, using our procurement, using our ability to manage risk in the space. We have a lot of scale processes and procedures that I think are going to be very, very valuable as this fragmented space becomes more and more standardized in a way.

So we think there's a big opportunity there. I think medical transportation has gotten a lot of -- a lot more appreciation from hospital systems CEOs because they realize that it's a big component of their patient flow. How patients come into the hospital, how patients go out of the hospital, how they get coordinated that transportation, I think that hospital systems are realizing it's a big component of what they need to solve for to make sure that their beds and their capacity and their utilization are well managed. I think health plans are realizing, wait a second. A lot of these patients are going uncared for because they're missing appointments. The transportation is not solved for, they're not going to their doctor's appointment because they don't have transportation or they don't have child care.

I was looking at 1 hospital system data. They have 28% of all their appointments are no shows for the hospital systems. And the insurance providers also don't like when you miss your appointments because that's where you're getting the care that you need. So I think transportation and the coordination of how patients access care, how they get to and from points of care is getting a lot more appreciation in the market, I'd say, over the last 12 months.

I have time for 1 more, telehealth. So you had mentioned a little bit before, from a competitive perspective, when you think about it, just given the lower barriers for some of your competitors to enter into that segment. How do you see that as kind of an opportunity, but also when you think about it from a competition standpoint, too?

Yes. We think telehealth obviously solves a big need in the space. I think we've learned post COVID, there's a big role for telehealth to play. It's convenient and it serves its purpose. And so we're very, very -- we're very bullish on telehealth. At the same time, we think that telehealth is incomplete in many cases, right? You cannot provide a patient a vaccine through a Zoom call, through a telehealth visit. You cannot take -- draw patients' blood through a screen. You can't take a swab, you can't take a sample, you can't take a colon cancer kit through telehealth alone. So we feel again that the boots on the ground, paired with the tech platform, telehealth, is really what our unique value proposition is. It's very hard to do. Very, very hard to do. That's why you see a lot of people in the telehealth space, a lot of people in the, let's call it, software and tech enablement space and very few people in the actually frontline space like we are.

And we think our ability to be in the frontline space, 1,000 vehicles with thousands of clinicians, all in the field on the front lines, providing care. Again, last year, we provided care to 1 million patients in the field. This year, I shared, we'll do 750,000 patient transports, 150,000 patient visits in their home. We're monitoring another 50,000 patients. There are very few companies that are doing that type of care in the field at scale with the workforce like we have that's incredibly well trained as well as the software platform.

And we feel like the software platform, the telehealth platform, paired with those frontline staff and the coordination and logistics and the infrastructure of all that is going to be incredibly compelling and is incredibly compelling.

And Lee, thank you for joining us today. Really appreciate the conversation.

Absolutely. Thank you, Chris, and thank you to Morgan Stanley.

Good afternoon, ladies and gentlemen, and welcome to the DocGo Second Quarter Earnings Conference Call. [Operator Instructions] This call is being recorded on Thursday, August 7, 2025.

I would now like to turn the conference over to Mike Cole, VP, Investor Relations. Please go ahead.

Thank you, Michael. Before turning the call over to management, I would like to make the following remarks concerning forward-looking statements. All statements made in this conference call other than statements of historical fact are forward-looking statements. The words may, will, plan, potential, could, goal, outlook, design, anticipate, aim, believe, estimate, expect, intend, guidance, confidence, target, project and other similar expressions may be used to identify such forward-looking statements. These forward-looking statements are not guarantees of future performance, and we cannot assure you that we will achieve or realize our plans, intentions, outcomes, results or expectations.

Forward-looking statements are inherently subject to substantial risks, uncertainties and assumptions, many of which are beyond our control and which may cause our actual results or outcomes or the timing of results or outcomes to differ materially from those contained in our forward-looking statements. These risks, uncertainties and assumptions include, but are not limited to, those discussed in our risk factors and elsewhere in DocGo's annual report on Form 10-K, quarterly reports on Form 10-Q, our earnings release this quarter and other reports and statements filed by DocGo with the SEC to which your attention is directed. Actual outcomes and results or the timing of results or outcomes may differ materially from what is expressed or implied by these forward-looking statements.

In addition to today's call contains references to non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are included in our earnings release or the current report on Form 8-K that includes our earnings release and an exhibit with additional information regarding certain non-GAAP financial measures, which are posted on our website, docgo.com as well as furnished with the SEC.

The information contained in this call is accurate as of the date discussed. Investors should not assume that statements will remain relevant and operative at a later time. We undertake no obligation to update any information discussed in this call to reflect events or circumstances after the date of this call or to reflect new information or the occurrence of unanticipated events, except as to the extent required by law.

At this time, it is now my pleasure to turn the call over to Mr. Lee Bienstock, CEO of DocGo. Lee, please go ahead.

Thank you, Mike, and thank you all for joining us today. On our last call, I shared how we are building DocGo around innovative solutions for payers, providers and health systems that transform the manner in which proactive healthcare is delivered. I also shared confidence in the value and strong market need for our mobile health at any address and medical transportation platform.

I could not be more excited about the path that we are on, and I am pleased to share our Q2 accomplishments, which include a substantial increase in our cash balance, making key reductions to SG&A, delivering strong operational metrics and winning multiple new contracts, all of which position us to achieve our goals for 2025 and for the many growth opportunities ahead.

Regarding our cash balance, we had a very strong cash flow from operations during the quarter, totaling more than $30 million as we continue to make substantial progress collecting receivables from past migrant-related programs. Last quarter, we reported that we had approximately $120 million in migrant-related accounts receivable. At the end of Q2, that number is now roughly $54 million.

Our total cash, which includes cash and restricted cash and investments was $128.7 million as of the end of Q2, up from $103.1 million last quarter, an increase of $25.6 million. We continue to expect strong cash flow from operations and total net cash of more than $110 million at year-end.

In addition to our strong cash collections, we made progress reducing SG&A. At the end of Q2, we undertook a substantial reduction in force that eliminated dozens of roles in HR, finance, operations and IT and made additional reductions to corporate overhead, resulting in an estimated $10 million annualized savings. We continue to evaluate our business structure to seek additional SG&A efficiencies and right size where it is prudent, while at the same time, working to position ourselves to capitalize on growth opportunities in each of our business verticals.

We continue to make considerable progress delivering against our key operational metrics. To put the scope of our operations into perspective, during the quarter, we completed more than 176,000 medical transports, more than 6,000 gap closure and transitional care management visits and more than 28,000 mobile phlebotomy visits, hitting our targets and all consistent with our goal of bringing healthcare to any address.

The need for proactive healthcare at any address has never been more acute than it is today. Chronic disease is the biggest challenge in American healthcare with trillions of dollars being spent treating chronic disease each year, creating a substantial challenge for payers, providers, hospitals and the overall U.S. healthcare system.

We're seeing payers wrestle with these challenges, including risk pool deterioration and escalating medical loss ratios. We believe we are helping address the root causes of these issues. We are already working with an enviable roster of customers to bring proactive care to people where they are, when they need it and doing so at scale.

As I normally do, I would like to spend a few minutes covering the progress in each of those verticals, payer and providers, health systems and government population health. First, in our payer and provider vertical, we continue to make significant progress as we recently launched a new care gap closure program in Southern California with one of the largest not-for-profit Medicare and Medicaid public health plans in the U.S. Not only are we continuing to aggressively expand with our existing customer base in the Northeast and California, but we are also anticipating adding services in more than a dozen and a half dozen new states by the end of 2026 across multiple payers. In addition to our care gap closure program, we are seeing strong interest in our transition to care program designed to provide in-home visits for recently discharged patients to reduce readmissions.

An early pilot for these services at 1 hospital in Southern California is now expanding to 4 locations where an on-site transition coordinator will help manage discharges that are at high risk for readmission across all business lines for this payer. This is one of our most significant customer expansions to date and highlights the fact that while relationships in this vertical do take time to mature, the customer base we are already contracted with has tremendous potential for growth.

We have collectively exceeded 1.2 million assigned lives to engage with since the inception of our care gap closure program, up from 900,000 just a quarter ago. We are seeing increased velocity in our gap closure business. In the first half of 2025, we've already completed more at-home visits than we did in the entirety of 2024. We are also seeing a positive trend in patient conversions as we test, learn and optimize our outreach strategies with a 50% increase in patient conversions in Q2 relative to the previous quarter.

We also expanded our care gap closure relationship with a major insurance company in the Northeast to now include primary care services. We continue to invest to build our capacity and capabilities to meet this growing level of demand, and our payer vertical pipeline has never been stronger.

We are already working with 2 of the top 10 national payers and are in active discussions with both of these customers to expand those contracts. Additionally, we are in contracting with 2 more of the top 10 national payers and have an additional 35 deals with payers at various stages in our business development pipeline.

Our solutions address real issues for insurance payers and clearly, they are resonating with this audience. We are on track to end the year at more than 31,000 care gap visits and believe we can increase that number to more than 54,000 by the end of 2026. We anticipate converting a large percentage of these care gap patients to DocGo's primary care practice, which we believe represents a much larger revenue opportunity.

Not only are we scaling our impact, we continue to push the frontier of how technology and now AI can be incorporated into our operations to more efficiently engage patients and bring care to where it's needed. For example, our engineering team built a text-based AI agent to automate appointment reminders, confirmations and rescheduling in 7 different languages.

Recently launched, this AI agent has already confirmed over 3,000 appointments and rescheduled another 350, saving roughly 10% of our live operators' time. We are now training this agent to sign patients up for care gap services as well and look forward to sharing additional results on future calls.

Second, in our medical transportation business, as I mentioned previously, we completed more than 176,000 transports across our fee-for-service and leased hour trips in the U.S. and the U.K. during the quarter as we invested and prepared resources for a major new customer launch in New York that began on July 1. This new rollout is expected to help drive record trip volumes and top line revenue for our medical transportation business in the second half of the year.

Our engineering team integrated our proprietary software platform with this customer's electronic health record system in under 5 weeks, providing the hospital with a single centralized platform to order, track and manage patient transportation across their entire health system. Additionally, we signed a multiyear deal to provide medical transport for the Albany Stratton VA Medical Center, renewed medical transportation contracts with the city of Atlantic City and with an academic medical center in Wisconsin and continue to grow both the number of facilities and our trip volumes in Dallas, Texas.

Third, in our population health vertical, we continue to wind down the migrant-related programs with the vast majority of this work concluding in late June. We launched a project with the Mescalero Apache Tribe and the New Mexico Department of Health to help expand access to preventative wellness care, women's health services, chronic disease management and behavioral health services for rural communities in New Mexico. We also announced a new contract to provide mobile health vaccination services for San Diego County.

We continue to selectively pursue government and agency opportunities that we perceive as evergreen and not emergency response or episodic in nature. We are seeing interest in areas such as general population behavioral health, which is an area we gained significant experience with over the last couple of years. We will continue to update you on progress and plan to break out and report on the revenue impact of this municipal population health work, which Norm will touch on in his remarks.

I'd like to close with this. On June 19, we rang the closing bell at NASDAQ to celebrate both our company's 10-year anniversary and our 10 millionth patient interaction. Both of these milestones are a testament to the scale and impact of our accomplishments. We have just completed the first decade of this 100-year journey to fundamentally transform how healthcare is delivered, and I see endless opportunity ahead of us in the next 90 years and beyond.

Now I'll hand it over to Norm to cover the financials.

Thank you, Lee, and good afternoon. Total revenue for the second quarter of 2025 was $80.4 million compared to $164.9 million in the second quarter of 2024. The revenue decline was entirely due to the government vertical, primarily in migrant-related projects. As we've pointed out over the past several quarters, our migrant-related work peaked in the fourth quarter of 2023 and the first quarter of 2024 and began to wind down in May of 2024 with the exit from the HPD sites in New York City. By the end of 2024, we had exited all the HPD sites and the remaining migrant work with New York City Health and Hospitals was substantially completed by June 30 of this year with a bit more revenue expected to extend into the second half.

Mobile Health revenue for the second quarter of 2025 was $30.8 million, down from $116.7 million in the second quarter of last year, driven by the wind down of migrant revenues. Included in this year's amount was approximately $18 million in migrant-related revenues and less than $1 million in government population health revenues, which we'd stated previously we would break out.

Medical Transportation Services revenue increased to $49.6 million in Q2 of 2025 from $48.2 million in transport revenues that we recorded in the second quarter of 2024. Revenues were driven higher by increases in Delaware, Tennessee, Pennsylvania and New Jersey, which outweighed the impact of our exiting Colorado, an exclusively fee-for-service market that did not meet our threshold for scale. Removing Colorado results from both periods and our underlying transportation revenues increased by approximately 7% year-over-year.

In the second quarter, medical transport revenues accounted for 62% of total consolidated revenue and Mobile Health for the remaining 38%. Adjusted EBITDA for the second quarter of 2025 was a loss of $6.1 million compared to adjusted EBITDA of $17.2 million in the second quarter of 2024.

The adjusted gross margin, which removes the impact of depreciation and amortization and is the measure of margins that we track most closely, was 31.6% in the second quarter of 2025 compared to 33.9% in the second quarter of 2024. During the second quarter of 2025, adjusted gross margin for the Mobile Health segment was 32.5% versus 35.9% in the second quarter of 2024, but up from adjusted gross margins of 30.8% in the first quarter of 2025. We witnessed improved margins in the early-stage payer and provider business. As this business continues to grow, we expect to see improved utilization rates for our clinicians, which make up the bulk of the cost of goods sold. We expect this improved utilization to lead to higher gross margins for this business line and to continue to raise the overall Mobile Health segment in the future.

In the medical transportation segment, adjusted gross margins were 31.1% in Q2 of 2025 compared to 29.1% in Q2 of 2024. Despite the 200 basis point year-over-year improvement, medical transportation margins were restrained in Q2 by several factors, including the ongoing aggressive hiring of field personnel such as EMTs in anticipation of further growth in our key markets. The largest impact was seen in New York, where we hired field personnel during the quarter in advance of the July 1 launch of services with a major new health system customer, which Lee just mentioned.

Looking at operating costs, we've seen SG&A increase sharply as a percentage of total revenues as migrant revenues have wound down over the past several quarters. On an absolute dollar basis, though, SG&A expenses were 7% lower year-over-year in the second quarter of 2025 and were down 5% on a sequential basis.

Looking at what we call recurring SG&A by adding back noncash items such as depreciation and stock comp and nonrecurring items that are added back for adjusted EBITDA purposes, we have seen significant reductions on both a year-over-year and a sequential basis. For Q2, recurring SG&A was $3.2 million or 9% lower than in Q1 of 2025 and $7.1 million or 18% lower than in Q2 of 2024.

We are taking costs out of the business by reducing headcount across all shared services areas, and we continue to slash vendor costs by either switching to lower-cost providers or by obtaining competing bids for these services. We will continue to focus on lowering our SG&A costs throughout the remainder of 2025.

Now looking ahead, we continue to expect to reach positive adjusted EBITDA in the back half of next year. For illustrative purposes, this would require us to generate quarterly revenues in the $80 million to $85 million range with gross margins between 33% and 35% and with adjusted SG&A 5% to 10% lower than what we just witnessed in Q2 of 2025. We are confident that our robust pipeline, our strong balance sheet and these cost-cutting measures will enable us to execute this plan.

Now from a cash flow perspective, Q2 was a very strong quarter. We generated $33.6 million in positive cash flow from operations as we continue to collect our older, larger invoices. Through the first 6 months of 2025, we've generated more than $43 million in cash flow from operations. Consequently, our cash balances were much higher at the end of Q2 than at the end of Q1 or the end of 2024 despite cash used in our stock buyback program and the acquisition of PTI Health.

As of June 30, 2025, our total cash and cash equivalents, including restricted cash and investments, was $128.7 million, up more than $25 million from the $103.1 million at March 31, 2025, the highest quarter end level that we've seen since the second quarter of 2023.

Our accounts receivable continued to decrease, reflecting our cash collections and this wind down of migrant-related revenues that we've witnessed since the middle of the second quarter of 2024. We made substantial progress in Q2 collecting our municipal receivables. At quarter end, we had approximately $54 million in accounts receivable from the various migrant programs, which represented less than half of our total AR. This compares to $120 million in migrant program-related AR at the end of Q1 and $150 million at the end of 2024, which at the time represented approximately 71% of the company's total.

We have now collected about 95% of all of our migrant-related revenues from the inception of those programs until today. And we believe that we have good visibility into and full confidence in the collection of all remaining outstanding amounts. While the wind down of migrant-related programs has had an impact on revenues, our balance sheet has benefited substantially in 2025 as we collect this AR, leading to an improvement in cash flow from operations. This will provide us with the resources we need to support the pipeline that Lee just referenced, invest in our growth and to further bolster our balance sheet.

Last week, we used our enhanced cash balances to pay the outstanding amounts under our line of credit, removing $30 million in debt from our balance sheet. One of the ways that we deployed our cash during the second quarter was to execute our stock buyback program. During the quarter, we repurchased 2.5 million shares via open market purchases for an aggregate amount of approximately $5.1 million. To this point in 2025, we have spent close to $11 million on our stock repurchase. In June, our Board of Directors approved the extension of the buyback program until December 31. We currently have approximately $11 million remaining under the terms of this program.

At this point, I'd like to turn the call back over to Michael for Q&A. Michael, please go ahead.

[Operator Instructions] We will take our first question now from Phil Chickering with Scotiabank.

It looks like the patients under the care gap closure services went from 900,000 last quarter to $1.2 million this quarter. But the revenue and EBITDA guidance for the year is left unchanged. I guess you talked about sort of, I guess, the structure of those economics, but can you sort of walk us through how adding 30,000 patients in your care gap coverage doesn't change guidance for the year.

Absolutely, and thank you for the question. So first off, this increase in patients is from contracts that we've already signed that we started the year out with. So these have been communicated to us. Of course, they materialize in the quarter, and we are planning to scale and ramp the operations to meet the demand. The key right now for us is with this increased list of patients, increasing our engagement rate with these patients, but also increasing our ability and our teams in the field to be able to go and fulfill all the visits that we're currently booking with these list of patients. And that's the big goal for us right now is ramping the teams in the field, making sure they're well trained to deliver a very high-quality service. And that's the key factor for us right now as we scale in the back half of the year.

Okay. Great. And then on the medical transport, revenue stepped down a little bit sequentially, something we don't see very often. Can you just sort of bridge the moving pieces of the Colorado exit? Was there any revenues to that in the first quarter that sort of made a harder comp? Or just walk us through the bridge of revenue sequentially in medical transport from the first quarter to the second quarter?

So it's Norm. So as far as Colorado is concerned, there really wasn't much in the way of revenue in Q1. It was really more of a year-over-year comp. If you look at Q2 of 2024, there was about $1.8 million, I want to say, somewhere in that area in Colorado, and there was immaterial amount of revenue in Q2 of 2025. So it was more of a matter of the year-over-year than the sequential comp.

In terms of the -- a little bit of a step back between Q1 and Q2, it was mostly a matter of seasonality. We had higher revenues than we had expected in the first quarter in a couple of our larger markets. So it's simply a matter of that settling in.

Okay. Great. So then there's no changes to any of those contracts repricing negatively or anything along those lines?

No, no. No, no, absolutely not. I would say that when you look at a lot of this is connected, right? Because if you look at Q1, we were bumping up against what I would consider some of our capacity ceilings, right? We were able to -- we managed the business at an extremely high capacity utilization rate in Q1, which sort of leads you to some of the increased cost of goods sold that we had in Q2, where we had to obviously hire people in order to be able to take more volume. So that's the kind of thing that's going to happen. So it's not exactly a step function, but what tends to happen is that we will run our crews and our equipment to as much capacity as we can squeeze out of it and then you get to a point where you kind of have to take a little bit of a step back and readjust so that you can take it the next step higher. And that's what I would say happened between Q1 and Q2.

Our next question comes from Mike Latimore with Northland Capital.

This is Aditya on behalf of Mike Latimore. Could you give some color on what was the EBITDA margin on your medical transport business? And what do you think it would be on a long-term target basis?

So I'll go out of order there. I mean we've talked about how we want to drive a double-digit EBITDA margin on that business. During the quarter that would not have been the case. I would say it was probably in the mid-single digits during the quarter. So somewhere on the 5% to 6% area. We talked about how gross margins were probably, I would say, close to 2 points lower than we would have expected. Most of that was driven by what we did in New York, whereas we've talked about, there's our #1 market size-wise. We just launched with a large hospital system here in New York. And that launched on July 1.

And during the month, particularly -- during the quarter, particularly towards the last month of the quarter, so during the month of June, we definitely added to our headcount. We have people who are in training. We have people who are on payroll, but we're not obviously running trips just yet. So we had a little bit of a mismatch in the timing between the cost of goods sold and the revenue kicking in. So that was something that suppressed margins a little bit. But otherwise, we continue to feel that, that EBITDA margin of 10% on an underlying basis for the transport business is very much doable.

Got it. And what do [ indiscernible ] the medical transport to be as a percentage of your annual revenue this year?

So we mentioned it's about 62% in the past quarter. It's not going from this point, it would probably step down from that because we have the much faster-growing health plan and provider -- payer and provider business that's growing at a faster rate. So are those ancillary businesses on the Mobile Health side. I would say that it's still going to be something on the order of 60% or so, 60% to 65% for the year versus 35% to 40% for what we consider the Mobile Health segment.

That appears to be our last question. I'll turn the conference at this time over back to Lee Bienstock, CEO, for any additional remarks.

Thank you, Michael. I appreciate everyone taking the time to join today's call and for the thoughtful questions. CMS projected that at-home healthcare expenditures are going to double from 2021 to 2031 to reach an estimated $250 billion. We believe our company is at the vanguard of this trend, care in the home, bringing quality care to the home. We're doing so at a scale we believe few other companies can match with a purpose-built technology platform and contracts with some of the biggest names in the healthcare industry. And most importantly, patients love opening the door for DocGo. Thank you to our incredible team and our investors as we make our collective vision of healthcare at any address a reality. We look forward to speaking with you all again soon. Be well.

Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.

Good day, and welcome to the iAccess Alpha Virtual Best Ideas Summer Investment Conference 2025. The next presenting company is DocGo Inc. [Operator Instructions]

I'd now like to turn the floor over to today's host, Lee Bienstock, CEO at DocGo Inc. Sir, the floor is yours.

Wonderful. Thank you so much. It's great to be with everybody at the Best Ideas Summer Conference 2025. We have a great idea, a big idea. DocGo brings high-quality, highly accessible care to all. It's an old idea. The doctor and care used to come to you, and we do that. We bring care to where patients need it, when they need it. And that big idea, bringing care to patients, meeting the customer, meeting the patient where they are is a big idea. And generally, when you meet the customer where they are, you tend to have a better outcome, and we improve health outcomes. So that's the best idea. That's the big idea I'd love to talk with you all about today and tell you a lot more about it.

Before we get started, I would like to remind participants that today's presentation may contain forward-looking statements, which are subject to substantial risks and uncertainties, including those discussed in our 10-K and other filings with the SEC. Actual outcomes may differ material from what is -- materially from what is expressed by these forward-looking statements.

And with that, I can really sum up the DocGo thesis with these very key points, and we'll go through all of them today. But DocGo at its core is a leading provider of tech-driven mobile care. As I mentioned, our big idea is bringing care to where patients are when they need it. The only way to do that efficiently, the only way to do that at scale is to leverage technology, much of which we've built ourselves, and I'll walk you through what that looks like. But our platform allows us to manage all of the units we have in the field with the right vehicle, with the right clinician, with the right diagnostic equipment, all for the right patient need, all stacked up together so that we can have each of our clinicians and our units in the field have a full, meaningful quality, impactful day and very efficient. So we leverage our technology to allow us to do that.

We have a foundational expanding medical transportation business where we leverage technology to bring patients from care to care across our medical transportation business. We have a rapidly growing care in the home business where we bring care to patients in their home, many of which are patients that are bed bound, have access issues. The traditional health care system has been unable to reach them and we are able to meet them where they are in their home. As I mentioned, we have a proprietary technology backbone. We have a strong balance sheet and the resources to support and fund our growth, and we'll talk about that.

The TAM, the addressable market is absolutely massive and expanding. Our country, unfortunately, is getting sicker and sicker. Our health care system is costing more and more money. And our whole goal is to improve outcomes allow -- to allow patients to live healthier, more meaningful lives. And the great thing about that is when patients are healthier, they cost the system less money. So everybody wins, and that's really gets us absolutely fired up and gets us excited about what we're doing in the field day in and day out. And we have a great leadership team. You won't get a chance to meet them or hear from them today, but we have a wonderful dedicated team of people across domains, whether it be medical background. We have great people across all of our teams that are delivering care in the field each and every day. And we have a big vision and big ambition for our company, a 100-year plan for our company. So we'll talk through all of these, but this is the company in summary, this is our thesis. This is everything that we're building towards.

So we are on a mission to deliver health care at any address, not just within a hospital, not just within a doctor's office, but at any address. And we believe that when you meet the patient where they are, you improve health outcomes. We have 2 service lines. One is mobile health, where we have an innovative approach, using upskilled clinicians to provide care in the comfort of a patient's home, office or community setting and payers and providers and municipal customers have been leveraging our services to meet patients where they are and serve the underserved and improve health outcomes. We'll talk about that.

We have one of the largest medical transportation businesses in the country and across the U.K., where we have a technology-powered state-of-the-art fleet and a wonderful dedicated team of thousands of EMS professionals that are providing medical transportation to large health care systems. We work with hundreds of hospitals today across our footprint, some of the largest hospital systems, which we'll show you in just a moment here.

All in, we have over 3,000 clinical staff. We have over 900 mobile health vehicles providing both mobile health and medical transportation services. We provided care across 31 states in the U.K. last year, and we're growing that. Patients love it. When you meet them where they are, our patient Net Promoter Score for our mobile health business is in 87. I think industry average is in the 50s. And because we meet patients where they are, we've been able to save the system a lot of money. We've saved through our ED diversion programs, where we reduce visits to the emergency department. We've saved our partners over $265 million to date, and we're just getting started. Last year, we traveled over 8.8 million miles to deliver care across 1.5 million patient interactions. I mentioned we provided care across 31 states in the U.K. Our health insurance partners have assigned us over 500,000 patients to close gaps in care for these hard-to-reach patients I was talking and we'll talk more about. We calculated over 15 million ETAs with our tech platform, letting hospital systems and patients know exactly when we'll be arriving to provide them care. We filled over 600,000 shifts with our clinical staff. We coordinated over 100,000 behavioral health screenings and over 58,000 vaccinations for both adults and children. So we are really operating at scale, meeting patients across -- a vast number of patient interactions with unrivaled technology and scale. And again, we're just getting started.

Our -- we have a strong balance sheet to fund our growth. You can see here our growth both in revenue, but as well as the assets we have on the balance sheet. We have over $100 million of cash on the balance sheet. We'll talk more about the financial profile of the company. But I'd really like to highlight our core businesses, medical transportation and the care in the home, payer and provider businesses have been growing steadily from 2021 through to today. We guided -- our most recent guidance was $300 million to $330 million of revenue. And you see here how it's broken down between medical transportation and payer. And so we've been funding that growth ourselves. Obviously, by going public, we're able to access the public markets, raise funds, and we have a strong balance sheet with all of the resources we need to fund the growth and all of the ambition that we have to make this company a great company serving a lot of the -- a lot of the ALS of the health care system today. You will see here the gray portion of the graph are some of the large municipal deployments we've done for emergencies that have taken place over the course of these last 4 or 5 years, namely COVID. We were mobilized extensively to help [ before ] the spread of COVID. We're one of the largest providers of testing and vaccinations during that infectious disease outbreak and obviously, in that moment in time. And more recently, we were called up and utilized to help with the migrant crisis and providing care and medical care and screening and behavioral health care for the asylum-seeking migrant population that has come through to the U.S., particularly in New York City. And so we've been providing care and support across those 2 emergencies. And so we have that listed here in terms of where you see with the revenue. Those gray bars represent those projects, particularly. And you see here that we're guiding this year that $300 million to $330 million only includes a small residual portion of the migrant work that's continued into this year, obviously, no COVID anymore, but the growth of those medical transportation and those payer and provider care in the home businesses. And we're excited about the resources we have and the opportunity that we have ahead of us. And we see here really highlighting the growth of those businesses, those base businesses, those core businesses, even without the once-in-a-lifetime sort of infectious disease and other sorts of emergency mobilizations.

Hopefully. But we're very proud of the work we've done during those crises. Like I mentioned, our balance sheet is improving. We had a large capital outlay to fund the mobilization to help in those crises and those emergencies. And we outlaid a lot of capital to mobilize and help in those instances and those receivables are coming down. Those are being converted to cash on the balance sheet, those receivables as well as our days sales outstanding for our billing and our collections cycle has been going down again with those resources converting on to the balance sheet. As of our last quarterly call, we had a total of $103 million of cash on the balance sheet, up from about $58.9 million from the year prior. So we continue to convert those receivables and our days sales outstanding continues to go down and convert to more and more resources on our balance sheet.

We shared on our last earnings call, our Q1 results, we did $96 million of revenue in the quarter. Our gross margin -- our adjusted gross margin was 32.1%. We continue to invest in the business. Our adjusted EBITDA loss was $3.9 million. As I mentioned, we have the resources to grow and scale the company. And our mobile health segment revenue was $45.2 million, and our medical transportation revenue was $50.8 million. Pretty consistent margins, 31% on the mobile health and about 33% on medical transportation. As I mentioned, we have about over $100 million of cash on the balance sheet. Again, those receivables continue to convert and add to that cash position. And we do have a line of credit that we can leverage that we have leveraged with Citibank, and we have about $30 million -- we have exactly $30 million outstanding on that.

We continue to highlight the growth we have. We signed a major contract with a large New York health plan to offer DocGo primary care services to their members in their home. We surpassed now 900,000 patients assigned to the company's payer and provider partners. As I mentioned on previous slide, at the end of last year, in 2024, we have about 500,000. Now at this point this year, we've increased that from 500,000 to over 900,000. We signed a contract that extends the company's California-based cardiology group, with a cardiology group to do cardiac monitoring for those patients, added 1,000 patients to our platform, and we continue to add features to our tech stack, our industry-leading tech stack that helps health plans and health systems manage the flow of patients and the patient visits.

So I want to talk a little bit about really the vision for the company and why we think there's such a huge opportunity ahead. It's sad to say, but chronic disease is just a massive issue for the U.S. health care system. The CDC estimates that 90% of the nation's $4.5 trillion in annual health care spending is for people with chronic disease and mental health condition. So if we can really help that portion of the population that's suffering from these chronic conditions, that's suffering from mental health condition, we can do a lot of good and save the system a lot of money. And that cost that's being borne on this percentage of the population, that's the vast majority of the spend creates a substantial challenge for payers, for providers, for our Medicaid and Medicare programs. And it's just that we feel like will drive demand for our services because if we're able to improve outcomes, ultimately, healthier patients lead, of course, to better outcomes for patients, but also those patients then cost the system far less money. And that's the wonderful aspect of our business. If we're able to help patients lead healthier lives, patients are much better off. If the patients are better off, that means the system is less burdened by the cost. It's saving the system money. So the system and our governmental programs, Medicaid to Medicare are better off and then we do well as a company. It's one of those great scenarios where the patients do better, the system does better and our company does better as a result. And we're just so excited about the opportunity to both help patients, help the system and, of course, build a great company. And this is a big opportunity.

As I mentioned I want to talk a little bit more about what we do with the partners we work with. We have tailored solutions for crucial, crucial stakeholders in the health care system, payers and providers, they have a percentage of their members of health plans and providers that are in value-based arrangements of patients that have chronic conditions, but for whatever reason, are not getting the care they need. They have gaps in care. They are costing the system a lot of money. And so we provide care in the home programs to reach this hard-to-reach population, and we go to their home and we close care gaps. We provide primary care services. One out of 4 Americans doesn't even have a primary care provider or know who that primary care provider that's assigned to them is. And the first primary care visit saves the system $4,000 just by having that proactive primary care annual wellness visit. We provide virtual care management, population health and medical staffing for payers and providers. And the value proposition is clear. We increase access to care by treating bed bound and unattributed hard-to-reach patients overall lowering the total cost of care. Very powerful, especially in this world of decreasing budgets, higher utilization, being more efficient and being able to reach patients in a more efficient, cost-effective, better outcome way is very, very valuable. And then for health systems, so we work with the payers and the providers. We also work with health systems to provide medical transportation and transitional care management programs. Efficient, reliable medical transportation, I'll talk a lot more about what that looks like. And ultimately, hospital systems don't want patients bouncing back within a 30-day readmit window because they don't get reimbursed for that, and they don't -- and it hurts their quality measures. And so helping transition patients out of the hospital to their next care setting and helping ensure that they don't bounce back to the hospital is obviously great for patients. It's also very much valued by the hospital system partners we work with. So this is who we work with. They assign us the patients. They identify the patients that are in need. They tell us which patients are getting discharged. So it takes a lot of the guesswork or patient acquisition cost out of the process. We contract directly with these, and I'll show some of the logos we work with, we contract directly with these crucial stakeholders in the health care ecosystem, and we bring very clear value to them for the metrics and for the impact that they very clearly are trying to measure and make progress on. And I'll do a deep dive into both.

So mobile health, mobile health, these are some of the customers we work with, and they assign us patients that are in need of care gap closure, primary care services, and I'll talk a little bit about what that looks like, but we've been able to sign and we have a very nice robust pipeline of additional customers that we're working with now to get launched. But 30% of the PCP market is expected to shift from -- to nontraditional providers like ourselves according to Bain. And about -- the addressable market of mobile health is about a $265 billion market for care in the home according to McKinsey. So these are not our numbers. This is sort of -- a lot of the care is being transitioned to new settings. The home is probably one of the most crucial settings that's being transitioned to. And because of technology and innovations like some of the models we're bringing to the market, more and more of that is going to be accessible to patients, and it's a gigantic addressable market that we think is good for patients and good for the system. So payers and providers, they're looking for solutions to increase access and improve quality metrics, reduce their overall cost. And we offer a broad range, perhaps the broadest range of services that is available in the home that we can do, including mobile phlebotomy, urgent care, care gap closure, transitional care management, PCP and other services that bring care to patients. The way we do it, we do not send a doctor door-to-door. There's too much drive time. There's too much downtime in that. We send an LPN on-site, a licensed practical nurse. And we use that advanced practice provider in a central location that is overseeing that hands-on clinician in the home via telehealth. So it's the best of both worlds. You have the efficiency of telehealth, and I'll talk more about that model, but you have the efficiency of telehealth and the centralized clinician with the hands-on clinician in the home that's able to take labs, that's able to see inside the ear, nose and throat and send that diagnostic back to that centralized expensive resource. We close over 30 more different care gaps in the home. And the way we manage it all is through our proprietary technology platform that helps us drive that efficiency that's very crucial when you're running a mobile service like ours.

So to talk about that efficiency, here's what we do, what we do. I mentioned in the onset, this is the Best Ideas Conference. This idea is an old idea. The doctor used to come to your home, but it was incredibly inefficient, right, to have this very specialized, very skilled resource going from home to home, right? There's just too much commute time. There's too much drive time. And so eventually, the system oriented to the doctor being in a central location and having all the patients come to him or her. And so we put that back a little bit. We basically send a licensed practical nurse equipped with diagnostic technology, with the ability to take blood, the ability to do ultrasound, the ability to take readings, the ability to send back images and real-time synchronous view of the patient's ear, nose and throat, listen to the chest. And they're sending that LPN that's driving door-to-door is sending back that -- those diagnostics to a centralized clinician, the centralized advanced practice providers, such as a physician assistant or a upskilled clinician that is then overseeing those visits. And while the LPN is going home to home, maybe doing 1 patient an hour or so, our remote APPs that are overseeing each and every one of these visits can do multiple patients per hour. And that efficiency is what's driving our model and technology has unlocked our ability to do that. And this platform can be leveraged across a multitude of different use cases. And here's just a continuum. We do mobile phlebotomy, care gap closure, transitional care management. We have staffed clinics, urgent care and PCP services. We can do it in the home. We can do it in telehealth. We can take mobile clinics and park them anywhere, take them deep into communities that are underserved and give access in a way that's innovative and next generation and allowing us to do multiple services leveraging this platform. It all comes down to access and ultimately, access drives better outcomes.

That's mobile health. Our other segment of the 2 is medical transportation. That also is a multibillion-dollar addressable market, where we have a full vertical integration, and I'll talk more about that, but we provide nonemergency medical transportation between clinical settings and patients' residences. You see here a picture of our -- one of our great crews and what those ambulances are. You may see those light blue ambulances running around your cities, providing care. We provide a full continuum of medical transportation services. We provide the software that the transfer centers can utilize, and I'll talk more about that in a minute. And that proprietary technology paired with the fleet of ambulances and crews is a tremendous, tremendous value proposition. These are some of the customers we work with. We work with the largest hospital systems in the markets that we serve. We also work with the NHS in the U.K., and we help provide them with seamless medical transportation. Why does that matter? Patients that have to stay an extra night in the hospital because the transportation was not provided to them cost the system a lot of money. That bed needs to be freed up, and I'll talk about how our tech platform helps with that. Such that it could be used for the next patient that desperately needs it. Those hospital beds are scarce resources. It takes the system. It costs on average, $3 million to bring a new hospital bed into the system. And so we could be more efficient and help our hospital partners be more efficient with the hospital beds they have, that's a huge win. And we do that with our technology platform that we've built proprietary, and it's a mobile health and medical transportation management platform. It's integrated with the hospital system's EHR such as Epic. And directly from the patient's chart, a clinician that is discharging -- a discharge nurse that's discharging a patient, click a button, and they can see exactly when we're arriving so that he or she knows when to get the patient ready for discharge when we'll arrive on scene. In addition, intake is going to get notified that when that bed is being freed up for the next patient, housekeeping is going to know when to come and get that bed turned over so that we can be super efficient on the bed management side. So not only transporting the patients, but really integrating with the hospital systems so that the beds are freed up and made ready and utilized for the next patient that needs it. And so the discharging nurse knowing exactly when we're going to arrive, that ETA, that Uber-like experience. And so that is very, very valuable to the health systems, and this is the technology that we've built -- purpose-built.

I know we're running short on time. I do want to get some questions in, so I'll wrap up here in a minute or so. But I really wanted to highlight the company -- while we've wound down some of the municipal work that we've been doing on COVID and migrant, the company continues to grow this medical transportation and care gap and care in the home business. You see some of the metrics here. We've never done more medical transportation than we're doing now. We've never done more care in the home than what we're doing now. And we just think there's a massive opportunity in front of us to continue to scale. And you see here some of the growth metrics that we're projecting out. You can spend some time. There's a more background on our team, but we have our Chairman of the Board. You may know Dr. Stephen Klasko, world renowned. He's a former -- he's the former CEO of the Jefferson Health System. He is currently an executive resident at General Catalyst. He's a physician by training and obviously a great, great partner for us as we scale out our health care offering. You've got a chance hopefully to know me a little bit more. My background is in tech and scaling platforms such as this. And we have a great team with Norm and Dr. Powell. We have a tremendous medical advisory board that's weighing in on our programs and our clinical efficacy and design. So I invite you to take a look at all those people that are helping build our great company that's detailed that on our website.

We vertically integrated everything. We've talked about it. We have our proprietary tech platform. We have our own staff, our lab license, our clinical practice group, all together so that we can do this care at any address. And that vertical integration is both a competitive moat and allows us to give a great patient experience. We're pretty unique. If you look across what we offer and compare to others out there that are doing this, very few have all of the capabilities that we're able to offer.

Okay. I'm going to jump to our key takeaways, and then I see we have a few questions, which I'll do some rapid fire in the Q&A. But again, just the key takeaways, I hope you've taken from our presentation today. We have a strong balance sheet. We have our defensible competitive advantage in our technology and our vertical integration. We have a very unique value proposition that benefits both the patients and the payers and providers in the hospital systems and we're building this recurring revenue base with great -- with a roster of tremendous customers that we're so privileged and honored to be working with. And I think our team is just fired up every day to come in, knowing that we're helping patients live healthier, better lives.

Let me check quickly for some of the questions we have in here today. The HHS Secretary Kennedy says, we're expanding rural health access through innovators in telemedicine and AI-powered diagnostics, bringing cutting-edge care to every corner of the country. Does that DocGo give -- does this give DocGo a tailwind?

We think it does. We think our ability to be mobile. We think our ability to be out in the field to bring care deep into communities is absolutely what Secretary Kennedy is talking about. But more broadly, we feel there's been a lot of talk of lowering the total cost of care, being more efficient, dropping budgets, we feel like we fit well into that. Our whole goal is to help the system save money.

So why is there going to be this growth now? There's no crisis like COVID to make money. This really needs to have a spike in home care. Why is there going to be a spike now?

So we feel like there is a big, big percentage of the population that doesn't have great access to care. And very often, the best site of care is often the patient's home. The last place you want to be perhaps when you're sick is in a waiting room, and there are just patients that are not able to access the system and they are costing the system a lot of money. And so at the end of 2023, we were working with one payer that gave us 2,000 patients that needed -- that had these gaps in care. And today, I shared all the payers we're working with have given us over 900,000. And we think, yes, patients that are being served by the traditional doctor's office, that's great. But there are a lot of patients that are falling through the cracks, that are drifting that are unattributed and unfortunately, are very sick. And we feel like if we can go and meet them in their home, close care gaps and bring them care where they are, there is a tremendous need for that and a very, very large TAM.

I see we're at time. Perhaps we'll leave it there. But we are available. You can reach out to our Investor Relations team. I spent a lot of time with investors, getting feedback, getting input into the business and sharing a lot of the great, great opportunities that we're working on. So absolutely go to our website, reach out. But we're excited to be joining you here at this Best Ideas Conference, and we're very excited about the big idea and the big opportunity we have in front of us. Thank you so much for joining us.

Okay. Good afternoon. We're going to get started with our next panel. I'm Jamie Perse, health care provider analyst at Goldman Sachs. Next, we have DocGo and Lee Bienstock, CEO. Thank you for joining.

Thank you, Jamie. Thank you to Goldman. It's great to be here.

Thank you. Well, maybe we can just start -- you've got a couple of different business lines, but maybe you can outline for us like what is the core competency that connects these all and just give us a quick overview of the business, and we'll dive in from there.

Yes. So an overview on DocGo. We're a mobile health care company. We bring care to where it's needed or we'll transport a patient to a location of care that they need or as they're being discharged from the hospital. So we have a very large medical transportation platform, and we have a mobile health care platform that brings care to patients where and when they need it.

I guess just starting from high level and we'll work down from there. But you've gone through a little bit of a rebasing period across a couple of the businesses. How are you thinking about just the positioning of the business overall, redeploying assets and sort of using this period to transition to what's next?

Yes. So as you mentioned, we are going through an evolution of the business. But really, it's continuing to expand what we've always done and what we've been so successful doing. So the company got started as a medical transportation company, and we built probably the best tech platform for EMS nonemergency medical transportation, where essentially a discharging nurse can click a button on the platform and know exactly when the medical transportation, when the ambulance is arriving for that patient that's being discharged to take that patient home. And just like the common tech platforms of today, get an exact ETA. Last year, our tech platform calculated 15 million ETAs for our partners. And so we've continued to expand on that.

And as the country was hit with COVID, as New York City was hit with the migrant crisis, we were one of those companies that essentially the public health apparatus turned to because we had so many ENTs, paramedics, ambulances, we were very natural partners to help respond to some of these, frankly, what seem to be once-in-a-lifetime events, a pandemic and a big 200,000-person influx to New York City.

And those events like COVID and the migrant crisis took on a lot of the story of the company. And really, what I've focused the company is to really focus in on continuing to expand the medical transportation platform that we have and also all the while continuing to expand the care-in-the-home business. And that's really what the company has been focusing on. Yes, we've done a lot of crisis response, a lot of municipal work, which I know we'll talk about. But all the while, we've been really expanding our capabilities of the medical care we can deliver in patients' homes and really expanding the medical transportation platform. And really, that's the focus of the company. We've been doing that. We're going to celebrate our 10-year anniversary this summer. And over that span, we've helped care for 10 million patients. So we've been doing this at scale. Yes, we responded to a lot of these crises that have happened over the last 5 years, but all the while, we've been building the capabilities to deliver care where it's needed, and that's the big focus of the company.

Okay. Well, you mentioned some of the one-off things that have emerged over the last couple of years. We'll come back to that. I want to start with the core business today. Obviously, the medical transit business, I think that's $225 million in guidance of $325 million -- excuse me, $315 million at the midpoint. So it's the bulk of the business today. You're coming off, I think, your highest medical transports ever in the first quarter. Can you just talk about the growth drivers? I think you're growing mid-teens or thereabouts. What's driving the bulk of the business today?

Yes. So our medical transportation business is focused on large hospital systems. We partner with large hospital systems that utilize our tech platform. And at the same time, we also provide them with the ambulances and the crews with which to transport the patients in the system. So that's been a big focus of ours. We work with some of the largest hospital systems in the country. We work with New York City Health and Hospitals, Northwell, HCA. We work with Methodist. And so we work with Jefferson, Mainline, lots of different hospital systems, and we go in and we help manage all the patient flow. They utilize our tech platform and their discharging stations use our platform. It's all embedded and integrated with Epic.

So directly from a patient's chart, the discharging nurse can click a button. And so that's how we grow that medical transportation business. So there's an inherent organic growth that happens with the hospital systems we're already working with. Unfortunately, America is getting sick [indiscernible] more patients that are being moved around. And so that tends to have a tailwind for us. But at the same time, also, we sign new hospital systems that come on to the platform, and that creates a step change function in the growth. So that's how we get, I'd say, 2% to 3% of organic growth just on the number of volume that just goes up for the trips, but then we bring on additional hospital systems that get us to a 10% or 15% year-over-year growth rate.

And just thinking about the growth drivers in that way, is there opportunity to deepen relationships within existing health systems? You're in -- I'm making this up, you're in 5 of 10 hospitals within a health system and you can expand to additional hospitals. How does that fit into the growth algorithm?

Yes. So today, we serve hundreds of hospitals across all of our markets. And I should have mentioned in the opening, DocGo, we serve patients in 30 states. We're licensed to provide medical care to our physicians group in 48 states. So we're serving hundreds of hospitals across many states in the U.S. as well as many of the hospital trusts in the U.K., which we can talk about. And so there's an opportunity for us to do more with the hospital systems we're already working with, bring on additional locations that they may have, but there's also an opportunity for us to provide more and more services to those hospital systems. And I think we've only scratched the surface of that.

Most of the hospital systems we work with, we're only providing medical transportation. But because we're such an expanded mobile medical care company, some of the hospitals we work with now, we're doing cardiac monitoring and patient monitoring for them. Some of the hospitals we work with, we're doing transitional care management, which we can talk about as the patient is being discharged, helping to stop and reduce them from being readmitted to the hospital within 30 days. So we have great partnerships with the hospitals we work with. It's primarily medical transportation today, but we think that we could expand it pretty significantly to other services.

And just as we think about the next year or 2, you've guided to 575,000 transits this year. I don't know that I'll call it guidance, but alluded to that you can get to 700,000 next year, that would be like a 20% growth trajectory. Is that underpinned by visibility on new contracts coming online? Or just give us a sense, it sounds like new logos, new customers is a big piece of that. So what's the visibility that's driving that?

Yes. So we have good visibility certainly for this year's number. I think we have good visibility for next year's number. And really, those numbers are based on 3 factors. One is signing new hospital systems onto the platform. So as an example, just this month, we signed a very large hospital system in New York City, in New York that we're bringing on right now actually as we speak. Over the last 6 months, we've expanded to Chattanooga, Tennessee. We've expanded to the Dallas-Fort Worth area. We think that Texas is going to be a large market for us over this year and next year. So it's really a confluence of multiple variables. One is signing new hospital systems; two is geographic expansion and then also, of course, bringing on additional hospitals for the systems we already work with.

And what are you displacing when you add these new customers? Is there just small regional competitors that you tend to be displacing, maybe there's no solution? Who are you displacing?

Yes. So on the medical transportation side, we are displacing existing providers. we're coming in with our own technology platform, which is displacing whatever technology platform they may be using. Sometimes they're just using Excel file, they're using Teams messages, things of that nature. And then, of course, we bring on our transfer center software that allows them to manage the whole system. And then there's existing providers that we're displacing very often. So in that business, on the health insurance side, which we'll talk about on the business where we provide care in the home, that's just an expanding pie that's a greenfield opportunity for us.

Yes. And can you just give us a sense of the -- sticking with the medical transportation business, a sense of the market. I imagine it's very fragmented. And you've invested in the technology platform that's enabling an elevated, more sophisticated process for nurses, more seamless for integration with EHR, et cetera, that they probably can't provide. Is that what's enabling kind of the share gain dynamic that you're seeing?

Exactly. It's a very fragmented industry. And we've invested heavily in that tech platform, and that's what's allowing us to win a lot of this share. And so really, that's been a focal point for us. And it's a very fragmented industry, and we are coming in with scale. We're coming in with a certain level of service, and we can talk about what our model is because it's a very differentiated model from what has existed prior, which I think we should talk about actually. So the old model is really what I call a jump ball model, right? A patient is being discharged from the hospital, the nursing station has a list of ambulance providers that he or she can call. She calls the first one, they're not available. He or she calls the second one and down the list, they go. And we think that just fundamentally creates a bad experience for everybody.

It creates a bad experience for the patient. They could be sitting around waiting for transportation. Creates a bad experience for the hospital system. They don't know when someone is going to arrive. They don't have sort of this predictability that they need to run their health care facility. And so we came and we said, we're going to upend that. A, we're going to give you a technology where you know exactly when we're arriving. So you know exactly when to get the patient ready. Intake knows exactly when that bed is being freed up for the next patient. And we're going to provide you with a fleet of dedicated ambulances and crews for your facility. You tell us which patients are most critical to be moved. You tell us which patients to prioritize. You know exactly that those ambulances and those crews are going to be there, gives you tremendous predictability. And also gives us predictability because those hospital systems are guaranteeing the rate for those vehicles, those dedicated fleet of vehicles so that we know that they're going to be highly utilized.

So this, I think, has revolutionized the space, not only the technology platform, but just the model itself, right? The hospital system gets predictability and they know exactly that those fleet of ambulances are there ready, willing and able to transport those patients in real time. That's a big, big change to the industry. And I think that combined has allowed us to really gain share.

And you mentioned the New York Hospital, the Chattanooga Hospital. I imagine you don't want to speak about specific customers. But as you're going into these conversations and winning RFP, what's the 1 or 2 things that's most resonating pain points for hospitals that allow them to get across the finish line with DocGo?

Yes. So I think the #1 is the patient bed management and flow because to bring on a new hospital bed in this country, just one new hospital bed will cost $3 million. So hospital systems are faced with, do we have to build more capacity, which costs a lot of money and takes a long time? Or can we use the capacity we already have to be more efficient? And we enable them to do that, right? And so like as I was describing, when the discharging nurse clicks that button, a, he or she knows exactly when we're arriving, but then housekeeping gets a notification when to come and make the bed ready for the next patient. And then intake is getting a notification, alerting them that the bed is now ready for the next patient. So the flow of the patient allows their hospital system to be more efficient. And as a result, they utilize the beds and a lot more efficiently and then the capacity as a system increases. That is a very, very profound value proposition for the hospital systems we work with. And that really is the cornerstone of what we provide to them.

And then how does pricing work? Is that all contracted between you and the hospital? Is it Medicare rates? I mean, give us a sense of pricing dynamics, and are you taking price in this market?

Yes. So we go to the hospital system and we say, we're going to provide you with a dedicated ambulance and dedicated crew. And depending on, as an example, we know Friday at 2:00 p.m., you have the most number of discharges. We're going to have 5 ambulance and crews ready for you because we look at all your historical data, and we know exactly how many patients on average, you're going to be -- need to transport. And we say then, let's say, our basic life support or advanced life support ambulance is going to cost you x for the day, cost you x for the day. We're going to bill insurance. Whatever we collect, let's say, it's $1,500 is going to cost the hospital system. If we're able to collect $1,500, then the hospital system doesn't owe us any money. If we collect $1,200, then the hospital system has to make up the shortfall. So they're basically guaranteeing that they have capacity, but at the same time, they're also guaranteeing that they'll help us make sure that those vehicles are highly utilized. And also, we don't take on the reimbursement risk, right? So if they require that we transport patients that are uninsured, underinsured, then ultimately, they're going to help fill the gap that's there between what we're able to collect and really what it costs to procure a great quality service.

And just in that example, how much is the hospital typically funding?

Well, we have hospitals that fund almost 0. In many cases, we have hospital systems that have payer mixes that allow them to fund 0. At the end of the month, they don't owe us anything. And we have hospital systems as an example, we work with a hospital. I'm not going to call them out by name, but we work with a hospital as an example that 30% of their patients that are being discharged are either uninsured, it's a safety net hospital. So as a result, a big percentage of their patients just don't have insurance, and we get no reimbursement for them. In the old jump ball days, they make phone calls, we need to transport this patient. Nobody is going to transport a patient that they're not getting reimbursed for at all. So that hospital tends to have to make up the shortfall to us. But they know that we're going to be ready, willing and able to transport those patients and free up the next bed for the next patient, and that's worth a lot more than what the shortfall ends up being with us.

Okay. Let's maybe shift gears to the payer-facing side of the business. And here, it seems like you're creating more of a market. I mean these are patients that just aren't addressed by the health care system as it exists today. Can you talk a little bit about the needs from the perspective of the payer, your customer and how your solution fills that need?

Yes. So this is a really rapidly growing part of the company. And essentially, the way it works is we partner with the payers and provider groups, the value-based ecosystem. And they share with us list of patients and they assign us patients that have gaps in care. They maybe have diabetes and they need a retinal scan or A1c check. They have osteoporosis, they need a bone density scan. We provide over 40 different care gap services in the home. And basically, the insurers are providing us with list of patients that they know are chronically ill that are not going to get these care gaps addressed, and they've tried and tried to get them to go to the clinic or to their physician to get these care gaps closed and they haven't been successful doing that. So they give us those patients to meet the patients where they are in their home with success in closing out those care gaps.

And you say to yourself, well, why are the insurers doing this? This is the reason why we're just so excited about this business. To me, it's like everybody wins in this scenario, right? You have the patient who, for whatever reason, is not accessing the care they need. Maybe they have mobility issues, maybe they're disabled, maybe they don't have good access to care. So we're going and meeting them where they are. And pretty much in any business, when you meet the customer or the patient where they are, you're going to be successful. So the patient is winning. The insurer is basically funding and paying for the medical costs relating to this patient. So the more gaps in care they have and the longer they go unaddressed, the more expensive that member is going to be for them. So they're highly incentivized for us to go and provide care to that member.

And then, of course, if we're successful doing it, our company does well. And the U.S. health care system also does well because the healthier patients are, the less of a cost they are on the system. So we are very excited about this opportunity, and the insurers are really taking us up on this right now. So we started doing this in Q4 of '23. We had one payer assign us a list of 2,000 patients. It was December 3. They're trying to close out the year, get a call. We've been working with this payer, and they're taking a while to sign the contract. They call us on December 3, okay, we want you to make progress by the end of the year. We have a list of 2,000 patients who want you to go to their home to close care gaps.

And we have a culture of saying yes. We have a culture of taking on that comes from the emergency medical background that we have on the transportation side. We took that list of 2,000 patients, and we were quite successful in going and meeting at least a portion of that list in their home, even over the holidays and over New Year's and so forth. Since then, since that list of 2,000 in December of '23, we now have lists of patients that total 900,000 patients with a list of about half a dozen very, very large payers. And they're giving us these list of patients to go engage and close care gaps. And we're very excited about that because, ultimately, that's really -- no we'll talk about this. This is the right solution for the right time. This industry right now is under enormous stress, higher utilization, causing them a fortune and now there's going to be potential cuts in funding. So we feel like our solution is tailor-made for this. We are absolutely trying to cut costs in the system, and we're trying to meet patients that are sick to keep them out of the hospital so that it costs the system less money. Ultimately, that's going to be what the health care system in this country ultimately needs.

And I mean, you mentioned the 900,000 list. I think that's up from 700,000 a year ago, high-20s growth, 28%.

That's right.

How would you break this down into a revenue opportunity? I mean, like is there a revenue per member type of goal? And then I guess, as a related point, what does success look like? If you can reach 50,000, is that the 25,000 -- what does good and great look like in terms of addressing that list?

Yes. So right now, we're getting paid essentially a custom rate per visit that we do per patient. And sort of basically fee-for-service style model. We go and close the care gap in the home. We get paid an at-home visit rate. That's where we're starting right now. And we're getting paid per care gap closed. So as an example, we might go to -- on average, we close 2 care gaps every visit we do. So we might go and titrate a patient's meds, take vitals and do a vaccination or we might do a bone density scan, a diabetic retinal scan. We do multiple care gaps when we visit a patient's home. What we're finding is -- so we get paid that per visit rate. What we're finding is, so far, 50% of the patients that we're going and visiting don't have a primary care provider. And by the way, that's not like such a -- it's a high number. But on average, right, I look in this room, 1 in 4 average Americans don't have a primary care provider. So what we're finding is we're going to the home, we're closing gaps in care, and we're finding these patients don't have a primary care provider. So we're now starting to enroll them in our primary care practice so they can become our primary care patients. So we can get that longitudinal recurring revenue.

And then over time, we may take some capitation or value-based payments on these members, but we're being very, very cautious, and we're sort of gradually easing into that value base. So right now, we're in a fee-for-service model. Over time, we feel like we'll be in probably the most strategic position to take a value-based arrangement because we're in the patient's home. We're closing gaps in care and we're their quarterback on the primary care side. We think those are crucial ingredients to take risk intelligently. But right now, we're starting in the fee-for-service way. But over time, you can see us go from an at-home visit rate to primary care rate to capitation to value-based payments as we go through the progression here.

I'll come back to primary care and the risk side in a minute. But just thinking about the list that you have today, how much runway does that give you in terms of growth opportunity over the next couple of years just in terms of penetrating that? And maybe as part of it, just talk about how you're doing that. I think you've talked in the past about you're constantly trying to figure out how to better reach patients in terms of when to call all these different strategies to better reach them. So how do you execute on that? And how much runway in terms of growth does it...

It's a lot of runway. It takes a lot. So obviously, we can convert a higher percentage of the list we already have. And there's so many great -- that is a competency that the company is building that I think is going to be a tremendous strategic advantage to us. I'm going to give you a few examples. So we get this list of patients. We know God forbid, Jamie has diabetes. He needs a diabetic retinal scan, an A1c check, check his vitals. We get a list. Here's Jamie's name and number. And here's his address. So we started reaching out to these patients. And originally, what happens is the health plan is going to send you a postcard from them. Hey Jamie, valued member, you need some critical screenings. DocGo is going to be reaching out to you to schedule an at-home visit.

Originally, I was maniacal with the team. The day that Jamie gets that postcard, make sure you call him. The day after Jamie gets that postcard, make sure you call him. And the team gleefully comes back to me and says, Lee, you were wrong. The best time to call is like 20-some-odd days after he receives that postcard. Why? Because a lot of the population we're dealing with has -- only checks their mailbox once or twice a month, right? We know that there are certain times now to call seniors during the day that's better. We know that we're calling in their native language. We know that text messages works better for certain populations. So we're creating this cadence of communication, and it's just getting better and better, the more and more data we have and the more and more engagement we do, it's feeding the engine, and we're just getting smarter and smarter at this. So first growth is just get more and more patients, but then also convert more and more of those lists, and we're getting smarter and smarter about how we do that and then layering on more and more services. That's how we're going to grow. Right now, we're focused on New York for this business. Right now, we're focused on New York and California. But there's absolutely an opportunity for us to also take the show on the road to other states as we grow this as well. So there's growth with the list we have, grow the list we have. There's growth to penetrate the list we have even further on the conversion rate. We can sign more payers. We can go to new states. So we're just scratching the surface of this opportunity.

And then one thing I'm unclear on, I guess, is the goal here to get them reengaged and they'll have a primary care doctor on their own and you sort of are out of the picture at that point, you're reengaging for a period of time and then get them back into regular engagement? Or is there a longer longitudinal relationship here that you're trying to develop? I think that's part of the primary care strategy. Help us understand like, I guess, the duration of the relationship you're trying to create?

Well, we feel strongly that if a patient has a primary care doctor that they like and they're going to see for whatever reason, we go to their home to close a gap in care, we're going to close the loop with their physician. If you have -- it was once famously said, if you have a doctor you like, you can keep your doctor, right? If you have a doctor, you can keep your doctor. We believe that. If you have a physician that you like, we want you to continue. But like I said, half of the patients we go and see don't have physicians, they don't have a primary care doctor, and we are ready, willing and able to fill that void. So that's kind of the way we feel. We feel like we are in existence to care for a subset of the patients that are not getting good care today or don't have coverage, don't have good access. That's the void we're filling. By the way, it's a massive void that we're filling. The patients that are well served today, we bless them, we want them to continue to be well served by the establishment that serving them today, and that's kind of the way we think about it.

And then can you talk about the labor model a little bit, particularly as you're thinking about building the primary care side? Lots of companies interested in hiring primary care doctors at this point. So like how challenging is that to build?

So we have a very unique model, right? I mean I always like to remind people, this is not a new idea. Like everyone's seen the Norman Rockwell paintings, like the doctor used to come to your house. But it's wildly inefficient to have doctors travel from house to house. There's so much drive time, downtime that they're not utilizing. Everybody has this sort of cliche and mean that when you go and see the doctor, the doctor only comes into your room for like 1.5 minutes and they're out, right? So we basically -- we don't do that, but we say we are sending an LPN, a licensed practical nurse from house to house. We're sending a medical assistant from house to house. They're serving as the hands, eyes and ears in the patient's home, and they're being directed synchronously in real time by a physician, nurse practitioner, physician assistant and an advanced provider centrally, let's say, in HQ, in our headquarters. And so where that LPN going house to house can see 1 patient an hour, our advanced providers in HQ can maybe see 3, 4 patients an hour. And that's how we're leveraging the very scarce resource that you're describing in HQ and scaling the more prevalent clinician base, which is the licensed practical nurse and the medical assistant, and that's how we're sort of arbitraging between the 2.

We have a very scarce centralized resource that's been directing in real time the sort of more prevalent clinician that's going from house to house. And that clinician that's going from house to house is equipped with what we call a go bag that includes all of the various different diagnostics to be able to listen to the chest, to see inside the ear, nose and throat to be able to take different swabs, to take bloods, to do various different diagnostics and send back those readings in real time to the advanced practice provider that's centrally located. And so that's how we've been able to scale this model. I think this is by far going to be the model that's necessary if you want to be a successful mobile health care company.

And it seems like you have a lot early in this opportunity, you can add primary care. This gives you a lot of runway. Why not just kind of focus on those pieces? You're already talking about risk. Why is that necessary at this point and not just building some scale and track record, I suppose, in some of these newer categories.

Yes. Well, we're not taking risk. We absolutely are focused on the sort of building scale, fee-for-service today. The reason why I say that is because I know that we are leaving a lot of the value that we're creating on the table. I'll give you an example. The other month, one of our clinicians goes to a patient's home, they have 6 open gaps in care. And we closed 6 gaps in care in that one visit that we got paid that one home visit rate for. That visit was worth a lot more to the payer and to the system at large than what we were paid for that at-home visit business we closed so many different care gaps. Basically, there was a peer-reviewed study that published that said, just the first preventative care visit is worth about $4,000 to the health care system. We're getting paid 1/10 or less of that. So I just know that our company is creating a tremendous amount of value for the system, particularly with these hard-to-reach patients, particularly with these patients that cost the system so much money. And over time, we're going to look for ways for the company to receive credit for that value we're accreting.

Probably got to move on here. I've been running a little long today. So just on the migrant business, really just one question. I mean you've been pretty clear this is winding down. I think the primary question I'd have is just your visibility on the accounts receivables. It's a pretty significant balance. What's your level of confidence in sort of the collectability? Have you taken any reserves against that? Any color there?

Yes. We are very confident in the collectability. In fact, we see progress. Just today, we received the payment. The payments are coming in. We had $150 million outstanding, went down to $120 million. Now it's sitting at $100 million, and we're making progress. So that balance is being worked down, and that's what's being converted to cash on the balance sheet.

Any updates there relative to the guidance? I mean, you've already done most of the revenue you expect to do this year. There will be a little more in 2Q, I guess, any updates?

Exactly. No, well said. Correct.

So on the government piece, this is a big focus coming off the last earnings call. You cut it entirely out of guidance. I guess, is the message there -- you kind of expect revenue, but you have no idea what it's going to be. And so it's out of guidance? Or just want to make sure I understand what the message is. Do you have revenue in this channel today or you would need some of these programs to launch in order to have any revenue?

Yes. So we will have some revenue from the municipal programs this year. I think the reason -- the decision that I made was really the predictability of how much it's going to be and the timing of that revenue became very difficult to predict. And so we said, let's remove that from the guidance. Any municipal revenue will be in addition to the guidance that we have on the medical transportation and the care in the home businesses that we've been talking about. And part of that is because I just feel like the company's message, it will be easier for the company's message to resonate with investors. When I meet with the team, I talk a lot about we've never done more medical transportation than we're doing right now. We've never done more care in the home than what we're doing right now.

The company's balance sheet is incredibly healthy, right? We have over $100 million of cash on the balance sheet, very little to no debt. So that's the message that needs to be resonating, not whether or not this municipal program is going to come on, how long it's going to be, whether it's episodic, whether it's an emergency, whether they're going to pay, those are pieces that's just going to be incremental and reported separately. But the base business, the business that we're growing on the medical transportation side, that's the reason why I gave a lot more specificity around that on the last earnings call.

Okay. Yes, I think that makes sense from a communication standpoint. I want to understand what was embedded in the prior guidance actually just to think about how much potential upside it could be -- maybe it's this year, maybe it's next year, but I think it was $100 million that you took out of that. How much of that was projects that were already approved that had not launched versus new RFPs that you are hoping to win, but obviously, probability adjusted? Any context on that?

Exactly. So we had a pipeline. So first off, we had contracts that we had signed that were set to launch, and those got delayed with what's going on right now in Washington. We had projects that we had submitted that we were waiting to hear back on. I'm going to give you a couple of examples of that. And then we had projects that were set to scale that are sort of sitting in the early or earlier stages. So that was the reason why we said, hey, we saw companies pulling their guidance completely. And I said to the team that doesn't -- we saw a lot of companies doing that around that time that we had our earnings call and said, no, the predictability of the businesses that we were just talking about is there. It's really the municipal piece. So let's just take that and put it incremental to the guidance. And I'll give you an example. We have over 30 RFPs that are sitting that we submitted over half a year ago that we're just waiting to hear back on. We haven't heard that we won it. We haven't heard that we lost it. We just don't know. It's sitting in limbo. It's sitting in purgatory.

And ironically, the week of our last earnings call, we got notified that week that we had won -- it's small, but we had won a municipal vaccination program in Southern California. That we had expected to hear about at the end of last year that originally when we submitted that RFP was set to launch in February. Now obviously, we can't launch something in February when they get back to us in May. Now we are in the process of launching that right now, and it's launching this month. But the predictability of the timing of it just sort of precipitated us saying, let's take it and put it on the side.

Okay. Last minute or so here. On SG&A, you're going through a process of rationalizing that. How do you do that without cutting into future growth opportunities? Just give us a sense of your focus there.

Yes. So SG&A as a percentage of revenue is really what's driving the margin pressure for the business and sort of the adjusted EBITDA loss. So we're focused on cutting the sort of centralized SG&A and being efficient there. But at the same time, we want to preserve some of the capabilities we have for the future growth. So it's a balance. The way I think about it is we're cutting SG&A around that sort of municipal work. I think we continue to run the medical transportation business very efficiently. Like I said, we're now in our 10th year in that business. And then we're investing heavily spending, and we're going to continue to do so in that payer and provider vertical that we talked about because the upside is just so enormous there.

Okay. Well, I think with that, we're out of time. But thank you, Lee, for joining, and thanks, everyone, in the room.

Thank you so much. Appreciate it, Jamie.