Brightspring Health Services, Inc.(BTSGU) - 2023 Q4 - Annual Report

Acquisitions and Market Expansion - The company acquired Abode Healthcare in April 2021, enhancing its service offerings in the healthcare sector[6]. - The company is actively expanding its market presence through new branch and facility openings, referred to as "de novo" locations[6]. - The company anticipates future growth driven by strategic acquisitions and market expansion initiatives[9]. - The company has completed 59 acquisitions since 2018, with a total purchase consideration exceeding $1.7 billion since January 2020, enhancing its market position[43]. - The company has expanded to 143 new locations since 2018, generating total revenue of$ 226.8 million in 2023, representing an 18.1% growth compared to the previous year[91]. Financial Performance and Metrics - Revenue grew from $6,698.1 million in 2021 to$ 8,826.2 million in 2023, primarily from organic growth and strategic acquisitions[24]. - Adjusted EBITDA increased from $493.1 million in 2021 to$ 537.8 million in 2023[24]. - Pharmacy Solutions segment revenue totaled $6,522.5 million in 2023, accounting for 73.9% of total revenue[23]. - Provider Services segment revenue totaled$ 2,303.7 million in 2023, accounting for 26.1% of total revenue[23]. - The company has a substantial indebtedness of approximately $3.4 billion as of December 31, 2023[13]. Patient Care and Satisfaction - The Medication Possession Ratio (MPR) is a key performance metric, with a compliance threshold set at over 80% under contracts with payors[7]. - The Net Promoter Score (NPS) is utilized to gauge patient satisfaction, with scores above 50 considered "excellent" and above 80 classified as "world class"[7]. - The overall patient satisfaction is measured through various quality metrics, reflecting the company's commitment to high standards of care[7]. - The company achieved 99.99% order accuracy and 98.20% order completeness across its pharmacies[27]. - The company has achieved a 98% satisfaction score for outpatient rehab services and 95% for home infusion patients, indicating strong customer satisfaction across its services[30]. Market Trends and Opportunities - The market for Senior and Specialty patients is over$ 1.0 trillion, with these patients accounting for 40% of total healthcare spending[17]. - The company is positioned for long-term growth due to its complementary pharmacy and provider services that address multiple patient needs[19]. - The total addressable market opportunity is estimated to be over $1.0 trillion, with complex populations driving the highest growth within healthcare services[85]. - Home health patient expenditures are expected to increase by approximately 7% over the next five years, while hospice patient expenditures are projected to grow by 8%[48]. - The U.S. population aged 65 and older is expected to grow by an average of 3% annually over the next five years, driving demand for the company's services[47]. Regulatory and Compliance Risks - The company is subject to various risks, including governmental inquiries and regulatory actions that could adversely affect operating results[13]. - The company must adhere to HIPAA regulations, which govern the security and confidentiality of personal health information, with potential penalties for violations[180]. - The company is subject to audits by federal, state, and commercial payors, which could lead to substantial repayments if overpayments are identified[176]. - The company faces increased competition due to local competitors developing strategic relationships with payors and referral sources, which may limit the ability to retain referrals and payors in local markets[202]. - The company is required to establish new policies to comply with proposed amendments to HIPAA regulations affecting the handling of personal health information[1]. Employee Relations and Workforce - The company has increased employee compensation by 50% over the last three years to attract and retain talent[145]. - As of December 31, 2023, the company employed over 35,000 full-time equivalent employees, with approximately 6,500 represented by labor unions[148]. - The company actively supports veterans and their families through various programs, including partnerships with Soldier's Angels[147]. - The company is committed to creating higher-paying jobs through career pathways and talent pipeline programs[145]. - The company has received numerous awards for its human resources and employee relations practices[148]. Technology and Innovation - Investments in technology and information systems have been made to improve overall efficiency and workflow, including new EMR and ERP systems[77]. - The company has developed innovative technology solutions that allow employees to access their pay daily[145]. - Significant investments have been made into technology resources and systems to drive continuous improvement and reflect leading infrastructure standards[141]. - The company maintains a 99.9% generic efficiency rate, saving an average of$ 58 per therapeutic interchange[63]. - The company’s integrated care management model is supported by home-based primary care, transitional care management, and clinical care coordination[105]. Strategic Partnerships and Relationships - The company currently has 360 formal strategic partnerships with health systems, including approximately 20 home health partnerships, enhancing its service delivery network[35]. - The company has a diversified payor mix, with 50% of revenues from Medicare, 23% from Medicaid, and 21% from commercial sources, positioning it well for evolving reimbursement models[41]. - The company has developed new relationships with healthcare stakeholders, focusing on patient experiences and quality, including ACOs and MCOs that contract with CMS and state programs[120]. - Maintaining strong relationships with pharmaceutical manufacturers, wholesalers, and distributors is crucial for the company's business and financial condition[205]. - The company provides services to pharmaceutical manufacturers for patient access to specialty pharmaceuticals, and failure to maintain optimal service levels could result in loss of access to products[205].