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Universal American Corporation (NYSE:UAM)

Citi Global Healthcare Conference Call

February 25, 2014 09:40 AM ET

Executives

Richard Barasch - Chief Executive Officer

Analysts

[Abrupt start]

[No formal presentation session for this event]

Question-and-Answer Session

Unidentified Analyst

with Universal American and up on stage Richard Barasch, CEO. So, of course the topic of the day Medicare Advantage; we’ll discuss your take on the 2015 rates, the Humana set baseline down 3.4 to 4. Included in that though is their assumption that they are going to get hit by the star rating, call it 200 basis points give or take. So, I know there is obviously lots of differences, but is it sort of right to think about your rate impact maybe being couple of hundred basis points better to where they are because you don’t have that same star rating impact?

Richard Barasch

We should, and then all other things being equal basis, we should be better as we are going to have a positive impact from Star’s, sort of probably 1.5 to 2, but the starting point is each number specific. So that doesn’t mean, you should just go from 4 to 5 and subtract to 2.

Unidentified Analyst

So, you think that your Star Rating -- you actually see a benefit of 1.5 to 2?

Richard Barasch

Yes, I mean that’s here, that’s kind of -- if you just take the difference and multiply, that’s kind of what you get to.

Unidentified Analyst

Okay. So that Humana overall rate decrease…

Richard Barasch

I like when Humana does those 8-Ks, makes my life a lot easier also.

Unidentified Analyst

Doesn’t include any assumptions around the in-home assessments and coding and what the negative impact, do you have any sort of a sense of what kind of an impact that could look like if…

Richard Barasch

I can’t quantify. There is a first issue which is, this was a comment, it’s more than a comment, this was a -- this is a proposal and the same proposal or something similar was in last year; it didn’t survive till the end. So there is -- I don’t think there is a necessary assumption that’s going to survive in its current form. I know what the point is, I think the point actually has -- and there is a point to the point. And I think there are potentially some compromises that make it less theoretically draconian. So that’s the first starting point.

Second piece though is that it’s going to be very plant and location specific. We in Houston for example where we have our biggest plant, we have very close relationships with primary care docs and we can get our way through this, I think better than we frankly will be able to do in upstate New York, where we don’t have quite the same relationship with the docs. So, again, it’s going to be company specific and location specific. And I think there will be ways to mitigate the effect.

Unidentified Analyst

So, one thing that’s confused me is I ask Medicare plans, and I say do you do coding where you then don’t follow up with clinical visit. And essentially, we’re coding for the purpose of coding and most of them say absolutely not, no way, we use the codes and sit. But then at the same you have all these companies saying we don’t want this proposal to be implemented. If you’re actually getting cared, why would you care about the proposal?

Richard Barasch

You’re asking and answering the question in a very logical way.

Unidentified Analyst

So, you’d take the view that there are plans out there that…

Richard Barasch

I can always be -- I don’t like to speculate about what the other folks are doing. But if -- I think you’re correct in saying that if there isn’t clinical follow up, it shouldn’t be an issue.

Unidentified Analyst

So, one point where I guess you could make a case is basically to say we go out, we code, we then set up an appointment so person can actually get seen, we can’t guarantee to actually show after their appointment. So, I guess that would be one area and maybe one other option would be within the codes, there are certain things that you can call for, it’s not clear what the follow up care would be. So, for example, you have a heart attack last year, you find now, you can code for that. I guess you get a doctor sign, also I mentioned what you would actually…

Richard Barasch

I think where you’re heading, I think it’s not quite absolute. I think there will be ways to compromise this point so that it’s not -- it takes into account, there actually is very good work being done on this home business. They are in fact picking up a lot of chronic conditions and they are in fact going into clinical follow-up. And there is some great anecdotal stories about people finding things out of that and some say no, and then I think there is some good stuff there. I think what CMS is reacting to is a hunch that there is some, coding might be a touch on the aggressive side.

Unidentified Analyst

So, you have actually seen a fairly decent shift in mix membership in 2014, so I think the HMO penetrations on from 45% to 55% of the business. Can you remind us of what you said in the past about differences in profitability…

Richard Barasch

Yes. Look, I think what I said and I think this is ultimately -- first of all, I’m very bullish on the macro and Medicare Advantage. And I think there are really two different flavors in Medicare Advantage, one is -- and I don’t actually judge it by whether you call it an HMO or not, what I judge is whether or not a plan in a particular area has the ability to move the needle on cost and quality and there are many, many HMOs that are indemnity plans [interact]. And there are many non-HMOs where there is actually a fair amount of medical management and work being done to move the needle on cost and quality.

So I tend not to get hung up on the labels and maybe go one level further into figure out if there is actually something working with the providers and medical management. In our case, our HMOs happen to be where we have our most advanced models also. So what we’ve got in Houston where we’ve got the organic partnerships with the primary care physicians, I think it’s a wonderful model. We’re trying to expand that to our more indemnity locations in the Northeast. But it will -- even this home visit thing, we’ll be able to deal with these issues much better given our close relationship with providers, less so or it’s more of an indemnity product. So I think [long call], it’s not the question of profitability as much as it is Medicare Advantage will do the best where companies and plants can move the needled on cost and quality, long answer, short question.

Unidentified Analyst

Yes. So, I guess the broader point of the question was, if you see a 10 percentage point shift to places where you can improve cost and have higher qualities, is that enough to move the needle financially?

Richard Barasch

For us in general?

Unidentified Analyst

Yes. Or is this really, we need to wait till 2015 when you can really move the needle by getting out of some of the unprofitable…

Richard Barasch

I think there is two things to look at when you look at our company. First is our core loss ratios have been consistently pretty good. We had some issues in the first quarter and the first half which seem to write themselves in the third quarter. So the loss ratio issue for us is less of a concern. The biggest issue that we had in ‘13 frankly was expenses, the ALR more than MLR. And our issue is maintaining loss ratios where we’ve got them. And even in the North East, the indemnity type plants, they are fine, just got to get expenses down. So I think ‘14, one of the report cards that you would want from us in ‘14 is in fact what’s happening to our ALR and candidly we are looking to ‘15 because ‘15 is when the stars really impact us.

Unidentified Analyst

And so on the administrative cost, I guess the question that people have had is you certainly have some initiatives to improve that whatever year the membership is shrinking.

Richard Barasch

Right.

Unidentified Analyst

It’s a lot harder to improve the loss ratio when the revenue base is coming down than the other way. So do you still think you can see meaningful improvement?

Richard Barasch

Yes, I do. I think first off, we spent [high] money on Stars and something we’re going to take them, take our foot off the pedal on Stars, we’re going to keep it, but it’s more engrained in the business now. First couple of years were a lot of consulting expenses to get us to deploy where we can actually measure the elements of Stars and I think it would not [bolstering] to say that we did a good job on that, so I am pretty happy about that.

I think a lot of -- we will never be able to pay claims on a cost per claim, as well as somewhere with 10 times our membership. We’ll always have a little bit of a structural disadvantage. But I think by being smart and figuring out appropriate ways to both use our internal and external resources meaning here we go fair amount of outsourcing, I think we’ll be okay on that.

So I think the hope is that the membership that we have for that we clearly made the right choice investing in real piece of it this year. We’ll have a stronger fundamental plan if we do that. So we’re going to continue to shed businesses that we think makes sense for us. And it’s rather interesting issue too, because we are -- on a broad basis we don’t have the same scale as some of our larger competitors, but for example Houston, we’re the largest plan, so the scale that matters is that we've got wonderful relationships with our providers and have a great plan so.

Unidentified Analyst

So, can segue to my next question which is in Texas your [almost] up 14% year-to-date, I’m going to guess the market size didn’t increase 14%?

Richard Barasch

We did well.

Unidentified Analyst

So at least in Houston you only really have one sizable competitor, HealthSpring, so just interested in your thoughts on why you have been able to do so well?

Richard Barasch

Thank you. I appreciate the compliment. I will have to pass that on to the folks running the plan.

Unidentified Analyst

Okay. I’ll make up my next question maybe company to grow a lot tends to…

Richard Barasch

It’s a valid point, but we will take the growth. The plan, the Houston has been -- we have bought this actually 10 years ago, as -- mentioned 10 years has passed, we bought this 10 years ago. They have been in business even prior to that. So this is 15 years of creating relationships with the provider community particularly primary care physicians where the model works. We are full partners with our primary care physicians very similar to some of our competitors. We spent a lot of money improving our plan.

And it’s interesting because the Stars investment it was really basically and you got to think you got to give the government the credit for having did this, 32 measures not all 32 measures are great, but most of them are and most of them are in nature of making the plan better. So if we have gone from 3 to 3.5 to 4 Stars during this last two or three years that means the plan has got better, means we are delivering more value to our members.

What’s very interesting about growth rate is that its enrollment rate is very low, which means there are numbers like the value of what we are providing to them. If you look on this -- and this will come to your next question you look on the plan finder we were the most -- we have offered the most value on the plan finders so that's a good thing. So I think we're just delivering good value to our members.

Unidentified Analyst

One thing to pick your question first, if there is any questions from the audience. We've heard a lot over the last day or so with this conference about the major changes in healthcare and hear a lot about in three to five years capitation is going to dominate the world et cetera, et cetera.

Richard Barasch

Capitation to providers.

Unidentified Analyst

Capitation to providers. You have done a lot with Texas, you're doing stuff with ACOs now. Is that first time experience, I guess I'm just very skeptical when I think and I think it's very easy to say that capitation is going to rule the world in three years and the reality is that actually implementing those programs is a lot more challenging I think than people first anticipate, but just be interested in…

Richard Barasch

Yes. Look we’re -- I would say it slightly differently, I would say that risk is going to be pass to providers in greater amounts over this period of time, won’t necessarily the capitation, because many provider groups frankly are capable of taking the cap payment, people think it's usually running a risk business, it's not, I think that's part of your point. We saw this in the 90s lot of the companies taking risk were prepared to do it, went under.

So I think the smarter way of thinking about this and this is where we, this is exactly where we’ve built our business plan on is partnering with providers to assume risk in an appropriate way. So it's a little -- our plans in Houston are not cap, it's [rotational], but different. We are actually mostly 50-50 partners with our primary care physicians. So I'm not a great believer in the 85, in some cases it can make sense is work or not on my critical orders, but in our particular case, what’s better is real fundamentally granular partnerships with the providers.

Now taking even the step further, I think providing the world between primary care and facility-based providers is a big difference. I can say, I think the primary care providers have much more leverage and incentive to reduce cost and improve quality where most providers put some [mortgage], this guy keep selling the room. And I think that it’s going to -- some of them share models with the large sort of integrated health systems are going to be interesting to follow because the hospitals have a very mixed incentive, of course we have no mix incentive.

Unidentified Analyst

Any question?

Unidentified Analyst

[Question Inaudible]

Unidentified Analyst

I just want to make sure I understand. You mean if have to prioritize buckets of risk in terms of cost per (inaudible) maybe viewing I’m really focused on -- update me on (inaudible) is it more about the fact that the seniors will not show up to the clinical follow-up, you have to pay for the transportation to get them to the clinical follow-up or there is going to be a [battery] of tests run by the doctors?

Richard Barasch

Yes. I think in places where -- we’re in speculation there right now because this is all new, it’s very interesting because you know visitor relatively new phenomenon also. I think without the requirement of a clinical follow-up, we do require them in the clinical follow-up everything you said is going to come into play, there is not going to be one factor that matters more than the mix, but if this really comes into play there will have to be clinical follow-up and the companies will then be in a position of determining whether it’s worth it for them, send the transportation in order to make sure the visit happens and everybody is going to be looking at a lot of them looking at sort of on a specific rates in a different way and I’m not avoiding the question, this is going to be market-by-market, this is not a one size fits all. I think every plan even within the plan is going to have very different ways of having to deal with this.

Unidentified Analyst

[Question Inaudible]

Richard Barasch

Again, what I said in the call before, I cannot worry about label HMO, plenty of HMO plans out there that will [endemic] the drag as I’ve said and look -- are fundamentally the same as PPO plans even though they haven’t entered in my life. So I tend not to think of it that way or tend to think of a more nature if you have good relationships with your providers, you are more likely to be able to deliver the care, but same incidents said that you could deliver.

Unidentified Analyst

All the issues with the APS side, is your fundamental view on care management, disease management and what that might mean for government market change and if it has how that could change?

Richard Barasch

Putting APS to the side which I am happy to do, it’s interesting. We’re I think sort of the original disease management model, call center, call people can’t do a few things, I think what is improving not to be incredibly affecting as an overall basis, but what we’re seeing now is sort of a confluence of a lot of really great technology advances, mostly in the nature of information technology, which is getting data and putting the data in a place was usable.

So who are that people, who can be most impacted by care management, where are they, what are their behavior patterns? So we sort of call that, sort of the area where you have to do, really interesting technological stuff to stratify fine et cetera. But healthcare is a, which talking about is the health of individual people, like kind of resist any conversation that starts with the word population health management, it’s not population health management it’s people health management. And what we've seen and then APS actually as some of the things that didn’t frankly do particularly well, it’s helped us figure this out, is that once you know what you need to do, you need send human beings to go out and deal with the issues.

If you have been following the company at all, you know we had some loss ratio issues in the first half of the year. And we were, we've basically decided to just put everything on the table, what works, what doesn’t and what can we do with that though.

So we created this program called intensive care management, when we basically call our care managers, well, send nurses that yes they should try to call people on the phone, but instead of a phone card, we gave them the gas cards and we call them to go out and physically find these people and find out why Mrs. Smith goes to the emergency room 40 times a year, find a really --find out what's actually going on. And two no one’s surprise, but I think people really didn’t pay attention to it, easy 50% of the issues about why people won’t go to the doctor or social, behavioral, psychological. And once you sort of get into these homes and get sort of one to one with these folks you realize that there are so many other factors that impact their healthcare, they impact their behavior other than just this real clinical thing. And I think the notion of kind of going door to door is really an important aspect of healthcare and then [what people say that] it’s not scalable, well I think it’s still scalable I think it is still the right way to do this.

Unidentified Analyst

So I am going to ask you an EPS question. But it’s actually an EPS lawsuit question which [I think you] can answer. So I am going to keep it high level, every deal I know what the specific term is but there is a clause that the seller puts in that basically says we can’t be sued for any warranties or representations we have made up to this point that are not exclusively in this merger agreement. Are you aware of any President lawsuits on deals that have successfully gotten around that?

Richard Barasch

So I am going to, I have graduated law score in 1979, long time ago but there is a very settled law that fraud takes you outside of the country, pretty simple. And there is plenty of precedent about that Delaware. So if you look at our lawsuit there is some stuck inside the contract some stuck that’s outside the contract.

Unidentified Analyst

Okay. I haven’t gone through the Puerto Rico Medicaid RFP in detail but I know there is conversation about carving behavioral health into the contract. What, when is it that's happening with that?

Richard Barasch

They carved it into the RFI or the RFP. And we've got a very actually a wonderful provider infrastructure in Puerto Rico, where they [sell towards] behavioral provider on the island. And whomever is going to win bid and win the Medicaid piece of it, it's going to new to sorts of services that we've got.

So, we're very active in this RFP process, we will likely not be a direct bidder or we will likely be partners in bit.

Unidentified Analyst

And my data is little but 2011 it looks like Puerto Rico was roughly $130 million in revenue.

Richard Barasch

Yes.

Unidentified Analyst

If that goes away any situation where it doesn't create a meaningful headwind. So is that…..

Richard Barasch

Well, the headwinds are already existing and we're not making money there now . (Inaudible) Because there is no additional headwind.

Unidentified Analyst

Got it.

Richard Barasch

And (inaudible) the damage on APS has been done largely.

Unidentified Analyst

Okay. So you haven't reported fourth quarter yet. My estimate is to come back to the G&A that it's going to be down roughly 100 basis points this year. So puts you at roughly 14%. So good improvement peers generally 9% to 10% in Medicare. And that 14% also doesn't include the corporate expenses that get allocated during the ACO investments that you are doing.

So, I guess the question is just coming back again to the enrollment decline. Where do you think a reasonable target is long term?

Richard Barasch

The ‘14 counts, some of them expenses we're able to move to the (inaudible). So, that's about 150 basis points. So our kind of real number is in mid 12s. And we still should pretend. And it's going to be hard, but it’s doable. And I am not saying in ‘14 that’s the long-term goal.

Unidentified Analyst

Long-term. Yes. And I think when you started the cost cutting process I think your view was this is going to be fun, that’s what we have got to do, I think it’s been probably a little bit more challenging than you anticipated. So if you could go back again, anything you we would have done differently?

Richard Barasch

It is probably, there probably are some things we probably could have accelerated some of the outsourcing that we’ve done, we hired new CAO this past Jan, January ‘13. I think he has done a wonderful job in moving us forward.

So I think there are things we certainly could have done. But as I said before a lot of the expenses and more explicit expenses around stars and improvement. So on the margin yes, I am sure we could have done things better and quicker. I think the fact there were four stars and so much of our business now matters a lot. And then so it’s hard to see where what specific expense we might not have it’s been that way. But your point is right, if I were to working at our company that would be a great area of focus.

Unidentified Analyst

What’s the latest on ACOs? I believe it is open-ended.

Richard Barasch

Open ended.

Unidentified Analyst

Maybe you can touch on both the revenue to recognize -- revenue recognition when it happens and then whether there is a new revenue recognized?

Richard Barasch

Well, we’re not going to have revenue for ‘13 that’s pretty clear. And more of the point if you saw which I am sure you did the broad results were okay for the ACOs in the first generation.

Unidentified Analyst

You missed it at press release it’s a little different than that.

Richard Barasch

But they weren’t great, okay. It was totally different but subsequently the same. But I think the point though and [he is our CMS] he is correct is that this is not a one year process, it’s going to be a multiyear process, I made the point that Houston took 15 years to get to the point that they have got to. And I am not thinking it is going to be 15 years, but having providers take risk, it is not something that you flip a switch and it moves.

So I would say that there is a broad issue. This also -- continues to be some issues around data and how members are attributed with CMS is very I think carefully doing with it. And there is a great desire on part of the administration for this program to work. There is also a great desire on part of the administration not to make a fair and not sort of a give away program, which it shouldn’t be. So I think what CMS would say which is something I would say is that even though in the aggregate results weren’t great, there is still a lot of progress in this program. We are not given up. In fact we are going to make, it’s continue to make the investment. We have called down some of the ACOs that we thought were not going to perform, give or take around 30 will end the year or start ‘14 with that 30.

To your, the question you asked couple of minutes ago is taking risk, these physician groups get that the world that they new 20 years ago is over, they get the fact that they have band together into risk oriented pools. We’ve provided them a lot of infrastructure to do this, they still are enthusiastic, we haven’t lost any doctors to lack of enthusiasm, or lack of enthusiasm in the program. So, we’re still pretty optimistic and we’re going to invest in this. What’s great fun about my job is I’ve got couple of very nice mature businesses and we’ve got a stock up inside our company.

Unidentified Analyst

So, you touched on a couple of these pieces already and this is really more of a Humana focus question but I think you have a good perspective. So, 40% of Humana’s enrollment growth this year has come from regional PPO products. And so you operate a whole spectrum, not regional PPO and there is obviously differences between fee for service and regional PPOs, but I’d just be interested as you sort of look at the next couple of years as Medicare given the rate environment, you’re obviously shifting away from fee for service and some of the less managed products, if the Board says to you, we want you to have strategies involved fee for service or regional PPOs, how would you make that work?

Richard Barasch

If I was hired by Humana…

Unidentified Analyst

No, I’m just thinking if…

Richard Barasch

Broad question on Medicare Advantage; I’m very bullish on Medicare Advantage, I don’t think there is a thoughtful policy maker in Washington that doesn’t understand that the movement toward Medicare Advantage, toward shifting risk, toward defined contribution is the right thing to do a long pull for the physical health of this country. It’s hard for the democrats to fully get on board with this. But you saw the letter that came up (inaudible) letter, it was driven by the democrats, kind of interesting, Chuck Schumer was the driving person behind that letter. There is absolutely no doubt in my mind that Medicare Advantage is going to grow and thrive over this period of time.

I think one of the very underappreciated parts of Medicare Advantage is the non-financial benefit that’s given to members by the plan. And this goes back to this whole, and I mentioned this before, the stars incentives are generally correct, they are telling the plan that they’ve got to deliver more value. How would you value is there -- and even this home motion and the home visits are turning into a clinical visit, there is a lot that’s coming from these home visits. A lot of these home visits are turning into clinical. And in fact one of the measures is making sure that our members get their glaucoma examined, good stuff; the maximum amount of pockets, good stuff and sort of the ability for there to be some certainty on the part of the senior for their cost is good stuff.

So, I don’t think the regional PPO plan is wrong. I think that it’s going to be a product that has a very or in New York, we’re doing something similar to this. I think it sort of sits next to Medicare supplement as opposed to somewhere in between Medicare supplement and highly managed plans. And think there is a price for that. And I think -- I don’t think what Humana is doing is wrong at all. And of course, I never say anything bad about my competitors.

Unidentified Analyst

Understood. So from a cash perspective, $250 million at the end of the third quarter, above the regulatory requirements; business will be shrinking, so won’t have a heavy capital drag there. Anything that’s new or different that we should think about that would broke out just as an example you end up with no Puerto Rico Medicaid you have to shut that down. I mean is there anything sizable enough that…

Richard Barasch

Actually that creates capital too, if we exclude lease of capital. So our calculus on this is always if we're going to imply capital, we want to make money. So the capital is not being implied properly and we’ve been pretty good. I think as we had good things and other things happen, but I think managing the cash has been a good thing. And our history is that we get the cash up like the parent and try to be really thoughtful about how we deploy it if necessary.

Unidentified Analyst

Any change in the deployment priorities, I mean I'm going to the guess the M&A leases probably a little shorter after…

Richard Barasch

Yes, maybe a little bit shorter, but we were -- it was a great -- by the way how [Ramus] dive yesterday, one of my heroes.

Unidentified Analyst

It sounds very stress

Richard Barasch

Probably it’s not, it’s worth, but even if it is, it’s worth caring, right, it’s a great movie. So there is scene where Bill Murray is trying to get his (inaudible) stuff and he is like where (inaudible) one being with other more and I feel that APS where we sort of 20 deals and we screwed up on one of them, it's not great, but it was still a pretty good track record. I mentioned the Texas issue, no we bought that 10 years ago for $99 million and given where we taken out and that's were terrific and both number have everybody I think knows the story there.

So, yes I think clearly APS is a black mark on our record. But probably work also so I wouldn’t make the assumption necessarily. It will be more scrutiny, a little more, so I wouldn’t by the way that’s not to say there is going to be an announcement tomorrow, but I think. But we use that, we’ve bought back stock we’ve paid dividends, we’ve bought things, we’ve sold things and I think we’ve been pretty thoughtful about that.

Unidentified Analyst

Other questions? As you look at your capital base relative to the stock price more still than really anybody else in the industry they’re basically equivalent. So at the management or the Board level, what’s the thought process around that?

Richard Barasch

Well, thought process is to do we go, which is to use capital wisely. I mean if we shrink M&A capital is available, Puerto Rico doesn’t to bid, capital is available, so okay that prepares as quickly as we can and deploy it in an intelligent way. So I don’t think anything has really changed, no one in our inside group is happy with where the stock is at this point.

Candidly we’ve got some credit for it to do we’ve got enough EPS we’ve got to get our expenses down, so we’re not as you know we’re not a typical story a little bit different and particularly in the world now where there is companies have gotten so big, not even many companies of our size around, so we’re sort of in an anomaly in the situation. So I would say that there is inside there is a fair amount of optimism I guess we still believe we you mentioned grew 13% in Houston and we’re thrilled about that, didn’t grow as fast in New York but we’re going to be four stars in ‘15, so we think that’s a nice tailwind. And if I were looking at us, I would look at our ACO strategy and it’s really there is no value being described to it, it’s call option on a pretty big opportunity.

Unidentified Analyst

I think the last update on the (inaudible) business was not going to product anymore, basically running it out. Any possibility of selling that, is this because why hasn’t it been sold?

Richard Barasch

Well, it’s generally a lot of cash, when you sell toward the capital deployment kind of an issue also, if we needed the capital, it would be an obvious sell. But what if buyer buys a run off block business they want a very high or good return on this understandably, given the fact that we have got the capital, we want to keep those returns for sell until we think it’s not in point. It’s not a distraction for relatively mostly outsourced, it actually represents (inaudible).

Unidentified Analyst

And then last question here, for the last couple of minutes. So given the fact that the company relative to others, you have been discussed this an M&A candidate over and over and over again. Some of the, we called them platform acquisitions how they really turned out the way the buyer spot so well point buying Care More we are going to take that model and expand it everywhere hasn’t really worked, being the buying Health Spring, maybe extended to a couple of markets, but there really hasn’t been wide spread expansion. So I think the historical M&A view was great product in Houston and we are going to take that model and expand it everywhere. Now that seems like that hasn’t work, do you think that depresses interest in making more of a geographic acquisition?

Richard Barasch

Well, look it is a geographic acquisition. I shouldn’t speculating here, company is not for sale. But I think that -- and I think (inaudible) piece of that actually changes that a little bit, because we've got 30 outlets, where we have these physician partnerships that have the ability to be swapped or turn into this very model. I think that would be the main sort of difference, I would say.

Unidentified Analyst

Thank you very much.

Richard Barasch

Thank you. Thanks everyone.

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Source: Universal American's CEO Presents at Citi Global Healthcare Conference (Transcript)
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