Agilon health reports fourth quarter and fiscal year 2021 results
Austin, texas--(business wire)--agilon health, inc. (nyse: agl), the company transforming health care for seniors by empowering primary-care physicians to focus on the entire health of their patients, announced results for the fourth quarter and year ended december 31, 2021. fourth quarter and fiscal year 2021 results: total revenue of $463 million increased 44% during the fourth quarter, driven by 42% growth in medicare advantage membership, including 15% membership growth in same geographies. for fiscal year 2021, total revenues of $1.83 billion increased 50% from 2020. total members live on the agilon platform increased 82% to 238,000 as of december 31, including 186,300 medicare advantage members and 51,700 direct contracting beneficiaries. net loss of $57 million in the fourth quarter compared to a net loss of $24 million in the fourth quarter 2020. for fiscal year 2021, net loss of $407 million compared to a net loss of $60 million in 2020. net loss for the fiscal year 2021 includes $292 million in non-cash stock-based compensation expense primarily related to agilon’s initial public offering in april 2021. medical margin of $31 million in the fourth quarter compared to $27 million in the fourth quarter 2020. for fiscal year 2021, medical margin of $182 million compared to $192 million in 2020. the year-over-year change in medical margin during fiscal 2021 in part reflects the impact from covid on healthcare utilization in the prior year. adjusted ebitda loss of $27 million during the fourth quarter compared to a loss of $13 million during the fourth quarter 2020. for fiscal year 2021, adjusted ebitda loss of $39 million compared to a $6 million gain in 2020. “our partnership model produced distinctive, predictable results in 2021, despite evolving covid dynamics,” said steve sell, chief executive officer. “looking ahead to 2022, we expect to generate significant gains in profitability while maintaining strong growth in membership and revenue. our partnership model and purpose-built platform, supported by powerful structural drivers, has enabled us to make rapid progress against our vision to transform healthcare in 100+ communities by empowering primary care.” outlook for first quarter and fiscal year 2022: quarter ended march 31, 2022 year ended december 31, 2022 low high low high medicare advantage members1 245,000 250,000 260,000 270,000 direct contracting members1 85,000 90,000 80,000 85,000 total members live on platform1 330,000 340,000 340,000 355,000 total revenues ($m) $635 $650 $2,505 $2,590 medical margin ($m) $82 $88 $290 $305 adjusted ebitda ($m)2 $10 $14 $0 $10 1membership reflects management’s outlook for end of period. agilon’s partnered direct contracting entities (dces) are not consolidated within its financial results. 2we have not reconciled guidance for adjusted ebitda to net income (loss), the most comparable gaap measure, and have not provided forward-looking guidance for net income (loss), because of the uncertainty around certain items that may impact net income (loss), including stock-based compensation, that are not within our control or cannot be reasonably predicted. membership details for the year ending 2021 total members live on the agilon platform as of december 31, 2021, were 238,000, an increase of 82% from 2020. total members live on the platform include 186,300 medicare advantage members and 51,700 attributed direct contracting beneficiaries. agilon’s consolidated medicare advantage membership increased 42% during 2021, driven by contributions from new geographies and 15% growth within same geographies. average medicare advantage membership was 186,200 during the fourth quarter and 181,800 for the fiscal year 2021. outlook for class of 2023 new partners agilon health expects to add 80,000 medicare advantage members from 7 new partner groups in 2023, driving record growth and entry into 4 new states and 8 new geographies. with the addition of these new partner groups, agilon health will have long-term partnerships with 23 physician groups in 12 states and 25 geographies. management intends to provide additional details on the class of 2023 new partners at the company’s investor day on march 11, 2022. webcast and conference call: agilon health will host a conference call and webcast to discuss fourth quarter and fiscal year 2021 results on friday, march 4, 2022 at 8:30 am eastern time. the conference call can be accessed by dialing (844) 200-6205 for u.s. participants and +1 (929) 526-1599 for international participants, and referencing participant code 269811. a simultaneous webcast can be accessed by visiting the “events & presentations” section of https://investors.agilonhealth.com. a replay of the call will be available via webcast for on-demand listening shortly after the completion of the call. about agilon health agilon health is transforming health care for seniors by empowering primary-care physicians to focus on the entire health of their patients. through our partnerships and our platform, agilon is leading the nation in creating the system we need – one built on the value of care, not the volume of fees. we honor the independence of local physicians and serve as their partners so they can be the doctors they trained to be. agilon provides the capital, data, payor relationships, executive experience and contract support that allow physician groups to take on the risk of total care for their most vulnerable patients. the result: healthier communities, and doctors who can devote the right amount of time with the patients who need it most. with rapidly growing appeal, agilon is scaled to grow and is here to help our nation’s best independent physician groups have a sustained, thriving future. together, we are reinventing primary care. for more information about agilon health, visit www.agilonhealth.com and connect with us on twitter, instagram, linkedin and youtube. forward-looking statements statements in this release that are not historical facts are “forward-looking statements” within the meaning of section 27a of the securities act of 1933, as amended, and section 21e of the securities exchange act of 1934, as amended. forward-looking statements include, among other things, statements regarding our and our officers’ intent, belief or expectation as identified by the use of words such as “may,” “will,” “project,” “expect,” “believe,” “intend,” “anticipate,” “seek,” "target," “forecast,” “plan,” “potential,” “estimate,” “could,” “would,” “should,” and other comparable and derivative terms or the negatives thereof. examples of forward-looking statements include, among other things: (i) statements regarding timing, outcomes and other details relating to current, pending or contemplated new markets, new partnership structures, financing activities, dispositions, or other transactions discussed in this release; and (ii) statements regarding growth opportunities, ability to deliver sustainable long-term value, business environment, long term opportunities and strategic growth plan including without limitation with respect to expected revenue and net income, total and average membership, adjusted ebitda, and other financial projections and assumptions, as well as comparable statements included in other sections of this release. forward-looking statements reflect our current expectations and views about future events and are subject to risks and uncertainties that could significantly affect our future financial condition and results of operations. while forward-looking statements reflect our good faith belief and assumptions we believe to be reasonable based upon current information, we can give no assurance that our expectations or forecasts will be attained. further, we cannot guarantee the accuracy of any such forward-looking statement contained in this release, and such forward-looking statements are subject to known and unknown risks and uncertainties that are difficult to predict. these risks and uncertainties that could cause actual results and outcomes to differ from those reflected in forward-looking statements include, but are not limited to: our history of net losses, and our ability to achieve or maintain profitability in an environment of increasing expenses; our ability to identify and develop successful new geographies, physician partners and payors, or to execute upon our growth initiatives; our ability to execute our operation strategies or to achieve results consistent with our historical performance; our expectation that our expenses will increase in the future and the risk that medical expenses incurred on behalf of members may exceed the amount of medical revenues we receive; our ability to secure contracts with medicare advantage payors or to secure medicare advantage payments at favorable financial terms; our ability to recover startup costs incurred during the initial stages of development of our physician partner relationships and program initiatives; significant reductions in our membership; challenges for our physician partners in the transition to a total care model; inaccuracies in the estimates and assumptions we use to project the size, revenue or medical expense amounts of our target markets; the spread of, and response to, the novel coronavirus, or covid-19, and the inability to predict the ultimate impact on us; security breaches, loss of data or other disruptions to our data platforms; the impact of devoting significant attention and resources to the provision of certain transition services in connection with the disposition of our california operations; our subsidiaries’ lack of performance or ability to fund their operations, which could require us to fund such losses; our dependence on a limited number of key payors; the limited terms of our contracts with payors and that they may not be renewed upon their expiration; our reliance on our payors for membership attribution and assignment, data and reporting accuracy and claims payment; our dependence on physician partners and other providers to effectively manage the quality and cost of care and perform obligations under payor contracts; our dependence on physician partners to accurately, timely and sufficiently document their services and potential false claims act or other liability if any diagnosis information or encounter data are inaccurate or incorrect; reductions in reimbursement rates or methodology applied to derive reimbursement from, or discontinuation of, federal government healthcare programs, from which we derive substantially all of our total revenue; statutory or regulatory changes, administrative rulings, interpretations of policy and determinations by intermediaries and governmental funding restrictions, and their impact on government funding, program coverage and reimbursements; regulatory proposals directed at containing or lowering the cost of healthcare and our participation in such proposed models; the impact on our revenue of cms modifying the methodology used to determine the revenue associated with ma members; the potential that we may incur future indebtedness; and risks related to other factors discussed under “risk factors” in our annual report on form 10-k for the year ended december 31, 2021. except as required by law, we do not undertake, and hereby disclaim, any obligation to update any forward-looking statements, which speak only as of the date on which they are made. agilon health, inc. consolidated balance sheets in thousands, except share and per share data december 31, 2021 december 31, 2020 assets current assets: cash and cash equivalents $ 1,040,039 $ 106,795 restricted cash and equivalents 14,781 28,383 receivables, net 293,407 144,555 prepaid expenses and other current assets, net 18,968 9,639 current assets held for sale and discontinued operations, net — 4,825 total current assets 1,367,195 294,197 property and equipment, net 9,161 6,456 intangible assets, net 55,398 60,468 goodwill 41,540 41,540 other assets, net 112,958 43,700 total assets $ 1,586,252 $ 446,361 liabilities, contingently redeemable common stock and stockholders’ equity (deficit) current liabilities: medical claims and related payables $ 239,014 $ 162,868 accounts payable and accrued expenses 112,946 97,244 current portion of long-term debt 5,000 3,041 current liabilities held for sale and discontinued operations — 3,682 total current liabilities 356,960 266,835 long-term debt, net of current portion 43,401 64,665 other liabilities 94,295 90,091 total liabilities 494,656 421,591 commitments and contingencies contingently redeemable common stock, $0.01 par value: 76,201 shares issued and outstanding at december 31, 2020 — 309,500 stockholders' equity (deficit): common stock, $0.01 par value: 2,000,000 and 500,000 shares authorized; 400,095 and 249,374 shares issued and outstanding, respectively 4,001 2,494 additional paid-in capital 2,045,572 263,966 accumulated deficit (957,677 ) (551,190 ) total agilon health, inc. stockholders' equity (deficit) 1,091,896 (284,730 ) noncontrolling interests (300 ) — total stockholders’ equity (deficit) 1,091,596 (284,730 ) total liabilities, contingently redeemable common stock and stockholders’ equity (deficit) $ 1,586,252 $ 446,361 agilon health, inc. consolidated statements of operations in thousands, except per share data three months ended december 31, year ended december 31, 2021 2020 2021 2020 (unaudited) revenues: medical services revenue $ 461,999 $ 320,227 $ 1,829,735 $ 1,214,270 other operating revenue 887 780 3,824 4,063 total revenues 462,886 321,007 1,833,559 1,218,333 expenses: medical services expense 430,620 292,928 1,647,659 1,021,877 other medical expenses 22,678 22,794 109,487 102,306 general and administrative (including noncash stock-based compensation expense of $4,414, $1,738, $292,394, and $6,472, respectively) 53,840 41,358 455,821 137,292 depreciation and amortization 3,621 3,670 14,544 13,531 total expenses 510,759 360,750 2,227,511 1,275,006 income (loss) from operations (47,873 ) (39,743 ) (393,952 ) (56,673 ) other income (expense): other income (expense), net (8,534 ) 2,886 (4,500 ) 2,465 interest expense (840 ) (1,953 ) (6,146 ) (8,135 ) income (loss) before income taxes (57,247 ) (38,810 ) (404,598 ) (62,343 ) income tax benefit (expense) (179 ) (791 ) (886 ) (865 ) income (loss) from continuing operations (57,426 ) (39,601 ) (405,484 ) (63,208 ) discontinued operations: income (loss) before gain (loss) on sales and income taxes (1,209 ) (6,890 ) (3,463 ) (20,049 ) gain (loss) on sales of assets, net — 19,087 473 20,401 income tax benefit (expense) 1,898 3,189 1,687 2,804 total discontinued operations 689 15,386 (1,303 ) 3,156 net income (loss) (56,737 ) (24,215 ) (406,787 ) (60,052 ) noncontrolling interests’ share in (earnings) loss 16 — 300 — net income (loss) attributable to common shares $ (56,721 ) $ (24,215 ) $ (406,487 ) $ (60,052 ) net income (loss) per common share, basic and diluted continuing operations $ (0.14 ) $ (0.12 ) $ (1.09 ) $ (0.20 ) discontinued operations $ — $ 0.05 $ — $ 0.01 weighted average shares outstanding, basic and diluted 396,411 327,231 372,931 323,462 agilon health, inc. consolidated statements of cash flows in thousands, except per share data year ended december 31, 2021 2020 cash flows from operating activities: net income (loss) $ (406,787 ) $ (60,052 ) adjustments to reconcile net loss to net cash used in operating activities: depreciation and amortization 14,670 14,099 stock-based compensation expense 292,394 6,688 loss on debt extinguishment 1,590 — loss (income) from equity method investments 6,766 (514 ) deferred income taxes and uncertain tax positions (3,231 ) (2,809 ) release of indemnification assets 1,705 3,475 (gain) loss on sale of assets, net (473 ) (20,401 ) distributions of earnings from equity method investments 174 — other non-cash items 58 (162 ) changes in operating assets and liabilities: receivables, net (149,041 ) (59,381 ) prepaid expense and other current assets (3,916 ) (5,085 ) other assets 3,931 (1,977 ) medical claims and related payables 76,339 42,383 accounts payable and accrued expenses 19,360 24,922 other liabilities (1,698 ) 5,610 net cash provided by (used in) operating activities (148,159 ) (53,204 ) cash flows from investing activities: purchase of property and equipment, net (6,564 ) (1,775 ) purchase of intangible assets (6,862 ) (575 ) investment in loans receivable and other (82,831 ) (3,847 ) proceeds from repayment of loans receivable and other 7,095 2,058 proceeds from sale of business and property, net of cash divested (1,344 ) 26,205 net cash provided by (used in) investing activities (90,506 ) 22,066 cash flows from financing activities: proceeds from initial public offering 1,170,942 — proceeds from other equity issuances, net — 33,590 proceeds from exercise of stock options 18,086 814 repurchase of shares, net — (6,742 ) proceeds from the issuance of long-term debt 100,000 — repayments of long-term borrowings and other (119,899 ) (3,041 ) equity and debt issuance costs and other (14,739 ) — net cash provided by (used in) financing activities 1,154,390 24,621 net increase (decrease) in cash, cash equivalents and restricted cash and equivalents 915,725 (6,517 ) cash, cash equivalents and restricted cash and equivalents from continuing operations, beginning of period 135,178 139,152 cash, cash equivalents and restricted cash and equivalents from discontinued operations, beginning of period 3,917 6,460 cash, cash equivalents and restricted cash and equivalents, beginning of period 139,095 145,612 cash, cash equivalents and restricted cash and equivalents from continuing operations, end of period 1,054,820 135,178 cash, cash equivalents and restricted cash and equivalents from discontinued operations, end of period — 3,917 cash, cash equivalents and restricted cash and equivalents, end of period $ 1,054,820 $ 139,095 agilon health, inc. key operating metrics in thousands (unaudited) medical margin three months ended december 31, year ended december 31, 2021 2020 2021 2020 medical services revenue $ 461,999 $ 320,227 $ 1,829,735 $ 1,214,270 medical services expense (430,620 ) (292,928 ) (1,647,659 ) (1,021,877 ) medical margin $ 31,379 $ 27,299 $ 182,076 $ 192,393 medical margin represents the amount earned from medical services revenue after medical services expenses are deducted. medical services expense represents costs incurred for medical services provided to our members. as our platform matures over time, we expect medical margin to increase in absolute dollars. however, medical margin per member per month (pmpm) may vary as the percentage of new members brought onto our platform fluctuates. new membership added to the platform is typically dilutive to medical margin pmpm. general and administrative costs, including platform support costs three months ended december 31, year ended december 31, 2021 2020 2021 2020 platform support costs $ 30,899 $ 25,802 $ 123,521 $ 99,943 geography entry costs(1) 7,872 11,607 20,583 17,945 severance and related costs 7,763 493 12,861 4,009 management fees(2) — 395 433 1,530 stock-based compensation expense 4,414 1,738 292,394 6,472 other(3) 2,892 1,323 6,029 7,393 general and administrative $ 53,840 $ 41,358 $ 455,821 $ 137,292 (1) represents direct geography entry costs, including investments to develop and expand our platform and costs in geographies that are in implementation and are not yet generating revenue. (2) represents management fees and other expenses paid to clayton dubilier & rice, llc (“cd&r”). in connection with our initial public offering, we terminated our consulting agreement with cd&r, effective april 16, 2021. we were not charged a fee in connection with the termination of this agreement. (3) includes changes in non-cash accruals for unasserted claims and contingent liabilities. our platform support costs, which include regionally-based support personnel and other operating costs to support our geographies, are expected to decrease over time as a percentage of revenue as our physician partners add members and our revenue grows. our operating expenses at the enterprise level include resources and technology to support payor contracting, clinical program development, quality, data management, finance and legal functions. agilon health, inc. non-gaap financial measures in thousands (unaudited) network contribution three months ended december 31, year ended december 31, 2021 2020 2021 2020 income (loss) from operations $ (47,873 ) $ (39,743 ) $ (393,952 ) $ (56,673 ) other operating revenue (887 ) (780 ) (3,824 ) (4,063 ) other medical expenses 22,678 22,794 109,487 102,306 other medical expenses—live geographies(1) (18,704 ) (17,957 ) (97,498 ) (93,377 ) general and administrative 53,840 41,358 455,821 137,292 depreciation and amortization 3,621 3,670 14,544 13,531 network contribution $ 12,675 $ 9,342 $ 84,578 $ 99,016 represents physician compensation expense related to surplus sharing and other direct medical expenses incurred to improve care for our members in our live geographies. excludes costs in geographies that are in implementation and are not yet generating revenue. for the three months ended december 31, 2021 and 2020, costs incurred in implementing geographies were $4.0 million and $4.8 million, respectively. for the years ended december 31, 2021 and 2020, costs incurred in implementing geographies were $12.0 million and $8.9 million, respectively. adjusted ebitda three months ended december 31, year ended december 31, 2021 2020 2021 2020 net income (loss) $ (56,737 ) $ (24,215 ) $ (406,787 ) $ (60,052 ) (income) loss from discontinued operations, net of income taxes (689 ) (15,386 ) 1,303 (3,156 ) interest expense 840 1,953 6,146 8,135 income tax expense (benefit) 179 791 886 865 depreciation and amortization 3,621 3,670 14,544 13,531 geography entry costs(1) 11,846 16,670 32,572 27,100 severance and related costs(2) 7,763 493 12,861 4,009 management fees(3) — 395 433 1,530 stock-based compensation expense 4,414 1,738 292,394 6,472 ebitda adjustments related to equity method investments(4) (571 ) — 1,736 — other(5) 2,642 1,323 5,293 7,393 adjusted ebitda $ (26,692 ) $ (12,568 ) $ (38,619 ) $ 5,827 represents direct geography entry costs, including investments to develop and expand our platform and costs in geographies that are in implementation and are not yet generating revenue. for the three months ended december 31, 2021 and 2020, (i) $4.0 million and $4.8 million, respectively, are included in other medical expenses and (ii) $7.9 million and $11.6 million, respectively, are included in general and administrative expenses. for the years ended december 31, 2021 and 2020, (i) $12.0 million and $8.9 million, respectively, are included in other medical expenses and (ii) $20.6 million and $17.9 million, respectively, are included in general and administrative expenses. for the three months and year ended december 31, 2021, includes taxes and related costs on stock option exercises for departed executives of $5.4 million. represents management fees and other expenses paid to cd&r. in connection with our initial public offering, we terminated our consulting agreement with cd&r, effective april 16, 2021. we were not charged a fee in connection with the termination of this agreement. includes direct geography entry costs of $0.1 million and $1.3 million for the three and twelve months ended december 31, 2021, respectively. includes changes in non-cash accruals for unasserted claims and contingent liabilities. in addition to providing results that are determined in accordance with gaap, we present network contribution and adjusted ebitda, which are non-gaap financial measures. we define network contribution as medical services revenue less the sum of: (i) medical services expense and (ii) other medical expenses excluding costs incurred in implementing geographies. other medical expenses consist of physician compensation expense related to surplus sharing and other direct medical expenses incurred to improve care for our members. we believe this metric provides insight into the economics of our total care model as it includes all medical services expense associated with our members’ care as well as partner compensation and additional medical costs we incur as part of our aligned partnership model. other medical expenses are largely variable and proportionate to the level of surplus in each respective geography. we define adjusted ebitda as net income (loss) adjusted to exclude: (i) income (loss) from discontinued operations, net of income taxes, (ii) interest expense, (iii) income tax expense (benefit), (iv) depreciation and amortization expense, (v) geography entry costs, (vi) stock-based compensation expense, (vii) severance and related costs, and (viii) certain other items that are not considered by us in the evaluation of ongoing operating performance. we reflect our share of adjusted ebitda for equity method investments by applying our actual ownership percentage for the period to the applicable reconciling items on an entity-by-entity basis. income (loss) from operations is the most directly comparable gaap measure to network contribution. net income (loss) is the most directly comparable gaap measure to adjusted ebitda. we believe network contribution and adjusted ebitda help identify underlying trends in our business and facilitate evaluation of period-to-period operating performance of our live geographies by eliminating items that are variable in nature and not considered by us in the evaluation of ongoing operating performance, allowing comparison of our recurring core business operating results over multiple periods. we also believe network contribution and adjusted ebitda provide useful information about our operating results, enhance the overall understanding of our past performance and future prospects, and allow for greater transparency with respect to key metrics we use for financial and operational decision-making. we believe network contribution and adjusted ebitda or similarly titled non-gaap measures are widely used by investors, securities analysts, ratings agencies, and other parties in evaluating companies in our industry as a measure of financial performance. other companies may calculate network contribution and adjusted ebitda or similarly titled non-gaap measures differently from the way we calculate these metrics. as a result, our presentation of network contribution and adjusted ebitda may not be comparable to similarly titled measures of other companies, limiting their usefulness as comparative measures.
