The following discussion should be read in conjunction with our consolidated financial statements and accompanying notes included elsewhere in this Annual Report on Form 10-K. In addition, the following discussion and analysis and information contains forward-looking statements about the business, operations and financial performance of the Company based on our current expectations that involve risks, uncertainties and assumptions. Our actual results could differ materially from those anticipated by these forward-looking statements as a result of many factors. including, but not limited to, those identified below and those discussed in the sections titled "Risk Factors" and "Information Regarding Forward-Looking Statements" in this Annual Report on Form 10-K.
Overview
Privia Health is a technology-driven, national physician-enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual care settings on the "Privia Platform". We directly address three of the most pressing issues facing physicians today: the transition to the VBC reimbursement model, the ever-increasing administrative requirements to operate a successful medical practice and the need to engage patients using modern user-friendly technology. We seek to accomplish these objectives by entering markets and organizing existing physicians and non-physician clinicians into a unique practice model that combines the advantages of a partnership in a large regionalMedical Group with significant local autonomy for Privia Providers joining our Medical Groups. Our Medical Groups are designated as in-network by all major health insurance payers in all of our markets and all Privia Providers are credentialed with such health insurance payers. Under our standard model, Privia Physicians join theMedical Group in their geographic market as an owner of theMedical Group . Certain of our Medical Groups are Owned Medical Groups, with Privia Physicians owning a minority interest. However, in those markets in which state regulations do not allow us to own physician practices, the Medical Groups are Non-Owned Medical Groups or Friendly Medical Groups. Privia Physicians who owned their own practices prior to joining Privia continue to own their Affiliated Practices, but those Affiliated Practices no longer furnish healthcare services. The Medical Groups have no ownership in the underlying Affiliated Practices, but the Affiliated Practices do provide certain services to our Medical Groups, such as use of space, non-physician staffing, equipment and supplies. We provide management services to eachMedical Group through a local MSO established with the objective of maximizing the independence and autonomy of our Affiliated Practices, while providing Medical Groups with access to VBC opportunities either directly or through Privia-owned ACOs. We have national committees that distribute quality guidance, and we employ Chief Medical Officers who provide clinical oversight and direction over the clinical affairs of the Owned Medical Groups. Additionally, we hold the provider contracts, maintain the patient records, set reimbursement rates, and negotiate payer contracts on behalf of the Owned Medical Groups and the owned ACOs.
GAAP Financial Measures
• Revenue was
ended
• Operating (loss) income was
million
• Net (loss) income attributable to
million
2022
Key Metrics and Non-GAAP Financial Measures
• Practice Collections was
the years ended
• Care Margin was
years ended
• Platform Contribution was
for the years ended
• Adjusted EBITDA was
years ended
See "Key Metrics and Non-GAAP Financial Measures" for more information as to how we define and calculate Implemented Providers, Attributed lives, Practice Collections, Care Margin, Platform Contribution, Platform Contribution Margin, Adjusted EBITDA and Adjusted EBITDA Margin, and for a reconciliation of income from operations, the most comparable GAAP measure, to Care Margin, income from operations, the most comparable GAAP measure, to Platform Contribution, and net (loss) income, the most comparable GAAP measure, to Adjusted EBITDA. 68
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The COVID-19 Pandemic and the Coronavirus Aid, Relief and Economic Stimulus Act
(“CARES Act”)
As the COVID-19 pandemic evolves, disruptions caused by the pandemic and
recurring COVID-19 outbreaks, including outbreaks caused by different virus
variants, could potentially impact the Company and its future results of
operations, cash flows and financial position.
OnMarch 27, 2020 , the CARES Act was passed. It is intended to provide economic relief to individuals and businesses affected by the coronavirus pandemic. It also contains provisions related to healthcare providers' operations and the issues caused by the coronavirus pandemic. The following are significant economic impacts for the Company and its subsidiaries as a result of specific provisions of the CARES Act for the years endedDecember 31, 2022 and 2021: •The Company elected to defer its portion ofSocial Security taxes in 2020, which was repaid over two years as follows: 50% at the end of 2021 and 50% at the end of 2022; and •The Company received$0.8 million and$13.3 million in grant funds from theProvider Relief Fund under the CARES Act during the year endedDecember 31, 2021 and 2020. The Company did not receiveProvider Relief Fund under the CARES Act during the year endedDecember 31, 2022 .
Our Revenue
We recognize revenue from multiple stakeholders, including health care consumers, health insurers, federal and state governments, employers, providers and health systems. Our revenue includes (i) FFS revenue generated from providing healthcare services to patients through Privia Providers of Owned Medical Groups or administrative fees collected for providing administrative services to Non-Owned Medical Groups, (ii) VBC revenue collected on behalf of our providers, primarily capitated revenue, shared savings (including surplus payments, shared savings, total cost of care budget payments and similar payments) and per member per month (PMPM) fees (including care management fees, management services fees, care coordination fees and all other similar administrative fees), and (iii) other revenue from additional services, such as concierge services, virtual visits, virtual scribes and coding.
FFS Revenue
We generate FFS-patient care revenue when we collect reimbursements for FFS medical services provided by Privia Providers. Our agreements with our providers have a multi-year term length and we have historically experienced a 95% provider retention rate, both of which lead to a highly predictable and recurring revenue model. Our FFS contracts with payer partners typically contain annual rate inflators and enhanced commercial FFS rates given our scale in each of our markets. As a result of receiving these rate inflators and enhancements, if we continue to be successful in expanding our provider base, we expect revenue will grow year-over-year in absolute dollars. In addition, in our FFS-patient care revenue, we include collections generated from ancillary services such as clinical laboratory, imaging and pharmacy operations. We also generate FFS-administrative services revenue by providing administration and management services to medical groups which are not owned or consolidated by us. FFS-patient care revenue represented 64.1%, 79.9% and 79.2% for the years endedDecember 31, 2022 , 2021 and 2020, respectively. FFS-administrative services revenue represented 7.0%, 7.1% and 7.1% for the years endedDecember 31, 2022 , 2021 and 2020, respectively. VBC Revenue Over time, we create incremental value for our provider partners by enabling them to succeed in VBC arrangements. We generate VBC revenue when our providers are reimbursed through traditional FFS Medicare, MSSP, Medicare Advantage, commercial payers and other existing and emerging direct payer and employer contracting programs. The revenue is collected in the form of (i) capitated revenue, (ii) shared savings earned based on improved quality and lower cost of care for our attributed patients in VBC arrangements earned primarily through Privia-owned ACOs and (iii) PMPM care management fees to cover costs of services typically not reimbursed under traditional FFS payment models, including population management, care coordination, advanced technology and analytics. VBC revenue represented 28.5%, 12.4% and 11.4% for the years endedDecember 31, 2022 , 2021 and 2020, respectively. We expect VBC revenue to continue to increase as a percentage of total revenue as we grow total Attributed Lives under management as well as increase risk levels undertaken across value-based arrangements.
Other Revenue
The remainder of our revenue is derived from leveraging our existing base of providers and patients to deliver value-oriented services such as virtual visits, virtual scribes and coding. Other revenue represented 0.4%, 0.6% and 2.2% of total revenue for the years endedDecember 31, 2022 , 2021 and 2020, respectively. Provider Relief Funds under the CARES Act have been recorded within other revenue on the statement of operation for the years endedDecember 31, 2021 and 2020. 69
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Key Factors Affecting Our Performance
Addition of New Providers
Our ability to increase our provider base will enable us to deliver financial growth as our providers generate both our FFS and VBC revenue. Our existing provider penetration and market share provides us with significant opportunity to grow in both existing and new geographies, and we believe the number of providers joining Privia is a key indicator of the market's recognition of the attractiveness of our platform to our providers, patients and payers. We intend to increase our provider base in existing and new markets by adding new practices and assisting our existing practices with recruiting new providers, using our in-market and national sales and marketing teams. As we add providers to the Privia Platform, we expect them to contribute incremental economics as we leverage our existing brand and infrastructure, both at the corporate and in-market levels.
Addition of New Patients
Our ability to add new patients to our provider base in existing and new markets will also enable us to deliver revenue growth in both our FFS and VBC contracts. We believe the number of attributed patient lives in VBC programs is a key driver of our VBC revenue growth. Our branding and marketing strategies to drive growth in our practices has continued to result in increased engagement with new and existing patients. We believe our continued success in growing the visibility of the Privia brand will result in increased patient panels per provider and contribute incremental revenue in both FFS and VBC for our practices.
Expansion to New Markets
Based upon our experience to date, we believe Privia can succeed in all reimbursement environments and payment models. The data we collected from older provider cohorts consistently suggest that we improve their performance in both FFS and VBC metrics over time and inform our expectations for our new markets. We believe our in-market operating structure and ability to serve providers wherever they are on their transition to VBC can benefit physicians and providers throughout theU.S. and that our solution is applicable across all 50 states. We enter a market with an asset-light operating model and employ a disciplined, uniform approach to market structure and development. We partner with market leading medical groups and health systems to form anchor relationships and align other independent, affiliated, or employed providers into a single-TIN medical group. Our business model also gives us flexibility for future, incremental growth through the acquisition of minority or majority stakes in our practices and opening de-novo, fully-owned sites of care focused on Medicare Advantage and direct contracting models. InFebruary 2022 , the Company announced a partnership with Surgery Partners, Inc. forPrivia Health to enter theState of Montana withGreat Falls Clinic , a multi-specialty practice with approximately 65 providers spanning 24 specialties. A wholly owned subsidiary of Surgery Partners,Great Falls Clinic will serve asPrivia Health's anchor practice in the state.Privia Health will also provide performance operations services and technology capabilities toGreat Falls Clinic as well as to new providers inMontana who join the Privia Platform.
In
partnership with
launch
physicians and provider groups throughout
reduce administrative burden and enable care insights and collaboration, as well
as to support their transition to value-based care.
In
not-for-profit community healthcare system located in
to launch an ACO in that state.
InFebruary 2023 , we announced a partnership withCommunity Medical Group , the largest Clinically Integrated Network ("CIN") inConnecticut with approximately 1,100 multi-specialty providers, to launch Privia Quality Network ofConnecticut .
Provider Satisfaction and Retention
Privia Providers have high satisfaction with their overall performance on our platform, and we strive to continuously improve provider well-being and patient satisfaction. Our percentage of collections model combined with high patient and provider satisfaction results in 90%+ Practice Collections predictability on a rolling twelve month forward basis. We believe these metrics demonstrate the stability of our provider base and the appeal to prospective providers and patients of our platform.
Payer Contracts and Ability to Move Markets to VBC
Our FFS and VBC revenue is dependent upon our contracts and relationships with
payers. We partner with a large and diverse set of payer groups nationally and
in each of our markets to form provider networks and to lower the overall cost
of care, and we structure bespoke contracts to help both providers and payers
achieve their objectives in a mutually aligned manner. Maintaining, supporting
and increasing the number of these contracts and relationships, particularly as
we enter new markets, is important for our long-term success. We typically enter
into multiyear contracts with our Medical Groups, Privia Physicians, health
system or hospital partners, ACO participants and payer customers, which often
have a stated initial term of three years and automatically renew for successive
one-year terms. From time to time, we may renegotiate or attempt to renegotiate
our payer contracts in the ordinary course of business prior to the expiration
of their stated terms. If the counterparties fail to renew their contracts,
renew their contracts upon less favorable
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terms or at lower fee levels or fail to utilize additional products and services obtained from us, or if we fail to renegotiate contracts with our counterparties on favorable terms or at all, our revenue may decline and our future revenue growth may be constrained. Our ability to work within each geographic market as it evolves in its shift towards VBC, with our experience working in all reimbursement environments, enables providers to accelerate and succeed in their transition. Our model is aligned with our payer partners, as we have demonstrated improved patient outcomes while driving incremental revenue growth. We intend to accelerate the move towards the adoption of VBC reimbursement in each market in current and emerging payer programs. To do so, we will need to continue enhancing our VBC capabilities and executing on initiatives to deliver next generation access, superior quality metrics and lower cost of care.Privia Health launched three new Accountable Care Organizations (ACOs) at the beginning of 2022 and three new ACOs in the first two months of 2023, expanding the total number of Privia-owned ACOs to ten, serving beneficiaries across theDistrict of Columbia and eleven states, includingCalifornia ,Connecticut ,Delaware ,Florida ,Georgia ,Maryland ,Montana ,North Carolina ,Tennessee ,Texas , andVirginia . Out of the ten ACOs, five are now participating in the MSSP Enhanced Track with potential upside and downside financial risk. During 2022, we entered into capitated payer arrangements. As ofJanuary 1, 2023 , our capitated agreements cover healthcare services provided to approximately 40,600 Medicare Advantage beneficiaries. Capitated revenue is generated through what is typically known as an "at-risk contract." At-risk capitation refers to a model in which the Company is entitled to fixed monthly fees from the third-party payer in exchange for providing healthcare services to attributed beneficiaries in Medicare Advantage plans. The fees are typically based on a percentage of the defined premium that payers receive from CMS. The Company is responsible for providing or paying for the cost of healthcare services required by those attributed beneficiaries. At-risk capitated fees are recorded gross in revenues because the Company is acting as a principal in arranging for, providing, and controlling the managed healthcare services provided to the attributed beneficiaries.
Components of Revenue
Our FFS revenue is primarily dependent upon the size of our provider base, payer contracted rates and patient volume. Our ability to maintain or improve pricing levels in our contracts with payers and patient volume for our providers will impact our results of operations. In addition to increasing our provider base and contracted rates over time, we also seek to increase patient volume by demonstrating the ability to provide a better patient experience that leads to higher retention rates and drives referrals to preferred, high quality and value-based providers. Our VBC revenue is primarily dependent upon the number of attributed patients in our VBC arrangements, risk levels of our payer contracts, and effective management of our patients' total cost of care. As we grow our provider base, we also expect to increase our total number of attributed patients in existing and new markets. In addition, we intend to increase the risk levels of our value-based programs as we seek a higher revenue opportunity on a per patient basis over time.
Investments in Growth
We expect to continue focusing on long-term growth through investments in our sales and marketing, our technology-enabled platform, and our operations. In addition, as we continue our efforts to move markets toward VBC, we expect to continue making additional investments in operations for an expanded suite of clinical capabilities to manage our patient population. We launchedPrivia Care Partners onJanuary 1, 2022 to offer a more flexible affiliation model for providers who do not desire to join one of our medical groups. This model aggregates providers in certain of our existing markets as well as new markets who are looking solely for VBC solutions without the necessity of changing EHR providers. We furnish population health services, reporting and analytics to such providers along with a menu of management services from which providers may choose. As ofJanuary 1, 2023 , approximately 350 providers with more than 42,000 attributed lives are participating in thePrivia Care Partners model. During 2022, severalPrivia Care Partners' providers transitioned to ourPrivia Medical Group model, which demonstrates the flexibility of our operating model and technology platform, as well as the ability to support physicians wherever they are in their transition value-based care.
Key Metrics and Non-GAAP Financial Measures
We review a number of operating and financial metrics, including the following
key metrics and non-GAAP financial measures, to evaluate our business, measure
our performance, identify trends affecting our business, formulate our business
plans, and make strategic decisions.
Key Metrics
For the Years Ended December 31,
2022 2021 2020
Implemented Providers (as of end of period) 3,606 3,317 2,550
Attributed Lives (in thousands) (as of end of
period) 856 786 682
Practice Collections (1) ($ in millions) $ 2,424.1 $
1,626.1
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(1) We define Practice Collections as the total collections from all practices in all markets and all sources of reimbursement (FFS, VBC and other) that we receive for delivering care and providing our platform and associated services. Practice Collections differ from revenue by including collections from Non-Owned Medical Groups. Implemented Providers We define Implemented Providers as the total of all service professionals onPrivia Health's platform at the end of a given period who are credentialed byPrivia Health and bill for medical services, in both Owned and Non-Owned Medical Groups during that period. This includes, but is not limited to, physicians, physician assistants, and nurse practitioners. We believe that growth in the number of Implemented Providers is a key indicator of the performance of our business and expected revenue growth. This growth depends, in part, on our ability to successfully add new practices in existing markets and expand into new markets. The number of Implemented Providers increased 8.7% betweenDecember 31, 2021 and 2022 mainly due to due to organic growth in our healthcare delivery business as well as entrance into theMontana market and a full year of operations in theWest Texas andCalifornia markets. Implemented Providers increased 30.1% between 2020 and 2021, organic growth as well as the entrance into theWest Texas andCalifornia markets.
Attributed Lives
We define Attributed Lives as any patient that a payer deems attributed to Privia, in both Owned and Non-Owned Medical Groups, to deliver care as part of a VBC arrangement. We define our Attributed Lives as patients who have selected one of our owned or Non-Owned Medical Groups as their provider of primary care services as of the end of a particular period. The number of Attributed Lives is an important measure that impacts the amount of VBC revenue we receive. Attributed Lives increased 8.9% betweenDecember 31, 2021 and 2022 due to the launch ofPrivia Care Partners onJanuary 1, 2022 , as well as organic growth in all markets. Attributed Lives increased 15.2% between 2020 and 2021, due to organic growth.
Practice Collections
We define Practice Collections as the total collections from all practices in all markets and all sources of reimbursement (FFS, VBC and other) that we receive for delivering care and providing our platform and associated services. Practice Collections differ from revenue by adding collections from Non-Owned Medical Groups both in FFS and VBC arrangements. FFS arrangements accounted for 79.1%, 91.2% and 89.7% of our practice collections for the years endedDecember 31, 2022 , 2021 and 2020, respectively, while VBC accounted for 20.6%, 8.5% and 8.6% of practice collections for the years endedDecember 31, 2022 , 2021 and 2020, respectively. Practice Collections increased 49.1% for the year endedDecember 31, 2022 when compared to the same period in 2021 due mainly to organic growth of our healthcare delivery business, our new at-risk Capitated revenue contracts, as well as a full year of operation in theWest Texas andCalifornia markets and entrance into theMontana markets and increased 25.0% between 2020 and 2021 due to organic growth of our healthcare delivery business.
Non-GAAP Financial Measures
In addition to our financial results determined in accordance with GAAP, we
believe Care Margin, Platform Contribution, Platform Contribution Margin,
Adjusted EBITDA and Adjusted EBITDA Margin are useful as non-GAAP measures to
investors as these are metrics used by management in evaluating our operating
performance and in assessing the health of our business. We use Care Margin,
Platform Contribution, Platform Contribution Margin, Adjusted EBITDA and
Adjusted EBITDA Margin to evaluate our ongoing operations and for internal
planning and forecasting purposes. We believe that these non-GAAP financial
measures, when taken together with the corresponding GAAP financial measures,
provide meaningful supplemental information regarding our performance by
excluding certain items that may not be indicative of our business, results of
operations or outlook.
However, non-GAAP financial information is presented for supplemental
informational purposes only, has limitations as an analytical tool and should
not be considered in isolation or as a substitute for financial information
presented in accordance with GAAP. In addition, other companies, including
companies in our industry, may calculate similarly-titled non-GAAP measures
differently or may use other measures to evaluate their performance, all of
which could reduce the usefulness of our non-GAAP financial measure as a tool
for comparison. A reconciliation is provided below for our non-GAAP financial
measures to the most directly comparable financial measure stated in accordance
with GAAP. Investors are encouraged to review the related GAAP financial
measures and the reconciliation of non-GAAP financial measures to their most
directly comparable GAAP financial measures, and not to rely on any single
financial measure to evaluate our business.
In the third quarter of 2022, we changed the definition of Adjusted EBITDA to
exclude employer taxes on equity vesting/exercise. In prior periods, this amount
was considered de minimis and the Adjusted EBITDA amounts were not adjusted.
Employer payroll tax expense related to employee stock transactions are tied to
the vesting or exercise of underlying equity awards and the price of our common
stock at the time of vesting, which varies in amount from period to period and
is dependent on market forces that are often beyond our control. As a result,
management excludes this item from our internal operating forecasts and models.
Management believes that non-GAAP measures adjusted for employer payroll taxes
on employee stock transactions provide investors with a basis to measure our
core performance against the performance of other companies without the
variability created by employer payroll taxes on employee stock transactions as
a result of the stock price at the time of employee exercise.
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For the Years Ended December 31,
(amounts in thousands, except for percentages) 2022 2021 2020
Care Margin 1 ($) $ 305,620 $ 238,393 $ 187,588
Platform Contribution 1 ($) $ 148,540 $ 107,550 $ 82,582
Platform Contribution Margin 1 (%) 48.6% 45.1% 44.0%
Adjusted EBITDA 1 ($) $ 60,852 $ 41,377 $ 29,372
Adjusted EBITDA Margin 1 (%) 19.9% 17.4% 15.7%
1. See below for more information as to how we define and calculate Care Margin, Platform Contribution, Platform Contribution
Margin, Adjusted EBITDA and Adjusted EBITDA Margin and for a reconciliation of income from operations, the most comparable
GAAP measure, to Care Margin, income from operations, the most comparable GAAP measure, to Platform Contribution, and net
income, the most comparable GAAP measure, to Adjusted EBITDA.
Care Margin
We define Care Margin as total revenue less the sum of provider expense. Our Care Margin generated from FFS revenue is contractual and recurring in nature, and primarily based on an individually negotiated percentage of collections for each practice that joins Privia. Our Care Margin generated from VBC revenue is based on a percentage of care management fees and shared savings collected. We view Care Margin as all of the dollars available for us to manage our business, including providing administrative support to our practices, investing in sales and marketing to attract new providers to the Privia Platform, and supporting the organization through our corporate infrastructure. We expect Care Margin will grow year-over-year in absolute dollars as we continue to expand our provider base. We would also expect our care management and shared savings economics in our VBC arrangements to improve on a per patient basis as we manage towards lower total cost of care for our Attributed Lives and move towards higher risk VBC arrangements over time. Care Margin increased 28.2% for the year endedDecember 31, 2022 when compared to the same period in 2021 due to organic growth of our medical practice business and increased 27.1% between 2021 and 2020, due to organic growth of our medical practice business. As a percentage of revenue, Care Margin decreased to 22.5% for the year endedDecember 31, 2022 from 24.7% and 23.0% for the same periods in 2021 and 2020, respectively, due to the addition of the at-risk capitation arrangements during 2022. In addition to our financial results determined in accordance with GAAP, we believe Care Margin, a non-GAAP measure, is useful in evaluating our operating performance. We use Care Margin to evaluate our ongoing operations and for internal planning and forecasting purposes. We believe that this non-GAAP financial measure, when taken together with the corresponding GAAP financial measures, provides meaningful supplemental information regarding our performance by excluding certain items that may not be indicative of our business, results of operations or outlook. In particular, we believe that the use of Care Margin is helpful to our investors as it is a metric used by management in assessing the health of our business and our operating performance. The following table provides a reconciliation of operating (loss) income, the most closely comparable GAAP financial measure, to Care Margin. For the year endedDecember 31, 2022 , Cost of platform included$13.8 million of stock-based compensation expense, Sales and marketing included$2.7 million of stock-based compensation expense, and general and administrative included$50.9 million of stock-based compensation expense. For the year endedDecember 31, 2021 , Cost of platform included$43.9 million of stock-based compensation expense, Sales and marketing included$8.9 million of stock-based compensation expense, and general and administrative included$200.7 million of stock-based compensation expense primarily related to the modification of outstanding options in connection with our IPO. For the Years Ended December 31, (unaudited and amounts in thousands) 2022 2021 2020 Operating (loss) income$ (19,122) $ (217,436) $ 25,380 Depreciation and amortization 4,571 2,464 1,843 General and administrative 129,592 255,884 44,016 Sales and marketing 19,741 22,750 11,343 Cost of platform 170,838 174,731 105,006 Care margin$ 305,620 $ 238,393 $ 187,588 Platform Contribution We define Platform Contribution as total revenue less the sum of provider expense and cost of platform excluding stock-based compensation expense included in Cost of platform. The following table provides a reconciliation of operating income, the most closely comparable GAAP financial measure, to Platform Contribution. For the year endedDecember 31, 2022 , cost of platform included$13.8 million of stock-based compensation expense, sales and marketing included$2.7 million of stock-based compensation expense, and general and administrative included$50.9 million of stock-based compensation expense. For the year endedDecember 31, 2021 , Cost of platform included$43.9 million of stock-based compensation expense, Sales and marketing included$8.9 million of stock-based compensation expense, and general and administrative included$200.7 million of stock-based compensation expense 73
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primarily related to the modification of outstanding options in connection with our IPO. We consider platform contribution to be an important measure to monitor our performance, specific to pricing of our services, direct costs of delivering care, and cost of our platform and associated services. As a provider spends a longer time on the Privia Platform, we expect the Platform Contribution from that provider to increase both in terms of absolute dollars as well as a percent of Care Margin. We expect that this increase will be driven by improving per provider revenue economics over time as well as our ability to generate operating leverage on our in-market infrastructure costs. Platform Contribution increased 38.1% for the year endedDecember 31, 2022 when compared to the same period in 2021 due to organic growth of our medical practice business and new market entry and increased 30.2% between 2021 and 2020, due to organic growth of our medical practice business.
Platform Contribution Margin
We define Platform Contribution Margin as Platform Contribution as a percentage of Care Margin. We consider Platform Contribution Margin to be an important measure to monitor our performance, specific to pricing of our services, direct costs of delivering care, and cost of our platform and associated services. As a provider spends a longer time on the Privia Platform, we expect the Platform Contribution from that provider to increase both in terms of absolute dollars as well as a percent of Care Margin. We expect that this increase will be driven by improving per provider revenue economics over time as well as our ability to generate operating leverage on our in-market infrastructure costs. Platform Contribution Margin was 48.6% for the year endedDecember 31, 2022 compared to 45.1% during the same period in 2021 and 44.0% in 2020. We continue to make strategic investments to provide better service to both our patients and physicians at a pace slower than the increase in revenue. In addition to our financial results determined in accordance with GAAP, we believe platform contribution, a non-GAAP measure, is useful in evaluating our operating performance. We use Platform Contribution to evaluate our ongoing operations and for internal planning and forecasting purposes. We believe that this non-GAAP financial measure, when taken together with the corresponding GAAP financial measures, provides meaningful supplemental information regarding our performance by excluding certain items that may not be indicative of our business, results of operations or outlook. In particular, we believe that the use of Platform Contribution is helpful to our investors as it is a metric used by management in assessing the health of our business and our operating performance.
The following table provides a reconciliation of operating income, the most
closely comparable GAAP financial measure, to platform contribution:
For the Years Ended December 31,
(unaudited and amounts in thousands) 2022 2021 2020
Operating (loss) income $ (19,122) $ (217,436) $ 25,380
Depreciation and amortization 4,571 2,464 1,843
General and administrative 129,592 255,884 44,016
Sales and marketing 19,741 22,750 11,343
Stock-based compensation(1) 13,758 43,888 -
Platform contribution $ 148,540
(1) Amount represents stock-based compensation expense included under Cost of Platform.
Adjusted EBITDA We define Adjusted EBITDA as net (loss) income excluding interest income, interest expense, non-controlling interest expense / income, depreciation and amortization, stock-based compensation, severance, other one time or non-recurring expenses, employer taxes on equity vesting/exercises and the (benefit from) provision for income taxes. We include Adjusted EBITDA because it is an important measure on which our management assesses and believes investors should assess our operating performance. We consider Adjusted EBITDA to be an important measure because it helps illustrate underlying trends in our business and our historical operating performance on a more consistent basis. Adjusted EBITDA has limitations as an analytical tool including: (i) Adjusted EBITDA does not reflect the impact of stock-based compensation expense, and (ii) Adjusted EBITDA does not reflect interest expense on our debt or the cash requirements necessary to service interest or principal payments. Adjusted EBITDA increased 47.1% for the year endedDecember 31, 2022 , when compared to the same period in 2021 due to organic growth of our medical practice business, new market entry and a focus on managing the investment in new expenses and increased 40.9% between 2020 and 2021 due to organic growth of our medical practice business.
Adjusted EBITDA Margin
We define Adjusted EBITDA Margin as Adjusted EBITDA as a percentage of Care Margin. We included Adjusted EBITDA Margin because it is an important measure on which our management assesses and believes investors should assess our operating performance. We consider Adjusted EBITDA Margin to be an important measure because it helps illustrate underlying trends in our business and our historical operating performance on a more consistent basis. Adjusted EBITDA Margin was 19.9% for the year endedDecember 31, 2022 an increase from 17.4% for the same period in 2021 due to organic growth of our medical practice business, 74
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new market entry and a focus on managing the investment in new expenses and an
increase from 15.7% in 2020, due to organic growth of our medical practice
business.
We believe that Adjusted EBITDA, when taken together with the corresponding GAAP
financial measures, provides meaningful supplemental information regarding our
performance by excluding certain items that may not be indicative of our
business, results of operations or outlook. In particular, we believe that the
use of Adjusted EBITDA is helpful to our investors as it is a metric used by
management in assessing the health of our business and our operating
performance.
The following table provides a reconciliation of net (loss) income attributable
to the Company, the most closely comparable GAAP financial measure, to Adjusted
EBITDA:
For the Years Ended December 31,
(unaudited and amounts in thousands) 2022 2021 2020
Net (loss) income attributable to Privia Health
Group, Inc. $ (8,585) $ (188,230) $ 31,244
Net loss attributable to non-controlling
interests (3,479) (2,419) (340)
Benefit from income taxes (6,516) (27,857) (7,441)
Interest (income) expense, net (542) 1,070 1,917
Depreciation and amortization 4,571 2,464 1,843
Stock-based compensation 67,359 253,531 484
Other expenses(1) 8,044 2,818 1,665
Adjusted EBITDA $ 60,852 $ 41,377 $ 29,372
(1) Other expenses include employer taxes on equity vesting/exercises, legal, severance and certain
non-recurring costs. Employer taxes on equity vesting/exercises of $3.2 million for the year ended December
31, 2022 .
Components of Results of Operations
Revenue
As noted above under “Our Revenue,” revenue is earned in three main categories:
FFS revenue, VBC revenue and other revenue.
Operating Expenses
Provider expenses
Provider expense, previously referred to as "Physician and Practice expense", are amounts accrued or payments made to physicians, hospitals and other service providers, including Privia physicians, their related physician practices, and providers the Company has contracted with through payer partners. Those costs include physician guaranteed payments and other required distributions pursuant to the service agreements as well as medical claims costs for services provided to attributed beneficiaries under at-risk Capitated revenue arrangements for which the Company is financially responsible whether paid directly by the Company or indirectly by payers with whom the Company has contracted. Provider expenses are recognized in the period in which services are provided.
Cost of platform
Third-party EMR and practice management software expenses are paid on a percentage of revenue basis, while we pay most of the costs of our platform on a variable basis related to the number of implemented physicians we service. In addition, expenses contain stock-based compensation related to employees that provide Cost of platform services, but exclude any depreciation and amortization expense. Software development costs that do not meet capitalization criteria are expensed as incurred. As we continue to grow, we expect the cost of platform to continue to grow at a rate slower than the revenue growth rate.
Sales and marketing
Sales and marketing expenses consist of employee-related expenses, including salaries, commissions, stock-based compensation, and employee benefits costs, for all of our employees engaged in marketing, sales, community outreach, and sales support. In addition, sales and marketing expenses also include central and community-based advertising to generate greater awareness, engagement, and retention among our current and prospective patients as well as the infrastructure required to support all of our marketing efforts.
General and administrative
Corporate, general and administrative expenses include employee-related expenses, including salaries and related costs and stock-based compensation, technology infrastructure, occupancy costs, operations, clinical and quality support, finance, legal, human resources, and development departments.
Depreciation and amortization expense
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Depreciation and amortization expenses are primarily attributable to our capital investment and consist of fixed asset depreciation and amortization of intangibles considered to have definite lives. We do not allocate depreciation and amortization expenses to other operating expense categories.
Interest Expense
Interest expense consists primarily of interest payments on our outstanding
borrowings under our Term Loan Facility. See “Liquidity and Capital
Resources-General and Note Payable.”
Results of Operations
Comparison of the Years Ended
The following table sets forth our consolidated statements of operations data
for the years ended
For the Years Ended December 31,
2022 2021 Change ($) Change (%)
(in thousands)
Revenue $ 1,356,660 $ 966,220 $ 390,440 40.4 %
Operating expenses:
Provider expense 1,051,040 727,827 323,213 44.4 %
Cost of platform 170,838 174,731 (3,893) (2.2) %
Sales and marketing 19,741 22,750 (3,009) (13.2) %
General and administrative 129,592 255,884 (126,292) (49.4) %
Depreciation and amortization 4,571 2,464 2,107 85.5 %
Total operating expenses 1,375,782 1,183,656 192,126 16.2 %
Operating loss (19,122) (217,436) 198,314 (91.2) %
Interest (income) expense, net (542) 1,070 (1,612) (150.7) %
Loss before benefit from income taxes (18,580) (218,506) 199,926 (91.5) %
Benefit from income taxes (6,516) (27,857) 21,341 (76.6) %
Net loss (12,064) (190,649) 178,585 (93.7) %
Less: Loss attributable to non-controlling
interests (3,479) (2,419) (1,060) 43.8 %
Net loss attributable to Privia Health Group,
Inc. $ (8,585) $ (188,230) $ 179,645 (95.4) %
Revenue
The following table presents our revenues disaggregated by source:
For the Years Ended December 31,
(Dollars in Thousands) 2022 2021 Change ($) Change (%)
FFS-patient care $ 869,165 $ 772,482 $ 96,683 12.5 %
FFS-administrative services 94,929 68,805 26,124 38.0 %
Capitated revenue 218,463 - 218,463 - %
Shared savings 132,615 83,016 49,599 59.7 %
Care management fees (PMPM) 35,541 36,503 (962) (2.6) %
Other revenue 5,947 5,414 533 9.8 %
Total Revenue $ 1,356,660 $ 966,220 $ 390,440 40.4 %
Revenue was $1.36 billion for the year ended December 31, 2022 , an increase from
$966.2 million for the year ended December 31, 2021 . Key drivers of this revenue
growth were the addition of capitated revenue in 2022 of $218.5 million ,
FFS-patient care revenue, which increased $96.7 million , shared savings revenue,
which increased $49.6 million and FFS-administrative services which increased
$26.1 million . Revenue increases were partially offset by a decrease in care
management fee, which decreased $1.0 million as some care management fee revenue
was replaced by capitated revenue.
Growth in FFS-patient care revenue and FFS-administrative services was primarily
attributed to an increase in visit volumes as COVID-19 restrictions were lifted
in certain states as well as the addition of new providers and the new markets
of California and West Texas , which were part of Privia for the full year in
2022. Capitated revenue growth is due to the commencement of at-risk capitation
arrangements during the first quarter of 2022 resulting in an increase in
revenue of $218.5 million . Shared savings growth was primarily due to more
Attributed Lives in Medicare programs as well as continued strong estimated
performance in our value based care programs.
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Operating Expenses
For the Years Ended December 31,
(Dollars in Thousands) 2022 2021 Change ($) Change (%)
Operating Expenses:
Provider expense $ 1,051,040 $ 727,827 $ 323,213 44.4 %
Cost of platform 170,838 174,731 (3,893) (2.2) %
Sales and marketing 19,741 22,750 (3,009) (13.2) %
General and administrative 129,592 255,884 (126,292) (49.4) %
Depreciation and amortization expense 4,571 2,464 2,107 85.5 %
Total operating expenses $ 1,375,782 $ 1,183,656 $ 192,126 16.2 %
Provider expenses
Provider expenses were $1.05 billion for the year ended December 31, 2022 , an
increase from $727.8 million during the same period in 2021. This increase was
driven primarily by the commencement of at-risk capitation arrangements during
the first quarter of 2022 and higher FFS-patient care revenue and growth in
Implemented Providers.
Cost of platform
Cost of platform expenses were$170.8 million for the year endedDecember 31, 2022 , a decrease from$174.7 million during the same period in 2021. The decrease was primarily driven by the reduction of$30.1 million in stock-based compensation expense primarily related to the modification of vesting terms of options in connection with the Company's IPO during the year endedDecember 31, 2021 , partially offset by an increase in salaries and benefits of$16.4 million related to continued growth, and an increase in EMR and platform technology costs of$6.2 million driven by an increase in FFS claims and an increase in consulting costs of$1.8 million due to continued growth and market expansion, and various other immaterial expenses related to growth and market expansion.
Sales and marketing
Sales and marketing expenses were$19.7 million for the year endedDecember 31, 2022 , a decrease from$22.7 million during the same period in 2021. The decrease was driven by the reduction of$6.2 million in stock-based compensation primarily related to the modification of vesting terms of options in connection with the Company's IPO during the year endedDecember 31, 2021 , partially offset by an increase in salaries and benefits of$2.1 million .
General and administrative
General and administrative expenses were$129.6 million for the year endedDecember 31, 2022 , a decrease from$255.9 million during the same period in 2021. This decrease was primarily driven by the reduction of$149.8 million in stock-based compensation expense primarily related to the modification of vesting terms of options in connection with the Company's IPO during the year endedDecember 31, 2021 , partially offset by an increase in compensation and benefits of$11.3 million , which includes$2.4 million of employer taxes on equity vesting/exercises, an increase in professional services of$5.1 million related to additional consulting services for audit, tax and SOX compliance and various other immaterial expenses.
Depreciation and amortization expense
Depreciation and amortization expenses were$4.6 million for the year endedDecember 31, 2022 , an increase from$2.5 million during the same period in 2021. This increase was primarily driven by amortization of intangible assets related to the acquisition ofBASS Privia Management Company of California, LLC ("BPMC") andPrivia Medical Group West Texas, PLLC , formerly known asAbilene Diagnostic Clinic, PLLC ("PMG West Texas" or "WTX Friendly Medical Group ") during the fourth quarter of 2021.
Interest (income) expense, net
Interest income was$0.5 million for the year endedDecember 31, 2022 , compared to interest expense of$1.1 million during the same period in 2021. This change was primarily the result of the repayment of the Term Loan Facility at the end ofJune 2022 and the increase in the rate of interest earned on cash in our bank accounts in 2022. Benefit from income taxes The benefit from income taxes of$6.5 million for the year endedDecember 31, 2022 decreased from$27.9 million during the same period in 2021. The benefit for the year endedDecember 31, 2022 is primarily the result of the pre-tax loss and windfall tax deductions related to the exercise of the stock options and vesting of RSUs partially offset by the non-deductible stock-based compensation expense..
Net loss attributable to non-controlling interests
Net loss attributable to non-controlling interests was$3.5 million for the year endedDecember 31, 2022 , an increase from$2.4 million during the same period in 2021. This change was primarily related to investments in new joint venture markets. 77
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Comparison of the Years Ended
The following table sets forth our consolidated statements of operations data
for the years ended
For the Years Ended December 31,
2021 2020 Change ($) Change (%)
(in thousands)
Revenue $ 966,220 $ 817,075 $ 149,145 18.3 %
Operating expenses:
Physician and practice expense 727,827 629,487 98,340 15.6 %
Cost of platform 174,731 105,006 69,725 66.4 %
Sales and marketing 22,750 11,343 11,407 100.6 %
General and administrative 255,884 44,016 211,868 481.3 %
Depreciation and amortization 2,464 1,843 621 33.7 %
Total operating expenses 1,183,656 791,695 391,961 49.5 %
Operating (loss) income (217,436) 25,380 (242,816) (956.7) %
Interest expense 1,070 1,917 (847) (44.2) %
(Loss) income before benefit from income taxes (218,506) 23,463 (241,969) (1031.3) %
(Benefit from) provision for income taxes (27,857) (7,441) (20,416) 274.4 %
Net (loss) income (190,649) 30,904 (221,553) (716.9) %
Less: Loss attributable to non-controlling
interests (2,419) (340) (2,079) 611.5 %
Net (loss) income attributable to Privia Health
Group, Inc. $ (188,230) $ 31,244 $ (219,474) (702.5) %
Revenue
The following table presents our revenues disaggregated by source:
For the Years Ended December 31,
(Dollars in Thousands) 2021 2020 Change ($) Change (%)
FFS-patient care $ 772,482 $ 647,314 $ 125,168 19.3 %
FFS-administrative services 68,805 58,278 10,527 18.1 %
Shared savings 83,016 66,414 16,602 25.0 %
Care management fees (PMPM) 36,503 26,766 9,737 36.4 %
Other revenue 5,414 18,303 (12,889) (70.4) %
Total Revenue $ 966,220 $ 817,075 $ 149,145 18.3 %
Revenue was $966.2 million for the year ended December 31, 2021 , an increase
from $817.1 million for the year ended December 31, 2020 . Key drivers of this
revenue growth were FFS-patient care revenue increases of $125.2 million , shared
savings revenue increases of $16.6 million , care management fee increases of
$9.7 million , and FFS-administrative services increases of $10.5 million .
Revenue increases were partially offset by a decrease in other revenue of
$12.9 million related to CARES Act Provider Relief Funds in 2020 that were not
similarly granted in 2021.
Growth in FFS-patient care revenue and FFS-administrative services were
primarily attributed to an increase in visit volumes as COVID-19 restrictions
are lifted in certain states as well as the addition of new providers. Care
management fee (PMPM) growth was due mainly to an increase in the total number
of VBC contracts that include the payment of care management fees and an
increase in Attributed Lives. Shared savings growth was primarily due to more
Attributed Lives in government programs as well as performance realized in those
programs that was greater than previously estimated. The decrease in other
revenue was primarily driven by a decrease in grant funds received as part of
the CARES Act Provider Relief Fund .
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Operating Expenses
For the Years Ended December 31,
(Dollars in Thousands) 2021 2020 Change ($) Change (%)
Operating Expenses:
Physician and practice expense $ 727,827 $ 629,487 $ 98,340 15.6 %
Cost of platform 174,731 105,006 69,725 66.4 %
Sales and marketing 22,750 11,343 11,407 100.6 %
General and administrative 255,884 44,016 211,868 481.3 %
Depreciation and amortization expense 2,464 1,843 621 33.7 %
Total operating expenses $ 1,183,656 $ 791,695 $ 391,961 49.5 %
Physician and practice expenses
Physician expenses were$727.8 million for the year endedDecember 31, 2021 , an increase from$629.5 million during the same period in 2020. This increase was driven primarily by higher FFS-patient care revenue and the addition of new providers partially offset by a decrease in physician expense related to CARES Act grant receipts. Cost of platform Cost of platform expenses were$174.7 million for the year endedDecember 31, 2021 , an increase from$105.0 million during the same period in 2020. This increase was driven primarily by a$43.9 million increase in stock compensation expense, which was the result of the modification of vesting terms of options in connection with the Company's IPO, an increase of$9.6 million related to additional consulting costs, driven by growth in our direct to employer business and partnerships with certain health systems; an increase in compensation and benefits of$7.9 million driven by expansion into new markets and products; and an increase in EMR and platform technology costs of$7.3 million driven by an increase in FFS claims. Sales and marketing Sales and marketing expenses were$22.7 million for the year endedDecember 31, 2021 , an increase from$11.3 million during the same period in 2020. This increase was primarily driven by the increase of$9.0 million of stock-based compensation expense recognized during the year endedDecember 31, 2021 , primarily related to the modification of vesting terms of options in connection with the Company's IPO and an increase in compensation and benefits of$2.0 million related to same store growth and market expansion.
General and administrative
General and administrative expenses were$255.9 million for the year endedDecember 31, 2021 , an increase from$44.0 million during the same period in 2020. This increase was primarily driven by the increase of$200.2 million of stock-based compensation expense recognized during the year endedDecember 31, 2021 primarily related to the modification of vesting terms of options in connection with the Company's IPO, an increase in compensation and benefits of$6.5 million and an increase in corporate insurance of$2.8 million .
Depreciation and amortization expense
Depreciation and amortization expenses were$2.5 million for the year endedDecember 31, 2021 , an increase from$1.8 million during the same period in 2020. This increase was primarily driven by amortization of intangible assets related to the acquisition ofBASS Privia Management Company of California, LLC ("BPMC") andPrivia Medical Group West Texas, PLLC , formerly known asAbilene Diagnostic Clinic, PLLC ("PMG West Texas" or "WTX Friendly Medical Group ").
Interest expense
Interest expense was
decrease from
primarily driven by the repayment of a note payable to related parties in 2020.
Benefit from income taxes
The benefit from income taxes of$27.9 million for the year endedDecember 31, 2021 increased from$7.4 million during the same period in 2020. The benefit for the year endedDecember 31, 2021 is primarily the result of the pre-tax loss partially offset by the non-deductible stock-based compensation expense related to the modification of vesting terms of options in connection with the Company's IPO.
Net loss attributable to non-controlling interests
Net loss attributable to non-controlling interests was$2.4 million for the year endedDecember 31, 2021 , an increase from$0.3 million during the same period in 2020 and is primarily due to an increase in net loss before non-controlling interest. 79
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Liquidity and Capital Resources
General
To date, we have financed our operations principally through sale of our equity, payments received from various payers and through borrowings under the Credit Facilities. As ofDecember 31, 2022 , we had cash and cash equivalents of$348.0 million . We received$211.0 million of net proceeds from the Company's IPO and Anthem private placement onMay 3, 2021 . Our cash and cash equivalents primarily consist of highly liquid investments in money market funds and cash. We believe that our cash and cash equivalents, including the proceeds from the IPO, and borrowings under the Revolving Loan Facility (as defined below) together with cash flows from operations, will provide adequate resources to fund our short-term and long-term operating and capital needs. Our assessment of the period of time through which our financial resources will be adequate to support our operations is a forward-looking statement and involves risks and uncertainties. Our actual results could vary because of, and our future capital requirements will depend on many factors, including our growth rate, and the timing and extent of spending to increase our sales and marketing activities. We may in the future enter into arrangements to acquire or invest in complementary businesses, services and technologies, including intellectual property rights. We have based this estimate on assumptions that may prove to be wrong, and we could use our available capital resources sooner than we currently expect. We may be required to seek additional equity or debt financing. In the event that additional financing is required from outside sources, we may not be able to raise it on terms acceptable to us or at all. If we are unable to raise additional capital when desired, or if we cannot expand our operations or otherwise capitalize on our business opportunities because we lack sufficient capital, our business, results of operations, and financial condition would be adversely affected. Indebtedness
See Note 9 “Note Payable” for discussion on our Credit Facilities.
Cash Flows Overview
The Company's cash requirements within the next twelve months include physician and practice liabilities, accounts payable and accrued liabilities, current maturities of long-term debt, and purchase commitments and other obligations. We expect the cash required to meet these obligations to be primarily generated through cash flows from current operations; cash available for general corporate use; and the realization of current assets, such as accounts receivable. Based on current and anticipated levels of operations, we anticipate that net cash provided by operating activities, together with the available cash on hand atDecember 31, 2021 , should be adequate to meet anticipated cash requirements for the short term (next 12 months) and long term (beyond 12 months).
The following table presents a summary of our consolidated cash flows from
operating, investing and financing activities for the periods indicated.
For the Years Ended
2022 2021 2020
(in thousands)
Consolidated Statements of Cash Flows Data:
Net cash provided by operating activities $
47,196
Net cash used in investing activities
(104) (32,775) (380) Net cash (used in) provided by financing activities (19,677) 213,661 (767) Net increase in cash and cash equivalents$ 27,415 $ 235,944 $ 37,744 Operating Activities Net cash provided by operating activities was$47.2 million for the year endedDecember 31, 2022 compared to$55.1 million for the same period in 2021. Significant changes impacting net cash provided by operating activities for the year endedDecember 31, 2022 compared to the same period in 2021 were as follows: •Decrease in loss of$178.5 million from a loss of$(12.1) million during the year endedDecember 31, 2022 compared to loss of$(190.6) million during the year endedDecember 31, 2021 , primarily driven by the recognition of stock-based compensation expense related to the modification of vesting terms of options in connection with the Company's IPO during the year endedDecember 31, 2021 when compared to the recognition of stock-based compensation for the same period in 2022. •An increase of$(72.2) million in accounts receivable, net, for the year endedDecember 31, 2022 compared to the same period in 2021 of$(14.6) million , an increase of$(57.6) million . The increase is primarily driven by the commencement of at-risk capitation arrangements during the year endedDecember 31, 2022 and an increase in FFS and VBC revenue.
•An increase of
period in 2021, an increase of
an increase
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in shared savings and the commencement of at-risk capitation arrangements during
the year ended
Net cash provided by operating activities was$55.1 million for the year endedDecember 31, 2021 compared to$38.9 million for the same period in 2020. Significant changes impacting net cash provided by operating activities for the year endedDecember 31, 2021 compared to the same period in 2020 were as follows: •Increase in loss of$221.5 million from income of$30.9 million of net income during the year endedDecember 31, 2020 to$190.6 million of net loss during the same period in 2021, primarily driven by the recognition of$253.5 million of non-cash stock-based compensation expense related to the modification of vesting terms of options in connection with the Company's IPO. •A reduction in the increase of$7.2 million in accounts receivable, net, for the year endedDecember 31, 2021 of$14.6 million compared to the same period in 2020 of$21.8 million , primarily driven by an increase in FFS and VBC revenue. •Decrease of$20.6 million related to the increase in deferred tax benefit for the year endedDecember 31, 2021 of$28.4 million as compared to the loss in the same period in 2020 of$7.8 million . This is primarily due to the tax benefit generated in the current year from the stock-based compensation expense related to the modification of vesting terms of options in connection with the Company's IPO. A portion of the expense is not currently deductible for tax purposes.
Investing Activities
Net cash used in investing activities was
primarily due to Privia investing in two new markets during the fourth quarter
of 2021.
Net cash used in investing activities was
primarily due to Privia investing in two new markets during the fourth quarter
of 2021.
Financing Activities Net cash used in financing activities was$19.7 million for the year endedDecember 31, 2022 compared to net cash provided by financing activities of$213.7 million . This decrease primarily related to the receipt of the net proceeds from the Company's IPO of$211.0 million during year endedDecember 31, 2021 , and the use of cash to repay the Company's Term Loan Facility during the year endedDecember 31, 2022 , partially offset by the receipt of proceeds from stock options exercised of$13.4 million . Net cash provided by financing activities was$213.7 million for the year endedDecember 31, 2021 compared to$0.8 million used for financing activities for the same period in 2020. This increase primarily related net proceeds from the Company's IPO of$211.0 million during year endedDecember 31, 2021 , and net proceeds from stock options exercised of$3.8 million .
Contractual Obligations, Commitments and Contingencies
Operating Leases. The Company leases office space under various operating lease agreements. The initial terms of these leases range from 2 to 9 years and generally provide for periodic rent increases, renewal, and termination operations. Total rent expense under operating leases was$2.7 million ,$2.1 million and$2.5 million for the years endedDecember 31, 2022 , 2021 and 2020, respectively.
Off Balance Sheet Obligations. We do not have any off-balance sheet arrangements
as of
Commitments and Contingencies. See Note 14 “Commitments and Contingencies” for
further discussion on our commitments and contingencies.
Emerging Growth Company Status
Based on the aggregate worldwide market value of our shares of common stock held by our non-affiliate stockholders onJune 30, 2022 , as ofDecember 31, 2022 , we have become a "large-accelerated filer" and have lost emerging growth status for the year endedDecember 31, 2022 . We are no longer exempt from the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act of 2002, as amended, and our independent registered public accounting firm will evaluate and report on the effectiveness of internal control over financial reporting.
Critical Accounting Policies and Estimates
Our consolidated financial statements have been prepared in accordance withU.S. GAAP. The preparation of these consolidated financial statements requires us to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenue and expenses, and related disclosures. We base our estimates on historical experience and on various other factors that we believe are reasonable under the circumstances. We evaluate our estimates and assumptions on an ongoing basis. Actual results may differ from these estimates. To the extent that there are material differences between these estimates and our actual results, our future financial statements will be affected. 81
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While our significant accounting policies are described in greater detail in Note 1, "Organization and Summary of Significant Accounting Policies," to our consolidated financial statements included elsewhere in this Annual Report, we believe that the following accounting policies are those most critical to the judgments and estimates used in the preparation of our consolidated financial statements. Business Combination Accounting for business combinations requires us to allocate the fair value of purchase considerations to the tangible assets acquired, liabilities assumed, and intangible assets acquired based on their estimated fair values, which were determined primarily using the income method. The excess of the fair value of purchase consideration over the fair values of these identified assets and liabilities is recorded as goodwill. Such valuations require us to make significant estimates and assumptions, especially at the acquisition date with respect to intangible assets. Significant estimates in valuing certain intangible assets include, but are not limited to, revenue growth rates, medical claims expense, cost of care expenses, operating expenses, discount rate, contract terms and useful life from acquired assets. Our estimates of fair value are based upon assumptions believed to be reasonable, but which are inherently uncertain and unpredictable and, as a result, actual results may differ from estimates. Allocation of purchase consideration to identifiable assets and liabilities affects our amortization expense, as acquired finite-lived intangible assets are amortized over the useful life, whereas any indefinite lived intangible assets, including goodwill, are not amortized. During the measurement period, which is not to exceed one year from the acquisition date, we may record adjustments to the assets acquired and liabilities assumed, with the corresponding offset to goodwill. Upon the conclusion of the measurement period, any subsequent adjustments are recorded to earnings. For additional details, refer to Note 3. "Business Combinations."
Revenue Recognition
Revenue is recognized when a customer obtains control of promised goods or
services, in an amount that reflects the consideration which the entity expects
to receive in exchange for those goods or services. The Company determines
revenue recognition through the following five steps:
i.Identify the contract(s) with a customer;
ii.Identify the performance obligations in the contract;
iii.Determine the transaction price;
iv.Allocate the transaction price to the performance obligations in the
contract; and
v.Recognize revenue as the entity satisfies a performance obligation.
FFS revenue
FFS-patient care
Our FFS-patient care revenue is primarily generated from providing healthcare services to patients. Providing medical services to patients represents our performance obligation under third party payer agreements, and accordingly, the transaction price is allocated entirely to that one performance obligation. We recognize revenue as services are rendered and approved by the Privia Providers, which is typically a single day for each service. We receive payment for services from third party payers, as well as from patients who have health insurance, but are also financially responsible for some or all of the service in the form of co-pays, coinsurance or deductibles. Patients who do not have health insurance are required to pay for their services in full. FFS-patient care revenue is reported net of provisions for contractual allowances from third-party payers and patients. We have certain agreements with third-party payers that provide for reimbursement at amounts different from our standard billing rates. The differences between the estimated reimbursement rates and the standard billing rates are accounted for as contractual adjustments, which are deducted from gross revenue to arrive at FFS-patient care revenue. We determine our estimate of implicit price concessions based on our historical collection experience with classes of patients using a portfolio approach as a practical expedient to account for patient contracts as collective groups rather than individually. The financial statement effects of using this practical expedient are not materially different from an individual contract approach. Subsequent changes to the estimate of the transaction price (determined on a portfolio basis when applicable) are generally recorded as adjustments to revenue in the period of the change. For the years endedDecember 31, 2022 , 2021, and 2020, changes in the Company's estimates of implicit price concessions and contractual adjustments to expected payments for performance obligations satisfied in prior periods were not significant.
FFS-administrative services
The Company’s FFS-administrative services business provides administration and
management services pursuant to MSAs with Non-Owned Medical Groups.
The Company's MSAs with the Non-Owned Medical Groups range from 5 -20 years in
duration and outline the terms and conditions of the administration and
management services to be provided, which includes RCM services such as billings
and collections, as well
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as other services, including, but not limited to, payer contracting, information
technology services and accounting and treasury services.
In certain MSAs, the Company is paid administrative fees equal to the cost of supplying certain services as outlined in the MSAs, and if applicable, a margin is added to the cost of certain services. The margin, if applicable, is fixed based on the MSAs; however, the cost of supplying certain services can fluctuate during the life of the MSAs.
In certain MSAs, the Company is paid a percentage of net collections. The
percentage is fixed per the MSAs; however, the net collections can fluctuate
during the life of the contract.
Under each MSA, there is a single performance obligation to provide a series of administration and management services required for the contract period. The Company believes that eachNon-Owned Medical Group receives the management and administrative services each day and has concluded that an output method is appropriate for recognizing administrative services revenue. Administrative fees are reported at the amount that reflects the consideration to which the Company expects to be entitled in exchange for the provision of administration and management services to Non-Owned Medical Groups. In addition, certain of our MSAs include rebates to the customers in the event that certain conditions occur. The Company estimates the transaction price using the most likely amount methodology and amounts are included in the net transaction price to the extent that it is probable that a significant reversal will not occur once any uncertainty associated with the variable consideration is subsequently resolved. Rebates in the amount of$2.8 million have been recorded as ofDecember 31, 2022 . No rebates were recorded for years endedDecember 31, 2021 and 2020. VBC revenue The Company's VBC business consists of its clinically integrated network and Accountable Care Organizations which bring together independent physician practices within our medical groups to focus on sharing data, improving care coordination, and collaborating on initiatives to improve outcomes and lower healthcare spending. The Company has contracts with theU.S. federal government and large payer organizations that are multi-year in nature typically ranging from three to five years and is earned as follows: (1) Capitated revenue (2) on a shared savings basis and (3) Care management fees on a per member per month basis. Capitated Revenue Capitated revenue consists of capitation fees earned under contracts with various Medicare Advantage payers ("Payers") in at-risk capitation arrangements. The Company is entitled to monthly fees to provide a defined range of healthcare services for Medicare Advantage health plan members ("attributed beneficiaries" or "attributed lives") attributed to the Company's contracted physicians (typically primary care). Monthly fees are determined as a percentage of the premium payers receive from theCenters for Medicare & Medicaid Services ("CMS") for these attributed beneficiaries. In at-risk arrangements, the Company generally accepts financial risk for beneficiaries attributed to its contracted physicians and, therefore, is responsible for the cost of contracted healthcare services required by those beneficiaries in accordance with the terms of each agreement. Fees are recorded gross in revenue because the Company is acting as a principal in coordinating and controlling the range of services provided (other than clinical decisions) under its Capitated revenue contracts with payers. Capitated revenue contracts with payers are generally multi-year arrangements and have a single monthly stand ready performance obligation, as defined by ASC Topic 606, Revenue from Contracts with Customers ("ASC 606"), to provide all aspects of necessary medical care to members for the contracted period. The Company recognizes revenue in the month in which the eligible beneficiary is entitled to receive healthcare benefits during the contract term. The transaction price for the Company's capitation contracts is a fixed percentage of premium per attributed life with periodic adjustment, as the monthly fees to which the Company are entitled are subject to periodic adjustments under CMS's risk adjustment payment methodology. CMS deploys a risk adjustment model that determines premiums paid to all payers according to each attributed life's health status and certain demographic factors. Under this risk adjustment methodology, CMS calculates the risk adjusted premium payment using diagnosis data from various settings. The Company and healthcare providers collect and submit diagnosis data to payers (and ultimately to CMS) to be utilized in the determination of risk adjustments and such data is used by the Company to estimate any adjustments to the Capitated revenue earned that may increase or decrease revenue in subsequent periods pursuant to contractual terms. Such adjustments are estimated using the most likely amount methodology and amounts are only included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. Capitated revenue fees are also subject to adjustment for incentives or penalties based on the achievement of certain quality metrics defined in the Company's contracts with payers. The Company recognizes incentive revenue as earned using the most likely amount methodology and only to the extent that it is probable that a significant reversal of cumulative revenue will not occur once any uncertainty is resolved. Neither the Company nor any of its affiliates are a registered insurance company as state law in the states in which we operate do not require such registration for risk bearing providers. Shared Savings Under the shared savings basis, the Company is offered financial incentives to increase its accountability for the cost, quality and efficiency of the care provided to the population of attributed members. The Company is paid the financial incentives when, for a given twelve-month measurement period, its performance on quality of care and utilization meets or exceeds the standards set by the 83
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payers as outlined in the contracts and when savings are achieved for medical costs associated with the population of attributed members. The payers analyze the activities during the measurement period using the agreed upon benchmarks, metrics and performance criteria to determine the appropriate payments to the Company. The Company estimates the transaction price by analyzing the activities during the relevant time period in contemplation of the agreed upon benchmarks, metrics, performance criteria, and attribution criteria based on those and any other contractually defined factors. Revenue is not recorded until the price can be estimated by the Company and to the extent that it is probable that a significant reversal will not occur once any uncertainty associated with the variable consideration is subsequently resolved. Revenue is recorded during the period when the services were provided during a pre-set twelve-month annual measurement period.
Care Management Fees (PMPM)
Under the PMPM basis, the Company is paid a PMPM rate for each covered
individual who is attributed by the payer to the Company ("attributed members").
The Company records revenue in the month for which the PMPM rate applies and the
member was attributed. The PMPM rate is based on a predetermined monthly
contractual rate for each attributed member regardless of the volume of care
coordination services provided under the contracts with the payers. The PMPM
rate varies based on payer and product.
Revenue is reported at the amount that reflects the consideration to which the
Company expects to be entitled in exchange for the provision of care
coordination services to its population of attributed members. The Company's
contracts with payers have a single performance obligation that consists of a
series of services for the provision of care coordination services for the
population of attributed members for the duration of the contract. The
transaction price for the contracts is entirely variable, as it is primarily
based on a PMPM rate on monthly attributed membership, which can fluctuate
during the life of the contract.
The majority of the Company's net PMPM transaction price relates specifically to
its efforts to transfer the service for a distinct increment of the series and
is recognized as revenue in the month in which attributed members are entitled
to care coordination services.
Other Revenue
The remainder of our revenue is derived from leveraging our existing base of providers and patients to deliver value-oriented services such as concierge services, virtual visits, virtual scribes and coding, clinical trials, behavioral health management, and partnerships with self-insured employers to offer direct primary care to their employees. CARES Act funds received have been recorded within other revenue on the statement of operations throughDecember 31, 2021 . No funds were received from the CARES Act for the year endedDecember 31, 2022 .
Goodwill represents the excess of the purchase price, plus the fair value of any non-controlling interests in the acquiree, over the fair value of identifiable net assets acquired. The Company performs a qualitative assessment on goodwill at least annually or more frequently if events or changes in circumstances indicate that the carrying value of goodwill may not be recoverable. If it is determined in the qualitative assessment that the fair value of a reporting unit is more likely than not below its carrying amount, then the Company will perform a quantitative impairment test. The quantitative goodwill impairment test is performed by comparing the fair value of a reporting unit with its carrying amount. Any excess in the carrying value of a reporting unit's goodwill over its fair value is recognized as an impairment loss, limited to the total amount of goodwill allocated to that reporting unit. The Company completes a single assessment ofGoodwill as it has one reporting unit.
Stock-Based Compensation
The Company accounts for share-based compensation in accordance with the expense
recognition provisions of ASC 718, Compensation-Stock Compensation ("ASC 718"),
which requires the issuer to recognize compensation expense for all share-based
payments made to employees based on the fair value of the share-based payment at
the date of grant. Up until April 2021,the estimated fair value of share-based
payments granted to the Company's employees was determined using the Monte-Carlo
option pricing model, which requires inputs based on certain subjective
assumptions, including expected term of the option, expected stock price
volatility, the risk free interest rate for a period that approximates the
expected term of the option and the Company's expected dividend yield (See Note
11 "Stockholders' Equity"). The share-based payments granted or modified prior
to April 2021 to employees of the Company do not have quoted market prices, and
changes in subjective input assumptions can materially affect the fair value
estimate. Since April 2021 , the Company has estimated the fair value of the
options granted to Company's employees and contractors using the Black-Scholes
option-pricing model. Option valuation models require several inputs, such as
the expected stock price volatility, the fair value of the stock, the risk free
rate, the expected term of the award and the dividend yield. The Company records
share-based compensation forfeitures as a reversal of previously recognized
compensation expense as the forfeitures occur. For additional details refer to
Note 11 "Stockholder Equity."
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