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This story begins over a decade ago with the formation of Accretive Health.
Accretive is a provider of revenue cycle services to many health care providers.
A simple way of looking at this- it handles almost all front and back office
needs of health organizations. This hospital servicing company ran into some
problems when unencrypted laptops of patient data were stolen from the company.
Federal Trade Commission in 2013 then stepped in and the company entered into a
twenty year settlement over data security measures.
The Minnesota Attorney General, following an investigation
into the company’s debt collecting practices, fined them $2.5 million in a
settlement while Company admitted no wrongdoing. Following these issues in early
2013, the CEO and Chairman were replaced with several new managers. The FTC
and Minnesota Attorney General investigations resulted in delayed and missed
filings and restatements. The financial restatements resulted in a New York Stock
Exchange delisting. By June 2014, all filings were completed and were then
current. That then was a Cliff notes history of what crunched the company.
RCM is a revenue cycle services and physician services company. It handles
patient registration, insurance and benefits verification, medical treatment
documentation and coding, bill preparation and collections for patients and
payers. The company focuses on gathering individual patient data and validating
insurance eligibility and monitors this data thru the full lifecycle.
Additionally, it provides patient care billing classification reviews.
In the first quarter of 2016, Accretive, renamed as R1-RCM, closed a strategic
transaction with Ascension, the second largest hospital system in the country
(141 hospitals) which injected $200 million of cash into the company, acquiring
along with Towerbrook Capital Partners a 40% position in RCM and made RCM the
exclusive revenue cycle partner for a 10-year term.
Subsequently it started adding revenues from the Ascension hospitals onboarding
the revenues and is continuing with an assured revenue stream over subsequent
quarters and feels that it can save the hospital from 10 to 30% in customer costs
to collect. Obviously in a world of low- to mid-single digits operating margins,
such numbers are quite meaningful. RCN has posted a corporate presentation on its
website which indicates that they expect to generate $700-$900 million revenues
with mid- to high teens net cash margins by 2020. It should be noted
management further stated that 90% of the low end of revenues are currently
The full onboarding of contracted business suggests an annualized EBIDTA of over
$100 million or over $0.55. According to one observer, the closest peer is
Athenahealth(ATHN) which is certainly larger but trades at a 15 times EBIDTA.
A recent Needham conference presentation indicated the company plans to greatly
expand their sales efforts to add others customers. Since guidance assumes no
such sales, any new accounts would be additive. Additionally, with money on the
balance sheet, management further disclosed they are looking for acquisition
candidates- all of which suggests possible new investment banking and brokerage
coverage. Company has no current analyst reports- William Blair, Robert Baird
and Cowan analysts were on the recent conference call. Long-term debt was zero
while just over 108 million shares were outstanding. Warrants from the
Ascension/Towerbrook to acquire 60 million shares @$3.50 are on the books.
The long term macro trends also favor RCM. The new increasingly complex
regulations for healthcare providers and reimbursements as well as HIPPA
rules all offer strong tailwinds.
1.Newly relisted on Nasdaq.
2.New presentations on company site
3.Expected new broker coverage
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