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| 8-K - 8-K - R1 RCM INC. | a1-108xk.htm |
35th Annual J.P. Morgan
Healthcare Conference
January 12, 2017
Exhibit 99.1
2
Safe Harbor Statement and Non-GAAP Financial Measures
This presentation contains forward-looking statements, including statements regarding future growth, plans and performance. All forward-
looking statements contained in this presentation involve risks and uncertainties. The Company’s actual results and outcomes could differ
materially from those anticipated in these forward-looking statements as a result of various factors, including the factors set forth under the
heading “Risk Factors” in its Annual Report on Form 10-K for the year ended December 31, 2015, filed with the SEC on March 10, 2016. The
words “strive,” “objective,” “anticipates,” “believes,” “estimates,” “expects,” “intends,” “may,” “plans,” “projects,” “vision,” “would,” and
similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying
words. The Company has based these forward-looking statements on its current expectations and projections about future events. Although
the Company believes that the expectations underlying any of its forward-looking statements are reasonable, these expectations may prove to
be incorrect and all of these statements are subject to risks and uncertainties. Should one or more of these risks and uncertainties materialize,
or should underlying assumptions, projections, or expectations prove incorrect, actual results, performance, financial condition, or events may
vary materially and adversely from those anticipated, estimated, or expected.
All forward-looking statements included in this presentation are expressly qualified in their entirety by these cautionary statements. The
Company cautions readers not to place undue reliance on any forward-looking statement that speaks only as of the date made and to
recognize that forward-looking statements are predictions of future results, which may not occur as anticipated. Actual results could differ
materially from those anticipated in the forward-looking statements and from historical results, due to the uncertainties and factors described
above, as well as others that the Company may consider immaterial or does not anticipate at this time. Although the Company believes that
the expectations reflected in its forward-looking statements are reasonable, the Company does not know whether its expectations may prove
correct. The Company’s expectations reflected in its forward-looking statements can be affected by inaccurate assumptions it might make or
by known or unknown uncertainties and factors, including those described above. The risks and uncertainties described above are not
exclusive, and further information concerning the Company and its business, including factors that potentially could materially affect its
financial results or condition or relationships with customers and potential customers, may emerge from time to time. The Company assumes
no, and it specifically disclaims any, obligation to update, amend, or clarify forward-looking statements to reflect actual results or changes in
factors or assumptions affecting such forward-looking statements. The Company advises investors, however, to consult any further disclosures
it makes on related subjects in our periodic reports that it files with or furnishes to the SEC.
This presentation includes the following non-GAAP financial measures on a projected basis: Gross Cash Generated and Net Cash Generated
from Customer Contracting Activities (only for 2016), Adjusted EBITDA and Free Cash Flow. Please refer to the supplemental information
located at the end of this presentation for a reconciliation of these projected non-GAAP financial measures to the most directly comparable
projected GAAP financial measures and other important information.
3
The trusted partner to manage
client revenue built on strong
relationships with the confidence
to commit to results
Your one revenue partner across payment model,
engagement model or settings of care fueled by a values
driven organization
The first in the market with the most
experience, leading performance, one
partner to manage all aspects of
revenue cycle
4
Company Overview
Comprehensive Provider of Technology-Enabled RCM Services
Operating Experience Critical to Enabling Growth
of Outsourced RCM Offering
Joe Flanagan – President & CEO
Joined June 2013; CEO since Q2’16
Extensive experience building technology
driven, scalable commercial infrastructure in
industrial and services sectors
New Management Team Significant Footprint Under Contract
• $65B of gross billings
• 16.5M patient annual encounters
• 132 hospital sites/ 17 states
Seasoned Human Capital
• 5K employees growing to 12K with current
contracted business
• Strong mix of innovation & execution
Global Shared Services
• Full coverage of all core processes
• Captive & integrated India operations
• Higher performance vs. local ops
Proprietary Technology
• Built for purpose from best in class
operations
• Exception-based & integrated
• Agnostic to EMR
Chris Ricaurte – CFO & Treasurer
Experienced Executive Team
With new investment and a strong, stable
platform, rebuilt Sr. Exec Team in 2016
Functional competency in scaling combined with
deep domain expertise
Joined August 2013 as SVP of Shared Services;
CFO since Q2’16
15 years CFO experience in 5 industries
alongside CEO
5
Investment Highlights
RCM market continues to be underdeveloped with high-growth
potential
Significant investments made since 2013 to strengthen and re-establish
leadership position
Only pure-play RCM provider with a comprehensive technology-
enabled solution
Compelling growth story underpinned by strong fundamentals
Financial Guidance ($M) 2016 2017 2020
Revenue1 205-210 400-425 700-900
GAAP Operating Income 295-300 (25)-(30) 75-105
Adj. EBITDA1 (24)-(27) 0-5 105-135
Free Cash Flow2 (100) – (105) (25)-(30) 75-105
Note1: For 2016 only, Revenue = Non-GAAP Gross Cash Generated from Customer Contracting Activities; Adjusted EBITDA = Non-GAAP Net Cash
Generated from Customer Contracting Activities.
Note2: Free Cash Flow, a non-GAAP measure, includes changes in customer deposits and accrued service costs: 2016 ~($50); 2017 ~($15)
6
Significant Improvement Since 2013
Driven by Consistent Focus Across 5 Key Areas
Simplified pricing improves customer alignment
Expanded engagement model
Commercial Model
1
Adopted new architecture
Doubled IT development spend
Technology Platform
3
Overhauled Shared Services
Created operating system
Operational Framework
2
Overhauled organization and increased investment
Addressed internal control framework
Compliance
5
CFO customer satisfaction up 94% since 2013
Contract KPI’s on average up 78% since 2013
Customer Performance
4
Significant Investment Made to Enable Scaling
7
Healthcare Provider Dynamics
Increasing transactional complexity and declining reimbursement Tighter Margins
Industry consolidation Infrastructure is not prepared to deliver scale advantages
Scarce capital Care-related investments and acquisitions prioritized
Financial
Pressures
Increasing
Complexity
Declining
reimbursement
Increasing patient
responsibility
Emerging payment
models
ICD-10
Regional consolidation
Integration across
continuum of care
Aged technology &
fragmented solutions
Scarcity of human
capital
Industry Dynamics are Forcing Healthcare Providers to
Review Mission Critical RCM Strategies
Implications for Providers:
Industry
Consolidation
Capital
Constraints
8
Market Dynamics
Structural Growth with Shift to External Services Providers
Source: CMS NHE Projections, KPMG, R1 estimates
2015: $51.6B
In-House RCM Spend
External RCM Spend
Outsourced RCM Services
External RCM Apps / Software
52.2
8.8
7.7
16.5
Estimated Hospital Revenue Cycle Spend
43.3
4.5
3.8
8.3
15% CAGR
2020: $68.7B
9
Market Dynamics Impacting Traditional Approaches
Historical way market is served has not evolved to meet industry needs
− Consulting, point-solution technologies, transactional outsourcing
− Providers on the hook to get right outcome from fragmented solutions
− 70% of providers are expected to change approach over next 4 years
− Significant customer dissatisfaction
Market forces drive the need for a strong commercial partner
− Fatigue with lack of results from historical approach
− Provider consolidation increases pressure to deliver scale advantage
− Healthcare reform drives increasing reimbursement complexity
Holistic, High Performance Solution has the Potential to Drive
Growth Higher than Current Market Projections
10
Our Approach . . .
Holistic and Differentiated Relative to the Market
One Trusted Partner to Optimize the Revenue Cycle
Acute (serves 89 hospitals, >$20B
contracted NPR)
Physician (experience with 3,500+
physicians and >$1.8B NPR)
CARE SETTING
Order to Intake
Care to Claim
Claim to Payment
REVENUE CYCLE PHASES
Payor-based
− Fee for Service, Risk-based
Patient-based
− Insured/uninsured
PAYMENT MODELS
+ Comprehensive Coverage of Provider Requirements +
Flexible
Delivery Models
CO-MANAGED
Embedded managers,
processes & technologies in
the organization
OPERATING PARTNER
Full, risk-sharing
infrastructure partners
MODULAR
Targeted components of
revenue cycle
1
2
3
PERFORMANCE STACKSM
Robust and Proven
Operating Model
11
. . . Drives Meaningful Financial Improvement for
Customers . . .
Income
Statement
Bad Debt Expense
Denials
Bad Debt write-offs
Uncompensated Care (Bad
Debt + Charity)
Insured Patient Yield
Uninsured Patient Yield
Balance
Sheet
Discharged Not Final Billed
Total Gross AR Days
Credit AR Days
AR Days > 180
Customer
Service
Average Speed to Answer
Call Abandonment Rate
Data sourced from independent
3rd Party
− Validated for payment and
service level agreement (SLA)
service
This translates into real financial
impact. For typical $3B customer
achieved over 3 year period….
− $100M Income Statement
improvement
− $125M Balance Sheet working
capital improvement
Performance Metric Improvement >10% >25% >100%
R1 vs. Customer Internal (same customer) Summary of Impact
+
+
12
. . . And Outperforms Comparatives
-20.0%
-10.0%
0.0%
10.0%
20.0%
30.0%
40.0%
Provider 1
Provider 2
Provider 3
Ascension -
R1
Better Performance Drives Superior Overall Economics For Providers
AR Days1 Performance – % Increase/(Decrease) from FY 2011
2011 2012 2013 2014 2015
% Change – Decrease is Favorable
(16.7%)
+ 9.8%
+ 22.9%
+ 25.7%
% Incr. / (Decr.)
from 2011
Source: Definitive Healthcare Note1: Gross Accounts Receivable divided by average daily Gross Revenue
Comparison of a blinded cohort of
$10Bn+ systems that are served by
mature E2E RCM Providers
13
Growth Roadmap
Ascension Contract + 2016 Investments Provide
Confidence for Growth
Ascension Rollout Provides Growth Visibility Through 2020
Incremental New Business Wins
Expansion of Capabilities
Drive Margin Expansion
Strong execution of Ascension contracted business
Maximize growth potential inside of Ascension (Physician/Acquisitions)
Leverage brand launch & Ascension/TowerBrook partnership to expand pipeline
Invest in commercial organization capability & capacity; increase external focus
Maximize installed base to expand with full suite of R1 offerings (PAS, Technology)
Utilize healthy balance sheet to develop M&A pipeline
Commit capacity & technology to driving next wave of productivity
Utilize 2016 investments to drive scaling benefits
14
Financial Highlights
2016 investments drive confidence to scale with leverage
Expect doubling top line and returning to profitability in 2017
High visibility in long range forecast
− Contracted customers with high recurring revenue
Healthy balance sheet: strong cash balance, no debt
Adopting new revenue recognition in 2017 to simplify GAAP reporting
Contracted Revenue and 2016 Investments Drive
Confidence in Future Profitability
15
Capital Structure
~$180 million in cash and equivalents, as of 12/31/16
No Debt
Ascension/TowerBrook investment vehicle has warrants to acquire 60
million common shares at $3.50 per share
Can be exercised on a cash or cashless basis
Warrants
Cash and Debt
$200 million investment by Ascension/TowerBrook in February 2016
Equivalent to 80 million common shares issued, with 8% annual dividend
payable in kind on a quarterly basis for 7 years, and cash thereafterConvertible
Preferred Stock Common-equivalent share count progression (M shares)
Feb. 2016 Dec. 2017 Dec. 2020
80.0 91.0 115.4
107 million shares outstanding as of 12/31/16Common Stock
16
Market Offerings and Financial Impact
Three Compelling Offerings that Meet our Customers' Needs
Revenue EBITDA contribution
Year 1 Year 5
70-80
120-150
30-40
$M
~(12)
5-15
30-50
15-20
~(2.0)
10-20
3-12
$M $M
10-20
3-12
Co-ManagedOperating Partner Modular
Illustrative Revenue and EBITDA contribution based on typical $3B NPR
Year 1 Year 5 Year 1 Year 5
17
Financial Model for Operating Partner Offering
Evolution of Contribution of $3B NPR
Profitability Trends Up as Model is Fully Deployed
Growth
Deploy transition resources
Perform financial assessment
Invest in infrastructure
Implement technology
Finalize employee transitions
Transfers to Shared Services
Complete standardization
Steady state org structure
Continuous optimization:
− KPI metric improvement
− Technology advancement
− Productivity improvement
Financial Impact – $M
Mid-Point of
Range
Revenue 120
EBITDA contribution 17
EBITDA contribution % 14%
0 – 12 Months 12 – 36 Months 36+ Months
Launch Steady State
Financial Impact – $M
Mid-Point
of Range
Revenue 75
EBITDA contribution (12)
EBITDA contribution % (16%)
Financial Impact – $M
Mid-Point
of Range
Revenue 135
EBITDA contribution 35
EBITDA contribution % 26%
Illustrative
18
Long Term Outlook
Accelerating Growth 2017 to 2020
Positioned to Drive 2017 Profitability & Meet 2020 Projections
2017 Outlook & Improvement from 2016
High visibility to 2020 projections
Currently contracted business delivers 90%+ of the low end of the 2020 projection
Expect to turn cash flow positive in 2H 2017
Highlights
$M 2016 2017 2020
Revenue1 205-210 400-425 700-900
GAAP Operating Income 295-300 (25)-(30) 75-105
Adj. EBITDA1 (24)-(27) 0-5 105-135
Free Cash Flow2 (100) – (105) (25)-(30) 75-105
Note1: For 2016 only, Revenue = Non-GAAP Gross Cash Generated from Customer Contracting Activities; Adjusted EBITDA = Non-GAAP Net Cash
Generated from Customer Contracting Activities.
Note2: Free Cash Flow, a non-GAAP measure, includes changes in customer deposits and accrued service costs: 2016 ~($50); 2017 ~($15)
19
Investment Summary
RCM market continues to be underdeveloped with high-growth
potential
Significant investments made since 2013 to strengthen and re-establish
leadership position
Only pure-play RCM provider with a comprehensive technology-
enabled solution
Compelling growth story underpinned by strong fundamentals
20
Use of Non-GAAP Financial Measures
In order to provide a more comprehensive understanding of the information used by R1’s management team in financial and operational
decision making, the Company supplements its GAAP consolidated financial statements with certain non-GAAP financial measures, which
are included in this presentation on a projected basis. These include Gross Cash Generated from Customer Contracting Activities, Net Cash
Generated from Customer Contracting Activities , Free Cash Flow, and adjusted EBITDA. Our Board and management team use these non-
GAAP measures as (i) one of the primary methods for planning and forecasting overall expectations and for evaluating actual results against
such expectations; and (ii) a performance evaluation metric in determining achievement of certain executive incentive compensation
programs, as well as for incentive compensation plans for employees.
Gross Cash Generated from Customer Contracting Activities is defined as GAAP net services revenue, plus the change in deferred customer
billings. Accordingly, Gross Cash Generated from Customer Contracting Activities is the sum of (i) invoiced or accrued net operating fees, (ii)
cash collections on incentive fees and (iii) other services fees. Net Cash Generated from Customer Contracting Activities reflects non-GAAP
adjusted EBITDA and the change in deferred customer billings. The Company anticipates that it will no longer report Gross Cash Generated
from Customer Contracting Activities and Net Cash Generated from Customer Contracting Activities once it adopts the new revenue
recognition accounting standard in 2017.
Adjusted EBITDA is defined as net income before net interest income (expense), income tax provision, depreciation and amortization
expense, share-based compensation, transaction-related expenses, reorganization-related expenses and certain other items. The use of
adjusted EBITDA to measure operating and financial performance is limited by our revenue recognition criteria, pursuant to which GAAP
net services revenue is recognized at the end of a contract or other contractual agreement event. Adjusted EBITDA does not adequately
match corresponding cash flows from customer contracting activities. As a result, the Company uses Gross and Net Cash Generated from
Customer Contracting Activities to better compare cash flows to operating performance.
Free Cash Flow is defined as cash flow from operations, less capital expenditures. For 2017 and 2020 the Company expects Free Cash Flow
to be approximately equal to GAAP Operating Income provided on slide 21 and, therefore, no reconciliation is provided.
Deferred customer billings include the portion of both (i) invoiced or accrued net operating fees and (ii) cash collections of incentive fees, in
each case, that have not met our revenue recognition criteria. Deferred customer billings are included in the detail of our customer
liabilities balance in the consolidated balance sheet available in the Company’s Quarterly Report on Form 10-Q for the quarter ended
September 30, 2016.
These adjusted measures are non-GAAP and should be considered in addition to, but not as a substitute for, the information prepared in
accordance with GAAP.
21
Reconciliation of GAAP to Non-GAAP Financial Measures
($M) 2016
GAAP Revenue 589-594
Change in deferred customer billings ~(384)
Gross Cash Generated from Customer Contracting Activities 205-210
Reconciliation of GAAP Revenue Guidance to Non-GAAP Gross Cash Generated from
Customer Contracting Activities
Reconciliation of GAAP Operating Income Guidance to Non-GAAP Adjusted EBITDA Guidance
($M) 2016 2017 2020
GAAP Operating Income Guidance 295-300 (25) - (30) 75 - 105
Plus: Change in deferred customer billings ~(384) 0 0
Depreciation and amortization expense ~10 ~15 10 - 15
Share-based compensation expense ~28 ~13 10 - 15
Transaction costs, severance and other ~22 ~5 ~5
Adjusted EBITDA Guidance (24) - (27) 0 - 5 105 - 135
1
Note1: For 2016, Adjusted EBITDA = Non-GAAP Net Cash generated from customer contracting activities.
($M) 2016
GAAP Operating Income 295 - 300
Adjustments to reconcile Operating Income to Fee Cash Flow:
Change in customer liabilities ~(434)
Change in other assets and liabilities ~5
Depreciation and amortization expense ~10
Share-based compensation expense ~28
Capital expenditures ~(14)
Free Cash Flow (100) - (105)
Reconciliation of 2016 GAAP Operating Income to Free Cash Flow