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Oak Street Health, Inc. (NYSE:OSH)
Q3 2020 Earnings Call
Nov 10, 2020, 8:00 a.m. ET


  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:


Good morning and welcome to Oak Street Health third-quarter 2020 earnings call. [Operator instructions] Please be advised that today's conference is being recorded. Hosting today's call are Mike Pykosz, chief executive officer; and Tim Cook, chief financial officer. The Oak Street press release, webcast link and other related materials are available on the Investor Relations section of Oak Street's website.

These statements are made as of November 10, 2020, and reflect management's views and expectations at this time and are subject to various risks, uncertainties, and assumptions. This call contains forward-looking statements, that is statements related to future, not past events. In this context, forward-looking statements often address our expected future business and financial performance and financial conditions, and often contain words such as anticipate, believe, contemplate, continue, could, estimate, expect, intend, may, plan, potential, predict, project, should, target, will or would or similar expressions. Forward-looking statements, by their nature, address matters that are, to different degrees, uncertain for us.

Particular uncertainties that could cause our actual results to be materially different than those expressed in our forward-looking statements include our ability to achieve or maintain profitability, our reliance on limited number of customers for a substantial portion of our revenue, our expectations and management of future growth, our market opportunity and our ability to estimate the size of our target market, the effects of increased competition as well as innovations by new and existing competitions in our market and our ability to retain our existing customers and to increase our number of customers. Please refer to our quarterly report for the quarter ended September 30, 2020, filed on Form 10-Q with the Securities and Exchange Commission, where you will see a discussion of factors that could cause the company's actual results to differ materially from these statements. This call includes non-GAAP financial measures. These non-GAAP financial measures are in addition to and not as a substitute or superior to measures of financial performance prepared in accordance with GAAP.

There are a number of limitations related to the use of these non-GAAP financial measures. For example, other companies may calculate similar titled non-GAAP financial measures differently. Refer to the appendix of our earnings release for the reconciliation of these non-GAAP financial measures to the most directly comparable GAAP measures. With that, I will now turn the call over to Mike Pykosz, CEO of Oak Street.

Mr. Pykosz?

Mike Pykosz -- Chief Executive Officer

Thank you, operator, and thank you to everyone that is joining us this morning. On the call with me is Tim Cook, our chief financial officer. Before we review our operational and financial performance for the quarter, I want to start by once again thanking our Oak Street team for their exceptional dedication to patient care during COVID-19. This starts with our care teams and center-based staff, which work diligently every day to engage our patients and ensure we are properly executing our care model while maintaining strict safety protocols to minimize any transmission risk to our team, our patients, and our communities.

I'm proud to report that our centers have remained open throughout all 2020, and our infection-control protocols have proven to be exceptionally effective at preventing the spread of the virus. Given the effectiveness of our protocols and our performance this year, we are confident that regardless of the duration of this pandemic, we'll continue to be able to operate successfully to provide outstanding care to our patients. I also want to acknowledge and thank our outreach teams that are working to bring more patients to our platform in these unprecedented times. By engaging patients in their care and ensuring they have access to the care they need, they are making an impact on our communities and chipping away health disparities every day.

Finally, I want to thank our corporate teams, which have now been remote for seven months yet still managed to help achieve all that we will discuss today. Over the last several months, either as part of the IPO process or since, we had an opportunity to describe our care model and its success to the U.S. investment community, including many on this call. As some of you have heard me say, what we do is hard and requires tremendous focus across all of our team members.

There is no silver bullet when it comes to improving the health and well-being of our patients. And instead, it's about consistently applying a focused and differentiated approach every day across all of our centers for all of our patients. I always find the stories from our centers to be helpful in bringing our care model to life. We have a patient in one of our Chicago centers who first came to Oak Street about a year ago.

Prior to being engaged by our community outreach team and deciding to give Oak Street a chance, he hadn't been to the doctor in over 40 years. As part of our screening and vaccination program, he was given a fit test, and had a positive result. Our provider recommended he get a colonoscopy, but the patient was very resistant to getting one. However, because of the relationship we have with his provider at Oak Street as well as her persistent follow-up, he finally completed one.

A large malignant mass was found but caught just in time before it spread. The patient is currently cancer-free. This is just one of thousands of stories about how our teams help provide patients the care they need to improve their overall well-being. Switching gears, we are pleased with our third-quarter performance, which demonstrated the financial and operational strength of Oak Street's business model.

We generated record revenue of $217.9 million, exceeding the top end of the guidance range we have communicated to investors. This represents an increase of 57% from third-quarter 2019. We cared for roughly 59,500 at-risk patients, up 38% from third-quarter 2019. We generated this patient growth despite essentially putting a halt on our community outreach and marketing efforts from early spring through midsummer due to uncertainties around COVID.

As I'll discuss in more detail, we ramped up these activities over the course of Q3. As we mentioned on our last call, while we temporarily halted new center openings, we restarted our center expansion in August, opening 13 centers in third quarter and finishing the quarter with 67 centers. This represents the greatest number of centers we have opened in a quarter in the company's history. I'm incredibly proud of our team for delivering this level of center growth amid both the operational challenges prompted by COVID-19 and the effort required to complete our IPO on August 6th.

I will now touch briefly upon -- on a few of our key initiatives that will position us for sustainable long-term growth. First, as I mentioned earlier, we continue to look to scale our network of de novo centers. As we discussed, we proactively chose to halt new center openings earlier this year as we learned more about how to effectively operate during COVID pandemic. However, in addition to the 16 we opened in the first nine months of 2020, we expect to open additional six to eight stand-alone centers in the fourth quarter, bringing us to 22 to 24 openings for the year, excluding our Walmart centers.

In October, we also opened our first center in the State of New York, in Brooklyn, and we expect to expand in additional states over the next several months, which will bring our innovative care model to even more communities. Second, I want to provide a brief update on our pilot collaboration with Walmart that we announced in September. I'm pleased to report that we recently opened our first Walmart location and remain on track to open up all three pilot locations by year's end. The partnership remains in its early days, but we look forward to communicating our progress as we gain experience in the collaboration.

Third, in addition to opening new locations, we are also squarely focused on driving growth within our existing infrastructure. As a reminder, a typical Oak Street center can serve approximately 3,500 patients at full capacity, implying that our quarter-ending portfolio of 67 stand-alone centers has the capacity to care for approximately 235,000 patients, which is over three and a half times the actual patients on our platform in Q3. We are constantly refining, expanding, and improving our outreach process, embedding lessons learned throughout our history. And we continue to deliver strong patient growth despite being forced by COVID to limit many of our core community events-based patient acquisition channels.

To do this, we have developed alternative engagement channels that can be effective despite the limitations caused by COVID. We are confident that we can continue to be successful and drive strong patient growth in the current environment. When community events return, we believe we can leverage our broadened portfolio of patient acquisition channels to take our patient growth to yet another level. Lastly, I'm delighted to announce that in October, we began enrolling patients on traditional Medicare in the Medicare Direct Contracting program, which is a new voluntary risk-based program that allows CMS to directly contract with eligible providers for traditional Medicare patients.

We are very excited that this program allows us to capture risk-based economics similar to what we receive on our Medicare Advantage patients on our traditional Medicare patients, allowing us to benefit financially from the investment we are making in our patient care. Yesterday evening, we posted an updated investor presentation to our Investor Relations website that includes several slides detailing how we are participating in the program and our initial thoughts on both membership and patient economics. For those less familiar with the Direct Contracting program, it is part of CMS' strategy to use the redesign of primary care to reduce expenditures and improve quality for Medicare beneficiaries. Through this program, Oak Street and other participants will contract directly with CMS, in a similar fashion to how Oak Street currently contracts with MA plans.

We are currently operating our care model for our traditional Medicare patients in a similar manner to our Medicare Advantage patients. When we move from the fee-for-service payments we are currently receiving for our traditional Medicare patients to an at-risk model similar to how we are paid for MA patients, we believe we are well positioned to generate similar patient economics for our traditional Medicare patients as we achieve for MA patients today. If this expectation is correct, it will significantly improve patient economics for our traditional Medicare patients. The slides, which begin on Page 23 of our current investor presentation, detail how we are participating in the program.

I want to go over the slides about the membership and patient economics. There are two ways in which CMS can align beneficiaries to Direct Contracting entities. The first is claims-based alignment, whereby CMS will sign beneficiaries to providers based on historical claims data. Second is voluntary alignment, where beneficiaries choose to align with a Direct Contracting entity by designating a specific provider.

We've been offering eligible patients the option to voluntarily align with Oak Street over the past month, and the vast majority of patients we have seen have filled out the required paperwork for voluntary alignment. It's still early and we don't have full visibility to how many of our current traditional Medicare patients will also end up choosing Medicare Advantage or how CMS will treat patients that are aligned to multiple CMS programs, so it remains premature for us to communicate any firm estimates on precisely how many patients will ultimately flow through the program beginning in April 2021. Per-patient revenue will vary based upon how a patient is enrolled. For voluntarily aligned patients, per-patient revenue will be determined by applying the risk adjustment model using Medicare Advantage to a county-level benchmark.

This methodology is similar to the way per-patient revenue is determined for MA patients at Oak Street. For claims-aligned patients, the primary difference from voluntarily aligned patients are: one, benchmarks for claims-aligned patients incorporates the patient's specific historical cost and our resource. There's only a regional baseline rate for voluntary alignment. And two, there's a cap on the annual growth for risk scores of claims-based patients.

And because we do not know which patients will be aligned to the DC at this time, it is not possible to calculate per-patient revenue. Based on our understanding of the program and our expectations around which patients will be aligned, we would expect per-patient revenue for voluntarily aligned patients to be greater in Direct Contracting than it is in MA, assuming the same documented patient risk level, primarily because there are no supplemental benefits provided as there are in MA and we do not have to share a larger portion of surplus with CMS as with we do with MA plan. For claims-aligned patients, we expect the per-patient revenue to be lower than voluntarily aligned patients as our historical work with these patients results in lower healthcare expenditures, which are incorporated into their historical benchmark. Due to the lack of traditional health plan functions such as network design, prior authorization and utilization management, we expect the medical cost of Direct Contracting patients to be greater than our average MA patients for both alignment methods.

We expect the net profitability of voluntarily aligned patients to be roughly comparable to our MA economics, assuming comparable risk in the population. We expect claims-aligned patients to have worse economics than voluntarily aligned patients, driven by lower revenue and comparable medical costs, although still significantly better than the -- what will be our reimbursement fee-for-service today to care for our traditional Medicare patients. I want to stress that we are still working with CMS to make sure we understand the nuance of the program, and our economics will ultimately depend upon the underlying factors of specific patients that enroll with Oak Street. In summary, we are pleased with our third-quarter results.

And so, as I said at the beginning, I cannot be prouder the way our teams have navigated through incredibly challenging circumstances to make a massive impact on our patients and our communities. Despite these challenges, our teams continue to provide outstanding care for our patients and therefore, drive strong results to the organization. As we navigate through the remainder of the year, we'll continue to focus on positively impacting our patients and communities at a time when we -- they greatly need our support and delivering our mission to rebuild healthcare as it should be. I will now turn it over to Tim Cook, who will walk you through our financial results in more detail.


Tim Cook -- Chief Financial Officer

Thank you, Mike, and good morning, everyone. As Mike mentioned, we delivered record results in the third quarter despite the challenges of the COVID-19 pandemic, highlighted by both our recurring revenue model as well as continued growth in the markets which we serve. As a reminder, we expand our network in two important ways. First, we seek to drive patient growth in our existing centers.

And second, we strive to expand our network of centers across existing and new markets. In terms of membership, total patients grew roughly 28% year over year while our at-risk patient base, which drives most of our financial performance, grew by 38%. At the end of the third quarter, we operated 67 centers, an increase of 13 centers from the second quarter of 2020 and an increase of 21 centers compared to the third-quarter 2019. We generated capitated revenue of $211.8 million, representing 59% year-over-year growth, driven by the aforementioned growth in our at-risk patient base.

Total revenue grew 57% year over year to $217.9 million, driven entirely by growth in capitated revenue. Our medical claims expense for Q3 2020 was $154.6 million, representing growth of 58% compared to Q3 2019. Q3 medical claims expense was not meaningfully impacted by prior period adjustments. We continue to assess the impact on medical claims expense-related to COVID.

However, it's also still too early to determine the net effect, particularly as many of our markets are experiencing surging cases, similar to national trends. Our cost of care excluding depreciation and amortization was $43.2 million for the third quarter, an increase of 17% versus the prior year due to the growth in the number of centers we operated as well as growth in our total patients. I would note that the recognition of CMS provider relief funds favorably impacted cost of care by $3.9 million in the third quarter. Sales and marketing expense was $15.5 million during the third quarter, representing an increase of 29% year-over-year but slightly below our expectations simply due to timing, which we expect to reverse in Q4.

Corporate, general and administrative expense was $57.1 million in the third quarter, an increase of 164% year-over-year. The majority of this year-over-year increase is related to an increase in stock-based compensation expense, which was $29.7 million in the third quarter of 2020 compared to $1.4 million in the third quarter of 2019. Excluding stock-based compensation, corporate, general and administrative expense was $27.5 million in the third quarter of 2020, an increase of 36% compared to the third quarter of 2019, driven by increases in head count to support our organizational growth. The increase in stock-based compensation in the third quarter of 2020 compared to the second quarter 2020 was related to primarily two items: first, awards granted to employees in June 2020 ahead of our then planned IPO, which represented $5.7 million of stock-based compensation expense in the third-quarter 2020 and was only partially reflected in our second quarter financial results due to the timing of their issuance; and second, the modification of the vesting terms of equity incentive awards following our IPO, which represented $18.2 million of expense in the third-quarter 2020.

This incremental expense is not related to new equity award issuances beyond those awards described in our prospectus dated August 5, 2020. I would note that less than $200,000 of our stock-based compensation expense in the third quarter of 2020 related to the equity awards we issued since the IPO in August. I will now discuss three non-GAAP financial metrics that we find useful in evaluating our financial performance. Patient contribution, which we define as capitated revenue less medical claims expense, grew 63% year over year to $57.2 million.

We expect at-risk per-patient economics to improve the longer that our patients are on the Oak Street platform. Platform contribution, which we define as total revenue less the sum of medical claims expense and cost of care excluding depreciation and our amortization, was $20.1 million, an increase of 387% year over year. As individual center matures, we would expect both platform contribution dollars and margins to expand as we leverage the fixed cost base associated with our centers as well as improving patient economics over time. Adjusted EBITDA, which we calculate by adding depreciation and amortization and stock-based compensation while excluding other income to net loss, was a loss of $22.8 million in the third quarter of 2020 compared to a loss of $28.1 million in the third quarter of 2019.

We finished the third quarter with $474.6 million in unrestricted cash. Cash used by operating activities totaled $22.4 million in the first nine months of 2020. So, our capital expenditures totaled $12.6 million in the first nine months of 2020. I'd now like to talk about our 2020 financial outlook.

We are increasing our expected revenue to range of $854 million to $858 million, up from our prior outlook of $843 million to $853 million. We are also forecasting an adjusted EBITDA loss of between $93 million and $99 million versus our prior outlook of a loss between $100 million and $110 million. We anticipate having 73 to 75 stand-alone centers opened in December 31, 2020, slightly above our prior forecast of 72 to 74 centers. We are also narrowing our expected at-risk patient counts to a range of 61,500 to 63,000 patients.

As a reminder, our stand-alone center outlook for 2020 does not include Walmart pilot locations, which would represent an incremental three centers. In summary, this was a strong quarter financially and operationally, and we anticipate a strong fourth quarter as well while, at the same time continuing to make these necessary investments required to maximize long-term shareholder value. With that, we will now take any questions you may have. Operator?

Questions & Answers:


[Operator instructions] Your first question is from Robert Jones with Goldman Sachs. Your line is open.

Robert Jones -- Goldman Sachs -- Analyst

Great. Good morning. Thanks for the questions. I guess just a couple on Direct Contracting.

Appreciate the incremental thoughts here on the program. And clearly, based off the slides, there's still some important elements that I think need to be hammered out but I'm just curious if you could talk a little bit about how you're thinking about prioritizing eligible patients as you consider taking somebody from fee-for-service to either MA or trying to introduce the Direct Contracting? Just -- even just some of the qualitative considerations that would go into that type of decision would be helpful.

Mike Pykosz -- Chief Executive Officer

Yes, absolutely. This is Mike Pykosz, just to reorient people. So for us, it's not really around directing people. It's around making sure that we're educating our patients on the choice and doing what's right for them.

And it's not really an either/or. So today, when any of our patients who are on traditional Medicare show up for a visit, we're helping them fill up the required paperwork for voluntary alignment. Some of those people that filled up the paperwork may ultimately decide, since it is open enrollment, that Medicare Advantage is the right program for them. Historically, we have seen the majority of our traditional Medicare patients end of year end up choosing Medicare Advantage.

Because -- it's not a perfect switch, right? It's not like you're comparing benefits from one side to the other. If you join Medicare Advantage plan, and you'd have a lot more supplemental benefits, often free Part D program, et cetera. Now obviously, you have the trade-off of oftentimes being part of a network with some of those different aspects of being on a managed care plan. So it's not a perfect switch for our patients.

So our job and the process is to really educate people and help them make the best choice for them. So I don't anticipate because -- Direct Contracting is any different in the amount of patients who are also choosing Medicare Advantage because they're choosing it because it's right for them. And frankly, our economics on them is something they don't know and is irrelevant to their decision-making, as it should be. From a practical perspective, what it means though is, in the past, when patients either come to us on a traditional Medicare and for just whatever reason don't want to change to Medicare Advantage, we'll keep doing a great job caring for those patients but have lost money on all of them because we're not compensated for the investment we're making in their care.

Going forward with this program, now for the patients who decide that traditional Medicare is the best program for them, those patients and we'll will be able to receive at-risk economics, which make a big difference for us. But again, I don't look at this as a choice for Oak Street at all. I look at it as -- our goal is to make sure all of our programs are one of the two -- as that all our patients are on one of the two programs.

Robert Jones -- Goldman Sachs -- Analyst

Got it. No, that's helpful, Mike. I appreciate it. I guess just maybe on the specific financial options.

I know in the slide you have the risk-sharing option and then you have the capitation mechanism. Obviously, that's a big decision, I would imagine, around the economics back to Oak Street. Could you maybe just talk a bit about those two options? And then on the capitation mechanism, specifically the TBD, I guess, what exactly are the factors that would determine that economic model versus the risk-sharing option?

Mike Pykosz -- Chief Executive Officer

Yes, so two things about that. One, on the former, how much risk we're taking, that's an easy decision, right? We invest a lot of money upfront in our patients' care. We have a huge amount of confidence that we are keeping our patients healthy, lowering consultations and ultimately, saving a lot of money by keeping our patients healthy and that -- those investments are expensive, so we want to make sure we're sharing all the savings we're generating. So being 100% up and down was an easy decision for us.

On the second one around the capitation, that's all about cash flow, and that's more technical about kind of how we fit into the system. And so one of the options gives you kind of a monthly small payment and then even a settlement in January or in July to come into the next year, right? So it's a delay to get your savings. So you get all of it, but it's a cash flow delay. The other option has more upfront payment, but you also have to kind of have some signed agreements with all your specialists and other providers to kind of pay the claims for them.

So that one seemed -- I think we're leaning toward the former I talked through. Haven't made a final decision nor do we need to. But again, that's not going to change the economics for patients. It's just a question of kind of when do you get the settlements and how the money flows as opposed to actually changing the economics.

Robert Jones -- Goldman Sachs -- Analyst

Awesome. No, that's really helpful. I guess maybe just if I could sneak in one more. And I know the COVID, obviously, situation has impacted the ramp of enrollment in certain centers.

It sounds like things in some areas were back on track. I know some of Oak Street's geographies might be impacted by current spikes in COVID. Just curious how you're thinking about the general ramp in patients in the centers as we look at 4Q and then even just qualitatively as we look out to next year.

Mike Pykosz -- Chief Executive Officer

Yes. I mean if you would have -- if we would have been sitting here a year ago talking, I'd be talking about how many community events we're doing and how we're leveraging our community centers as a great way to introduce people to Oak Street and form relationships, and that was a core part of our model. And a lot of it's real face to face, handshakes, form relationship in the community. Obviously, in kind of mid-March, we had to shut all that down.

And so what we did is we made the decision -- again, if you go back to mid-March and remember where we are as a country as far as understanding the virus and all the different projections. We obviously want to err on the side of caution. So we really -- we shut down all of our outreach activities, both center marketing and our community marketing, in order to kind of get a better sense operationally how to operate within COVID, understand more about the virus, how it transmits, etc., etc., etc. There are many, many things that society did at that time period.

Over the last eight months, I mean, we've certainly learned a huge amount about how to kind of effectively navigate the pandemic and how to operate successfully. And so we just said we've kind of ramped up our care model and so we've transitioned most of our business back to in-person. We really made a lot of changes on our outreach model to let us be successful in bringing in new patients in a world where some of our core channels, we can't do right now. And so it's more digital marketing, a lot more kind of relationship-based selling with aggregators.

We're not setting up events with aggregators. We're actually just asking them for referrals, making them introduce us to people that need our care. There's a huge amount of need out there. I mean, this -- we covered -- my patient story I shared kind of illustrates how important it is to engage people in their healthcare and get them the care they need and how that can really literally save lives.

But -- so I think we feel really good about the channels we ramped up, and that we're seeing results from them. We're seeing it at a favorable LTV to CAC ratio. So we feel really good about where we're at overall. It's been a lot of work to get to where we're at now, and it's been a lot of trial and error over the last three, four months since we started ramping things back up again and kind of keep going.

And so the good news is we generally improve every week, and we have improved every week for the last couple of months on our average performance. And I really think we can continue to do that going forward. We are incredibly excited -- and I know it's not going to come until some time probably in the next year, but we are incredibly excited for the day that we can start the community events again. Because the great news is all of the things we learned during COVID, we'll keep these things -- we're keeping the channels, we're keeping the levers we can do, but we can add back the community events and maybe take it to the next level.

So again, it has -- there are some businesses out there that I think COVID really became an accelerant for those businesses. We are not one of them. It's been a huge challenge. And we also -- everyone here just cannot wait until we're back to normal operations.

But I think the team has done an amazing job putting us in a position where, regardless of the relative spread in a community, we can really effectively and safely operate the model. And we're seeing that in places like Illinois right now and Indiana, which are obviously struggling with regards to the pandemic. But we're still operating, I think, at a very high level, and I'm proud of our teams for that.

Robert Jones -- Goldman Sachs -- Analyst

Great. Thanks, Mike. I appreciate it.


Your next question is from Gary Taylor with JP Morgan. Your line is open.

Gary Taylor -- J.P. Morgan -- Analyst

Hey. Good morning, guys. Just a couple of questions on Direct Contracting. The first is on the claims-aligned patients, you talked about the profitability being below traditional MA patient and above current fee-for-service.

But to be fair, that gap -- you could drive a truck through that gap. It's so wide. So have you come to the determination or a thought that those patients would be profitable? Are you still keeping --

Mike Pykosz -- Chief Executive Officer

Yes. I mean -- look, Gary, when you're talking about individual patients and individual risk or individual Medicare costs, as I said in kind of my prepared remarks, we won't know exactly what the medical costs are until we know -- and the revenues until we know. Well, medical costs, we won't know until hindsight. Revenue, we won't know until we actually know who the individual people are, which we don't know yet.

That said, I fully expect that the economics on our claims-aligned patients will be much superior to what we're being paid in traditional Medicare. And then just -- 35% of the benchmark is still set by a regional benchmark. 65% is based on historical expenditures. And it also is risk-adjusted historically.

And while there's a cap on risk adjustment going forward, again, this is where I think Oak Street is pretty unique. We have not -- this is not a situation where we suddenly think, "Oh, great, we're going to be in this program and where we can benefit from savings. Let's change our care model and take better care of people," right? We've been running our care model for years, which both means that we've done a nice job of controlling the medical costs and keeping our patients healthier regardless of how they're getting their Medicare. But we've also run all of our diagnostic processes.

We do those because it's a way to understand our patients' conditions and make sure we are aligning them with the right program and caring from them the right way. A byproduct of that is now actively documenting risk more. And so again, I don't think -- we're not worried about the cap on our claims-aligned patients because they should -- because by definition, if they're claims aligned, we've had them for a while, we've seen them for a while. We feel like this course is going to be in the place it should be or relatively close to that.

So while I don't think they'll have the same revenue as our voluntarily aligned patients, and I do feel like we should have strong economics on them.

Gary Taylor -- J.P. Morgan -- Analyst

OK. My follow-up would be what's the pitch to a senior for voluntary enrollment? So like what would be the example of a senior where MA with a supplemental benefit offering isn't a better option? Or is voluntary enrollment primarily going to be for seniors who, for whatever reason, just aren't willing to go into a private plan, don't want to do MA and then this is something that you're offering to them? But even as you do, what's the pitch to get them to sign up for it?

Mike Pykosz -- Chief Executive Officer

Yes. One thing I -- and one thing to be clear about, I don't look at this as a trade-off. And operationally how we put these products into place, it's not that we're staying to someone, "Okay, here's Medicare Advantage. You can do that.

This is how this works. And here's voluntary alignment for Direct Contracting. You can do that if this is what you want." Like that is 100% not the way the conversation goes. When we're talking about Direct Contracting, regardless of whether we AEP, SEP, one of the kind of years, when a patient on traditional Medicare walks through the door who has not signed the paperwork, we're talking about it, right? And we're talking about it kind of when they're checking in and say, "Hey, here is a new government program we're part of.

We're your PCP. And we'd like you to sign this form that says, 'Yes, Oak Street Health is my primary care provider,'" right? That's what the form says. Is Oak Street your primary care doctor? And there's no downside for the patients who sign that, right? They can change also their primary care doctor the next day. They can still keep Oak Street as their primary care doctor and go see a different doctor if they want to.

They don't need prior authorization. There's no network, right? There's zero downside for patients to sign that form. And so what our goal is and what we're talking to patients about is to make sure they understand that. Like this will help us get more data on you.

This will help us take better care of you. But there's no limitation. You have to sign this form. The same patient may sign the form when they walk in the door and check in.

And then later in the visit, they may hear about Medicare Advantage and decide they want to explore that option and meet with their broker and sign up for Medicare Advantage, right? And the Medicare Advantage conversation is all about a trade-off between benefits. "Here's what I have on traditional Medicare. Here's what Medicare Advantage is going to offer me. What's right for me?" The Direct Contracting alignment is just something that you should do, right? And if the alignment -- individual during the visit signs for Direct Contracting and then later in the day she decides Medicare Advantage, so just join Medicare Advantage and the alignment will be -- won't matter, right? So I want to make sure that's really clear.

Like when we think about this, it's not a trade-off. Our economics don't play into this at all. It's really all about everyone who is on traditional Medicare should sign the alignment form because there's no downside to them, and obviously, and that means we can take better care of them. And then on the MA front that we got -- we want to educate our patients so they make the right decisions for them.

Gary Taylor -- J.P. Morgan -- Analyst

Appreciate that. Thank you.


[Operator instructions] Your next question is from Ricky Goldwasser with Morgan Stanley. Your line is open.

Ricky Goldwasser -- Morgan Stanley -- Analyst

Yes, thank you and good morning. You excluded from your guidance the three centers to be opened as part of the Walmart collaboration. How should we think about the top line and margin trajectory opportunity for Walmart sites versus the de novo Oak Street centers?

Tim Cook -- Chief Financial Officer

Hi, Ricky. This is Tim. Thanks for the question. It -- with respect to Walmart, I think as we've -- we may have discussed this on the last quarterly call.

But what we would expect generally speaking, given the footprint of the Walmart center, which is about a third of the size of our traditional stand-alone centers, we'd expect the ultimate economics, at least from a revenue top line perspective, to be smaller than what we currently generate on our stand-alone centers. The ultimate contribution of those centers is a different equation. At this point, one of the purposes of the pilot is nearly to better assess what those numbers could be and therefore, how aggressively we want to expand that partnership or not, candidly. So at this point, it's too early for us to know.

I'd say at three centers, it's relatively -- it's a very small part of the business. And we'll share more information as we have it, but at this point, still teasing it out. What I would say though is the economics for a patient at a Walmart center -- for an at-risk patient at a Walmart center are going to be the same economics that we'd see in a stand-alone center. So from that perspective, if you were thinking about it, it would just be -- and from a revenue perspective, I'd say, look, we'll be able to manage fewer patients because we just have less space to do it, but the economics we expect to generate those patients will be the same as we otherwise would.

Ricky Goldwasser -- Morgan Stanley -- Analyst

And then my follow-up question is around the COVID vaccine. Clearly, we heard some really good news yesterday from Pfizer. As we think about the potential contribution to your P&L next year, should we think that it is kind of like limited to your fee-for-service patients and just kind of like apply the CMS-established reimbursement? I think reimbursement is $28 to $44, depending on the dosing. And that then given that the government is paying for the cost of the vaccine, and how should we think about the flow-through to P&L? Thank you.

Mike Pykosz -- Chief Executive Officer

Yes. So one, we were all thrilled with the news of the vaccine being very effective on early results. We know it's all early, but I think, like everyone, we're really excited about that at Oak Street Health. When we think about the economics of the vaccine, honestly, it's de minimis for us.

Yes, we will get paid for administering the vaccine to our patients in theory, but as you -- I think, rightly noted, not for our at-risk patients, right? And for our traditional Medicare patients, depending on the timing of that, they may be in the Direct Contracting entity by then, in April or the reverse. In which case, it doesn't matter either for them, right? Hopefully -- by the way, these patients, they're generally at-risk demographics, and hopefully, they can also get it earlier. But again, I don't think the relative economics of administering the vaccine will -- I think it's going to be rounding error in our overall P&L for the end of 2020 and 2021. Where I think it makes much, much, much more of a difference for Oak Street is allowing us to open up some of the channels, whether it's from a growth perspective or a patient engagement perspective.

Our patients love the community events. So I think if and when those things come back, I think that will help both our outreach model. I think it will also help our care models if we will increase engagement for our patients. And then probably, look, it is also -- as I think everyone knows, it's difficult to operate safely in a COVID environment.

So that causes inefficiencies, whether it's our teams in the centers or call centers. So I think they're doing an amazing job of managing through it. On the flip side, everything gets easier. So again, we are very excited for that day, but I think the impact here on Oak Street Health will not be -- from the economics of the vaccine, I think that is de minimis, and frankly, that's the last thing on our minds.

I think what the impact will be is really allowing us to kind of add additional channels of patient acquisition and to add additional levers to engage patients, which we -- should drive even more the results for Oak Street.

Ricky Goldwasser -- Morgan Stanley -- Analyst

Thank you.


Your next question is from Ryan Daniels with William Blair. Your line is open.

Ryan Daniels -- William Blair and Company -- Analyst

Yes. Good morning, guys. Thanks for the question. Another one on Direct Contracting, Mike, you mentioned the need to build out claims processing capabilities in the network for some of those individuals.

Can you speak to one investment that might require and if you'll use a TPA or one of your existing plan partners for claims administration and network management? Thanks.

Mike Pykosz -- Chief Executive Officer

Yes, Ryan. That would only be relevant if we choose the -- I think I'm blanking on the term now, but if we choose the option where we get kind of the majority of the premium upfront and then have to go pay the claims and set this network up ourselves. Total care if it's making sense. I think that if we go that option, there's some cash flow benefits to it.

It's something that we can change over time. My suspicion right now -- and like I said, we don't need to make the decision yet nor have we, but my suspicion is we will not go in that direction actually for exactly the reasons you talked about, which is just creates more administrative challenges and more complexity. I just don't know if that trade-off is worth it. So my position today if you said I had to choose right now, which again I don't, I reserve the right to change this, but is -- I think we will go with the former then because then we don't have to worry about anything else so --

Ryan Daniels -- William Blair and Company -- Analyst

OK. That's helpful. And then a different topic, can you speak to kind of center expansions? I'm curious what your philosophy is in regards to building out existing markets where you kind of already have a brand and your customer acquisition cost may be a bit cheaper versus entering new markets like New York and Mississippi. How do you internally kind of balance those two from a growth standpoint and investment standpoint? Thanks.

Mike Pykosz -- Chief Executive Officer

Yes, I think balance is the right word. And -- but I think you have -- I think you said it. As you open up new centers in existing markets, obviously, it helps a lot on operational complexity. You see benefits from the brand, you benefit from relationships, etc., etc.

On the flip side, you obviously need to be growing in new markets to create those beachheads so you have more places where it's easier to grow. So when we think about whether it's how we're growing in 2020 or how we're planning to grow in 2021, etc., it will be a combination of both, for sure. When we really first go to a market, one thing we want to do in the first, call it, year or two we are in the market is get good coverage over the neighborhoods we want to serve. Primary care is local.

And so if you're more than, call it, a 15-minute drive time, you're probably not going to get someone to join your center. So when we look at our algorithms that predict where we'll be successful and we look at where there's need in the community, we try to essentially draw 15-minute drive time circles around our portfolio center to get us great coverage. And that's kind of step one when you go to a market, is getting that coverage. What we've seen in our more mature markets, whether it be Chicago, Indianapolis, Detroit, etc., you can see that demand in any 15-minute drive time catchment is larger than any center can serve by itself.

And so over time, when you have centers that are growing quickly, then you put more centers around there to make sure you have enough capacity to meet that need. And that's what we've done in Chicago. We added a couple more in Detroit just recently. We've added one in Minneapolis, over time, etc.

So that's how we think about the growth. It's go to new markets, get that beachhead, get good coverage over markets so we serve all the older adults that need our help in the market and then over time, and as those centers start going up, keep looking for more infills.


And your next question is from Stephen Tanal with SVB Leerink. Your line is open.

Stephen Tanal -- SVB Leerink -- Analyst

Hey. Good morning, guys. Thanks for taking the question. I'm going to ask a couple on Direct Contracting as well.

A lot of really helpful color today, so I appreciate that. I guess in the deck, we noticed that there's a 5,000-patient minimum to participate in performance year one. And I wasn't aware of that -- and I guess you'd written there that you expect slightly more voluntary-aligned patients than claims-based aligned. So I guess first question is is it reasonable to assume that, that comment is relative to, say, 2,500 of each kind of patient to start? And then just doing some math on that, with capitated PPPM revenue around $1,200 today, and you mentioned voluntary alignment should be above that threshold, I guess it's probably safe to assume about $1,000 for the blended PPPM revenue on the program, which would imply potentially high $800 to $900 above current fee-for-service revenue PPPM, which comes up to about 10,000 patients per year.

That math suggests sort of the bare minimum to start with 5,000 patients would produce over $50 million of incremental revenue annually. So is that reasonable to start, and -- the way we're thinking about that?

Mike Pykosz -- Chief Executive Officer

Well, on the 5,000 number, I mean, that's a floor from CMS on our program. We're confident we'll exceed the floor. So I wouldn't look at that -- I mean if you want to start the math around the floor, that is the floor. But again, I don't think that has any direct relations to how many patients we do expect.

On the question of voluntary versus just the claims-aligned patients, the reason why we expect more voluntarily aligned patients is twofold. One, because we do see the majority of our patients that are on traditional Medicare eventually moving to Medicare Advantage, you don't have as many tenured traditional Medicare patients that would be claims aligned. If you remember claims aligned, we'd look at multiple years of claims, right? And so think about the rate of Oak Street's growth and how many markets and then how many patients are relatively new to Oak Street. So think about the time period in which they're looking for claims alignment.

We'll get claims-aligned patients, but our models are more predicated on growth and people kind of proactively choosing Oak Street, which is very different than more of your traditional hospital system or doctors that had patients for a longer period of time. And then going forward, right, every patient we sign up, right -- every patient is going to start -- kind of complete visits as new patient of Oak Street Health, we will introduce to voluntary alignment. We will have them fill up these forms. And so they will be voluntarily aligned before they can be claims aligned, right? Because if the patient walks in today for their visit, right -- and their first visit, and we -- they saw the voluntary alignment form, they'll be voluntarily aligned.

It may take two years for them to be claims aligned, right? And so for that reason, we just expect a lot of voluntary-alignment patients. And obviously, when all the patients we're signing up today start becoming -- flipping to claims aligned, we'll have grown a lot more, right? And there'll be a lot more voluntarily aligned patients. So that's why we expect voluntary to be higher, much more around kind of that flow of new patients coming in, and voluntary alignment that happens a lot faster than claims alignment. And so I think what you'll see is a mix on April 1st of claims aligned and voluntarily aligned.

And then the mix, every single quarter, as more patients are enrolled, will go more and more toward much more voluntary alignment over time.

Stephen Tanal -- SVB Leerink -- Analyst


Mike Pykosz -- Chief Executive Officer

Yes, as far as the revenue, again, I would kind of point you toward our kind of PMPM MA revenue. And I think, as I said in my remarks, we expect, just based on some level of risk, we're probably higher for voluntary-aligned revenue per patient. For voluntarily aligned -- probably lower than voluntary-aligned per claims-aligned patient. And so again, I think directionally, you can probably look at then again we don't know which patient and what risk is, so I can't give you any exact numbers.

But I think probably, if you tell me directionally around MA, and if you kind of look at that, it probably gets you pretty close.

Tim Cook -- Chief Financial Officer

Yes, Stephen, I know you're -- I think the logic of your math was -- is obviously accurate. I think from a PMPM revenue perspective, I guess, $1,000 is probably conservative, but either way, that would be the revenue upside on 5,000 patients. And to Mike's point, the 50-50 split is probably conservative as well just given the amount of new patients we have during year three in our platform -- who have joined the platform over the last year.

Mike Pykosz -- Chief Executive Officer

And the only thing I'd add, Steve, there's April 1st, which is the first time patients can be in there, but that's not the expanse of the program, right? Because you can -- there's -- every quarter, you get more people aligned, so I certainly expect more to be aligned on July 1st than April 1st and then more on October 1st and more again in the 1st of next year. So I mean, again, I'm excited about the program. But I think what I'm most excited about is it is a really a long-term opportunity to get the vast majority of our patients to risk-based economics. I'm also trying to temper my expectations on the -- it's a new program, and that therefore, there's probably going to be some hiccups and just as we figure out or we expect the CMS also to figure out how to administer it.

So very excited about it for the medium and long term and also in the short term, but it's not just a one-shot deal.

Stephen Tanal -- SVB Leerink -- Analyst

Yes. They're all very helpful color. And I guess just as a follow-up, I mean, I think, at this stage, there's nothing in the model -- nothing in my model. I don't think there's anything in consensus, and we're five months away from this thing kicking off.

And so I think it probably makes sense to take a more conservative tack given there probably will be hiccups, but to follow up on sort of your comments, Mike, you also mentioned sort of a large majority of Medicare patients aligning on the voluntary side. Obviously, you have over 30,000 fee-for-service patients today but the program minimum is 5,000. Look, I don't want to put you in a corner and give us numbers you're not comfortable with, but you did mention 5,000 is probably very conservative relative to that 30,000 and that 5,000 is worth $50 million. Like, yes, you can run away with this and paint the F-side case.

So maybe a little bit of context just on -- something in the order of how many patients are actually -- or what percentage are actually aligning on that side and whether you think that 30,000 is possible in year one at all or maybe half of that is possible. Any context there would be pretty helpful too just to keep it all in check. Thanks.

Mike Pykosz -- Chief Executive Officer

Steve, it's just hard to give -- I understand the question. I understand why you're asking the question. I'm asking the same questions. What is really challenging is not just like how many people we're signing up, but how many of those people actually will choose Medicare Advantage, right and how many of those people will -- may get crossed into a different CMS program and outflow through.

And so we -- and the reality is we just don't know, right? And if a patient is on Medicare Advantage for one month of the year, then they're not eligible to be on Direct Contracting, right? We may have the traditional Medicare patients who try MA, try it for two months, don't like it, drop back to traditional Medicare. So they're on traditional Medicare but they're not going to be now eligible for the program. And that does happen, right? We will have patients who get aligned to a next-gen ACO, for example. And well, total voluntary alignment will trump -- and to kind of pass the line into a different program over time, but what over time means and how exactly that works, we don't know.

I think CMS, frankly, is still determining all those details. And so again, it's both a question of like what is the aggregate number of patients who are claims aligned; and what is the aggregate number of patients who sign the voluntary enrollment form; and then, of that group, how many will choose MA, and that number when it's established, probably it's a great outcome for us if they choose MA; and then how many of the ones that don't choose MA end up outflowing through our rosters. And this is what -- there is -- without more information upfront, we just -- there's no way to know it. So I don't want to give tighter ranges or imply anything.

I would say 5,000 to 30,000 is probably a fair range, and I'm probably not going to give you closer than that.

Tim Cook -- Chief Financial Officer

Yes. And, Steve, just one -- on that 30,000 at-risk -- or excuse me, fee-for-service patient base today, some portion of that fee-for-service patient base is -- they are on MA. Just for whatever reason, that MA plan is not at risk for us, there are some rare instances where that's the case. And also, that 30,000 is comprised of a fluid number of traditional Medicare patients.

Many of them are on -- they're traditional Medicare patients for just a month or two months and ultimately enroll in MA. So it isn't the same patients period to period necessarily. So I just -- I think that denominator, and at least as we sit here today, is probably not the most appropriate one. Now between now and April 1, as we continue to grow our patient panel, maybe 30,000 becomes more relatively, I don't know.

But just to make sure, we're kind of talking -- or that we're seeing it eye to eye, what was really in that number today.

Stephen Tanal -- SVB Leerink -- Analyst

That's helpful. All right. Thanks a lot, Tim. Thanks, Mike.

I appreciate the color.


Your next question is from Sean Wieland with Piper Sandler. Your line is open.

Sean Wieland -- Piper Sandler -- Analyst

Hi. Thank you and good morning. I also was looking to get a realistic assumption on the percent of patients going into the Direct Contracting program. But maybe in a quarter from now, and we're guiding on -- when you're guiding on 2021, what are the factors that you're going to include in your '21 guidance as it relates to the Direct Contracting program?

Tim Cook -- Chief Financial Officer

Thanks, Sean. We are -- well, as we get closer to when we would issue 2020 results, we'll probably be a bit better able to answer that. I'd say -- look, we would love to be able to provide [Audio gap]. We'd feel better about the economics based upon the math that's been outlined by CMS.

The patient number is just -- it's a challenge. Now come Q1 of next year, we'll have better alignment. So I'd say if we had our rudders, we'd be able to provide better specificity around what membership will look like on our next call. I say that with a caveat that I don't know what we'll learn from CMS between now and then and some -- what the moving pieces will be.

So I think we spoke about seven or eight weeks ago. I know this is a bit of a topic. But obviously, the market didn't have as much information that we have today. So we'll continually provide more information as we learn it and are confident in sharing and committing to it.

I think from our perspective, while we obviously love the opportunity in Direct Contracting, we want to just make sure that we're giving folks really our best look and not making changes on the fly and as we continue to learn more.

Sean Wieland -- Piper Sandler -- Analyst

OK. Do you see any risk of any channel conflict with your existing MA partners as you migrate some of your fee-for-service patients over to Direct Contracting?

Mike Pykosz -- Chief Executive Officer

I don't see any risk at all, channel conflict. Like I said before, this is not us advising patients to join one or the other. We're on the same processes we've always run on educating people how Medicare works. And we're going to do that because having the right benefits and the right support and maximizing what you get from Medicare is critical to our patients actually increasing their well-being and staying healthy, right? And the reality is, for the specific patient demographic we serve, the vast majority cannot afford a Med Sup plan.

That's around hundreds of dollars a month. And so for a lot of our patients, Medicare Advantage is the right program for them to join. And we're going to keep educating people on how the program works. And then if they want to learn more, they have to be with an insurance advisor.

We can't sell insurance. We don't talk to specific benefits, etc. So I don't think that's going to change. And if the patient wants to stay in traditional Medicare because that's right for them, then, obviously, we hope that they're aligned to the Direct Contracting program.

And you expect a lot of movement in and out of the programs, as I alluded to earlier, based on what patients want. So again, it's -- from our perspective, I don't see the mix changing at all across what our patients want that -- as it's been historically when we didn't have the program.

Sean Wieland -- Piper Sandler -- Analyst

OK. Thank you.


Your next question is from Matthew Gillmor with Baird. Your line is open.

Matthew Gillmor -- Baird -- Analyst

Hi. Thanks. Let me try one follow-up on Direct Contracting. Is it -- just given kind of the natural flow of patients that get introduced to Oak Street and then eventually shift over to Medicare Advantage because it tends to be a better deal for them, is it fair to think about Direct Contracting as improving the patient economics for patients that you may see in the first one to two years and then they naturally shift over to Medicare Advantage and then you capture that economics or do you have a portion of fee-for-service patients that are longer term in nature? Just wanted to -- if you could sort of help us think through that.

Mike Pykosz -- Chief Executive Officer

Yes, it's both. So I think you're absolutely right on kind of that flow of patients, and that's very real. But I think on the flip side, there are a set of patients -- think about someone who's got -- is a retired union member and the union -- the retirement benefit pays for their Med Sup program. So that person may be really in our core target demographic.

In this case, actually, they can afford their Med Sup plan. They're paying for that, right? And so for that patient, if this -- if they have a free Med Sup plan, that's probably going be the right option for them. And we're going to be very supportive of that, right? And so this program that benefits that person allows us to also get kind of average economics to benefit from the investment we're making to keeping them healthy, where prior to Direct Contracting, we would just lose money on the patient in perpetuity. We're obviously not going to differentiate our model or offer less high-quality care.

And so that's where the programming is also really powerful, to that profile of patients. And again -- and there's also obviously rare instances where children are paying for the Med Sup or some of our patients are higher income, right? It's not like all of them can't afford it. So again, there is a tail people, for a variety of reasons, who actually don't want to move to Medicare Advantage and sometimes for good reason. And in that case, this program will also allow them some success.

But I do think there will be a fair number, as you described, who kind of migrate through the program.

Matthew Gillmor -- Baird -- Analyst

Got it. That's helpful. And then, Mike, you talked about some of the alternative engagement channels, digital and then with brokers. I was hoping you could unpack that a little in terms of what you're doing different today versus a year ago? And as you're thinking about that week-over-week improvement, are either one of those approaches yielding more benefit than the other?

Mike Pykosz -- Chief Executive Officer

Yes, so one thing to always keep in mind that helps us out is we're not a static organization. Our care model is not static. Our outreach model is not static. While I sometimes can't remember life before Oak Street, we've only been around for -- we only have been operating centers for seven years and obviously have grown a lot and have improved along the way.

And so the reason I say that, something like digital marketing, two years ago, we did 0. Why didn't we do it? I mean we don't have that capability yet. We hadn't invested against it. And so as some of these channels come on, right, you could argue we should be doing digital marketing four or five years ago.

We think you're right. We should have. There's only so much you can do and so much you can add over time and so much investment you can make this as you grow. One of the great things about having the level of scale we have and frankly, having the level of scale we're going to have over the next couple of years as we continue to grow is it gives us more and more resources to build out additional channels, build out additional care model programs, et cetera.

And so some of the channels we're doing, whether, as we talked about, digital or working more with insurance and trying more programs there, it's not a question of like, "Oh, something has changed. Now this works." I mean obviously, more people are now engaging digitally. And that's stating more patients. That's helping.

But generally, the answer is, hey, like there's just -- there's a lot of opportunity out there, right? And we'll keep experimenting. We'll keep innovating. We'll keep trying new things and keep investing to improve, and a lot of those improvements will pay off. And I think digital is an example of about where we're really happy with the results so far.

And I think we'll see it get better as we try more and learn more.

Matthew Gillmor -- Baird -- Analyst

OK. Thanks a lot.


Your final question is from Gary Taylor with JP Morgan. Your line is open.

Gary Taylor -- J.P. Morgan -- Analyst

Very good. Thanks.Just a quick follow-up. I was just going to ask on -- just back to the topic of the day, Direct Contracting. On the voluntary enrollment, do you expect that to have the above average or above national average skew toward dual eligibles like you have in your MA patients just because of your physical locations? Is that also part of how you've kind of given us the revenue guidance for voluntary versus your average MA per member per month?

Mike Pykosz -- Chief Executive Officer

Yes. I don't -- with what I know today, I don't know if it'll be higher or lower dual penetration in Direct Contracting versus MA. But I think it will be similar, from what I know today. And just not to -- Gary, you asked the questions that are going to take -- if you guys want to go down the Direct Contracting rabbit hole, we're happy to talk about it because it's a really tidy program.

If you remember, for dual-eligible patients, they're a little bit different than what I described around the economics because, for dual-eligible patients, Medicaid -- there's a Medicaid wrap that just generally covers their copays and their out-of-pocket costs, right, and covers their Part D. So in their case, there's actually -- there's still reasons to join Medicare Advantage or supplemental benefits. But for them actually, economically, in some cases, they think they can stay in traditional Medicare. So there's also that aspect of it as well for people who really are dual eligible and we just don't want to be part of managed care plan.

You can -- I think they definitely benefit from managed care plans, from the supplementals, but a Direct Contracting will be valuable for those kinds of patients as well.

Gary Taylor -- J.P. Morgan -- Analyst

Correct. So just they're insulated from the fee-for-service cost sharing already.

Mike Pykosz -- Chief Executive Officer

You bet, yes.

Gary Taylor -- J.P. Morgan -- Analyst

OK. Thank you.


With no further questions, I'll turn the call back to presenters for closing remarks.

Mike Pykosz -- Chief Executive Officer

Well, look, I appreciate all the questions, and hopefully, it was helpful. I know there's a -- and I appreciate the desire to learn more and to continue to understand the opportunity for this program. What I'll probably end with is a little bit where I started, which is I could not be prouder of our team for really executing at incredibly high level. And what that means is being there for our patients, being there for our communities, and making these impacts.

And regardless of what happens with vaccines, although we're obviously -- we're members of the society and the world, we're very very excited about them in regards to having these programs like Direct Contracting. We feel really great about our future. And I think it shows the resiliency and effectiveness of the model that kind of regardless of different trajectories and different government programs and different futures, we feel really great about our ability to continue to grow and to continue to provide great care and really make an impact, and that is a testament to our team. And so we appreciate all the interest in Oak Street and thank you.


[Operator signoff]

Duration: 61 minutes

Call participants:

Mike Pykosz -- Chief Executive Officer

Tim Cook -- Chief Financial Officer

Robert Jones -- Goldman Sachs -- Analyst

Gary Taylor -- J.P. Morgan -- Analyst

Ricky Goldwasser -- Morgan Stanley -- Analyst

Ryan Daniels -- William Blair and Company -- Analyst

Stephen Tanal -- SVB Leerink -- Analyst

Sean Wieland -- Piper Sandler -- Analyst

Matthew Gillmor -- Baird -- Analyst

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