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Universal American Corporation (NYSE:UAM)

Q1 2013 Earnings Call

April 30, 2013 10:00 AM ET

Executives

Richard Barasch – Chairman and CEO

Tony Wolk – SVP, General Counsel and Secretary

Bob Waegelein – President and CFO

Analysts

Carl McDonald – Citigroup Inc

Thomas Carroll – Stifel Nicolaus

Scott Fidel – Deutsche Bank

Michael Baker – Raymond James

Operator

Greetings and welcome to the Universal American Corporation First Quarter 2013 Conference Call. At this time, all participants are in a listen-only mode. A brief question-and-answer session will follow the formal presentation. (Operator Instructions) As a reminder, this conference is being recorded.

It is now my pleasure to introduce your host, Richard Barasch, Chairman and CEO of Universal American Corp. Thank you, Mr. Barasch, you may begin.

Richard Barasch

Thank you, and good morning, everyone. Thanks for joining us on our first quarter 2013 conference call. I’m here with our CFO, Bob Waegelein and our General Counsel, Tony Wolk. I would like to ask Tony now to read our Safe Harbor language.

Tony Wolk

Before we begin, I would like to remind you that we have posted a presentation for this call in the Investors section of our website www.universalamerican.com. I would also like to remind all participants that our call this morning may contain forward-looking statements within the meaning of the federal securities laws. These statements, which reflect management’s current expectations, projections, and beliefs are subject to risks and uncertainties that may cause actual results to differ materially.

For a discussion of these risks and uncertainties, we recommend that you review the company’s risk factors and other disclosures set forth in our SEC filings. We undertake no obligation to update or revise any forward-looking statements to reflect events, developments or circumstances after the date hereof.

During the call, we will also be referring to certain non-GAAP financial measures. Please refer to the reconciliation tables listed in the press release for a discussion of these non-GAAP financial measures.

Richard Barasch

Thanks, Tony. Well or healthcare especially recently is not for the faint of heart. Having said that I am more convinced than ever that we are in the early stages of a massive revolution in the way healthcare in our country is delivered and financed. The combination of the reforms that have been legislated and the market and fiscally driven need to a more rational cost structure are causing every component of the healthcare system to figure out where we will be when this all shakes out.

There clearly will be winners and losers and we continue to be convinced that those who know how to deliver high quality healthcare at a fair cost will be among the winners. We are finding that even further we believe that we have positioned Universal American to be one of the winners through our ability to partner with providers largely primary care physicians to achieve these goals.

Turning to slide three, as you know Universal American has been actively involved in Medicare for quite a while and we have been quite adept over a long period of time in keeping pace with what the changing legislative and regulatory environments permits and adapting our business accordingly.

Thorough the Medicare Advantage business it’s got more complicated with sequester at the premium tax and lowered rates. But the product continues to gain popularity among seniors and the politics around the chain versus the 45 day letter show that the program has been embraced by both parties.

We believe our decision to pursue ACOs that the complement to Medicare Advantage is a natural extension of our provider focused approach to healthcare and also provides diversification of revenues and earnings. We also feel good about our decision to get into Medicaid. We are now actively pursuing the growing Medicaid market and in particular dual eligibles and people who need long term care.

The APS acquisition has proven to be more challenging than we had anticipated where we continue to believe that we will make progress in Medicaid certainly by 2014. I will come back to our current business and new initiatives in a moment but first let me turn it over to Bob who will describe our results for the first quarter.

Bob Waegelein

Thank you, Richard. I would like to remind you that we post additional information on our operating results in the financial supplement that can be found on our website in the Financial Reports tab of our Investors section.

So turning to slide four, you will see for the first quarter we reported adjusted after-tax income from our operations of $17.2 or $0.20 a share. Our Medicare Advantage business had a strong quarter with pre-tax profits of $38.6 million. Our reported MBR was 80.3% but after taking into account our typical positive prior year items, our restated Medicare Advantage MBR was 83.5 and was in line with our expectations.

We continue to be mindful of our administrative expenses and incur and expense ratio of 11.9% for the first quarter down from 12.4% in the first quarter of 2012. We do experience some seasonality as it relates to our expenses primarily for sales and marketing so we expect our Medicare Advantage expense ratio to be just above 13% for 2013. For the quarter, the traditional business also performed well earning 2.3 million for the quarter. As a reminder this business is in runoff and accordingly profits will reduce over time.

Finally, or corporate segment continues to cause related to the activities of our holding company and the results of various ancillary businesses including the contracts we acquired with APS Healthcare. The segment reported a loss of 11.9 million. As in the past we are reporting the startup and operating cost for ACOs in the corporate segment. As a result of accounting rules, we will not be recognizing revenue for our ACOs until the fourth quarter of 2013 and will continue report the expenses for the ACOs on an incurred basis. For the quarter ended March, these cost amounted to $8.3 million or $5 million after-tax which is reflected below the operating profit amount on slide four.

In addition to our operating results, after-tax we generated $1.6 million in investment gains. Taking account of these items reported net income of $14 million or $0.16 per share.

Moving on to page five, we show the balance sheet. As of March, we had $2.5 billion in total assets including $42 million in unregulated cash with the parent. When we exclude all our intangibles deferred acquisition cost, goodwill and other intangible assets we ended the quarter with a tangible book value per share of $7.58. Finally, the total capitalization ratio as of March was 14.4% a level that we believe still provides additional financial flexibility if needed. Richard?

Richard Barasch

Okay, thanks, Bob. I think the most important takeaway from the financial slides is that even as we have heavily in our core MA business and in through the ACO and Medicaid businesses, we’re still making money and have a lot of excess capital which gives us a great deal of financial and strategic flexibility. We’re actively looking at ways to get more capital up to the holding company so that we can continue to deploy our capital wisely.

We’ll go into the details on page six but suffice to say that a revolution in healthcare is being driven by the fact that all of the ultimate payers of healthcare cost that all government, state governments, municipality, companies and individuals are looking to reduce these cost either who did got severe fiscal problems who simply can no longer afford their health insurance.

There’s one thing that the federal government all 50 states in Puerto Rico have in common, they have fiscal issues that are exacerbated by the increasing cost of Medicare and Medicaid. Every state is looking for – at ways to make Medicare more efficient and more affordable especially for long term care patients and dual eligibles. The punch line here for Universal American is the companies who know how to partner effectively with providers and the government, to control cost and improve the quality of healthcare are going to slide in this environment.

Our healthy collaboration model in which we work and risk share with the primary care physicians will clearly become an increasingly important model of controlling cost and improving quality. We’ve been doing this very successfully for more than a decade in Texas and then we’re now working to expand the model to our PPOs especially in the Northeast. In addition, this is the core value proposition underlying our expansion into the ACOs.

Aligning the financial incentives is important but equally are more important is the intense collaboration enabled by technology and data which enhances the ability of primary care physicians to care for their patients. This is not an exercise of taking hospital rates down to 95% of Medicare or negotiating better specialist rates. This is one-on-one, patient-by-patient working with physicians to identity gaps in care to get folks compliant and healthy so they stay health without a high cost facilities.

Moving on to slide eight and nine which describes our business in 2013. Our first, we have a strong Medicare Advantage business which includes 60,000 HMO members in Texas and Oklahoma and our 40,000 members in network products in the Northeast. These markets which we talk about as our core markets create a stable foundation for effectively building out our healthy collaboration model.

Risk management has historically been a strength for Universal American but even with the modification of the 45 day letter, the 2014 bids will definitely present a new set of challenges to us. The reduction in rates, the risk were modifier and the imposition of the insurance company tax were putting even greater premium on reducing expenses and improving medical management.

We received the first tangible benefit from our investment in Stars as our rating improved in each of our core HMO markets and in the Northeast. The revenue increase is important but the reduction of the rebate for our 2014 bid in our Southeast Texas HMOs is even more significant since our bid is still likely to be substantially below the benchmark. This will provide some stability for 2014 bid against the 2014 headwinds. Further, we are seeing some success in expending our healthy collaboration model and medical management in our core Northeast markets.

As you can see in our financial slides we are making progress in reducing the core overhead of our MA segment but we saw the way to go to reach our target. This is especially important as the new MLR rules going to effect in 2014.

Next, we launched 31 ACOs with over 3,000 physicians covering around 328,000 fee-for-service Medicare beneficiaries including several thousand dual eligibles. We are actively engaging with our provider partners to deploy the necessary care management techniques to close gaps in care and reduce overall cost. While the data is still incomplete, we are starting to see some encouraging trends develop not really ACOs. CMS is now accepting notices of intent for the January 1, 2014 ACO start date and based on a robust pipeline we expect to add several more new ACOs in 2014.

The final point on slide nine is that even after the $1 dividend we paid last fall and the investments that we are making in our businesses, we retain capital strength in our subsidiaries, liquidity at the holding company and the flexibility to manage our capital appropriately. We have around 640 million of cash in capital of which 360 million is excess of the 350 RBC level plus approximately 50 million of usable cash at the holding company. Since most the excess capital is in the subsidiaries, we’ll be as aggressive as possible in moving the capital up to parent for further deployment.

Turning to slide 10, you can see we had nice growth in our core Medicare Advantage market. Even though we are not large by national standards, we enjoy strong positions in our core markets which allow us to get the attention of our physician partners and other providers. After a solid 2013 AEP, we believe that we have regained our momentum on the sales and marketing side and have a good base of our core markets for 2014.

Turning to slide 11, when the Medicare Shared Savings Program emerged from the 2010 bill, we anticipated that the sort of techniques that we have used very successfully in Southeast Texas would also work with ACOs. In the last year, we’ve worked with many primary care groups to create ACOs to participate in this program including in our Texas market and in several other markets outside of our MA footprint. We are now through some of the early administrative bonds and are now actively engaging with our physician partners to achieve the goals of the programs.

On slide 12, we show a map of the locations of our 31 ACOs. As you can see some of our ACOs particularly in Texas are in areas that overlap with our existing MA footprint and others are located in new areas giving us potential opportunity to expand these relationships in the future the different products and services including Medicare Advantage. We are delighted to be in partnership with such a diverse and high quality group of providers who are committed to making the necessary investments to make this program successful.

Turning to the next slide 13, financial opportunities straight forward, you have seen this slide before. If we are able to achieve the savings over the trended benchmark while demonstrating appropriate quality and I should mention we had our first quality filing which we successfully completed last week. The ACOs will split the savings with the government and will participate in the profits of the ACOs.

This one we’ll again reiterate that this slide is illustrative and should not be used as a way to chew back in the projections. We just wanted to see how the math works. Among the nice things about the ACOs as compared to MA, that there are no sales expenses, no marketing expenses, no claims paying issues. This is just an exercise of partnering with primary care docs to provide appropriate care management while reducing cost and maintaining or even improving quality.

As Bob said we expect to resolve to become clear at the end of 2013. CMS is being incredibly cooperative about this. They want this program to work and we are still struggling to get all the data we need to make an impact and measure our results as much as we would like to do. This will be a conversation that we will be having for the balance of the year until the contours of this become sharper.

Brining on to page 14, while we are excited about what are doing in Medicare with Medicare Advantage and the ACOs, we continue to be enthusiastic about the opportunities to pursue in the Medicaid space particularly around long-term care and dual eligibles. These populations require unique medical management capabilities that we believe they re posses and then showing the re posses.

We currently serve duals in each of our existing businesses Medicare Advantage, the ACOs and the legacy APS Medicaid business. With our strong balance sheet, risk management expertise, complex care management skills and the ability to partner with providers, we believe that we are well positioned to participate in this large opportunity from a variety of angles.

We are particularly proud of the work we do in Puerto Rico where we provide behavioral health coverage to approximately 1.4 million Medicaid beneficiaries. We’ve been impressed by the quality of the workforce in Puerto Rico as well as the pro business environment created by the new administration and we are actively looking and achieving opportunities to expand our workforce on the island.

I recognize acutely that this opportunity has not emerged as quickly as we had planned so we are very encouraged by the number of opportunities and programs that we are currently pursing.

Finally, moving to page 15, we think we are well positioned to participate in the high growth areas of healthcare. Start with MA on the left side of the page where we have a solid and profitable footprint. MA now has more than 25% penetration and is growing. One factor I think gets lost in some of the conversation and is in the first four years of the Obama administration Medicare Advantage grew by around 40%.

If ideas like premium support which has some bipartisan support or any kind of defined contribution catch on as part of any grant bargain made, we think this growth can accelerate. However, nearly 75% of the Medicare population is currently not in Medicare Advantage and this where the ACOs come in. We think our expertise in creating successful risk sharing agreements with primary care physicians to improve quality and lower costs position us well for this new program.

Moving across this spectrum with dual eligibles which is the intersection in Medicare and Medicaid, we know this area is large, important and emerging. We got the expertise in Medicare and Medicaid and complex case management so we can approach these opportunities on a fee-for-service or on a risk bearing basis.

As part of our commitment to Medicaid, we are beefing up the expertise required to effectively manage long term care. This area has taken on increasing important as integrated programs for dual eligibles become more widespread. Following the exchanges right now for us that still to be determined although we are in the final stages of making decisions on what to do.

We think there is a lot of opportunity in the exchanges for companies like ours, the only issue is where we should and what and the timing for us to do this. I can’t predict how this is all going to shake out but we have very good risk management expertise, licenses, capitals and no incumbency to the tax it’s not a bad start.

Medicare Advantage has been, and I can believe it will continue to be a core business for Medicare for Universal American. However, since the ACA was passed in 2010 and especially after we sold Part D in 2011, we have been intensely aware of the need to diversify our earnings away from Medicare Advantage only. This was the large part of the reasoning to build an ACO business than to the Medicaid business. By 2014, it’s our goal to have three vibrant businesses, Medicare Advantage, ACOs and Medicare Services and Risks.

Universal American has a successful history of demonstrating how the private sector can participate constructively in this type of evolving and growing market. While in the several years we’ve seen increasing number of prospects that dually done best. Partner with provider groups to help them analyze, manage and assume risk with the goal of providing measurably better care and controlling unnecessary cost.

Finally, we told you on the fourth quarter earnings call, we are not providing guidance for 2013. We expect that we will have another good year in Medicare Advantage especially given the growth in our core markets and we expect a run off of traditional to continue positive. However, there continue to be several uncertainties that may impact our numbers now exacerbated by sequestration and continued uncertainty about revenue recognition for our ACOs.

The biggest predictive issue that we’ll have is how if and when to start reporting numbers on ACOs even despite the issues about revenue recognition. This is a new business with complex issues that have not fully have been resolved. We do believe however, that we’ll see revenues in this program in 2013.

Thanks for your time this morning. Excuse me, Bob and I will be happy to answer your questions and again I will avoid – I am be happy to answer your questions and might not avoid any questions.

Question-and-Answer Session

Operator

(Operator Instruction) Our first question is coming from Carl McDonald from Citigroup Inc. Please proceed with your question.

Carl McDonald – Citigroup Inc

Thank you. I wanted to start with sequestration and the impact that you think that will have on the business starting this quarter in terms of how much of that cut you’ll be able to pass on to providers relative to how much do you think it will hit your bottom line?

Richard Barasch

Yeah, Carl, we did some analysis on this and we are implementing processes to make sure some of the premium reduction that we get does get put into the benefit line. We think that’s going to cost us between $6 million and $7 million this year.

Carl McDonald – Citigroup Inc

Okay. And then second question would just be the early view on 2014 when you put together everything you know in terms of the rate environment, do you think that will result in membership up or down in 2014 and same question for margin?

Richard Barasch

Well, it’s a little too early to answer that question. We are – no we’re just in the middle of the sausage making. We are gathering all the data. And kind of figuring out where we want to be in on markets, I’m guessing around the question little bit cautiously, we’re not quite ready to answer it.

Carl McDonald – Citigroup Inc

Okay. Thank you.

Operator

Thank you. Your next question today is coming from Tom Carroll from Stifel. Please proceed with your question.

Thomas Carroll – Stifel Nicolaus

Hey, guys, good morning. Also on 2014 in MA maybe some early thoughts on selling your Medicare Advantage products into new markets where ACOs are developing. I think you’ve referred to that a few quarters in a row. So, may be is it reasonable to assume that we do see growth in MA given just a much larger footprint, backbone kind of by this ACO strategy?

Richard Barasch

It’s actually a great question but I think it’s probably more of ‘15, ‘16 conversation because the first order of business is getting these groups working with us to adopt our model for us to adopt the models that they’ve got as well. So, I think it’s really one may be one more year out than

Thomas Carroll – Stifel Nicolaus

So you really don’t anticipate selling into new markets in 2014 where your ACO strategy is still developing?

Richard Barasch

I think that’s right. The other point I want to make going back to Carl’s question for a second, maybe this will be helpful, because I think what sometimes get lost in the conversation about Medicare Advantage is that it’s a little bit of a relative conservation as well as an absolute conversation.

There is a point in which premiums and benefits have to be more competitive than fee-for-service alone or med sub. The kind of raw Medicare Advantage entities now through the Stars are little bit of a other factor here more than a little bit factor as well. So I think that just because there may be some reduction in benefits or increases in premium doesn’t necessarily mean that there will be lower growth for the product.

Thomas Carroll – Stifel Nicolaus

And then a related question and again this is I guess conceptual right now, but do you think that your local partnered physicians that sign on to be part of the ACO with you will view you selling MA products as kind of competing with the ACO, I mean does that – is there a conflict of interest there?

Richard Barasch

Now it’s a good, it’s actually a good question. I think the best way for me to answer is you know the most enthusiastic group of physicians that signed out for our ACOs were our Houston, Vermont and many of our Dallas doctors where we have vibrant Medicare Advantage but in their practices they also have a lot of fee-for-service beneficiaries who are not members of any ones Medicare Advantage plan.

So for them it’s the ability to apply the kind of techniques and shared incentives that we can provide in MA and now we can provide it to them for their fee-for-service member. So I would say through the contrary it’s not conflict but very much complementary.

Thomas Carroll – Stifel Nicolaus

Okay, good. That’s interesting. And then one last one, I wonder if you could give us some, an example or something you guys are doing today with respect to Medicaid and kind of how you’re kind of moving the organization more in that direction?

Richard Barasch

We had some very significant programs in place where we went directly for states. Puerto Rico, we have a very large behavioral health presence. In some other states we are doing work including helping to manage duals, best example of that is West Virginia. So now we are as the dual opportunities emerge, we’re talking directly to some states about extending their fee-for-service programs if not every states is going to capitation as quickly as sort of the headlines would suggest.

And in addition we’re talking to several incumbent in states about helping them manage what’s becoming an increasingly complex population to manage including long-term care. So we’re active, wish I had, wish I could give you some better visibility into this, as I said in my prepared remarks we’re still very enthusiastic about this opportunity.

Thomas Carroll – Stifel Nicolaus

So that just that last comment you made you’re working with incumbents, does that mean you’re going into other markets and looking at the managed care companies that are there and perhaps reaching out to them proactively and seeing what you could offer to align with what they’re doing in particular market?

Richard Barasch

Yeah. I mean the work that’s being generated by the states these programs are difficult, they are complex. There aren’t many companies who can do this all without some statistics and we got a proven way of kind of helping out, we got very good technology, we now stratify risk and helps the people kind of actively working in the places where they should be working in. So what we got it can be pretty valuable to people who are already doing the work.

Thomas Carroll – Stifel Nicolaus

All right. Great, thank you.

Operator

Thank you. (Operator Instructions) Our next question is coming from Scott Fidel from Deutsche Bank. Please proceed with your question.

Scott Fidel – Deutsche Bank

Thanks. First question, just, have you guys been able to estimate yet what your all in MA rates will be for 2014 when including the industry fee? And then, on the risk adjustment model changes just interested if you have been able to evaluate what the effect will be on the Southwest HMOs just given that you have that pretty advance engagement with physicians there, so I would assume you been pretty successful on the risk or coding side?

Richard Barasch

We have many markets, so there is not one answer to your fee for question about rates. We got different Stars, different rates, so there is kind of market by market. But yet, the risk or adjustment had the effect of hurting markets like Houston a little bit worse than it hurt less advanced markets.

Scott Fidel – Deutsche Bank

In a anyway to frame that, Richard in terms of just thinking about the Houston market in particular if it sounds like...?

Richard Barasch

You know it’s got, it’s one of several, it’s one of everything that goes into the Southeast machine, this is both the most fun part of the year and the most challenging part of the year is getting, taking all the inputs, putting them in and coming out with products and benefits and premiums although I’m not signaling the one premium in – we certainly don’t want to have premium in our Houston market and don’t think we will. But the – too early to say that.

Scott Fidel – Deutsche Bank

Okay, then just second question, Richard, I know a quarter ago you were talking about, thinking about possibly reopening up the med sub book for live sales in 2014?

Richard Barasch

Glad you asked that question. I got, you actually got a response of that comment. And you noticed it wasn’t in my prepared remarks this time. That would have been really a defensive move if we really saw the MA program was going to be decimated, you know part of it was being a little bit fraught with politics but I think it became pretty clear as the 45 days rolled on that the administration really did not want to initiate the program at all.

In fact they are either – they are actually quite proud of a lot of the things that have happened in the program. So once it became clear that we weren’t going to be dealing with really crippled MA program which I don’t think we will be. I think it’s going to be effective and I there will be some significant effect. Med sub is not quite as appealing to us.

Scott Fidel – Deutsche Bank

Okay and then just lastly, can you just give some more details on what happened with the APS revs, sequentially it looked like your corporate and other revs were down around 8% sequentially so were there any specific contracts that went offline at the beginning of 2013 or just some details there?

Richard Barasch

No nothing of any individual significant on the contract basis. There were some that turned out but the other item that we flow through corporate was transitional services agreement with CVS which we reported as a revenue line, so that was worth a couple of million bucks last year.

Scott Fidel – Deutsche Bank

Okay, so that, was that still in there in the fourth quarter as well, or because that was...

Richard Barasch

Yeah that kind of year-over-year was obviously larger and it declined throughout 2012 and now gone for 2013 on.

Scott Fidel – Deutsche Bank

Okay, got it, thanks.

Richard Barasch

Yes.

Operator

Thank you. And next question is coming from Michael Baker from Raymond James. Please proceed with your question.

Michael Baker – Raymond James

Thanks a lot. Richard, I was wondering if you could give us a little bit better sense of what some of the key things you’re waiting on as it relates to revenue recognition on the ACO because what sounds a little bit different is it appears as though or feels as though maybe you guys might proceed if you don’t have exact clarity and I’m just trying to flush that out a bit and when you talk about in the fourth quarter, is it your intention at this point to begin recognizing at the beginning of the fourth quarter or just during some timeframe?

Richard Barasch

Well a lot in that question, so let me just go through a piece of that. The overall issue and Bob can talk about this as well is that based on the type of data that we’re currently getting from CMS and the fact that the program is a yearly program. We concluded with our auditors that the most appropriate way to deal with revenue recognition is on a yearly basis at least for starters. Bob, you want to?

Bob Waegelein

Yeah there is cutting literature out there Mike and we get very technical but basically when you read through the various fancies or accounting standards out there, the nature of contract we have with CMS requires really a fourth quarter accounting. We can measure maybe some results during the course of the year but was actually reported revenue in that by accounting standards has been the fourth quarter.

Richard Barasch

Yeah and we’re looking at this stuff. This is not to say that we don’t kind of track this stuff on a very period, very rapid periodic basis. And I think we are able to make a statement that we’re moving the needle in some of our ACOs which gives us some level of confidence about the fact that we will be showing some revenues in 2013.

Michael Baker – Raymond James

And then just to kind of remind us, when would you anticipate the cash coming through?

Richard Barasch

June of 14th for the two year program ended ‘13 and then it will be June of 15th for the program year ‘14 and on.

Bob Waegelein

Yeah I just would like to remind those of you have been around, we are at the start of Part D. We and almost every company in Part D would significantly cash flow negative until reconciliations like this were done in the subsequent years. So this is not new business for those of us in the government provident business.

Michael Baker – Raymond James

Thanks a lot guys for the update.

Richard Barasch

All right.

Operator

Thank you. (Operator Instructions). If there are no further questions at this time, I’ll turn the floor back over to management for any further or closing comments.

Richard Barasch

Yeah thanks very much everyone. As usual, Bob and Adam are available if there are any follow up question. We’ve got a fairly robust bit of financial information on our website and look forward to give you another update next quarter. Thanks very much.

Operator

Thank you. This does conclude today’s teleconference. You may disconnect your lines at this time and have a wonderful day. We thank you for your participation today.

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