Cover Page
Cover Page - shares | 6 Months Ended | |
Jun. 30, 2023 | Jul. 31, 2023 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Jun. 30, 2023 | |
Document Transition Report | false | |
Entity File Number | 001-41428 | |
Entity Registrant Name | R1 RCM Inc. /DE | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 87-4340782 | |
Entity Address, Address Line One | 433 W. Ascension Way | |
Entity Address, Address Line Two | Suite 200 | |
Entity Address, City or Town | Murray | |
Entity Address, State or Province | UT | |
Entity Address, Postal Zip Code | 84123 | |
City Area Code | 312 | |
Local Phone Number | 324-7820 | |
Title of 12(b) Security | Common stock, par value $0.01 per share | |
Trading Symbol | RCM | |
Security Exchange Name | NASDAQ | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filter Category | Large Accelerated Filer | |
Smaller Reporting Company | false | |
Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding (in shares) | 418,958,515 | |
Amendment Flag | false | |
Document Fiscal Year Focus | 2023 | |
Document Fiscal Period Focus | Q2 | |
Entity Central Index Key | 0001910851 | |
Current Fiscal Year End Date | --12-31 |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Millions | Jun. 30, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 123.1 | $ 110.1 |
Current portion of contract assets, net | 89.9 | 83.9 |
Prepaid expenses and other current assets | 108.3 | 110.3 |
Total current assets | 584.9 | 564.5 |
Property, equipment and software, net | 181.8 | 164.8 |
Operating lease right-of-use assets | 74.8 | 80.5 |
Non-current portion of contract assets, net | 37.8 | 32 |
Non-current portion of deferred contract costs | 30.1 | 26.7 |
Intangible assets, net | 1,413.2 | 1,514.5 |
Goodwill | 2,647.4 | 2,658.2 |
Deferred tax assets | 10.5 | 10.4 |
Other assets | 93.7 | 88.2 |
Total assets | 5,074.2 | 5,139.8 |
Current liabilities: | ||
Accounts payable | 26.1 | 33.4 |
Current portion of customer liabilities | 41.9 | 57.5 |
Current portion of customer liabilities - related party | 7.8 | 7.4 |
Accrued compensation and benefits | 93.1 | 109 |
Current portion of operating lease liabilities | 19.4 | 18 |
Current portion of long-term debt | 62.6 | 53.9 |
Accrued expenses and other current liabilities | 74.3 | 70.6 |
Total current liabilities | 325.2 | 349.8 |
Non-current portion of customer liabilities | 4.9 | 5 |
Non-current portion of customer liabilities - related party | 12.7 | 13.7 |
Non-current portion of operating lease liabilities | 89.3 | 94.4 |
Long-term debt | 1,691.5 | 1,732.6 |
Deferred tax liabilities | 184 | 200.7 |
Other non-current liabilities | 23.6 | 23.1 |
Total liabilities | 2,331.2 | 2,419.3 |
Stockholders’ equity: | ||
Common stock, $0.01 par value, 750,000,000 shares authorized, 443,374,297 shares issued and 418,811,379 shares outstanding at June 30, 2023; 750,000,000 shares authorized, 439,950,125 shares issued and 416,597,885 shares outstanding at December 31, 2022 | 4.4 | 4.4 |
Additional paid-in capital | 3,159.3 | 3,123.2 |
Accumulated deficit | (121.3) | (121.9) |
Accumulated other comprehensive income (loss) | 0.4 | (3.4) |
Treasury stock, at cost, 24,562,918 shares as of June 30, 2023; 23,352,240 shares as of December 31, 2022 | (299.8) | (281.8) |
Total stockholders’ equity | 2,743 | 2,720.5 |
Total liabilities and stockholders’ equity | 5,074.2 | 5,139.8 |
Nonrelated Party | ||
Current assets: | ||
Accounts receivable, net | 245.2 | 235.2 |
Related Party | ||
Current assets: | ||
Accounts receivable, net | $ 18.4 | $ 25 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions | Jun. 30, 2023 | Dec. 31, 2022 |
Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 750,000,000 | 750,000,000 |
Common stock, shares issued (in shares) | 443,374,297 | 439,950,125 |
Common stock, shares outstanding (in shares) | 418,811,379 | 416,597,885 |
Treasury stock, shares (in shares) | 24,562,918 | 23,352,240 |
Nonrelated Party | ||
Accounts receivable, allowance | $ 31.5 | $ 15.1 |
Related Party | ||
Accounts receivable, allowance | $ 0.1 | $ 0.1 |
Consolidated Statements of Oper
Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Income Statement [Abstract] | ||||
Net services revenue ($216.3 million and $433.1 million for the three and six months ended June 30, 2023, respectively, and $223.0 million and $439.7 million for the three and six months ended June 30, 2022, respectively, from related party) | $ 560.7 | $ 391.9 | $ 1,106.3 | $ 777.6 |
Operating expenses: | ||||
Cost of services | 445.9 | 310.1 | 880.6 | 606.6 |
Selling, general and administrative | 62.6 | 30.9 | 109.6 | 59.8 |
Other expenses | 28.3 | 88.9 | 58.5 | 106 |
Total operating expenses | 536.8 | 429.9 | 1,048.7 | 772.4 |
Income (loss) from operations | 23.9 | (38) | 57.6 | 5.2 |
Net interest expense | 32.5 | 6.9 | 63.2 | 11.6 |
Income (loss) before income tax benefit | (8.6) | (44.9) | (5.6) | (6.4) |
Income tax benefit | (8.9) | (24.5) | (6.2) | (15.4) |
Net income (loss) | $ 0.3 | $ (20.4) | $ 0.6 | $ 9 |
Net income (loss) per common share: | ||||
Basic (in dollars per share) | $ 0 | $ (0.07) | $ 0 | $ 0.03 |
Diluted (in dollars per share) | $ 0 | $ (0.07) | $ 0 | $ 0.03 |
Weighted average shares used in calculating net income (loss) per common share: | ||||
Basic (in shares) | 418,525,625 | 294,658,635 | 417,939,489 | 286,746,902 |
Diluted (in shares) | 455,245,607 | 294,658,635 | 454,097,654 | 328,169,238 |
Consolidated statements of comprehensive income (loss) | ||||
Net income (loss) | $ 0.3 | $ (20.4) | $ 0.6 | $ 9 |
Other comprehensive income (loss): | ||||
Net change on derivatives designated as cash flow hedges, net of tax | 4.9 | (1.2) | 3.2 | (1.1) |
Foreign currency translation adjustments | 0.1 | (3.2) | 0.6 | (4.6) |
Total other comprehensive income (loss), net of tax | 5 | (4.4) | 3.8 | (5.7) |
Comprehensive income (loss) | $ 5.3 | $ (24.8) | $ 4.4 | $ 3.3 |
Consolidated Statements of Op_2
Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited) (Parenthetical) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Net services revenue | $ 560.7 | $ 391.9 | $ 1,106.3 | $ 777.6 |
Related Party | ||||
Net services revenue | $ 433.1 | $ 223 | $ 216.3 | $ 439.7 |
Consolidated Statements of Stoc
Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Millions | Total | CoyCo 2 | Common Stock | Treasury Stock | Additional Paid-In Capital | Additional Paid-In Capital CoyCo 2 | Accumulated Deficit | Accumulated Other Comprehensive Income (Loss) |
Beginning Balance (in shares) at Dec. 31, 2021 | 298,320,928 | |||||||
Beginning Balance (in shares) at Dec. 31, 2021 | (20,094,686) | |||||||
Beginning Balance at Dec. 31, 2021 | $ 346.7 | $ 3 | $ (215.2) | $ 628.5 | $ (64.3) | $ (5.3) | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||||
Share-based compensation expense | 10.2 | 10.2 | ||||||
Issuance of common stock related to share-based compensation plans (in shares) | 1,757,955 | |||||||
Exercise of vested stock options (in shares) | (77,438) | |||||||
Exercise of vested stock options | 0.4 | 0.4 | ||||||
Acquisition of treasury stock related to share-based compensation plans (in shares) | (727,768) | |||||||
Acquisition of treasury stock related to share-based compensation plans | (18.7) | $ (18.7) | ||||||
Repurchases of common stock (in shares) | (8,000) | |||||||
Repurchases of common stock | (0.2) | $ (0.2) | ||||||
Net change on derivatives designated as cash flow hedges, net of tax | 0.1 | 0.1 | ||||||
Foreign currency translation adjustments | (1.4) | (1.4) | ||||||
Net income | 29.4 | 29.4 | ||||||
Ending Balance (in shares) at Mar. 31, 2022 | 300,156,321 | |||||||
Ending Balance (in shares) at Mar. 31, 2022 | (20,830,454) | |||||||
Ending Balance at Mar. 31, 2022 | 366.5 | $ 3 | $ (234.1) | 639.1 | (34.9) | (6.6) | ||
Beginning Balance (in shares) at Dec. 31, 2021 | 298,320,928 | |||||||
Beginning Balance (in shares) at Dec. 31, 2021 | (20,094,686) | |||||||
Beginning Balance at Dec. 31, 2021 | 346.7 | $ 3 | $ (215.2) | 628.5 | (64.3) | (5.3) | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||||
Net change on derivatives designated as cash flow hedges, net of tax | (1.1) | |||||||
Foreign currency translation adjustments | (4.6) | |||||||
Net income | 9 | |||||||
Ending Balance (in shares) at Jun. 30, 2022 | 436,986,859 | |||||||
Ending Balance (in shares) at Jun. 30, 2022 | (20,985,893) | |||||||
Ending Balance at Jun. 30, 2022 | 2,750.6 | $ 4.4 | $ (237.7) | 3,050.2 | (55.3) | (11) | ||
Beginning Balance (in shares) at Mar. 31, 2022 | 300,156,321 | |||||||
Beginning Balance (in shares) at Mar. 31, 2022 | (20,830,454) | |||||||
Beginning Balance at Mar. 31, 2022 | 366.5 | $ 3 | $ (234.1) | 639.1 | (34.9) | (6.6) | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||||
Share-based compensation expense | 11.6 | 11.6 | ||||||
Issuance of common stock related to share-based compensation plans (in shares) | 505,371 | |||||||
Issuance of common stock related to share-based compensation plans | 0 | |||||||
Issuance of common stock (in shares) | 135,929,742 | |||||||
Issuance of common stock | 2,387.5 | $ 1.4 | 2,386.1 | |||||
Replacement awards issued in conjunction with acquisitions | 11.3 | 11.3 | ||||||
Exercise of vested stock options (in shares) | (395,425) | (2,282) | ||||||
Exercise of vested stock options | 2 | $ (0.1) | 2.1 | |||||
Acquisition of treasury stock related to share-based compensation plans (in shares) | (153,157) | |||||||
Acquisition of treasury stock related to share-based compensation plans | (3.5) | $ (3.5) | ||||||
Net change on derivatives designated as cash flow hedges, net of tax | (1.2) | (1.2) | ||||||
Foreign currency translation adjustments | (3.2) | (3.2) | ||||||
Net income | (20.4) | (20.4) | ||||||
Ending Balance (in shares) at Jun. 30, 2022 | 436,986,859 | |||||||
Ending Balance (in shares) at Jun. 30, 2022 | (20,985,893) | |||||||
Ending Balance at Jun. 30, 2022 | $ 2,750.6 | $ 4.4 | $ (237.7) | 3,050.2 | (55.3) | (11) | ||
Beginning Balance (in shares) at Dec. 31, 2022 | 439,950,125 | 439,950,125 | ||||||
Beginning Balance (in shares) at Dec. 31, 2022 | (23,352,240) | (23,352,240) | ||||||
Beginning Balance at Dec. 31, 2022 | $ 2,720.5 | $ 4.4 | $ (281.8) | 3,123.2 | (121.9) | (3.4) | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||||
Share-based compensation expense | 10.7 | $ 1.8 | 10.7 | $ 1.8 | ||||
Issuance of common stock related to share-based compensation plans (in shares) | 2,308,591 | |||||||
Exercise of vested stock options (in shares) | (180,453) | |||||||
Exercise of vested stock options | 0.5 | 0.5 | ||||||
Acquisition of treasury stock related to share-based compensation plans (in shares) | (910,566) | |||||||
Acquisition of treasury stock related to share-based compensation plans | (13.2) | $ (13.2) | ||||||
Net change on derivatives designated as cash flow hedges, net of tax | (1.7) | (1.7) | ||||||
Foreign currency translation adjustments | 0.5 | 0.5 | ||||||
Net income | 0.3 | 0.3 | ||||||
Ending Balance (in shares) at Mar. 31, 2023 | 442,439,169 | |||||||
Ending Balance (in shares) at Mar. 31, 2023 | (24,262,806) | |||||||
Ending Balance at Mar. 31, 2023 | $ 2,719.4 | $ 4.4 | $ (295) | 3,136.2 | (121.6) | (4.6) | ||
Beginning Balance (in shares) at Dec. 31, 2022 | 439,950,125 | 439,950,125 | ||||||
Beginning Balance (in shares) at Dec. 31, 2022 | (23,352,240) | (23,352,240) | ||||||
Beginning Balance at Dec. 31, 2022 | $ 2,720.5 | $ 4.4 | $ (281.8) | 3,123.2 | (121.9) | (3.4) | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||||
Exercise of vested stock options (in shares) | (303,443) | |||||||
Net change on derivatives designated as cash flow hedges, net of tax | $ 3.2 | |||||||
Foreign currency translation adjustments | 0.6 | |||||||
Net income | $ 0.6 | |||||||
Ending Balance (in shares) at Jun. 30, 2023 | 443,374,297 | 443,374,297 | ||||||
Ending Balance (in shares) at Jun. 30, 2023 | (24,562,918) | (24,562,918) | ||||||
Ending Balance at Jun. 30, 2023 | $ 2,743 | $ 4.4 | $ (299.8) | 3,159.3 | (121.3) | 0.4 | ||
Beginning Balance (in shares) at Mar. 31, 2023 | 442,439,169 | |||||||
Beginning Balance (in shares) at Mar. 31, 2023 | (24,262,806) | |||||||
Beginning Balance at Mar. 31, 2023 | 2,719.4 | $ 4.4 | $ (295) | 3,136.2 | (121.6) | (4.6) | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||||
Share-based compensation expense | 20.7 | $ 1.9 | 20.7 | $ 1.9 | ||||
Issuance of common stock related to share-based compensation plans (in shares) | 812,138 | |||||||
Exercise of vested stock options (in shares) | (122,990) | (4,118) | ||||||
Exercise of vested stock options | 0.4 | $ (0.1) | 0.5 | |||||
Acquisition of treasury stock related to share-based compensation plans (in shares) | (295,994) | |||||||
Acquisition of treasury stock related to share-based compensation plans | (4.7) | $ (4.7) | ||||||
Net change on derivatives designated as cash flow hedges, net of tax | 4.9 | 4.9 | ||||||
Foreign currency translation adjustments | 0.1 | 0.1 | ||||||
Net income | $ 0.3 | 0.3 | ||||||
Ending Balance (in shares) at Jun. 30, 2023 | 443,374,297 | 443,374,297 | ||||||
Ending Balance (in shares) at Jun. 30, 2023 | (24,562,918) | (24,562,918) | ||||||
Ending Balance at Jun. 30, 2023 | $ 2,743 | $ 4.4 | $ (299.8) | $ 3,159.3 | $ (121.3) | $ 0.4 |
Consolidated Statements of St_2
Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - USD ($) $ in Millions | 3 Months Ended | |||
Jun. 30, 2023 | Mar. 31, 2023 | Jun. 30, 2022 | Mar. 31, 2022 | |
Accumulated Other Comprehensive Income (Loss) | ||||
Net change on derivatives designated as cash flow hedges, tax | $ 1.6 | $ 0.5 | $ 0.4 | $ 0 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Operating activities | ||
Net income | $ 0.6 | $ 9 |
Adjustments to reconcile net income to net cash provided by (used in) operations: | ||
Depreciation and amortization | 134.8 | 43.6 |
Amortization of debt issuance costs | 2.8 | 0.7 |
Share-based compensation | 30.5 | 21.7 |
CoyCo 2 share-based compensation | 3.7 | 0 |
Loss on disposal and right-of-use asset write-downs | 4.9 | 2.7 |
Provision for credit losses | 16.5 | 0.3 |
Deferred income taxes | (8.4) | (17.5) |
Non-cash lease expense | 5.8 | 6 |
Other | 3 | 1.5 |
Changes in operating assets and liabilities: | ||
Accounts receivable and related party accounts receivable | (20.2) | (34) |
Contract assets | (10.8) | (1.6) |
Prepaid expenses and other assets | (5.7) | (20) |
Accounts payable | (11.5) | 5 |
Accrued compensation and benefits | (16.1) | (76.1) |
Lease liabilities | (8.9) | (5.1) |
Other liabilities | 6.9 | 13.5 |
Customer liabilities and customer liabilities - related party | (15.8) | (15.2) |
Net cash provided by (used in) operating activities | 112.1 | (65.5) |
Investing activities | ||
Purchases of property, equipment, and software | (48.7) | (42.7) |
Proceeds from disposal of assets | 0 | 0.4 |
Other | 1.5 | 0 |
Net cash used in investing activities | (47.2) | (890) |
Financing activities | ||
Payment of debt issuance costs | 0 | (1) |
Exercise of vested stock options | 0.9 | 2.5 |
Purchase of treasury stock | 0 | (0.6) |
Shares withheld for taxes | (18.1) | (25.1) |
Other | (0.1) | (0.1) |
Net cash (used in) provided by financing activities | (52.1) | 991.5 |
Effect of exchange rate changes in cash, cash equivalents and restricted cash | 0.2 | (2.6) |
Net increase in cash, cash equivalents and restricted cash | 13 | 33.4 |
Cash, cash equivalents and restricted cash, at beginning of period | 110.1 | 130.1 |
Cash, cash equivalents and restricted cash, at end of period | 123.1 | 163.5 |
Supplemental disclosures of cash flow information | ||
Property, equipment and software purchases not paid | 29.4 | 24.6 |
Cloudmed | ||
Investing activities | ||
Acquisition of Cloudmed, net of cash acquired | 0 | (847.7) |
Senior Term Loan | ||
Financing activities | ||
Issuance of senior secured debt, net of discount and issuance costs and Borrowings on revolver | 0 | 1,016.6 |
Repayment of senior secured debt and Repayments on revolver | (24.8) | (8.8) |
Senior Revolver | ||
Financing activities | ||
Issuance of senior secured debt, net of discount and issuance costs and Borrowings on revolver | 30 | 30 |
Repayment of senior secured debt and Repayments on revolver | (40) | (20) |
Payment of equity issuance costs | $ 0 | $ (2) |
Business Description and Basis
Business Description and Basis of Presentation | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Business Description and Basis of Presentation | Business Description and Basis of Presentation Business Description R1 RCM Inc. (the “Company”) is a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers. The Company assists healthcare providers in generating sustainable improvements in their operating margins and cash flows while also enhancing patient, physician, and staff satisfaction for its customers. Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company’s financial position as of June 30, 2023, the results of operations of the Company for the three and six months ended June 30, 2023 and 2022, and the cash flows of the Company for the six months ended June 30, 2023 and 2022. These financial statements include the accounts of R1 RCM Inc. and its wholly owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information, have been included. Operating results for the three and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2023. When preparing financial statements in conformity with GAAP, the Company makes a number of significant estimates, assumptions, and judgments in the preparation of the financial statements. Actual results could differ from those estimates. For a more complete discussion of the Company’s significant accounting policies and other information, the unaudited consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements included in the Company’s Form 10-K for the year ended December 31, 2022, filed with the SEC on February 16, 2023 (the “2022 Form 10-K”). Recently Issued Accounting Standards and Disclosures In June 2022, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2022-03, Fair Value Measurement (Topic 820): Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (“ASU 2022-03”). ASU 2022-03 clarifies that a contractual sale restriction on an equity security should not be considered in measuring the security’s fair value. The Company will adopt ASU 2022-03 prospectively effective January 1, 2024 and is currently evaluating the impact of the standard on its consolidated financial statements. |
Acquisitions
Acquisitions | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Acquisitions | AcquisitionsAssets acquired and liabilities assumed in a business combination are recorded at their estimated fair value on the date of the acquisition. The difference between the purchase price amount and the net fair value of assets acquired and liabilities assumed is recognized as goodwill on the balance sheet if the purchase price exceeds the estimated net fair value or as a bargain purchase gain on the income statement if the purchase price is less than the estimated net fair value. The allocation of the purchase price may be modified up to one year after the acquisition date as more information is obtained about the fair value of assets acquired and liabilities assumed. Prior Acquisitions During 2022, the Company acquired all outstanding equity interests in Revint Holdings, LLC (“Cloudmed”), a provider of revenue intelligence solutions, in exchange for shares of the Company’s common stock and cash. The shares of common stock received by the Cloudmed sellers are subject to an 18-month lock-up period that expires on December 21, 2023. In addition, the Company replaced certain pre-acquisition awards held by certain Cloudmed sellers with restricted stock units (“RSUs”) of the Company. The fair value of assets acquired and liabilities assumed is: Purchase Price Allocation Total purchase consideration $ 3,281.6 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 32.1 Accounts receivable 61.8 Current portion of contract assets 70.9 Property, equipment and software 5.0 Operating lease right-of-use assets 25.3 Non-current portion of contract assets 22.2 Intangible assets 1,366.5 Goodwill 2,092.8 Other assets 6.7 Accounts payable (31.9) Customer liabilities (2.8) Accrued compensation and benefits (93.4) Operating lease liabilities (25.4) Deferred income tax liabilities (236.0) Other liabilities (12.2) Net assets acquired $ 3,281.6 Measurement period adjustments The Company had various measurement period adjustments due to additional information received since December 31, 2022. The significant adjustments included a reduction to deferred income tax liabilities and a corresponding decrease to goodwill of $9.4 million related to updated tax return information. The measurement period for the Cloudmed acquisition ended during the second quarter of 2023. RevWorks In 2020, the Company purchased certain assets relating to the RevWorks services business from Cerner Corporation. In accordance with the purchase agreement, the Company paid the first deferred payment of $12.5 million in the third quarter of 2021 and was required to make a second deferred payment of $12.5 million, which is included in other accrued expenses on the Consolidated Balance Sheet as of June 30, 2023. The two deferred payments related to the RevWorks acquisition were contractual obligations of the Company; however, they were refundable, in whole or in part, to the Company if certain RevWorks customer revenue targets defined in the purchase agreement for the first two years following the acquisition were not achieved. Consistent with the contract requirements, the parties engaged in arbitration to finalize the remaining deferred payment and contingently refundable consideration amounts. The parties reached a settlement after June 30, 2023 regarding the deferred payment and contingently refundable consideration in amounts that are materially consistent with the amounts recorded by the Company at December 31, 2022. Pro Forma Results The following table summarizes, on a pro forma basis, the combined results of the Company as though the Cloudmed acquisition had occurred as of January 1, 2021. These pro forma results are not necessarily indicative of the actual consolidated results had the acquisition occurred as of that date or of the future consolidated operating results for any period. Pro forma results are: Three Months Ended June 30, 2022 Six Months Ended June 30, 2022 Net services revenue $ 494.5 $ 980.9 Net income $ 19.5 $ 27.0 Adjustments, net of the income tax effects, that were made to earnings related to (i) depreciation and amortization to reflect the fair value of identified assets acquired, (ii) share-based compensation expense for awards granted in connection with the acquisition, (iii) extinguishing Cloudmed’s debt and replacing it with the debt of the Company, and (iv) the timing of acquisition related costs. |
Revenue Recognition
Revenue Recognition | 6 Months Ended |
Jun. 30, 2023 | |
Revenue from Contract with Customer [Abstract] | |
Revenue Recognition | Revenue Recognition Revenue is measured based on consideration specified in a contract with a customer, and presented net of any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contract term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. Disaggregation of Revenue In the following table, revenue is disaggregated by source of revenue: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Net operating fees $ 357.8 $ 318.3 $ 718.8 $ 641.1 Incentive fees 30.8 29.9 54.4 60.1 Modular and other (1) 172.1 43.7 333.1 76.4 Net services revenue $ 560.7 $ 391.9 $ 1,106.3 $ 777.6 (1) Modular and other revenue primarily consists of $138.6 million and $264.4 million in fees related to Cloudmed service lines for the three and six months ended June 30, 2023, respectively. Fees related to revenue integrity solutions, practice management (“PM”) services, physician advisory services (“PAS”), and software subscription revenue are also included in modular and other revenue. Contract Balances The following table provides information about contract assets, net and contract liabilities from contracts with customers: June 30, 2023 December 31, 2022 Contract assets, net Current $ 89.9 $ 83.9 Non-current 37.8 32.0 Total contract assets, net $ 127.7 $ 115.9 Contract liabilities Current (1) $ 10.9 $ 9.7 Non-current (2) 17.6 18.7 Total contract liabilities $ 28.5 $ 28.4 (1) Current contract liabilities include $8.9 million and $7.6 million classified in the current portion of customer liabilities and $2.0 million and $2.1 million classified in the current portion of customer liabilities - related party as of June 30, 2023 and December 31, 2022, respectively. (2) Non-current contract liabilities include $4.9 million and $5.0 million classified in the non-current portion of customer liabilities and $12.7 million and $13.7 million classified in the non-current portion of customer liabilities - related party as of June 30, 2023 and December 31, 2022, respectively. The contract assets, net balance will increase or decrease based on the timing of invoices and recognition of revenue. Significant changes in the carrying amount of contract assets, net for the six months ended June 30, 2023 were as follows: Contract Assets, net Balance as of December 31, 2022 $ 115.9 Revenue recognized 182.6 Amounts billed (169.8) Other (1) (1.0) Balance as of June 30, 2023 $ 127.7 (1) Other primarily includes purchase price allocation adjustments and changes to the allowance for credit losses. Contract Liabilities Balance as of December 31, 2022 $ (28.4) Advanced billings - January 1, 2023 (1) (85.0) Advanced billings recognized 85.0 Additions (8.9) Revenue recognized 8.8 Balance as of June 30, 2023 $ (28.5) (1) The Company records advanced billings to contract liabilities and accounts receivable on the first day of the respective service period, which are earned during the year. Transaction Price Allocated to the Remaining Performance Obligation The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period. The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Remainder of 2023 $ 47.5 $ 20.2 2024 57.6 2.1 2025 34.2 — 2026 9.6 — 2027 3.5 — 2028 1.9 — Thereafter 4.3 — Total $ 158.6 $ 22.3 The amounts presented in the table above include variable fee estimates of the Company’s physician group revenue cycle management (“RCM”) services contracts, fixed fees, and forecasted incentive fees. Fixed fees are typically recognized ratably as the performance obligation is satisfied and forecasted incentive fees are measured cumulatively over the contractually defined performance period. Estimates of revenue expected to be recognized in future periods exclude unexercised customer options to purchase services within the Company’s PAS contracts that do not represent material rights to the customer. |
Accounts Receivable and Allowan
Accounts Receivable and Allowance for Credit Losses | 6 Months Ended |
Jun. 30, 2023 | |
Receivables [Abstract] | |
Accounts Receivable and Allowance for Credit Losses | Accounts Receivable and Allowance for Credit Losses Accounts receivable is comprised of invoiced and unbilled balances due from modular services and end-to-end RCM customers, which are presented net after considering cost reimbursements owed to end-to-end RCM customers. The Company evaluates its accounts receivable for expected credit losses monthly. The Company maintains an estimated allowance for credit losses to reduce its accounts receivable to the amount that it believes will be collected. This allowance is based on the Company’s historical experience, the length of time a balance has been outstanding, and the Company’s assessment of each customer’s ability to pay, which is based on input from key Company personnel assigned to the customer, the status of ongoing operations with the customer, and business and industry factors, such as significant shifts in the healthcare environment that could impact the customer’s financial health. The Company has presented the rollforward below on a consolidated basis as the currently expected credit losses for its large integrated healthcare system customers are not anticipated to be material. Movements in the allowance for credit losses related to accounts receivable are as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Beginning balance $ 16.1 $ 2.4 $ 15.2 $ 2.5 Cumulative effect of Cloudmed ASC 326 adoption — 1.8 — 1.8 Provision (recoveries) 15.5 0.3 16.6 0.3 Write-offs — (0.1) (0.2) (0.2) Ending balance (1) $ 31.6 $ 4.4 $ 31.6 $ 4.4 |
Debt
Debt | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Debt | Debt The carrying amounts of debt consist of the following: June 30, 2023 December 31, 2022 Senior Revolver (1) $ 90.0 $ 100.0 Term A Loans 1,189.1 1,211.4 Term B Loan 496.3 498.7 Unamortized discount and issuance costs (21.3) (23.6) Total debt 1,754.1 1,786.5 Less: Current maturities (62.6) (53.9) Total long-term debt $ 1,691.5 $ 1,732.6 (1) As of June 30, 2023, the Company had $90.0 million in borrowings, $1.2 million letters of credit outstanding, and $508.8 million of availability under the $600.0 million senior secured revolving credit facility (“Senior Revolver”). Second Amended and Restated Senior Secured Credit Facilities On June 21, 2022, the Company, R1 RCM Holdco Inc. (f/k/a R1 RCM Inc.), a wholly owned subsidiary of the Company, and certain other of the Company’s subsidiaries entered into a second amended and restated senior credit agreement (the “Second A&R Credit Agreement”) with Bank of America, N.A., as administrative agent, and the lenders named therein, governing the Company’s second amended and restated senior secured credit facilities (the “Senior Secured Credit Facilities”), consisting of the $691.3 million existing senior secured term loan A facility (the “Existing Term A Loan”), a $540.0 million senior secured incremental term loan A facility (the “Incremental Term A Loan,” and together with the Existing Term A Loan, the “Term A Loans”), a $500.0 million senior secured term loan B facility (the “Term B Loan,” and together with the Term A Loans, the “Senior Term Loans”), and the $600.0 million Senior Revolver. In conjunction with entering into the Second A&R Credit Agreement, the Company incurred $7.2 million and capitalized $6.4 million of debt issuance costs. The interest rate as of June 30, 2023 was 7.35% for the Term A Loans and Senior Revolver and 8.10% for the Term B Loan. The Second A&R Credit Agreement contains a number of financial and non-financial covenants. The Company was in compliance with all of the covenants in the Second A&R Credit Agreement as of June 30, 2023. The obligations under the Second A&R Credit Agreement are secured by a pledge of 100% of the capital stock of certain domestic subsidiaries owned by the Company and a security interest in substantially all of the Company’s tangible and intangible assets and the tangible and intangible assets of certain domestic subsidiaries. Debt Maturities Scheduled maturities of the Company’s long-term debt are summarized as follows: Scheduled Maturities Remainder of 2023 $ 29.1 2024 67.0 2025 67.0 2026 708.3 2027 430.2 2028 5.0 Thereafter 468.8 Total $ 1,775.4 For further details on the Second A&R Credit Agreement, refer to Note 10 of the audited consolidated financial statements included in the Company’s 2022 Form 10-K. |
Derivative Financial Instrument
Derivative Financial Instruments | 6 Months Ended |
Jun. 30, 2023 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Derivative Financial Instruments | Derivative Financial Instruments The Company utilizes cash flow hedges to manage its currency risk arising from its global business services centers. As of June 30, 2023, the Company had recorded $1.1 million of unrealized gains in accumulated other comprehensive income related to foreign currency hedges. The Company estimates that $1.1 million of gains reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next six months. The net gains (losses) reclassified into cost of services were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 $ 0.5 $ (0.1) $ 0.8 $ 0.1 As of June 30, 2023, the Company’s foreign currency forward contracts had maturities extending no later than December 31, 2023, and had a total notional value of $61.2 million. The Company also utilizes cash flow hedges to reduce variability in interest cash flows from its outstanding debt. As of June 30, 2023, the Company had recorded $16.5 million of unrealized gains in accumulated other comprehensive income related to interest rate swaps. The Company estimates that $11.1 million of gains reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next twelve months. The net gains (losses) reclassified into interest expense were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 $ 2.5 $ (0.2) $ 4.4 $ (0.5) As of June 30, 2023, the Company’s interest rate swaps extended no later than June 30, 2025, and had a total notional value of $500.0 million. The location and fair value of derivative instruments designated as hedges in the Consolidated Balance Sheets as of June 30, 2023 and December 31, 2022 were as follows: June 30, 2023 December 31, 2022 Foreign currency forward contracts Prepaid expenses and other current assets $ 1.1 $ 0.1 Other accrued expenses — 0.5 Total foreign current forward contracts $ 1.1 $ 0.6 Interest rate swaps Prepaid expenses and other current assets $ 11.1 $ 8.7 Other assets 5.4 5.0 Other accrued expenses — — Total interest rate swaps $ 16.5 $ 13.7 As of June 30, 2023 and December 31, 2022, the accumulated gain, net of tax, recognized in accumulated other comprehensive income (loss) was $13.1 million and $9.9 million, respectively. The Company classifies cash flows from its derivative programs as cash flows from operating activities in the Consolidated Statements of Cash Flows. Fair values for derivative financial instruments are based on prices computed using third-party valuation models and are classified as Level 2 in accordance with the three-level hierarchy of fair value measurements. On July 5, 2022, the Company and Sutter Health (“Sutter”) entered into a put right agreement regarding the potential purchase of a business that would expand the Company’s service capabilities. This agreement is effective through approximately the end of 2023 and allows Sutter to sell the business to the Company for $150.0 million, subject to the negotiation of a definitive agreement and the satisfaction of agreed upon closing conditions, including the requirement that the purchase price be deemed to be fair value at the time of the potential transaction. Assuming an agreement is reached for the Company to acquire the business, the Company and Sutter would also need to reach an agreement as to whether the purchase price would be paid in cash or shares of the Company’s common stock. |
Share-Based Compensation
Share-Based Compensation | 6 Months Ended |
Jun. 30, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Share-Based Compensation | Share-Based Compensation The total share-based compensation expense relating to the Company’s stock options, RSUs, and performance-based restricted stock units (“PBRSUs”) that has been included in the Company’s Consolidated Statements of Operations and Comprehensive Income (Loss) were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Share-Based Compensation Expense Allocation Details: Cost of services $ 12.8 $ 5.1 $ 19.7 $ 9.4 Selling, general and administrative 9.1 6.5 14.5 12.3 Total share-based compensation expense (1) $ 21.9 $ 11.6 $ 34.2 $ 21.7 Related tax benefits $ 4.7 $ 2.1 $ 7.3 $ 3.9 (1) Included in the share-based compensation expense above is $1.9 million and $3.7 million of share-based compensation expense for the three and six months ended June 30, 2023, respectively, of CoyCo 2, L.P., a shareholder of the Company (“CoyCo 2”). This expense relates to equity awards held by certain Cloudmed employees that were modified as part of the Cloudmed acquisition into awards of CoyCo 2 and were granted for services that benefit the Company’s operations. The Company accounts for forfeitures as they occur. Excess tax benefits and shortfalls for share-based payments are recognized in income tax expense and included in operating activities. The Company recognized the following income tax benefits from windfalls associated with vesting and exercises of equity awards: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 $ 0.7 $ 2.4 $ 1.2 $ 4.9 The Company uses the Black-Scholes option pricing model to estimate the fair value of its service-based options as of their grant dates. The volatility for the options was calculated based on an analysis of historical volatility. The Company assesses current performance on performance-based PBRSUs by reviewing historical performance to date, along with any adjustments which have been approved to the reported performance, and changes to the projections to determine the probable outcome of the awards. The current estimates are then compared to the scoring metrics and any necessary adjustments are reflected in the current period to update share-based compensation expense to the current performance expectations. A Monte Carlo simulation was used to estimate the fair value of the Unvested Units (as defined below), which are being amortized over a period of 4 years on a straight-line basis. The volatility for the Unvested Units was calculated based on an analysis of historical and implied volatility. Stock options A summary of the options activity during the six months ended June 30, 2023 is shown below: Options Weighted- Outstanding at December 31, 2022 3,104,413 $ 3.38 Granted — — Exercised (303,443) 3.46 Canceled/forfeited (45,865) 2.59 Expired — — Outstanding at June 30, 2023 2,755,105 $ 3.38 Outstanding, vested and exercisable at June 30, 2023 2,755,105 $ 3.38 Outstanding, vested and exercisable at December 31, 2022 3,080,069 $ 3.23 Restricted stock units and performance-based restricted stock units A summary of the RSU and PBRSU activity during the six months ended June 30, 2023 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2022 3,232,002 6,876,797 $ 19.07 $ 19.48 Granted 3,111,313 1,486,574 15.08 15.59 Performance factor adjustment — 792,189 — 15.95 Vested (833,843) (2,286,886) 15.56 15.95 Forfeited (232,708) (647,019) 18.81 19.75 Outstanding and unvested at June 30, 2023 5,276,764 6,221,655 $ 17.29 $ 19.37 Shares surrendered for taxes for the six months ended June 30, 2023 302,902 903,658 Cost of shares surrendered for taxes for the six months ended June 30, 2023 (in millions) $ 4.8 $ 13.1 Shares surrendered for taxes for the six months ended June 30, 2022 155,355 725,570 Cost of shares surrendered for taxes for the six months ended June 30, 2022 (in millions) $ 3.5 $ 18.7 Upon consummation of the Cloudmed acquisition, outstanding restricted units of Cloudmed were replaced by an aggregate 1,536,220 RSUs of the Company. The Company also issued an aggregate of 3,173,184 inducement RSUs and PBRSUs to certain employees of Cloudmed under Nasdaq Listing Rule 5635(c)(4) pursuant to its 2022 Inducement Plan. The Company’s RSU and PBRSU agreements allow employees to surrender to the Company shares of common stock upon vesting of their RSUs and PBRSUs in lieu of their payment of the required personal employment-related taxes. Shares surrendered for payment of personal employment-related taxes are held in treasury. |
Other Expenses
Other Expenses | 6 Months Ended |
Jun. 30, 2023 | |
Other Income and Expenses [Abstract] | |
Other Expenses | Other Expenses Other expenses are incurred in connection with acquisition and integration costs, various exit activities, transformation initiatives, and organizational changes to improve our business alignment and cost structure. The following table summarizes the other expenses recognized for the three and six months ended June 30, 2023 and 2022. Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Business acquisition costs (1) $ 2.0 $ 67.9 $ 2.1 $ 74.2 Integration costs (2) 8.1 9.1 23.9 9.5 Technology transformation (3) 3.7 — 7.3 — Strategic initiatives (4) 6.4 2.5 10.8 2.8 Global business services center expansion project in the Philippines (5) — 6.9 — 10.0 Facility-exit charges (6) 7.3 1.2 8.5 6.0 Other (7) 0.8 1.3 5.9 3.5 Total other expenses $ 28.3 $ 88.9 $ 58.5 $ 106.0 (1) Costs, including legal, consulting, and bank fees, that are directly related to the closing of business acquisitions and include changes to contingent consideration, if applicable. (2) Costs reflect efforts to integrate acquisitions from a systems, processes, and people perspective and to achieve synergies expected from business acquisitions. Costs include consulting fees, IT vendor spend, severance, retention, and certain payroll costs. (3) Costs relate to projects underway to create a new platform that consolidates the Cloudmed and R1 customer solutions and migrates them to a cloud environment to reduce onboarding costs and accelerate the delivery of value to the Company’s customers. These projects are expected to be completed in 2025. Certain costs incurred qualify for capitalization and have been recorded on the Consolidated Balance Sheet. (4) Costs relate to performing portfolio and capital structure analyses and transactions and other business restructuring activities as part of the Company’s growth strategy. Costs include vendor spend, employee time and expenses spent on activities, severance, and retention amounts. (5) Costs include legal and consulting fees related to the establishment of the Company’s inaugural global business services center in the Philippines as well as severance costs for personnel whose roles are being relocated. The entry into the Philippines was the first new organic global business services center country expansion by the Company in approximately 15 years. The Company completed the expansion project in 2022. (6) As part of evaluating its footprint, the Company has exited certain leased facilities. Costs include asset impairment charges, early termination fees, and other costs related to exited leased facilities. (7) For the three and six months ended June 30, 2023, other includes $1.3 million and $6.8 million, respectively, of expenses related to the Company’s ongoing litigation matters. For the three and six months ended June 30, 2022, other includes $0.7 million and $1.8 million, respectively, of expenses related to the Company’s ongoing litigation matters. For further details, refer to Note 11, Commitments and Contingencies. |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes Income tax provisions for interim periods are based on estimated annual income tax rates, adjusted to reflect the effects of any significant and infrequent or unusual items which are required to be discretely recognized within the current interim period. The effective tax rates in the periods presented are largely based upon the projected annual pre-tax earnings by jurisdiction and the allocation of certain expenses in various taxing jurisdictions where the Company conducts its business. These taxing jurisdictions apply a broad range of statutory income tax rates. The global intangible low-taxed income (“GILTI”) provisions impose taxes on foreign income in excess of a deemed return on tangible assets of foreign corporations. The Company elected to account for GILTI tax in the period in which it is incurred. The Company recognized income tax expense for the three months ended March 31, 2023 and income tax benefit for the six months ended June 30, 2023 on the year-to-date pre-tax loss. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for taxes on foreign source income, state taxes, non-deductible expenses, and discrete items. The Company recognized income tax expense for the three months ended March 31, 2022 and income tax benefit for the six months ended June 30, 2022 on the year-to-date pre-tax loss. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for state taxes, GILTI, non-deductible expenses, and discrete items. The Company and its subsidiaries are subject to U.S. federal income tax as well as income tax of multiple state and foreign jurisdictions. U.S. federal income tax returns since 2019 are currently open for examination. State jurisdictions vary for open tax years. The statute of limitations for most states ranges from three |
Earnings (Loss) Per Share
Earnings (Loss) Per Share | 6 Months Ended |
Jun. 30, 2023 | |
Earnings Per Share [Abstract] | |
Earnings (Loss) Per Share | Earnings (Loss) Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding during the period. Diluted net income (loss) per share is calculated by adjusting the denominator used in the basic net income (loss) per share computation by potentially dilutive securities outstanding during the period plus, when their effect is dilutive, incremental shares consisting of shares subject to stock options and shares issuable upon vesting of RSUs and PBRSUs. Basic and diluted net income (loss) per common share are calculated as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Net income (loss) $ 0.3 $ (20.4) $ 0.6 $ 9.0 Basic weighted-average common shares 418,525,625 294,658,635 417,939,489 286,746,902 Add: Effect of dilutive equity awards 4,028,162 — 4,259,246 5,838,531 Add: Effect of dilutive warrants 32,691,820 — 31,898,919 35,583,805 Diluted weighted average common shares 455,245,607 294,658,635 454,097,654 328,169,238 Net income (loss) per common share (basic) $ — $ (0.07) $ — $ 0.03 Net income (loss) per common share (diluted) $ — $ (0.07) $ — $ 0.03 Because of their anti-dilutive effect, 511,308 and 2,025,091 common share equivalents comprised of stock options, PBRSUs, and RSUs have been excluded from the diluted earnings per share calculation for the three and six months ended June 30, 2023, respectively. For the three and six months ended June 30, 2022, 22,558,278 and 90,583 common share equivalents, respectively, were excluded from the diluted earnings per share calculation because of their anti-dilutive effect. Additionally, for the three months ended June 30, 2022, TCP-ASC ACHI Series LLLP’s (“TCP-ASC” or the “Investor”) and IHC Health Services, Inc.’s (“Intermountain”) exercisable warrants to acquire up to 40.5 million and 1.5 million shares, respectively, of the Company’s common stock were excluded from the diluted earnings per share calculation because they were anti-dilutive. |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Legal Proceedings Other than as described below, the Company is not presently a party to any material litigation or regulatory proceeding and is not aware of any pending or threatened litigation or regulatory proceeding against the Company which, individually or in the aggregate, could have a material adverse effect on its business, operating results, financial condition or cash flows. On April 13, 2021 and April 19, 2021, respectively, certain purported stockholders of the Company filed two complaints in the Delaware Court of Chancery regarding the Company’s January 15, 2021 recapitalization transaction with TCP-ASC. Both complaints allege that TCP-ASC, Ascension Health (“Ascension”), and TowerBrook Capital Partners (“TowerBrook”) controlled the Company and breached their fiduciary duties by using that alleged control to force the Company to overpay in redeeming TCP-ASC’s preferred stock as part of the recapitalization transaction. The plaintiffs seek an unspecified amount of damages against TCP-ASC, Ascension, and TowerBrook. The plaintiffs also allege that the Company and TCP-ASC entered into amendments to the Investor Rights Agreement that the plaintiffs contend contain provisions that are void under the Company’s charter, bylaws, and the Delaware General Corporation Law. The cases have since been consolidated into a single action. On February 18, 2022, plaintiffs filed a supplement to their complaint, naming certain additional defendants and asserting additional claims related to the Company’s agreement to acquire Cloudmed, which was announced on January 10, 2022. The additional claims assert that: (i) TCP-ASC, Ascension, and TowerBrook, along with the Company’s directors (“Individual Defendants”), breached their fiduciary duties by causing the Company to enter into and approving the Cloudmed acquisition, respectively, which plaintiffs claim will perpetuate TCP-ASC’s, Ascension’s, and TowerBrook’s control over the Company and entrench the Individual Defendants by virtue of certain agreements entered into as part of the transaction, including a Second Amended Investor Rights Agreement with TCP-ASC (the “Seconded Amended Investor Rights Agreement”) and an Investor Rights Agreement with Cloudmed (the “Cloudmed Investor Rights Agreement”); and (ii) Cloudmed’s stockholders aided and abetted such breaches. Plaintiffs also allege that certain provisions in the Cloudmed Investor Rights Agreement and the Second Amended Investor Rights Agreement are void under the Company’s charter, bylaws, and the Delaware General Corporation law. The plaintiffs seek a declaratory judgment and damages, as well as attorneys’ fees and costs. Trial is scheduled for November 2023. The Company believes it has meritorious defenses to all claims against it and intends to vigorously defend itself against these claims. In May 2016, the Company was served with a False Claims Act case brought by a former emergency department service associate who worked at a hospital of one of the Company’s customers, MedStar Inc.’s Washington Hospital Center (“WHC”), along with WHC and three other hospitals that were PAS customers and a place holder, John Doe hospital, representing all PAS customers ( U.S. ex rel. Graziosi vs. Accretive Health, Inc. et. al. ), and seeking money damages, False Claims Act penalties, and plaintiff’s attorneys’ fees. The Third Amended Complaint alleges that the Company’s PAS business violates the federal False Claims Act. The case was originally filed under seal in 2013 in the federal district court in Chicago and was presented to the U.S. Attorney in Chicago, and the U.S. Attorney declined to intervene. Both the Company’s and plaintiff’s motions for summary judgment were denied in December 2020, and the parties have completed damage and expert discovery. Additional dispositive motions are expected to extend into 2023, with trial, if necessary, likely to be scheduled in 2024. The Company believes it has meritorious defenses to all claims in the case and is vigorously defending itself against these claims. |
Related Party Transactions
Related Party Transactions | 6 Months Ended |
Jun. 30, 2023 | |
Related Party Transactions [Abstract] | |
Related Party Transactions | Related Party Transactions This note encompasses transactions between Ascension and its affiliates, including AMITA Health, and the Company pursuant to the Master Professional Services Agreement, including all supplements, amendments, and other documents entered into in connection therewith. For further details on the Company’s agreements with Ascension, see Note 1 and Note 19 of the 2022 Form 10-K. In conjunction with the Cloudmed acquisition, New Mountain became a new related party. There were no material transactions with New Mountain subsequent to the Cloudmed acquisition. Net services revenue from services provided to Ascension, as well as corresponding accounts receivable and customer liabilities are presented in the Consolidated Statements of Operations and Comprehensive Income (Loss) and the Consolidated Balance Sheets. Since Ascension is the Company’s largest customer, a significant percentage of the Company’s cost of services is associated with providing services to Ascension. However, due to the nature of the Company’s global business services and information technology operations, it is impracticable to assign the dollar amount associated with services provided to Ascension. |
Segments and Customer Concentra
Segments and Customer Concentrations | 6 Months Ended |
Jun. 30, 2023 | |
Segment Reporting [Abstract] | |
Segments and Customer Concentrations | Segments and Customer Concentrations The Company has determined that it has a single operating segment in accordance with the way that management operates and views the business. All of the Company’s significant operations are organized around the single business of providing management services of revenue cycle operations for U.S.-based healthcare providers. Accordingly, for purposes of segment disclosures, the Company has only one operating and reportable segment. Customers comprising greater than 10% of net services revenue are as follows: Three Months Ended June 30, Six Months Ended June 30, Customer Name 2023 2022 2023 2022 Ascension and its affiliates 39 % 57 % 39 % 57 % Intermountain Healthcare 10 % 13 % 11 % 14 % The loss of customers within the Ascension health system or Intermountain network could have a material adverse impact on the Company’s operations. As of June 30, 2023 and December 31, 2022, the Company had a concentration of credit risk with Ascension, representing 7% and 10% of accounts receivable, respectively. |
Supplemental Financial Informat
Supplemental Financial Information | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Supplemental Financial Information | Supplemental Financial InformationThe following table summarizes the allocation of depreciation and amortization expense related to property, equipment and software between cost of services and selling, general and administrative expenses: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Cost of services $ 17.4 $ 12.8 $ 32.9 $ 24.3 Selling, general and administrative 0.2 0.2 0.6 0.5 Total depreciation and amortization $ 17.6 $ 13.0 $ 33.5 $ 24.8 Intangible asset amortization expense was $51.2 million and $101.3 million for the three and six months ended June 30, 2023, respectively, and $11.7 million and $18.8 million for the three and six months months ended June 30, 2022, respectively. Amortization expense for intangible assets is included in cost of services on the Company’s Consolidated Statements of Operations and Comprehensive Income (Loss). Supplemental cash flow information related to leases are as follows: Six Months Ended June 30, 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 12.4 $ 9.0 Right-of-use assets obtained in exchange for operating lease obligations: 4.7 65.6 |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||||
Jun. 30, 2023 | Mar. 31, 2023 | Jun. 30, 2022 | Mar. 31, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Pay vs Performance Disclosure | ||||||
Net income (loss) | $ 0.3 | $ 0.3 | $ (20.4) | $ 29.4 | $ 0.6 | $ 9 |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Jun. 30, 2023 | |
Trading Arrangements, by Individual | |
Rule 10b5-1 Arrangement Adopted | false |
Non-Rule 10b5-1 Arrangement Adopted | false |
Rule 10b5-1 Arrangement Terminated | false |
Non-Rule 10b5-1 Arrangement Terminated | false |
Business Description and Basi_2
Business Description and Basis of Presentation (Policies) | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company’s financial position as of June 30, 2023, the results of operations of the Company for the three and six months ended June 30, 2023 and 2022, and the cash flows of the Company for the six months ended June 30, 2023 and 2022. These financial statements include the accounts of R1 RCM Inc. and its wholly owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information, have been included. Operating results for the three and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2023. |
Recently Issued Accounting Standards and Disclosures | Recently Issued Accounting Standards and Disclosures In June 2022, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2022-03, Fair Value Measurement (Topic 820): Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (“ASU 2022-03”). ASU 2022-03 clarifies that a contractual sale restriction on an equity security should not be considered in measuring the security’s fair value. The Company will adopt ASU 2022-03 prospectively effective January 1, 2024 and is currently evaluating the impact of the standard on its consolidated financial statements. |
Revenue Recognition | Revenue RecognitionRevenue is measured based on consideration specified in a contract with a customer, and presented net of any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contract term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. |
Acquisitions (Tables)
Acquisitions (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Schedule of Fair Value of Total Consideration Paid and Schedule of Acquisitions | The fair value of assets acquired and liabilities assumed is: Purchase Price Allocation Total purchase consideration $ 3,281.6 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 32.1 Accounts receivable 61.8 Current portion of contract assets 70.9 Property, equipment and software 5.0 Operating lease right-of-use assets 25.3 Non-current portion of contract assets 22.2 Intangible assets 1,366.5 Goodwill 2,092.8 Other assets 6.7 Accounts payable (31.9) Customer liabilities (2.8) Accrued compensation and benefits (93.4) Operating lease liabilities (25.4) Deferred income tax liabilities (236.0) Other liabilities (12.2) Net assets acquired $ 3,281.6 |
Schedule of Fair Value of Assets Acquired and Liabilities Assumed | The fair value of assets acquired and liabilities assumed is: Purchase Price Allocation Total purchase consideration $ 3,281.6 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 32.1 Accounts receivable 61.8 Current portion of contract assets 70.9 Property, equipment and software 5.0 Operating lease right-of-use assets 25.3 Non-current portion of contract assets 22.2 Intangible assets 1,366.5 Goodwill 2,092.8 Other assets 6.7 Accounts payable (31.9) Customer liabilities (2.8) Accrued compensation and benefits (93.4) Operating lease liabilities (25.4) Deferred income tax liabilities (236.0) Other liabilities (12.2) Net assets acquired $ 3,281.6 |
Schedule of Pro Forma Results | The following table summarizes, on a pro forma basis, the combined results of the Company as though the Cloudmed acquisition had occurred as of January 1, 2021. These pro forma results are not necessarily indicative of the actual consolidated results had the acquisition occurred as of that date or of the future consolidated operating results for any period. Pro forma results are: Three Months Ended June 30, 2022 Six Months Ended June 30, 2022 Net services revenue $ 494.5 $ 980.9 Net income $ 19.5 $ 27.0 |
Revenue Recognition (Tables)
Revenue Recognition (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Revenue from Contract with Customer [Abstract] | |
Schedule of Disaggregated Revenue By Source | In the following table, revenue is disaggregated by source of revenue: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Net operating fees $ 357.8 $ 318.3 $ 718.8 $ 641.1 Incentive fees 30.8 29.9 54.4 60.1 Modular and other (1) 172.1 43.7 333.1 76.4 Net services revenue $ 560.7 $ 391.9 $ 1,106.3 $ 777.6 (1) Modular and other revenue primarily consists of $138.6 million and $264.4 million in fees related to Cloudmed service lines for the three and six months ended June 30, 2023, respectively. Fees related to revenue integrity solutions, practice management (“PM”) services, physician advisory services (“PAS”), and software subscription revenue are also included in modular and other revenue. |
Schedule of Contract Assets and Contract Liabilities | The following table provides information about contract assets, net and contract liabilities from contracts with customers: June 30, 2023 December 31, 2022 Contract assets, net Current $ 89.9 $ 83.9 Non-current 37.8 32.0 Total contract assets, net $ 127.7 $ 115.9 Contract liabilities Current (1) $ 10.9 $ 9.7 Non-current (2) 17.6 18.7 Total contract liabilities $ 28.5 $ 28.4 (1) Current contract liabilities include $8.9 million and $7.6 million classified in the current portion of customer liabilities and $2.0 million and $2.1 million classified in the current portion of customer liabilities - related party as of June 30, 2023 and December 31, 2022, respectively. (2) Non-current contract liabilities include $4.9 million and $5.0 million classified in the non-current portion of customer liabilities and $12.7 million and $13.7 million classified in the non-current portion of customer liabilities - related party as of June 30, 2023 and December 31, 2022, respectively. The contract assets, net balance will increase or decrease based on the timing of invoices and recognition of revenue. Significant changes in the carrying amount of contract assets, net for the six months ended June 30, 2023 were as follows: Contract Assets, net Balance as of December 31, 2022 $ 115.9 Revenue recognized 182.6 Amounts billed (169.8) Other (1) (1.0) Balance as of June 30, 2023 $ 127.7 (1) Other primarily includes purchase price allocation adjustments and changes to the allowance for credit losses. Contract Liabilities Balance as of December 31, 2022 $ (28.4) Advanced billings - January 1, 2023 (1) (85.0) Advanced billings recognized 85.0 Additions (8.9) Revenue recognized 8.8 Balance as of June 30, 2023 $ (28.5) (1) The Company records advanced billings to contract liabilities and accounts receivable on the first day of the respective service period, which are earned during the year. |
Schedule of Transaction Price Allocated to the Remaining Performance Obligation | The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period. The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Remainder of 2023 $ 47.5 $ 20.2 2024 57.6 2.1 2025 34.2 — 2026 9.6 — 2027 3.5 — 2028 1.9 — Thereafter 4.3 — Total $ 158.6 $ 22.3 |
Accounts Receivable and Allow_2
Accounts Receivable and Allowance for Credit Losses (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Receivables [Abstract] | |
Schedule of Allowance for Credit Losses | Movements in the allowance for credit losses related to accounts receivable are as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Beginning balance $ 16.1 $ 2.4 $ 15.2 $ 2.5 Cumulative effect of Cloudmed ASC 326 adoption — 1.8 — 1.8 Provision (recoveries) 15.5 0.3 16.6 0.3 Write-offs — (0.1) (0.2) (0.2) Ending balance (1) $ 31.6 $ 4.4 $ 31.6 $ 4.4 |
Debt (Tables)
Debt (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Carrying Values Long-Term Debt | The carrying amounts of debt consist of the following: June 30, 2023 December 31, 2022 Senior Revolver (1) $ 90.0 $ 100.0 Term A Loans 1,189.1 1,211.4 Term B Loan 496.3 498.7 Unamortized discount and issuance costs (21.3) (23.6) Total debt 1,754.1 1,786.5 Less: Current maturities (62.6) (53.9) Total long-term debt $ 1,691.5 $ 1,732.6 (1) As of June 30, 2023, the Company had $90.0 million in borrowings, $1.2 million letters of credit outstanding, and $508.8 million of availability under the $600.0 million senior secured revolving credit facility (“Senior Revolver”). |
Scheduled Maturities of Long-term Debt | Scheduled maturities of the Company’s long-term debt are summarized as follows: Scheduled Maturities Remainder of 2023 $ 29.1 2024 67.0 2025 67.0 2026 708.3 2027 430.2 2028 5.0 Thereafter 468.8 Total $ 1,775.4 |
Derivative Instruments and Hedg
Derivative Instruments and Hedging Activities (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Derivative Instruments, Gain (Loss) | The net gains (losses) reclassified into cost of services were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 $ 0.5 $ (0.1) $ 0.8 $ 0.1 Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 $ 2.5 $ (0.2) $ 4.4 $ (0.5) |
Schedule of Derivatives Instruments Statements of Financial Performance and Financial Position, Location | The location and fair value of derivative instruments designated as hedges in the Consolidated Balance Sheets as of June 30, 2023 and December 31, 2022 were as follows: June 30, 2023 December 31, 2022 Foreign currency forward contracts Prepaid expenses and other current assets $ 1.1 $ 0.1 Other accrued expenses — 0.5 Total foreign current forward contracts $ 1.1 $ 0.6 Interest rate swaps Prepaid expenses and other current assets $ 11.1 $ 8.7 Other assets 5.4 5.0 Other accrued expenses — — Total interest rate swaps $ 16.5 $ 13.7 |
Share-Based Compensation (Table
Share-Based Compensation (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Share-based Compensation Expense | The total share-based compensation expense relating to the Company’s stock options, RSUs, and performance-based restricted stock units (“PBRSUs”) that has been included in the Company’s Consolidated Statements of Operations and Comprehensive Income (Loss) were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Share-Based Compensation Expense Allocation Details: Cost of services $ 12.8 $ 5.1 $ 19.7 $ 9.4 Selling, general and administrative 9.1 6.5 14.5 12.3 Total share-based compensation expense (1) $ 21.9 $ 11.6 $ 34.2 $ 21.7 Related tax benefits $ 4.7 $ 2.1 $ 7.3 $ 3.9 (1) Included in the share-based compensation expense above is $1.9 million and |
Schedule of Income Tax Benefits | The Company recognized the following income tax benefits from windfalls associated with vesting and exercises of equity awards: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 $ 0.7 $ 2.4 $ 1.2 $ 4.9 |
Schedule of Stock Options Activity | A summary of the options activity during the six months ended June 30, 2023 is shown below: Options Weighted- Outstanding at December 31, 2022 3,104,413 $ 3.38 Granted — — Exercised (303,443) 3.46 Canceled/forfeited (45,865) 2.59 Expired — — Outstanding at June 30, 2023 2,755,105 $ 3.38 Outstanding, vested and exercisable at June 30, 2023 2,755,105 $ 3.38 Outstanding, vested and exercisable at December 31, 2022 3,080,069 $ 3.23 |
Schedule of Non-Options Awards Activity | A summary of the RSU and PBRSU activity during the six months ended June 30, 2023 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2022 3,232,002 6,876,797 $ 19.07 $ 19.48 Granted 3,111,313 1,486,574 15.08 15.59 Performance factor adjustment — 792,189 — 15.95 Vested (833,843) (2,286,886) 15.56 15.95 Forfeited (232,708) (647,019) 18.81 19.75 Outstanding and unvested at June 30, 2023 5,276,764 6,221,655 $ 17.29 $ 19.37 Shares surrendered for taxes for the six months ended June 30, 2023 302,902 903,658 Cost of shares surrendered for taxes for the six months ended June 30, 2023 (in millions) $ 4.8 $ 13.1 Shares surrendered for taxes for the six months ended June 30, 2022 155,355 725,570 Cost of shares surrendered for taxes for the six months ended June 30, 2022 (in millions) $ 3.5 $ 18.7 |
Other Expenses (Tables)
Other Expenses (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Other Income and Expenses [Abstract] | |
Schedule of Other Expenses | The following table summarizes the other expenses recognized for the three and six months ended June 30, 2023 and 2022. Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Business acquisition costs (1) $ 2.0 $ 67.9 $ 2.1 $ 74.2 Integration costs (2) 8.1 9.1 23.9 9.5 Technology transformation (3) 3.7 — 7.3 — Strategic initiatives (4) 6.4 2.5 10.8 2.8 Global business services center expansion project in the Philippines (5) — 6.9 — 10.0 Facility-exit charges (6) 7.3 1.2 8.5 6.0 Other (7) 0.8 1.3 5.9 3.5 Total other expenses $ 28.3 $ 88.9 $ 58.5 $ 106.0 (1) Costs, including legal, consulting, and bank fees, that are directly related to the closing of business acquisitions and include changes to contingent consideration, if applicable. (2) Costs reflect efforts to integrate acquisitions from a systems, processes, and people perspective and to achieve synergies expected from business acquisitions. Costs include consulting fees, IT vendor spend, severance, retention, and certain payroll costs. (3) Costs relate to projects underway to create a new platform that consolidates the Cloudmed and R1 customer solutions and migrates them to a cloud environment to reduce onboarding costs and accelerate the delivery of value to the Company’s customers. These projects are expected to be completed in 2025. Certain costs incurred qualify for capitalization and have been recorded on the Consolidated Balance Sheet. (4) Costs relate to performing portfolio and capital structure analyses and transactions and other business restructuring activities as part of the Company’s growth strategy. Costs include vendor spend, employee time and expenses spent on activities, severance, and retention amounts. (5) Costs include legal and consulting fees related to the establishment of the Company’s inaugural global business services center in the Philippines as well as severance costs for personnel whose roles are being relocated. The entry into the Philippines was the first new organic global business services center country expansion by the Company in approximately 15 years. The Company completed the expansion project in 2022. (6) As part of evaluating its footprint, the Company has exited certain leased facilities. Costs include asset impairment charges, early termination fees, and other costs related to exited leased facilities. (7) For the three and six months ended June 30, 2023, other includes $1.3 million and $6.8 million, respectively, of expenses related to the Company’s ongoing litigation matters. For the three and six months ended June 30, 2022, other includes $0.7 million and $1.8 million, respectively, of expenses related to the Company’s ongoing litigation matters. For further details, refer to Note 11, Commitments and Contingencies. |
Earnings (Loss) Per Share (Tabl
Earnings (Loss) Per Share (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Earnings Per Share [Abstract] | |
Schedule of Basic and Diluted Net Income (Loss) Per Common Share | Basic and diluted net income (loss) per common share are calculated as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Net income (loss) $ 0.3 $ (20.4) $ 0.6 $ 9.0 Basic weighted-average common shares 418,525,625 294,658,635 417,939,489 286,746,902 Add: Effect of dilutive equity awards 4,028,162 — 4,259,246 5,838,531 Add: Effect of dilutive warrants 32,691,820 — 31,898,919 35,583,805 Diluted weighted average common shares 455,245,607 294,658,635 454,097,654 328,169,238 Net income (loss) per common share (basic) $ — $ (0.07) $ — $ 0.03 Net income (loss) per common share (diluted) $ — $ (0.07) $ — $ 0.03 |
Segments and Customer Concent_2
Segments and Customer Concentrations (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Customer Concentration, Net Services Revenue | Customers comprising greater than 10% of net services revenue are as follows: Three Months Ended June 30, Six Months Ended June 30, Customer Name 2023 2022 2023 2022 Ascension and its affiliates 39 % 57 % 39 % 57 % Intermountain Healthcare 10 % 13 % 11 % 14 % |
Supplemental Financial Inform_2
Supplemental Financial Information (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Summary Depreciation and Amortization Expense | The following table summarizes the allocation of depreciation and amortization expense related to property, equipment and software between cost of services and selling, general and administrative expenses: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Cost of services $ 17.4 $ 12.8 $ 32.9 $ 24.3 Selling, general and administrative 0.2 0.2 0.6 0.5 Total depreciation and amortization $ 17.6 $ 13.0 $ 33.5 $ 24.8 |
Schedule of Cash Flow, Supplemental Cash Flow Information | Supplemental cash flow information related to leases are as follows: Six Months Ended June 30, 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 12.4 $ 9.0 Right-of-use assets obtained in exchange for operating lease obligations: 4.7 65.6 |
Acquisitions - Narrative (Detai
Acquisitions - Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | 7 Months Ended | 12 Months Ended | |
Sep. 30, 2021 | Jun. 30, 2023 | Jun. 30, 2023 | Dec. 31, 2022 | Jun. 21, 2022 | |
Cloudmed | |||||
Business Acquisition [Line Items] | |||||
Decrease in deferred income tax liability | $ 9.4 | ||||
Decrease in goodwill | $ 9.4 | ||||
Accounts receivable | $ 61.8 | ||||
RevWorks | |||||
Business Acquisition [Line Items] | |||||
Payments to acquire business | $ 12.5 | $ 12.5 | |||
Payments to acquire business, number of payments, refund period, if circumstances met | 2 years | ||||
Cloudmed | Cloudmed | |||||
Business Acquisition [Line Items] | |||||
Lock-up period | 18 months |
Acquisitions - Fair Value of As
Acquisitions - Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions | Jun. 21, 2022 | Jun. 30, 2023 | Dec. 31, 2022 |
Allocation of consideration to assets acquired and liabilities assumed: | |||
Goodwill | $ 2,647.4 | $ 2,658.2 | |
Cloudmed | |||
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Net [Abstract] | |||
Total purchase consideration | $ 3,281.6 | ||
Allocation of consideration to assets acquired and liabilities assumed: | |||
Cash and cash equivalents | 32.1 | ||
Accounts receivable | 61.8 | ||
Current portion of contract assets | 70.9 | ||
Property, equipment and software | 5 | ||
Operating lease right-of-use assets | 25.3 | ||
Non-current portion of contract assets | 22.2 | ||
Intangible assets | 1,366.5 | ||
Goodwill | 2,092.8 | ||
Other assets | 6.7 | ||
Accounts payable | (31.9) | ||
Customer liabilities | (2.8) | ||
Accrued compensation and benefits | (93.4) | ||
Operating lease liabilities | (25.4) | ||
Deferred income tax liabilities | (236) | ||
Other liabilities | (12.2) | ||
Net assets acquired | $ 3,281.6 |
Acquisitions - Pro Forma Result
Acquisitions - Pro Forma Results (Details) - Cloudmed - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended |
Jun. 30, 2022 | Jun. 30, 2022 | |
Business Acquisition [Line Items] | ||
Net services revenue | $ 494.5 | $ 980.9 |
Net income | $ 19.5 | $ 27 |
Revenue Recognition - Schedule
Revenue Recognition - Schedule of Disaggregated Revenue by Source (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Disaggregation of Revenue [Line Items] | ||||
Net services revenue | $ 560.7 | $ 391.9 | $ 1,106.3 | $ 777.6 |
Cloudmed | ||||
Disaggregation of Revenue [Line Items] | ||||
Net services revenue | 138.6 | 264.4 | ||
Net operating fees | ||||
Disaggregation of Revenue [Line Items] | ||||
Net services revenue | 357.8 | 318.3 | 718.8 | 641.1 |
Incentive fees | ||||
Disaggregation of Revenue [Line Items] | ||||
Net services revenue | 30.8 | 29.9 | 54.4 | 60.1 |
Modular and other | ||||
Disaggregation of Revenue [Line Items] | ||||
Net services revenue | $ 172.1 | $ 43.7 | $ 333.1 | $ 76.4 |
Revenue Recognition - Schedul_2
Revenue Recognition - Schedule of Contract Balances (Details) - USD ($) $ in Millions | Jun. 30, 2023 | Dec. 31, 2022 |
Contract assets, net | ||
Current | $ 89.9 | $ 83.9 |
Non-current | 37.8 | 32 |
Total contract assets, net | 127.7 | 115.9 |
Contract liabilities | ||
Current | 10.9 | 9.7 |
Non-current | 17.6 | 18.7 |
Total contract liabilities | 28.5 | 28.4 |
Current portion of customer liabilities | 8.9 | 7.6 |
Non-current portion of customer liabilities | 4.9 | 5 |
Investor | ||
Contract liabilities | ||
Current portion of customer liabilities | 2 | 2.1 |
Non-current portion of customer liabilities | $ 12.7 | $ 13.7 |
Revenue Recognition - Changes t
Revenue Recognition - Changes to Contract Assets (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended |
Jun. 30, 2023 | Jun. 30, 2023 | |
Contract with Customer, Asset [Roll Forward] | ||
Balance as of December 31, 2022 | $ 115.9 | |
Revenue recognized | 182.6 | |
Amounts billed | (169.8) | |
Other | (1) | |
Balance as of June 30, 2023 | $ 127.7 | 127.7 |
Contract with Customer, Liabilities [Roll Forward] | ||
Balance as of December 31, 2022 | (28.4) | |
Advanced billings | (85) | |
Advanced billings recognized | 85 | |
Additions | (8.9) | |
Revenue recognized | 8.8 | |
Balance as of June 30, 2023 | $ (28.5) | $ (28.5) |
Revenue Recognition - Transacti
Revenue Recognition - Transaction Price Allocated to the Remaining Performance Obligation (Details) $ in Millions | Jun. 30, 2023 USD ($) |
Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 158.6 |
Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 22.3 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-07-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | 6 months |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-07-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 47.5 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-07-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 20.2 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | 1 year |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 57.6 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 2.1 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | 1 year |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 34.2 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 0 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | 1 year |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 9.6 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 0 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | 1 year |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 3.5 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 0 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | 1 year |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 1.9 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 0 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01 | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01 | Net operating fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 4.3 |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01 | Incentive fees | |
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items] | |
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount | $ 0 |
Accounts Receivable and Allow_3
Accounts Receivable and Allowance for Credit Losses - Rollforward (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Accounts Receivable, Allowance for Credit Loss [Roll Forward] | ||||
Beginning balance | $ 16.1 | $ 2.4 | $ 15.2 | $ 2.5 |
Provision (recoveries) | 15.5 | 0.3 | 16.6 | 0.3 |
Write-offs | 0 | (0.1) | (0.2) | (0.2) |
Ending balance | 31.6 | 4.4 | 31.6 | 4.4 |
Increase in allowance | 15.5 | 0.3 | 16.6 | 0.3 |
Increase in allowance for uncollectible amounts | 11.6 | |||
ASC 326 | Cloudmed | ||||
Accounts Receivable, Allowance for Credit Loss [Roll Forward] | ||||
Beginning balance | $ 0 | $ 1.8 | 0 | $ 1.8 |
Physician Customer | ||||
Accounts Receivable, Allowance for Credit Loss [Roll Forward] | ||||
Provision (recoveries) | 21.7 | |||
Increase in allowance | $ 21.7 |
Debt - Carrying Amounts of Debt
Debt - Carrying Amounts of Debt (Details) - USD ($) | Jun. 30, 2023 | Dec. 31, 2022 | Jun. 21, 2022 |
Debt Instrument [Line Items] | |||
Long-term debt | $ 1,775,400,000 | ||
Unamortized discount and issuance costs | (21,300,000) | $ (23,600,000) | |
Total debt | 1,754,100,000 | 1,786,500,000 | |
Less: Current maturities | (62,600,000) | (53,900,000) | |
Total long-term debt | 1,691,500,000 | 1,732,600,000 | |
Line of Credit | Senior Revolver | |||
Debt Instrument [Line Items] | |||
Long-term debt | 90,000,000 | 100,000,000 | |
Borrowing availability | 508,800,000 | ||
Line of Credit | Senior Revolver | Second A&R Credit Agreement | |||
Debt Instrument [Line Items] | |||
Credit agreement, maximum borrowing capacity | $ 600,000,000 | ||
Line of Credit | Term A Loans | |||
Debt Instrument [Line Items] | |||
Long-term debt | 1,189,100,000 | 1,211,400,000 | |
Line of Credit | Term B Loan | |||
Debt Instrument [Line Items] | |||
Long-term debt | 496,300,000 | $ 498,700,000 | |
Line of Credit | Term B Loan | Second A&R Credit Agreement | |||
Debt Instrument [Line Items] | |||
Credit agreement, maximum borrowing capacity | $ 500,000,000 | ||
Line of Credit | Letters of Credit | |||
Debt Instrument [Line Items] | |||
Long-term debt | $ 1,200,000 |
Debt - Narrative (Details)
Debt - Narrative (Details) - Line of Credit - Second A&R Credit Agreement - USD ($) | Jun. 30, 2023 | Jun. 21, 2022 |
Debt Instrument [Line Items] | ||
Debt covenant, secured obligation pledged, capital stock of certain domestic subsidiaries, percent | 100% | |
Term A Loans | ||
Debt Instrument [Line Items] | ||
Interest rate (as a percent) | 7.35% | |
Existing Term A Loan | ||
Debt Instrument [Line Items] | ||
Credit agreement, maximum borrowing capacity | $ 691,300,000 | |
Incremental Term A Loan | ||
Debt Instrument [Line Items] | ||
Credit agreement, maximum borrowing capacity | 540,000,000 | |
Term B Loan | ||
Debt Instrument [Line Items] | ||
Credit agreement, maximum borrowing capacity | 500,000,000 | |
Interest rate (as a percent) | 8.10% | |
Senior Revolver | ||
Debt Instrument [Line Items] | ||
Credit agreement, maximum borrowing capacity | 600,000,000 | |
Debt issuance costs incurred | 7,200,000 | |
Debt issuance costs, capitalized | $ 6,400,000 |
Debt - Scheduled Maturities of
Debt - Scheduled Maturities of Long-Term Debt (Details) $ in Millions | Jun. 30, 2023 USD ($) |
Debt Disclosure [Abstract] | |
Remainder of 2023 | $ 29.1 |
2024 | 67 |
2025 | 67 |
2026 | 708.3 |
2027 | 430.2 |
2028 | 5 |
Thereafter | 468.8 |
Total | $ 1,775.4 |
Derivative Financial Instrume_2
Derivative Financial Instruments - Narrative (Details) - USD ($) | 6 Months Ended | 12 Months Ended | |
Jul. 05, 2022 | Jun. 30, 2023 | Dec. 31, 2022 | |
Derivative [Line Items] | |||
Accumulated gain, net of tax, recognized in other comprehensive loss | $ 13,100,000 | $ 9,900,000 | |
Third Party | |||
Derivative [Line Items] | |||
Potential business combination, expected purchase price | $ 150,000,000 | ||
Designated as Hedging Instrument | Cash Flow Hedging | Foreign Currency Hedges | |||
Derivative [Line Items] | |||
Unrealized gains reported in accumulated other comprehensive loss | 1,100,000 | ||
Gains to be reclassified within next 12 months | 1,100,000 | ||
Notional amount | 61,200,000 | ||
Designated as Hedging Instrument | Cash Flow Hedging | Interest rate swaps | |||
Derivative [Line Items] | |||
Unrealized gains reported in accumulated other comprehensive loss | 16,500,000 | ||
Gains to be reclassified within next 12 months | 11,100,000 | ||
Notional amount | $ 500,000,000 |
Derivative Financial Instrume_3
Derivative Financial Instruments - Schedule of Derivative Gain (Loss) (Details) - Cash Flow Hedging - Designated as Hedging Instrument - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Foreign currency forward contracts | ||||
Derivative [Line Items] | ||||
Derivatives, net gain (loss) reclassified | $ 0.5 | $ (0.1) | $ 0.8 | $ 0.1 |
Interest rate swaps | ||||
Derivative [Line Items] | ||||
Derivatives, net gain (loss) reclassified | $ 2.5 | $ (0.2) | $ 4.4 | $ (0.5) |
Derivative Financial Instrume_4
Derivative Financial Instruments- Schedule Of Derivative Instruments as Hedged on Consolidated Balance Sheets (Details) - Cash Flow Hedging - Designated as Hedging Instrument - USD ($) $ in Millions | Jun. 30, 2023 | Dec. 31, 2022 |
Foreign currency forward contracts | ||
Derivative [Line Items] | ||
Derivative asset, current | $ 1.1 | $ 0.1 |
Derivative liability | 0 | 0.5 |
Derivative, fair value, net | 1.1 | 0.6 |
Interest rate swaps | ||
Derivative [Line Items] | ||
Derivative asset, current | 11.1 | 8.7 |
Derivative asset, noncurrent | 5.4 | 5 |
Derivative liability | 0 | 0 |
Derivative, fair value, net | $ 16.5 | $ 13.7 |
Share-Based Compensation - Comp
Share-Based Compensation - Compensation Expense Allocation (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | ||||
Total share-based compensation expense | $ 21.9 | $ 11.6 | $ 34.2 | $ 21.7 |
Related tax benefits | 4.7 | 2.1 | 7.3 | 3.9 |
CoyCo 2 | ||||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | ||||
Share-based compensation expense capitalized to deferred contract costs | 1.9 | 3.7 | ||
Cost of services | ||||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | ||||
Total share-based compensation expense | 12.8 | 5.1 | 19.7 | 9.4 |
Selling, general and administrative | ||||
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items] | ||||
Total share-based compensation expense | $ 9.1 | $ 6.5 | $ 14.5 | $ 12.3 |
Share-Based Compensation - Stoc
Share-Based Compensation - Stock Options Activity (Details) | 6 Months Ended | |
Jun. 30, 2023 $ / shares shares | Dec. 31, 2022 $ / shares shares | |
Options | ||
Outstanding at beginning of period (in shares) | shares | 3,104,413 | |
Granted (in shares) | shares | 0 | |
Exercised (in shares) | shares | (303,443) | |
Canceled/forfeited (in shares) | shares | (45,865) | |
Expired (in shares) | shares | 0 | |
Outstanding at end of period (in shares) | shares | 2,755,105 | |
Outstanding, vested and exercisable at end of period (in shares) | shares | 2,755,105 | 3,080,069 |
Weighted- Average Exercise Price | ||
Outstanding at beginning of period (in dollars per share) | $ / shares | $ 3.38 | |
Granted (in dollars per share) | $ / shares | 0 | |
Exercised (in dollars per share) | $ / shares | 3.46 | |
Canceled/forfeited (in dollars per share) | $ / shares | 2.59 | |
Expired (in dollars per share) | $ / shares | 0 | |
Outstanding at end of period (in dollars per share) | $ / shares | 3.38 | |
Outstanding, vested and exercisable at end of period (in dollars per share) | $ / shares | $ 3.38 | $ 3.23 |
Share-Based Compensation - Narr
Share-Based Compensation - Narrative (Details) - shares | 6 Months Ended | 12 Months Ended |
Jun. 30, 2023 | Dec. 31, 2022 | |
RSUs and PBRSUs | Cloudmed | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Replacement awards issued to Cloudmed equity award holders (in shares) | 3,173,184 | |
RSUs | Cloudmed | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Replacement awards issued to Cloudmed equity award holders (in shares) | 1,536,220 | |
PBRSUs | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Maximum exercisable (in shares) | 12,443,310 | |
PBRSUs | Minimum | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Number of shares vesting if targets conditions met, potential percentage | 0% | |
PBRSUs | Maximum | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Number of shares vesting if targets conditions met, potential percentage | 200% | |
Management Units | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Nonvested award, cost not yet recognized, period for recognition | 4 years |
Share-Based Compensation - Othe
Share-Based Compensation - Other Than Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Millions | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
RSUs | ||
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward] | ||
Outstanding and unvested at beginning of period (in shares) | 3,232,002 | |
Granted (in shares) | 3,111,313 | |
Performance factor adjustment (in shares) | 0 | |
Vested (in shares) | (833,843) | |
Forfeited (in shares) | (232,708) | |
Outstanding and unvested at end of period (in shares) | 5,276,764 | |
Weighted- Average Grant Date Fair Value | ||
Outstanding and unvested at beginning of period (in dollars per share) | $ 19.07 | |
Granted (in dollars per share) | 15.08 | |
Performance factor adjustment (in dollars per share) | 0 | |
Vested (in dollars per share) | 15.56 | |
Forfeited (in dollars per share) | 18.81 | |
Outstanding and unvested at end of period (in dollars per share) | $ 17.29 | |
Shares surrendered for taxes (in shares) | 302,902 | 155,355 |
Cost of shares surrendered for taxes | $ 4.8 | $ 3.5 |
PBRSUs | ||
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward] | ||
Outstanding and unvested at beginning of period (in shares) | 6,876,797 | |
Granted (in shares) | 1,486,574 | |
Performance factor adjustment (in shares) | 792,189 | |
Vested (in shares) | (2,286,886) | |
Forfeited (in shares) | (647,019) | |
Outstanding and unvested at end of period (in shares) | 6,221,655 | |
Weighted- Average Grant Date Fair Value | ||
Outstanding and unvested at beginning of period (in dollars per share) | $ 19.48 | |
Granted (in dollars per share) | 15.59 | |
Performance factor adjustment (in dollars per share) | 15.95 | |
Vested (in dollars per share) | 15.95 | |
Forfeited (in dollars per share) | 19.75 | |
Outstanding and unvested at end of period (in dollars per share) | $ 19.37 | |
Shares surrendered for taxes (in shares) | 903,658 | 725,570 |
Cost of shares surrendered for taxes | $ 13.1 | $ 18.7 |
Share-Based Compensation Schedu
Share-Based Compensation Schedule of Income Tax Benefits (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Share-Based Payment Arrangement [Abstract] | ||||
Income tax benefit | $ 0.7 | $ 2.4 | $ 1.2 | $ 4.9 |
Other Expenses - Schedule of Ot
Other Expenses - Schedule of Other Expenses (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Other Income and Expenses [Abstract] | ||||
Business acquisition costs | $ 2 | $ 67.9 | $ 2.1 | $ 74.2 |
Integration costs | 8.1 | 9.1 | 23.9 | 9.5 |
Technology transformation | 3.7 | 0 | 7.3 | 0 |
Strategic initiatives | 6.4 | 2.5 | 10.8 | 2.8 |
Global business services center expansion project in the Philippines | 0 | 6.9 | 0 | 10 |
Facility-exit charges | 7.3 | 1.2 | 8.5 | 6 |
Other | 0.8 | 1.3 | 5.9 | 3.5 |
Total other expenses | 28.3 | 88.9 | $ 58.5 | 106 |
Number of years since new country entry | 15 years | |||
Litigation expenses | $ 1.3 | $ 0.7 | $ 6.8 | $ 1.8 |
Income Taxes - Narrative (Detai
Income Taxes - Narrative (Details) - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2023 | Dec. 31, 2022 | |
Income Tax Disclosure [Abstract] | ||
Federal statutory tax rate | 21% | |
Statute of limitations minimum | 3 years | |
Statute of limitations maximum | 6 years | |
Gross deferred tax assets | $ 147.6 | |
Deferred tax assets related to operating loss carryforwards | $ 50 |
Earnings (Loss) Per Share - Com
Earnings (Loss) Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Earnings Per Share [Abstract] | ||||
Net income (loss) | $ 0.3 | $ (20.4) | $ 0.6 | $ 9 |
Net income (loss) | $ 0.3 | $ (20.4) | $ 0.6 | $ 9 |
Basic weighted-average common shares (in shares) | 418,525,625 | 294,658,635 | 417,939,489 | 286,746,902 |
Add: Effect of dilutive equity awards (in shares) | 4,028,162 | 0 | 4,259,246 | 5,838,531 |
Add: Effect of dilutive warrants (in shares) | 32,691,820 | 0 | 31,898,919 | 35,583,805 |
Diluted weighted average common shares (in shares) | 455,245,607 | 294,658,635 | 454,097,654 | 328,169,238 |
Net income (loss) per common share (basic) (in dollars per share) | $ 0 | $ (0.07) | $ 0 | $ 0.03 |
Net income (loss) per common share (diluted) (in dollars per share) | $ 0 | $ (0.07) | $ 0 | $ 0.03 |
Earnings (Loss) Per Share - Nar
Earnings (Loss) Per Share - Narrative (Details) - shares | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] | ||||
Antidilutive common share equivalents (in shares) | 511,308 | 22,558,278 | 2,025,091 | 90,583 |
Warrant | TCP-ASC ACHI Series LLLP | ||||
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] | ||||
Antidilutive common share equivalents (in shares) | 40,500,000 | |||
Warrant | Intermountain | ||||
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] | ||||
Antidilutive common share equivalents (in shares) | 1,500,000 |
Commitments and Contingencies -
Commitments and Contingencies - Narrative (Details) | Apr. 19, 2021 claim |
TCP-ASC Recapitalization Litigation | Pending Litigation | |
Loss Contingencies [Line Items] | |
Number of complaints filed | 2 |
Segments and Customer Concent_3
Segments and Customer Concentrations - Narrative (Details) - segment | 6 Months Ended | 12 Months Ended |
Jun. 30, 2023 | Dec. 31, 2022 | |
Segment Reporting Information [Line Items] | ||
Number of operating segments | 1 | |
Number of reporting segments | 1 | |
Customer Concentration Risk | Accounts Receivable | Ascension and its affiliates | ||
Segment Reporting Information [Line Items] | ||
Concentration percentage (as a percent) | 7% | 10% |
Segments and Customer Concent_4
Segments and Customer Concentrations - Concentration Risk by Customer (Details) - Revenue - Customer Concentration Risk | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Ascension and its affiliates | ||||
Concentration Risk [Line Items] | ||||
Concentration percentage (as a percent) | 39% | 57% | 39% | 57% |
Intermountain Healthcare | ||||
Concentration Risk [Line Items] | ||||
Concentration percentage (as a percent) | 10% | 13% | 11% | 14% |
Supplemental Financial Inform_3
Supplemental Financial Information - Schedule of Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Property, Plant and Equipment [Line Items] | ||||
Total depreciation and amortization | $ 17.6 | $ 13 | $ 33.5 | $ 24.8 |
Cost of services | ||||
Property, Plant and Equipment [Line Items] | ||||
Total depreciation and amortization | 17.4 | 12.8 | 32.9 | 24.3 |
Selling, general and administrative | ||||
Property, Plant and Equipment [Line Items] | ||||
Total depreciation and amortization | $ 0.2 | $ 0.2 | $ 0.6 | $ 0.5 |
Supplemental Financial Inform_4
Supplemental Financial Information - Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract] | ||||
Intangible asset amortization expense | $ 51.2 | $ 11.7 | $ 101.3 | $ 18.8 |
Supplemental Financial Inform_5
Supplemental Financial Information - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Millions | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Cash paid for amounts included in the measurement of lease liabilities: | ||
Operating cash flows for operating leases | $ 12.4 | $ 9 |
Right-of-use assets obtained in exchange for operating lease obligations | $ 4.7 | $ 65.6 |