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Bright Health Group Reports First Quarter 2023 Results

NEUE

  • Q1’23 Revenue from Continuing Business of$756.3 million, up 23% year over year on strong growth in Consumer Care external value-based consumers served
  • Q1’23 Net Loss from Continuing Business of $94.8 million, Adjusted EBITDA Loss of $35.1 million
  • Consumer Care segment generated positive Operating Income in Q1’23
  • Q1’23 California MCR was 89.0% excluding prior period Medical Costs, consistent with seasonal expectations
  • Maintaining expectation for 2023 consolidated Adjusted EBITDA profitability

Bright Health Group, Inc. (“Bright Health” or the “Company”) (NYSE: BHG), the technology enabled, value-driven healthcare company serving aging and underserved consumers with unmet clinical needs, today reported financial results for its first quarter ended March 31, 2023.

“Bright Health had a strong start to the year in the First Quarter. The Consumer Care segment generated positive Operating Income, and the Medical Cost Ratio in our Medicare Advantage business was in-line with our expectations after adjusting for prior period costs and given normal seasonality patterns,” said Mike Mikan, President and CEO of Bright Health. “Our Consumer Care business continued to add value-based care consumers in the First Quarter, and along with strength in our REACH ACO business, we believe that the segment is positioned well for long-term profitable growth.”

Key Metrics

As of March 31,

2023

2022

Consumer and Patient Metrics

Bright HealthCare Consumers

123,000

120,000

Consumer Care Value-Based Consumers

373,000

530,000

Three Months Ended

($ in thousands)

March 31

2023

2022

Financial Metrics

Revenue

$

756,341

$

613,263

Medical Cost Ratio - Bright HealthCare1

95.0

%

96.7

%

Net Loss from Continuing Operations

$

(94,792

)

$

(163,514

)

Adjusted EBITDA (non-GAAP)

$

(35,053

)

$

(59,089

)

1 Bright HealthCare Medical Cost Ratio includes $27.5 million in prior period medical costs (608bps) in the three months ended March 31, 2023, and $2.1 million in prior period medical costs (49bps) in the three months ended March 31, 2022.

See the table at the end of this release for additional information and a reconciliation of the non-GAAP measures used in the table above.

Financial Outlook

For full year 2023, Bright Health is providing the following guidance and commentary:

Bright Health’s 2023 Revenue and Adjusted EBITDA profitability expectations are unchanged, while Adjusted Operating Cost Ratio now forecast for the high end of the prior range.

  • Bright Health’s Enterprise Revenue is expected to be between $2.9 billion and $3.1 billion
  • On a segment basis, Bright HealthCare Revenue is expected to be greater than $1.8 billion, while Consumer Care Revenue is expected to be between $1.1 billion and $1.3 billion
  • Enterprise Adjusted Operating Cost Ratio is expected to be approximately 14%
  • Bright Health expects to be Adjusted EBITDA profitable in 2023

Reconciliations of projected Adjusted EBITDA and projected Adjusted Operating Cost Ratio to the most directly comparable GAAP financial measures are not provided because the Company is unable to provide such reconciliations without unreasonable effort. The inability to provide a reconciliation is due to the uncertainty and inherent difficulty predicting the occurrence, the financial impact and the periods in which the non-GAAP adjustments may be recognized. With respect to Adjusted EBITDA, these GAAP measures may include the impact of such items as interest expense, income tax expense, depreciation and amortization, impairment of goodwill or intangible assets, transaction costs, share-based compensation expense, changes in the fair value of equity securities, changes in the fair value of contingent consideration, contract termination costs, restructuring costs; and the tax effect of all such items. Historically, the Company has excluded these items from non-GAAP financial measures. With respect to Adjusted Operating Cost Ratio, these GAAP measures may include the impact of such items as stock-based compensation, changes in the fair value of contingent consideration, contract termination costs, and depreciation and amortization. The Company currently expects to continue to exclude these items in future disclosures of non-GAAP financial measures and may also exclude other items that may arise (collectively, “non-GAAP adjustments”). The decisions and events that typically lead to the recognition of non-GAAP adjustments, such as a decision to exit part of the business, are inherently unpredictable as to if or when they may occur. For the same reasons, the Company is unable to address the probable significance of the unavailable information, which could be material to future results.

Earnings Conference Call

As previously announced, Bright Health Group will discuss the Company’s results, strategy, and outlook on a conference call with investors at 8:00 a.m. Eastern Time today. Bright Health Group will host a live webcast of this conference call which can be accessed from the Investor Relations page of the company’s website (investors.brighthealthgroup.com). Following the call, a webcast replay will be available on the same site. This earnings release and the Form 8-K filed May 9, 2023 can be accessed on the Investor Relations page of the Company’s website. We routinely post important information on our website, including corporate and investor presentations and financial information. We intend to use our website as a means of disclosing material, non-public information and for complying with our disclosure obligations under Regulation FD. Such disclosures will be included in the Investor Relations section of our website. Accordingly, investors should monitor this portion of our website, in addition to following our press releases, U.S. Securities and Exchange Commission (“SEC”) filings and public conference calls and webcasts.

About Bright Health Group

Bright Health Group is a technology enabled, value-driven healthcare company that organizes and operates networks of affiliate care providers to be successful at managing population risk. We focus on serving aging and underserved consumers that have unmet clinical needs through our Fully Aligned Care Model in Florida, Texas and California, some of the largest markets in healthcare where 26% of the U.S. aging population call home. We believe everyone should have access to personal, affordable, and high-quality healthcare. Our mission is to Make healthcare right. Together. For more information, visit www.brighthealthgroup.com.

Forward-Looking Statements

Statements made in this release that are not statements of historical fact, including statements about our beliefs and expectations, are forward-looking statements and should be evaluated as such. Forward-looking statements include information concerning possible or assumed future results of operations, including descriptions of our business plan and strategies. These statements often include words such as “anticipate,” “expect,” “plan,” “believe,” “intend,” “project,” “forecast,” “estimates,” “projections,” “outlook,” “ensure,” and other similar expressions. These forward-looking statements include any statements regarding our plans and expectations with respect to Bright Health Group, Inc. Such forward-looking statements are subject to various risks, uncertainties and assumptions. Accordingly, there are or will be important factors that could cause actual outcomes or results to differ materially from those indicated in these statements. Factors that might materially affect such forward-looking statements include: our ability to continue as a going concern; our ability to comply with the terms of our credit facility, including financial covenants, both during and after any waiver period, and/or obtain any additional waivers of any terms of our credit facility to the extent required; our ability to sell our Medicare Advantage business in California on acceptable terms, including our ability to receive the proceeds thereof in a manner that would alleviate our current financial position; our ability to quickly and efficiently wind down our IFP businesses and MA businesses outside of California; potential disruptions to our business due to our corporate restructuring and resulting headcount reduction; our ability to accurately estimate and effectively manage the costs relating to changes in our businesses offerings and models; a delay or inability to withdraw regulated capital from our subsidiaries; a lack of acceptance or slow adoption of our business model; our ability to retain existing consumers and expand consumer enrollment; our and our Care Partner’s abilities to obtain and accurately assess, code, and report risk adjustment factor scores; our ability to contract with care providers and arrange for the provision of quality care; our ability to accurately estimate our medical expenses, effectively manage our costs and claims liabilities or appropriately price our products and charge premiums; our ability to obtain claims information timely and accurately; the impact of the ongoing COVID-19 pandemic on our business and results of operations; the risks associated with our reliance on third-party providers to operate our business; the impact of modifications or changes to the U.S. health insurance markets; our ability to manage the growth of our business; our ability to operate, update or implement our technology platform and other information technology systems; our ability to retain key executives; our ability to successfully pursue acquisitions and integrate acquired businesses; the occurrence of severe weather events, catastrophic health events, natural or man-made disasters, and social and political conditions or civil unrest; our ability to prevent and contain data security incidents and the impact of data security incidents on our members, patients, employees and financial results; our ability to comply with requirements to maintain effective internal controls; our ability to adapt to the new risks associated with our expansion into ACO REACH; and the other factors set forth under the heading “Risk Factors” in the Company’s reports on Form 10-K, Form 10-Q, and Form 8-K (including all amendments to those reports) and our other filings with the SEC. Except as required by law, we undertake no obligation to update publicly any forward-looking statements for any reason after the date of this release to conform these statements to actual results or changes in our expectations.

Bright Health Group, Inc. and Subsidiaries

Consolidated Balance Sheets

(in thousands, except share and per share data)

(Unaudited)

March 31,
2023

December 31,
2022

Assets

Current assets:

Cash and cash equivalents

$

382,506

$

466,325

Short-term investments

12,112

13,206

Accounts receivable, net of allowance of $6,513 and $6,098, respectively

125,241

73,605

ACO REACH performance year receivable

882,884

99,181

Current assets of discontinued operations

2,225,739

2,783,474

Prepaids and other current assets

142,932

134,843

Total current assets

3,771,414

3,570,634

Other assets:

Long-term investments

3,816

5,401

Property, equipment and capitalized software, net

40,747

42,596

Goodwill

760,078

760,078

Intangible assets, net

242,286

249,083

Other non-current assets

29,664

37,260

Total other assets

1,076,591

1,094,418

Total assets

4,848,005

4,665,052

Liabilities, Redeemable Noncontrolling Interest, Redeemable Preferred Stock and Shareholders’ Equity (Deficit)

Current liabilities:

Medical costs payable

$

458,465

$

411,753

Accounts payable

33,638

67,854

Unearned revenue

139,416

242

ACO REACH performance year obligation

719,420

Short-term borrowings

303,947

303,947

Current liabilities of discontinued operations

2,225,739

2,783,474

Other current liabilities

131,256

121,424

Total current liabilities

4,011,881

3,688,694

Other liabilities

32,191

36,673

Total liabilities

4,044,072

3,725,367

Redeemable noncontrolling interests

223,503

219,758

Redeemable Series A preferred stock, $0.0001 par value; 750,000 shares authorized in 2023 and 2022; 750,000 shares issued and outstanding in 2023 and 2022

747,481

747,481

Redeemable Series B preferred stock, $0.0001 par value; 175,000 shares authorized in 2023 and 2022; 175,000 shares issued and outstanding in 2023 and 2022

172,936

172,936

Shareholders’ equity (deficit):

Common stock, $0.0001 par value; 3,000,000,000 shares authorized in 2023 and 2022; 636,142,597 and 630,271,508 shares issued and outstanding in 2023 and 2022, respectively

63

63

Additional paid-in capital

3,005,592

2,972,271

Accumulated deficit

(3,331,406

)

(3,156,395

)

Accumulated other comprehensive loss

(2,236

)

(4,429

)

Treasury Stock, at cost, 2,522,148 shares at March 31, 2023, and December 31, 2022, respectively

(12,000

)

(12,000

)

Total shareholders’ equity (deficit)

(339,987

)

(200,490

)

Total liabilities, redeemable noncontrolling interests, redeemable preferred stock and shareholders’ equity (deficit)

$

4,848,005

$

4,665,052

Bright Health Group, Inc. and Subsidiaries

Consolidated Statements of Income (Loss)

(in thousands, except share and per share data)

(Unaudited)

Three Months Ended March 31,

2023

2022

Revenue:

Premium revenue

$

502,918

$

458,962

ACO REACH revenue

239,807

182,797

Service revenue

13,570

12,392

Investment income (loss)

46

(40,888

)

Total revenue

756,341

613,263

Operating expenses:

Medical costs

688,515

594,248

Operating costs

140,324

159,117

Restructuring charges

3,357

6,864

Depreciation and amortization

9,891

12,897

Total operating expenses

842,087

773,126

Operating loss

(85,746

)

(159,863

)

Interest expense

7,787

1,193

Other income

(784

)

Loss from continuing operations before income taxes

(93,533

)

(160,272

)

Income tax expense

1,259

3,242

Net loss from continuing operations

(94,792

)

(163,514

)

Loss from discontinued operations, net of tax

(74,669

)

(17,115

)

Net Loss

(169,461

)

(180,629

)

Net earnings from continuing operations attributable to noncontrolling interests

(5,550

)

(14,605

)

Series A preferred stock dividend accrued

(9,714

)

(8,938

)

Series B preferred stock dividend accrued

(2,180

)

Net loss attributable to Bright Health Group, Inc. common shareholders

$

(186,905

)

$

(204,172

)

Basic and diluted loss per share attributable to Bright Health Group, Inc. common shareholders

Continuing operations

$

(0.18

)

$

(0.30

)

Discontinued operations

(0.12

)

(0.02

)

Basic and diluted loss per share

(0.30

)

(0.32

)

Basic and diluted weighted-average common shares outstanding

631,534

628,765

Bright Health Group, Inc. and Subsidiaries

Consolidated Statements of Cash Flows

(in thousands)

(Unaudited)

Three Months Ended March 31,

2023

2022

Cash flows from operating activities:

Net loss

$

(169,461

)

$

(180,629

)

Adjustments to reconcile net loss to net cash provided by operating activities:

Depreciation and amortization

9,891

13,041

Impairment of intangible assets

6,720

Share-based compensation

33,320

32,921

Deferred income taxes

436

717

Unrealized loss on equity securities

40,968

Other, net

(2,807

)

2,378

Changes in assets and liabilities, net of acquired assets and liabilities:

Accounts receivable

(43,409

)

(29,221

)

ACO REACH performance year receivable

(783,703

)

(638,641

)

Other assets

22,448

(22,270

)

Medical cost payable

(423,459

)

337,180

Risk adjustment payable

4,153

354,276

Accounts payable and other liabilities

(119,416

)

52,182

Unearned revenue

137,563

(18,402

)

ACO REACH performance year obligation

719,420

533,537

Net cash (used in) provided by operating activities

(615,024

)

484,757

Cash flows from investing activities:

Purchases of investments

(2,880

)

(782,091

)

Proceeds from sales, paydown, and maturities of investments

690,161

154,765

Purchases of property and equipment

(1,863

)

(5,491

)

Business divestitures, net of cash disposed of

1,370

Business acquisitions, net of cash acquired

(310

)

Net cash provided by (used in) investing activities

686,788

(633,127

)

Cash flows from financing activities:

Net proceeds from short-term borrowings

(155,000

)

Proceeds from issuance of preferred stock

747,481

Proceeds from issuance of common stock

1

257

Distributions to noncontrolling interest holders

(1,805

)

Net cash (used in) provided by financing activities

(1,804

)

592,738

Net increase in cash and cash equivalents

69,960

444,368

Cash and cash equivalents – beginning of year

1,932,290

1,061,179

Cash and cash equivalents – end of period

$

2,002,250

$

1,505,547

Supplemental disclosures of cash flow information:

Changes in unrealized loss on available-for-sale securities in OCI

$

2,193

$

(26,340

)

Cash paid for interest

7,157

1,168

Bright Health Group, Inc. and Subsidiaries

Segment Information

(in thousands)

(Unaudited)

Bright HealthCare

($ in thousands)

Three Months Ended
March 31,

Statement of income (loss) and operating data:

2023

2022

Revenue:

Premium revenue

$

453,370

$

430,313

Investment income (loss)

46

80

Total revenue

453,416

430,393

Operating expenses

Medical costs

430,928

416,200

Operating costs

49,453

41,117

Depreciation and amortization

4,408

4,459

Total operating expenses

484,789

461,776

Operating loss

$

(31,373

)

$

(31,383

)

Medical Cost Ratio (MCR)(1)

95.0

%

96.7

%

(1) Bright HealthCare medical cost ratio includes $27.5 million in prior period medical costs (608bps) in the three months ended March 31, 2023, and $2.1 million in prior period medical costs (49bps) in the three months ended March 31, 2022.

Consumer Care

($ in thousands)

Three Months Ended
March 31,

Statement of income (loss) and operating data:

2023

2022

Revenue:

Premium revenue

$

49,548

$

28,649

Affiliated revenue

368,053

ACO REACH revenue

239,807

182,797

Service revenue

13,570

12,392

Investment income (loss)

(40,968

)

Total revenue

302,925

550,923

Operating expenses

Medical costs

257,587

566,694

Operating costs

37,814

47,281

Depreciation and amortization

3,132

7,002

Total operating expenses

298,533

620,977

Operating income (loss)

$

4,392

$

(70,054

)

Bright Health Group, Inc. and Subsidiaries

Historical Financials

Recast Income Statement(1)

(in thousands)

($ in thousands)

Three Months Ended

Consolidated Statements of Income (loss) and operating data:

March 31,

June 30,

September 30,

December 31,

2022

2022

2022

2022

Revenue:

Premium revenue

$

458,962

$

437,234

$

423,995

$

444,758

ACO REACH revenue

182,797

137,205

145,433

188,652

Service revenue

12,392

12,811

12,079

10,731

Investment income (loss)

(40,888

)

(16,213

)

4,882

(2,800

)

Total revenue

613,263

571,037

586,389

641,341

Operating costs

Medical costs

594,248

507,322

506,235

598,438

Operating costs

159,117

140,650

146,532

185,731

Restructuring charges

6,864

2,791

1,215

20,869

Goodwill impairment

70,017

1,208

Intangibles impairment

42,611

Depreciation and amortization

12,897

13,227

13,904

10,402

Total operating costs

773,126

663,990

780,514

816,648

Operating loss

(159,863

)

(92,953

)

(194,125

)

(175,307

)

Interest expense

1,193

337

4,905

6,386

Other income

(784

)

2

(2

)

Loss from continuing operations before income taxes

(160,272

)

(93,292

)

(199,028

)

(181,693

)

Income tax expense (benefit)

3,242

2,904

1,762

(4,228

)

Net loss from continuing operations

(163,514

)

(96,196

)

(200,790

)

(177,465

)

Loss from discontinued operations, net of tax

(17,115

)

(155,134

)

(69,339

)

(480,327

)

Net loss

(180,629

)

(251,330

)

(270,129

)

(657,792

)

Net earnings from continuing operations attributable to noncontrolling interests

(14,605

)

(23,336

)

(46,711

)

(11,012

)

Series A preferred stock dividend accrued

(8,938

)

(9,461

)

(9,684

)

(9,806

)

Series B preferred stock dividend accrued

(1,798

)

Net loss attributable to Bright Health

Group, Inc. common shareholders

$

(204,172

)

$

(284,127

)

$

(326,524

)

$

(680,408

)

Operating Cost Ratio

25.9

%

24.6

%

25.0

%

29.0

%

(1)The 2022 quarterly Statements of Income (Loss) have been recast to reflect the move of the IFP business to discontinued operations as well as to correct the accounting for gross versus net revenue recognition conclusion from certain value-based care arrangements and an error identified in the data to account for our risk adjustment factor.

Bright Health Group, Inc. and Subsidiaries

Historical Financials

Recast Segment Information (1)

(in thousands)

(Unaudited)

Bright HealthCare

Recast 2022 Segment Information

($ in thousands)

Three Months Ended

March 31,

June 30,

September 30,

December 31,

Statement of income (loss) and operating data:

2022

2022

2022

2022

Revenue:

Premium revenue

$

430,313

$

419,594

$

390,989

$

411,149

Investment income (loss)

80

(29

)

36

323

Total revenue

430,393

419,565

391,025

411,472

Operating expenses

Medical costs

416,200

378,801

355,347

400,586

Operating costs

41,117

43,513

43,291

59,715

Goodwill impairment

70,017

Depreciation and amortization

4,459

4,416

4,416

4,411

Total operating expenses

461,776

426,730

473,071

464,712

Operating loss

$

(31,383

)

$

(7,165

)

$

(82,046

)

$

(53,240

)

Medical Cost Ratio (MCR)

96.7

%

90.3

%

90.9

%

97.4

%

Consumer Care

Recast 2022 Segment Information

($ in thousands)

Three Months Ended

March 31,

June 30,

September 30,

December 31,

Statement of income (loss) and operating data:

2022

2022

2022

2022

Revenue:

Premium revenue

$

28,649

$

17,640

$

33,006

$

33,609

Affiliated revenue

368,053

203,965

250,594

206,421

ACO REACH revenue

182,797

137,205

145,433

188,652

Service revenue

12,392

12,811

12,079

10,731

Investment income (loss)

(40,968

)

(16,184

)

4,846

(3,123

)

Total revenue

550,923

355,437

445,958

436,290

Operating expenses

Medical costs

566,694

326,532

403,069

548,283

Operating costs

47,281

40,320

46,302

57,799

Goodwill impairment

1,208

Intangible assets impairment

42,611

Depreciation and amortization

7,002

7,195

6,375

3,680

Total operating expenses

620,977

374,047

498,357

610,970

Operating loss

$

(70,054

)

$

(18,610

)

$

(52,399

)

$

(174,680

)

(1)The 2022 segment financials have been recast to reflect the move of the IFP business to discontinued operations as well as to correct the accounting for gross versus net revenue recognition conclusion from certain value-based care arrangements and an error identified in the data to account for our risk adjustment factor.

Non-GAAP Financial Measures

We use the non-GAAP financial measures Adjusted EBITDA and Adjusted Operating Cost Ratio. We define Adjusted EBITDA as Net Loss excluding loss from discontinued operations, Interest Expense, Income Taxes, Depreciation and Amortization, adjusted for the impact of impairment of goodwill or intangible assets, acquisition and financing-related transaction costs, share-based compensation, changes in the fair value of contingent consideration, changes in the fair value of equity securities, contract termination and other exit costs and restructuring costs. We define Adjusted Operating Cost Ratio as Operating Cost Ration excluding share-based compensation. These non-GAAP measures have been presented in this quarterly Earnings Release as supplemental measures of financial performance that are not required by or presented in accordance with GAAP because we believe they assist management and investors in comparing our operating performance across reporting periods on a consistent basis by excluding and including items that we do not believe are indicative of our core operating performance. Management believes these measures are useful to investors in highlighting trends in our operating performance, while other measures can differ significantly depending on long-term strategic decisions regarding capital structure, the tax jurisdictions in which we operate and capital investments. Management uses Adjusted EBITDA and Adjusted Operating Cost Ratio to supplement GAAP measures of performance in the evaluation of the effectiveness of our business strategies, to make budgeting decisions, to establish discretionary annual incentive compensation and to compare our performance against that of other peer companies using similar measures. Management supplements GAAP results with non-GAAP financial measures to provide a more complete understanding of the factors and trends affecting the business than GAAP results alone.

Adjusted EBITDA is not a recognized term under GAAP and should not be considered as an alternative to Net Income (Loss) as a measure of financial performance or any other performance measure derived in accordance with GAAP. Additionally, Adjusted EBITDA is not intended to be a measure of free cash flow available for management’s discretionary use as it does not consider certain cash requirements such as interest payments, tax payments and debt service requirements. The presentation of Adjusted EBITDA has limitations as an analytical tool and should not be considered in isolation or as a substitute for analysis of our results as reported under GAAP. Because not all companies use identical calculations, the presentation of these measures may not be comparable to other similarly titled measures of other companies and can differ significantly from company to company.

Adjusted Operating Cost Ratio is not a recognized term under GAAP and should not be considered as an alternative to Operating Cost Ratio as a measure of financial performance or any other performance measure derived in accordance with GAAP. The presentation of Adjusted Operating Cost Ratio has limitations as an analytical tool and should not be considered in isolation or as a substitute for analysis of our results as reported under GAAP. Because not all companies use identical calculations, the presentation of these measures may not be comparable to other similarly titled measures of other companies and can differ significantly from company to company.

The following table provides a reconciliation of net loss to Adjusted EBITDA for the periods presented:

Three Months Ended
March 31,

($ in thousands)

2023

2022

Net loss

$

(169,461

)

$

(180,629

)

Loss from discontinued operations (a)

74,669

17,115

EBITDA adjustments from continuing operations:

Interest expense

7,787

1,193

Income tax expense (benefit)

1,259

3,242

Depreciation and amortization

9,891

12,897

Transaction costs (b)

1,849

852

Share-based compensation expense (c)

33,320

32,921

Change in fair value of equity securities

40,968

Change in fair value of contingent consideration (d)

(1,827

)

Termination and other exit costs (e)

4,157

5,488

Restructuring costs (f)

3,303

6,864

EBITDA adjustments from continuing operations

$

59,739

$

104,425

Adjusted EBITDA

$

(35,053

)

$

(59,089

)

(a)

Beginning in the fourth quarter of 2022, Adjusted EBITDA excludes the impact of discontinued operations. The comparable period in 2022 has been recast to exclude these impacts. Represents losses associated with the Commercial business segment that we exited at the end of 2022.

(b)

Transaction costs include accounting, tax, valuation, consulting, legal and investment banking fees directly relating to financing initiatives. These costs can vary from period to period and impact comparability, and we do not believe such transaction costs reflect the ongoing performance of our business.

(c)

Represents non-cash compensation expense related to stock option and restricted stock unit award grants, which can vary from period to period based on a number of factors, including the timing, quantity and grant date fair value of the awards.

(d)

Represents the non-cash change in fair value of contingent consideration from business combinations, which is remeasured at fair value each reporting period.

(e)

Represents amounts paid for early termination of existing vendor contracts and, beginning in 2023, includes the impact of our MA legacy operations that we exited at the end of 2022. The adjustment in the comparable period in 2022 has been recast to include these impacts.

(f)

Restructuring costs represent severance costs as part of a workforce reduction and impairment of certain long-lived assets relating to our decision to exit the Commercial business for the 2023 plan year.

The following table provides a reconciliation of Adjusted Operating Cost Ratio for the periods presented:

Three Months Ended
March 31,

($ in thousands)

2023

2022

Operating Cost Ratio

18.6%

25.9%

Impact of Share-based compensation expense

(4.4)%

(5.4)%

Adjusted Operating Cost Ratio

14.1%

20.6%



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