David Mountcastle
Thank you, Parth. Privia executed very well through the fourth quarter of 2024. Our implemented providers grew 147 sequentially from Q3 to reach 4,789 on December 31st, an increase of 11.2% year over year. The growth in implemented providers, along with continuation of solid ambulatory utilization trends and value-based performance led to practice collections increasing 4.7% from Q4 a year ago to reach $792.5 million.
Excluding revenue from the renegotiated Medicare Advantage capitated agreements, practice collections increased approximately 12.4% year over year in the fourth quarter of 2024. Adjusted EBITDA, which is reconciled the GAAP net income in the appendix, increased 44% over Q4 last year to reach $24.9 million, representing 23.1% of care margin. This is a 420-basis point improvement from a year ago as we generated operating leverage across both cost of platform and GNA while investing across all markets.
As Parth noted, we exceeded the high end of guidance for all key operating and financial metrics for full year 2024. Practice collections increased 4.5% to $2.97 billion. Care margin was up 12.4%, and adjusted EBITDA grew 25.2% to reach $90.5 million. The free cash flow generation of our business model further strengthens our healthy balance sheet as we ended 2024 with approximately $491 million in cash and no debt.
With the minimum capital expenditures in 2024, free cash flow for the year was $109.3 million or 121% of adjusted EBITDA, higher than previous guidance due to the timing of certain outgoing cash payments, as well as prudent working capital management. Our initial guidance for 2025 is built upon strong 2024 provider signings and the diversity and resiliency of our operating model in the current healthcare environment.
In 2025 we expect to focus on the same core priorities that have driven our business to date. First, provide our growth to increase density and scale in existing and new markets. Second, attribution growth and performance and value-based arrangements. And third, operational improvements and efficiencies that impact the bottom line. Using the midpoint of our 2025 guidance, implemented providers are expected to increase 9.6% year over year to reach 5,250 by year end.
An attribute to live growth is expected to be approximately 7.5%. We expect practice collections growth of approximately 7.8% at the midpoint. This guidance assumes minimal increase in shared savings accruals year over year given the ongoing challenges in the Medicare Advantage environment. We expect care margin growth of 8.9% at the midpoint given minimal increase in shared savings accruals. We are also guided to adjusted EBITDA growth of approximately 19% at the midpoint.
Even a margin as a percentage of care margin is expected to expand approximately 200 basis points year over year as our operating leverage in more mature markets more than offsets new market entry costs. While we are maintaining a robust pipeline of existing market expansion and potential new market opportunities, our initial 2025 guidance assumes no new business development activity or capital deployment.
Finally, we expect capital expenditures to be de minimis again this year as part of our capital li operating model and are assuming an effective tax rate of 26% to 28%. We are nearing the end of our net operating loss carry forward, so we expect to pay more for cash taxes in 2025. This should still lead to at least 80% of our full year adjusted EBITDA converting to free cash flow.
Privia Health remains focused on building one of the largest primary care centric delivery networks in the nation. We look forward to continuing to serve our physicians, providers, and health system partners and their patients while creating value for our shareholders for many years to come. Operator, we are now ready to take questions.
Operator
(Operator Instructions)
Your first question comes from the line of Elizabeth Anderson with Evercore ISI. Please go ahead.
Hi guys, this is Samir Patel on for Elizabeth Anderson. Congrats on the strong quarter and the solid guidance here. I just wanted to ask about the [CapEx] line. It looks like you're increasing OpEx based on your guide by only about 300k, year over year.
Can you just help us understand and break out the leverage between sales and marketing and GNA? Is sales and marketing expected to be maybe down year over year just given the fact that there's no, new market entry cost, or how should we think about this?
Parth Mehrotra
Yeah, thanks Samir. Yeah, I think you know you're seeing the scale, scaling of the cost structure. We added one new market last year and the sales infrastructure spend happens right at the at the outset, so. I think, our guidance does not assume any new markets, any business development activity.
If that happens, we'll update the guidance, but other than that, our job is to continue to scale the cost structure between GNA and sales and marketing. We are fifth year as a public company, and you should expect that. And so, you're seeing the operating leverage play out really nicely.
So that's one of the key levers to drive EBITDA growth.
Operator
Your next question comes from the line of Andrew Mock with Barclays. Please go ahead.
Hi, good morning. The cash on the balance sheet is now approaching $500 million, hoping you could provide a bit more colour on the M&A pipeline, and are you diligent in a lot of opportunities and passing on them or just haven't seen any opportunities that are, thus far? And then relatedly, are there any use of building cash if not M&A thing.
Parth Mehrotra
Yeah, I appreciate the question, Andrew. So yeah, you can expect us to look at everything in the space, we have 23 analysts covering us. You can expect we have 23 plus bankers covering us as well. And so given our strong financial position in this environment in our space, we're looking at all transactions that come across the table. As we noted, the pipeline is really robust.
However, we're going to be disciplined. It's been a pretty tough environment out there for value-based entities and a lot of revisions in estimates and performance, both, publicly as you've seen, but also in the private market. So, I think it's just finding the right opportunities. We can, we'll continue to be very aggressive but very disciplined in how we pursue those and take advantage of the situation, but you should expect us to deploy the capital, enter new states, increase density in existing states.
We've said previously we're looking at medical groups, risk entities, MSO entities, given our model, I think we can be very flexible, so we'll continue to look for opportunities to deploy capital to create shareholder value, and that remains the primary focus. Obviously, the strong balance sheet also helps us have sufficient capital to prepare for any. Unseen risks that might come, regulatory changes and so on and so forth to support our medical group and risk entities.
So that's a big part of the capital that we that we have. So I think it puts us in overall in very strong financial position and then ultimately if the stock price deviates fundamentally from what we think is intrinsic value, we have the option to return capital to shareholders as well.
Operator
Your next question comes from the line of Josh Raskin with Nephron Research. Please go ahead.
Yeah, thanks. Good morning. So it seems as though, other companies in the sectors, I think are looking maybe to sort of evolve their business models and take less risk, especially in their initial contracts with providers and plans. I heard one competitor speak to a glide path to risk. Now it sounded very familiar, so.
I guess my question, does that help Privia as plans and providers are getting more used to that sort of as you guys talk about this path to risk methodology, or do you think that puts competitors on sort of better footing now and then I just wanted to make sure I heard just a follow up. Did you say you were generating positive contribution margin from your MA risk contract still? And if so, how's that?
Parth Mehrotra
Yeah, I appreciate the question, Josh. So take them in order. So, on the first one, look, I think we've been very consistent for five years that we've been public that, you have to distinguish between the willingness to take risk and the ability to take risk. We've always had the ability to take risk. We do so at the highest level in MSSP, as we do capitation in MA with a small book. I don't think providers wake up every day saying we want to do full risk.
I think there's a lot of noise in the space by entities that jumped into full risk, and I think it's a misconception that to perform well in value-based care, to perform well in MA. You necessarily need to take full risk. We've always said we prefer models where the payer has skin in the game, an entity like Privia that's enabling has skin in the game, and the doctors have skin in the game, or the medical groups and the risk entities have skin in the game, and we share it upside and down, and I think that keeps everybody honestly. So, I just think it doesn't change our position in the marketplace.
I can't speak for competitors. I think they've learned a hard lesson. Ultimately our job is to take as much risk that pays us and pays our medical groups and risk entities by the payers to assume that risk. I don't think. We're not trying to do venture capital in public markets.
You don't need to lose money to do all this good work, and if we don't come across a fair contract from a Privia that compensates our medical groups for the work that they're doing, we're not going to take downside risk. It's pretty much simple and I think the providers appreciate that and actually respect that that glide path. So I don't think it changes our position. In fact, I think it validates our approach and makes our position much stronger.
And then secondly, on the MA book, yes, as you can see from the disclosure on our press release, we made a small, about 2% gross margin from on the capitated book, and, we said last year we had renegotiated a couple of contracts at the beginning of last year, much ahead of the curve, and the one that we remained, we were hoping that we'll make money and we're glad that we performed really well. It was better than expected and that led to some of the outperformance and the results that you see. And that's our hope that if you're doing taking downside risks, the objective is you do it to make money. It's pretty binary at the end of the day.
Operator
Your next question comes from the line of with Mayo with Leerink Partners. Please go ahead.
Hey, thanks. I just wanted to hear more about the factors influencing the flatness this year and shared savings. I don't know if this is all just V28, the respectfulness that you have around utilization cost trend, but there are there any other changes with, the benchmark methodology that's concerning you? And then I'm wondering. In the event that ACO reach doesn't get extended in sunsets, is this a thing that could be potentially good for you with new groups that may be looking to affiliate with your platform?
Parth Mehrotra
Yeah, thanks for the questions with. So, look, I think we've taken a pretty prudent approach last couple of years just given all the factors we outlined. Whether it's utilization trends, V28 star scores, benefit design changes, so on and so forth, and it's across the book, I think our guidance assumes prudence that we won't grow shared savings meaningfully year over year. We were able to do do so. We had the same assumption last year and then we outperformed and that led to better-than-expected results. So, I think we're adopting the same approach.
This guidance does not assume any meaningful step up in shared savings, and if we are wrong, we're hoping that there's an upside and downside, as we've consistently seen with our results over the past five years. So, I just think it's that it's across all the programs, utilization hurts us if you're taking risks. We've said you've got to manage that risk. So, I think it's more prudence across the board versus any one particular program from that perspective.
And then to your second question, yeah, as CMS obviously allows a risk entity or a or a tax ID medical group to choose between MSSB or ACOE today. So, we think there'll be convergence over time in some of these programs. MSSB has done really well. Reaches in the in this initial stage, and if that sunset, I just think providers ultimately are managing patients and their spend and would like to get paid for doing that good work irrespective of the program.
So ultimately, I think if this. We'll hopefully tend to benefit or capture some of that volume. We don't do reach today because we think we perform really well in MSSP, and if in all our ACOs or states, we've chosen to continue to add attribution in MSSP because we think that's the better outcome to save dollars for the government, taxpayers, perform well for our medical groups and risk entities, and if this convergence, I think it'll just validate our position even more.
Operator
Your next your next question comes from the line of Jailendra Singh with Truist Securities. Please go ahead.
Yeah, thank you and good morning and thanks for taking my questions and congrats on a good quarter. I wanted to follow up on higher-than-expected EBITDA to cash flow conversion in 2024. You guys called out certain outgoing cash payments, maybe provide a little bit more colon there. And is this the reason why you are expecting the conversion at 80% this year compared to like 90% you expected heading into 2024?
David Mountcastle
Yeah, thanks for the question. Yeah, it's really just sort of the timing of payments and where the liabilities and the cash ended up at the end of the year. I would say next year is really driven more based on the fact that we run out of some of our [NOLs] and we're going to have to start paying. Taxes next year and that's really going to decrease the percentage. So, might it next year have been a little bit higher than 80% without that, without the great year this year, perhaps, but we feel very confident in our 80% guidance.
Operator
Your next question comes from the line of AJ Rice with UBS. Please go ahead.
Hi everybody. When I look at your guidance, even down you're expecting within the range of sort of 16% to 22% growth. I know every year there's puts and takes. I wondered if you would comment on, what do you see as some of the key variables that will move you around within that range and is there anything that's different because you're heading into 25 from what you normally see and if I could squeeze in a variance on that, anything in Washington with all the uncertainty. I don't perceive you've got a lot of things at risk there, but anything you're looking at that they're discussing that could be an opportunity or a challenge for you.
Parth Mehrotra
Yeah, I appreciate the questions, AJ. So, on the first one, look for context, our guidance is very narrow. It's a $5 million range, that underscores the predictability and the consistency of our model, and, so it's not a big range from a dollar perspective. And then, there's nothing new this year, then, it's pretty much rinse and repeat. The variables are the same. We have a very predictable FIA service book.
We've sold a lot of the providers that'll get implemented already, as there's a 56-month lag, and so the FIA service book is extremely predictable. The only source of variability is the value-based book, and that's actual performance versus our accruals, and you've seen from a track record, you can see slide seven.
A seven-year track record that we've been pretty consistent with our accruals, and we follow the same methodology as I alluded to in the answer to the previous questions. So I think that's going to be the only source and then that's why you have the range if if the value-based book performs better than expected, then like last year, hopefully, we'll be at the at or above the high end of the range and if not, then we have the range. So, that's pretty much, underscores that that narrow guidance.
On your second question, look, I don't think there's anything specific with our model supporting community-based physicians. It's the lowest cost of setting in healthcare. The administration in its first term was really supportive of all the programs we are in. We don't expect them to change that. And so, there's nothing currently that we've heard that impacts our results. If something changes, obviously we'll let but, I think we'll continue to get good support from CMS here for all the programs that we participate in.
Operator
Your next question comes from the line of Jack Slevin with Jefferies. Please go ahead.
Hey, thanks for taking the question and congrats on the really strong print pretty simple one for me here, I guess just want to zero in on the care margin guidance and running quick numbers. It looks to me like. It's taking in a 6% drop in a sort of simplified view if you just look at care margin per average implementer provider and I know that doesn't take all the moving pieces into account but maybe just considering. What are the scenarios you guys think you'd have to look at to upside the care margin and the even with that guidance for the full year? Thanks.
Parth Mehrotra
Yeah, good question, Jack. So, it's predominantly the flat assumption in value-based care shared savings. So that's one factor and the other is, the mix between physicians and ABBs and nurse practitioners, so that impacts it a little bit given our scale, but not too much, and then obviously the mix between, primary care, feeds, [BOBs], and then specialists. And then how that flows down into care margin from practice collections.
So, I think overall we're looking to increase operating leverage down to even done free cash, and you can see that increasing pretty well, but I think that's flat, that is mainly driven by the first factor which is if shared savings assumptions are flat. And as our take rate is 40% on every dollar of shared savings, that is leading to that to that outcome. Hopefully we'll get leverage in future years as that improves.
Operator
Your next question comes from the line of Jeff Garrow with Stephens Inc. Please go ahead.
Yeah, good morning. Thanks for taking the questions. I thought maybe we'd check in on the Care Partners program and just curious how provider interest has trended in that model and similarly where previous level of interest is in not requiring providers to switch electronic health record systems to join the Privia platform. Thanks.
Parth Mehrotra
Yeah, I appreciate the question. So, I think that's progressing well, as we bought Community Medical Group in Connecticut, which was one of the largest IPAs, and that's a state where we're starting to implement providers on the on the same technology stack, but a large portion of that, those are not on the platform yet.
I think over time our hope is we'll migrate as many of our providers onto the same tech stack into our medical groups, but you know that's a good lever for us to continue to expand, get attribution, perform in value-based care, and over time get providers on the integrated stack. So I think it's performing pretty well as we had expected. It's all embedded in the results. We don't break it out. It's part of the core business, and so I think it's gone pretty well as planned.
Operator
Your next question comes from the line of Matthew Gilmore with Keybank. Please go ahead.
Hey, good morning. Thanks for the question. I wanted to ask about the physician fee schedule. I don't think Congress addressed the cut that started this year at this point. There's obviously a lot of bipartisan support to get that addressed hopefully in the next couple of weeks.
I was curious how you were thinking about that from a guidance perspective. Is that even something that's material enough to move anything either way? And if it doesn't get addressed, is that something that actually helps drive additional providers on the platform?
Parth Mehrotra
Yeah, I appreciate the question, Matt. So, I mean we've embedded, our best estimate into the guidance with whatever puts and takes. I think we have a lot of offsetting factors in there too. So, it's nothing material that we like to call out, and if it's better, it's better, I think. Look, our fundamental value proposition just does not change, with that particular variable.
If anything, all of these pressures, further validate the need for providers to join a very large integrated medical group, risk entity, and the value has to offer. So, I think nothing fundamentally changes, either way.
Operator
Your next question comes from the line of Richard Close with Canaccord Genuity. Please go ahead.
Yeah, congratulations. Thanks for the question. Maybe digging into Washington a little bit more specifically, how do you think about, maybe the level of uninsured increasing if subsidies go away and then the potential, changes in Medicaid, how does that impact your business? Obviously, it would be more 2026, but just thoughts there.
Parth Mehrotra
Yeah, I appreciate the question, Richard. So, as we don't have a big Medicaid book. We have about 97,000 lives in some value-based programs. Our mix represents the demographics in each state across our 14 states and DC, so it's pretty diversified, same with the uninsured, so I think we'll just see. We went through the whole Medicaid re determination, and you saw, like, we can capture some of those patients and lives into other parts of the book, whether it's commercial, MA, duals, whatever it is, on the individual exchange.
So I just think it depends on how it all plays out, what the impact is. Do patients actually move in a particular direction, and that'll be again state by state. So it's just tough to predict, but we don't have big exposure to Medicaid or to the uninsured yet.
Operator
Your next question comes from the line of Ryan Daniels with William Blair. Please go ahead.
Yeah, hey guys, this is Jack. I'm down for Ryan. Congrats on the strong year. I know you called out the cash balance where you can use, some of that to help enter new markets and build density, but, well, and your guide does not include the new market entries, but is there any one area that you're targeting more or that you should see more growth from like whether it is entering new markets versus new market growth? Just kind of curious what your mindset is, kind of parsing out the difference there. Thanks.
Parth Mehrotra
Yeah, thanks, Jack. So, look, I think all the sales and marketing expense for existing markets is fully expense in the P&L. So, I think you're seeing the power of the platform in that we can continue to grow organically in existing states pretty well without deploying capital. I think in existing states where we could use capital is to just double down or increase density, if there are opportunities that arise, and that's very value creative because we already have an infrastructure.
And then a lot of capital, obviously predominantly the business development is getting into new states which we've consistently done over the past, as you can again see on slide seven, we've consistently added new states every year and then, we've absorbed any incremental costs within our guide. I think that's pretty important. To also underscore, so I think if you look at some of the years like '2022, '23, we continue to absorb a lot of those costs within the guide that we gave. So, I think, our guidance is pretty prudent, assuming no impact of [BD].
Obviously if you deploy significant capital that'll come with the incremental collections, scare margin, even the, some will flow this year, some will flow next year. So, we'll just see when we can get those deals done and if and when that happens, we'll update guidance, but I think this guidance does not include any impact.
Operator
Your next question comes from the line of Matt Shea with Needham. Please go ahead.
Hey, thanks for taking the questions and congrats on a strong close to the year. I guess kind of as a follow up to the last question, it was great to hear earlier this year that 70% of the new provider pipeline is coming from referrals pushing down tax and payback period.
So now that referrals have reached this level, is this changing your philosophy at all? New market expansion versus stepping on the gas to grow more in existing markets and maybe as a follow up as we think about. New markets like Indiana, how long does it take for the referral flywheel to get going.
Parth Mehrotra
Yeah, I appreciate the question, Matt. So, on the first one, look, we're going to be aggressive everywhere existing states, new states, just given the business model is very proven, the unit economics are really proven. We know what to do, how to do it. We have the capital, so I think you'll see us pursue both. So, we're going to step on the gas in every which way to just continue the flywheel, and then. Each market evolves, so those conversion rates are in the most mature markets, as you would expect.
Some of the new markets, I think that takes time to develop. So, I just think each market evolves over time, but I think we can have referrals across markets too. We can have bigger groups. Join us as they hear about the success story of of their colleagues in other states.
So I think we're pursuing all all aspects, all levers to continue to grow and scale the business. You're seeing that in the results, despite challenging value-based environment, we're continuing to grow even that, grow free cash all the way down to the down the P&L. So I think that's just reflective of how this is playing out, and we're pretty proud of the accomplishment.
Operator
Your next question comes from the line of Ryan Langston with TD Cowan. Please go ahead.
Thanks. Good morning. In the 2025 guidance, providers, it looks like expected to grow around 10%, but lives around 7.5% year to year, I guess, despite kind of the strong 2024 provider pick up, for 2024, actually the lives growth was over the provider growth. So just wondering if that's an expectation of a slower ramp up of lives once you get those providers on boarded or anything else going on there.
Parth Mehrotra
Thanks.
Yeah, I appreciate the question. I mean, it's a wider range this year from 1.3million to 1.4 million lives. So, at the high end it's 11.5% growth. We'll just see how it plays out, it's a lot of large numbers are playing out, so I think the numbers you reflected were at the midpoint, but we'll just see how it plays out. It's also influenced by; we're building multi-specialty groups.
And so, primary care, the specialty mixes influences that a little bit as the attribution predominantly happens with the with PCPs, as and then to some extent with OBs and beats, but I think it's a broader range, so we'll just see how it plays out, but usually it's kind of is pretty consistent with provided growth.
Operator
Your next question comes from the line of David Larson with BDIG. Please go ahead.
Hey, congrats on the good quarter and the great year. Did I hear you say there's no new market entry costs in the guide for 25 and why not? You usually enter a couple of markets, you get a bunch of cash on the balance sheet. And then also did I also hear you say that the gross margin for cap revenue is 2%. It's great that it's positive, but that still sounds kind of low, right? I would assume a negative EBITDA margin if the gross margin were 2%. Why not just sort of exit those contracts? Thanks very much.
Parth Mehrotra
Yeah, thanks, David. So on the first one, yeah, just to correct, the guidance assumes no incremental new markets. We obviously entered a few new markets over the last couple of years, so those are still, we are investing in those as we noted in our prepared remarks, and all of those costs are fully embedded. In the guidance, and then I think if you refer to, page 10 of the press release, you can see we break out, the capitated revenue and then then the total claims incurred. So you can see that we actually generated positive contribution margin in that book.
So that's what we were alluding to.
Operator
Your next question comes from the line of Adam Ron with Bank of America. Please go ahead.
Hey, thanks for the question. I'd like to unpack more of the shared savings commentary you gave, particularly on MSSP. And so, you mentioned in '24 you had initially expected minimal accrual increases for shared savings, but then it ended up coming in better. So, first, was that more so on the 2023 sure up or was that based on what you're accruing for 2024?
And then second, it'd be helpful if you could share, somewhat directionally what you're seeing on trend for MSSP in 2024 and how that compares to what people are saying in ACH is like a high single digit trend and if that, what your kind of assuming in 2025 if you're assuming, similar trends continue in 2025 versus '24 accruals thanks.
Parth Mehrotra
Yeah, I appreciate the question. So, look, I mean, we don't obviously give guidance by year and by accrual versus actual, but in general it's a combination of both. So, in every year we are throwing up. Accruals versus actual performance for the previous year as the results come in and then adjust our accruals in the current year based on the data we see, so that's fundamental to the question you asked. Our methodology is the same, our assumptions are the same that we want to be very prudent with the trends we witness.
If we are wrong, we hope that this positive upside versus negative downside, that's how we look at when we guide. And so, I think the outperformance was again a combination, '23 versus '24, there was some prior period stuff. There was some in year stuff, it balances across different lines of business. We got commercial, we got MSSP, we got MA, so they put and takes across all, that balances itself out, and we're adopting the same approach this year.
Yeah, I can't specifically comment on trend and reach versus MSSP. It's really by geography, by book of business. By state, based on regional benchmarks, how they change, so on and so forth, ACC trends in those states, and so, we're just looking at the data that we get from CMS each quarter, each rolling quarter, and that influences, true ups on versus how we accrued foreign prior periods and then, how that informs us for adjusting accruals. In the current year, so it's a pretty dynamic exercise.
I mean, our healthcare economic teams, data analytics teams just does a fantastic job, with a pretty large book. I think you've seen that very consistently with our results over the last seven years. I mean, slide seven just speaks for itself. So, I just think we're going to keep following the same approach and just see how it plays out and the diversification of the book really helps us, mitigate, any puts and takes in any particular state or any particular program.
Operator
Your next question comes from the line of Michael Ha with Baird. Please go ahead.
Thank you. Just wanted to follow up on that last question. So, on an MSSP, I guess specifically CMS published their Hannibal pair perspective trend for '23 to '24, and I know everyone's saying it's significantly below emerging trend, right? AC reach like you just mentioned, but you sound very confident based on, what you're seeing internally.
Does that mean what they published for the ACPT? Is in line with what you're actually seeing for your own ACOs, and I guess how it impacts your 24 performance accruals and is there any potential go forward risk if rates do remain understated versus trend or I'm guessing maybe it's more in line than what people are assuming. Thank you.
Parth Mehrotra
Yeah, so I think it's important to recognize the ACPT impact is on newer ACOs, not older ACOs. So I think there's some of that you have to factor in. We have, I think 11 new ACO that's impacted a little bit, just given the gestation of these ACOs over time. So again, our book is very diversified, all those trends are factored into the guidance. Then it's our relative performance versus the benchmark, the ACO's rebates every five years.
So that happens over time with different ACOs. I mean, we've been in the program 10 years, so, I think we just have a methodology that we follow. We look at the balance book and we embed all that in the guidance. And then we hope that we're right and there's a track record. So, I don't think it fundamentally changes what we've done. If they are puts and takes, we absorb it and then try to outperform based on good clinical performance in our practices and all the levers that we can pull and so I think we're not doing anything different than we've done in past years.
Operator
Your next question comes from the line of Constantine Davides with Citizens JMP. Please go ahead.
Thanks. Parth, there's a number of competing medical group strategies out there in the marketplace that just haven't been as successful as yours. How much is technology a differentiator or enabler for you and supporting your growth in terms of just Leveraging the Athena backbone and I'm assuming now being one of their largest partners, in terms of driving your ability to scale quickly but efficiently, at this pace across as you mentioned, a pretty diverse set of providers, states payers, etc.
Parth Mehrotra
Yeah, thanks, Constantine for the question. I think, it's a great question, but it's much broader than just the tech stack. I think how we've differentiated ourselves; we've been saying this for five years since we were public, there are not too many entities that are creating integrated medical groups, risk entities, and a full tech and services platform all together in one shop.
Having providers join an integrated medical group on the same platform with the same governance structure where we are deeply embedded in the workflows, deeply embedded from a technology standpoint, not only just an EMR and RCM, but everything you build on top of that, and then having a risk entity that is fully embedded and is supporting that medical group to take risk, and we are seeing the data, day in and day out across all lines of business.
That's a very unique model. I don't think other models are this deeply embedded in the workflow. I think you've seen how that impacts performance. They're relying on pairs, they're relying on, a very light layer on top. They don't have the governance, the deep governance that we do, so I think it's the combination of those elements of our business model and then obviously the embedded technology stack. That allows us to really work very closely with our practices, organize them in small pods and influence results.
So I think it's all those factors that we have fundamentally built this business in a very thoughtful manner from day one, and you're seeing the fruits of that in empirical results over 78 years, a lot of companies went public, there are a lot of private companies out there that got funded. And it's very easy to just go take risks and on a few lives and support practices in a very light manner. I think that just plays itself out as you're seeing as this industry evolves.
So I think it's probably, very thoughtful question if you just, look at the results that we've produced consistently over 78 years that you can see publicly now that demonstrate the validity of this business model. And I think it's a combination of all of those factors, and that's why providers choose us given that strong value proposition.
Operator
Your next question comes from the line of Daniel Grosslight with Citi. Please go ahead.
Hi, thanks for taking the question. On your capitated book for 25, are you still assuming around a 2% contribution margin, or should we expect some improvement there? And then as we think about capitation full Cap in in 2026 and beyond it does seem like rates, the advance rate was, no, it was good and maybe some room for improving. That as it goes to final, it seems like bids have been a bit more rational this year, so curious how you're thinking about capitation also in in 2026 and beyond.
Parth Mehrotra
Yeah, I appreciate the question. So obviously we don't break out guidance in any particular program, as we've consistently said, we are in a particular program, and we are doing some capitation with the hope that we'll have positive contribution margin. I think it's tough to predict whether it'll be the same repeat from last year. I think we're going to be prudent in that book. The environment continues to be challenging as we alluded to with all the factors.
So, we'll see how it plays out in this year. If we are in it, we are hoping we'll make money. We'll just see how it plays out during the course of the year. And then on the broader question, look, I think this goes back to the first or second question that was asked. I, we continue to, distinguish, in our minds this need to take full risk and capitation to do well in MA. I think fundamentally we think a shared risk methodology with the payers where everybody's interests aligned is the right model A.
we are, we have the ability to take as much risk. I just don't think the pairs, given the pressures they are facing, will hand over contracts that are slam dunk for provider groups just to assume full risk and make money in this environment with all those factors. I mean, you've seen every payer go through the results and all the pressures, so it's pretty well documented by all of you on the call. So, I don't think you should expect us to ramp up our capitation book.
I think if there are opportunities where we can do so, where we see a good risk reward ratio and there's a fair payment for us to assume that risk, we will. Otherwise our preference is to share the risk with the payer across all aspects of the book, whether it's a it's Part B, it's Part C, it's PCP spend, specialist spend inpatient spend. I think we take as much risk as we can in the things we control, and if we don't control certain things, then we're not going to take risk or share it with the payer.
But our hope is if we are taking risks, we're going to make money, otherwise there's no need to take risk. We're making money for the pair, we're making money for our medical groups, we're making money for our shareholders, so it's a pretty simple concept. At the end of the day again it's a very binary outcome.
Operator
Your next question comes from the line of Jessica Tassson with Piper Sandler. Please go ahead.
Hi guys, thanks for taking the question. So this one's maybe for David. Can you just help us understand why the 4Q upside to the high end of the implied platform contribution guide didn't see more of a kind of complete flow through to adjust to Eva dot upside in 4Q.
Were there any one-time items in OpEx? And I guess just why the platform contribution upside wouldn't be really high incremental margin and drop kind of straight through toe out. Thanks.
David Mountcastle
Thanks, Jess relatively complicated question, I think. what you're asking is why is the EBITDA increasing greater than contribution margin platform contribution. If that's the case, it's due to, how our sales cost and our GNA cost run through for the year. And again, both of them were, I would say, positively or negatively impacting on how you want to look at it from how we did for the year. So, I don't know if 100% answer your question you ask a lot in there. So, if not we can follow up after.
Parth Mehrotra
Yeah, I think, we had a great sale here, so obviously the sales costs in four, were higher as we threw up commissions and then the company did pretty well. So, some of the bonus accruals are higher than, originally anticipated, so all that kind of just gets factored into even versus platform contribution.
Operator
Your next question comes from the line of [taou] with Macquarie. Please go ahead.
Unidentified Participant
Hey, thank you. Just to continue on the point about your willingness to take risks, looking back in 2024, you renegotiated some MA contracts, and your BBC share of total collection came down 7% versus the previous year. Parth, I think you mentioned that the BBC environment remains. Challenging out there and MSSP is expected to be flat.
Any changes contemplated to any of the risk contract you have today, should we expect the makeshift to further decline towards FSS? And if so, it will be helpful to decide that any potential decline in the mix active or passive. Thank you.
Parth Mehrotra
Yeah, I appreciate the question. So yeah, we don't anticipate any changes, we renegotiated whatever we had to beginning of last year. We're continuing with the capitated book we have. It's a pretty small piece of the business. Like we said, we're solving for positive contribution margin, and you have to recognize, I mean, just going from full risk to partial risk, it's all revenue recognition. The doctors don't go anywhere, the lives don't go anywhere.
Our ability to manage those lives does not change. So, you know that that decline was fundamentally the way top line gets recognized if you take full risk versus you don't take full risk. So, we're solving for positive care margin, positive contribution margin, positive even positive free cash flow, so, but there's no change contemplated from the book we have today.
Operator
Your last question comes from the line of Craig Jones with Stifel. Please go ahead.
Hey, thank you, thanks for thanks for Glen, let me ask you a question here, so. I wanted to hit on free cash flow conversion, you've been over 100% for the last, handful of years here, gotten to 80%, I think, through from a combination of, working capital maybe and then starting to pay cash taxes. So if you look at maybe more in a normalized year where your full cash tax and let's just say no working capital, where does that conversion kind of shake out? Thanks.
David Mountcastle
Yeah, I mean it's going to kind of shake out, I would say close to the 80% as we get rid of all of our NOLs, it's probably going to shake out a little bit lower than that if we don't take into account any working capital adjustments. So I would probably say in the 70% to 80% range is sort of a final resting place assuming they're working capital adjustments.
Operator
We do not have any more questions at this time. Gentlemen, you may continue.
Parth Mehrotra
Thank you all for listening to our call today. We appreciate your continued interest and support of Privia and look forward to speaking with you again in the near future.
Operator
Ladies and gentlemen, that concludes today's call.
Thank you all for joining. You may now disconnect.
