R1 RCM 10-Q 3 Aug 21 2021 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2021	Jul. 27, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2021
Document Transition Report	false
Entity File Number	001-34746
Entity Registrant Name	R1 RCM INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	02-0698101
Entity Address, Address Line One	434 W. Ascension Way
Entity Address, Address Line Two	6th Floor
Entity Address, City or Town	Murray
Entity Address, State or Province	UT
Entity Address, Postal Zip Code	84123
City Area Code	312
Local Phone Number	324-7820
Title of 12(b) Security	Common stock, par value $0.01 per share
Trading Symbol	RCM
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filter Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		278,870,428
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q2
Entity Central Index Key	0001472595
Current Fiscal Year End Date	--12-31

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 164.9	$ 173.8
Accounts receivable, net of $2.2 million and $3.7 million allowance	96.8	91.3
Accounts receivable, net of $0.1 million and $0.1 million allowance - related party	31.9	30.9
Prepaid expenses and other current assets	59.7	59.4
Total current assets	353.3	355.4
Property, equipment and software, net	89.8	93.7
Operating lease right-of-use assets	56.5	57.8
Intangible assets, net	162.2	171.1
Goodwill	375.5	375.3
Non-current deferred tax assets	62.6	73.7
Non-current portion of restricted cash equivalents	0.5	1
Other assets	77.4	61
Total assets	1,177.8	1,189
Current liabilities:
Accounts payable	21	18.2
Current portion of customer liabilities	30.8	16.7
Current portion of customer liabilities - related party	6.7	15.3
Accrued compensation and benefits	76.6	51.9
Current portion of operating lease liabilities	10.7	12.2
Current portion of long-term debt	38.7	32.3
Other accrued expenses	53.3	59.7
Total current liabilities	237.8	206.3
Non-current portion of customer liabilities - related party	16.4	16.3
Non-current portion of operating lease liabilities	65.3	71
Long-term debt	500.7	519.7
Other non-current liabilities	35.5	36.3
Total liabilities	855.7	849.6
8.00% Series A convertible preferred stock, par value $0.01, no shares authorized, issued or outstanding as of June 30, 2021; 370,000 shares authorized, 288,497 shares issued and outstanding as of December 31, 2020 (aggregate liquidation value of $294.3)	0	251.5
Stockholders’ equity:
Common stock, $0.01 par value, 500,000,000 shares authorized, 295,658,397 shares issued and 278,819,843 shares outstanding at June 30, 2021; 137,812,559 shares issued and 121,144,038 shares outstanding at December 31, 2020	3	1.4
Additional paid-in capital	587.2	393.7
Accumulated deficit	(117.3)	(161.5)
Accumulated other comprehensive loss	(7.1)	(6.5)
Treasury stock, at cost, 16,838,554 shares as of June 30, 2021; 16,668,521 shares as of December 31, 2020	(143.7)	(139.2)
Total stockholders’ equity	322.1	87.9
Total liabilities and stockholders’ equity	$ 1,177.8	$ 1,189

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	6 Months Ended	12 Months Ended
	Jun. 30, 2021	Dec. 31, 2020
Accounts receivable, allowance	$ 2.2	$ 3.7
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	500,000,000	500,000,000
Common stock, shares issued (in shares)	295,658,397	137,812,559
Common stock, shares outstanding (in shares)	278,819,843	121,144,038
Treasury stock, shares (in shares)	16,838,554	16,668,521
Redeemable Convertible Preferred Stock
Preferred stock, dividend rate (percentage)	8.00%	8.00%
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	0	370,000
Preferred stock, shares issued (in shares)	0	288,497
Preferred stock, shares outstanding (in shares)	0	288,497
Preferred stock, aggregate liquidation value		$ 294.3
Related Party
Accounts receivable, allowance	$ 0.1	$ 0.1

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income (Unaudited) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Statement [Abstract]
Net services revenue ($218.4 million and $433.9 million for the three and six months ended June 30, 2021, respectively, and $206.4 million and $414.8 million for the three and six months ended June 30, 2020, respectively, from related party)	$ 353.4	$ 314.7	$ 696	$ 635.2
Operating expenses:
Cost of services	287	248.3	554.2	502.2
Selling, general and administrative	29	23.3	54.6	48.8
Other expenses	9.8	18	22.8	26.7
Total operating expenses	325.8	289.6	631.6	577.7
Income from operations	27.6	25.1	64.4	57.5
Net interest expense	3.4	4.8	7.3	8.6
Income before income tax provision	24.2	20.3	57.1	48.9
Income tax provision	5.8	5.2	12.9	15.6
Net income	$ 18.4	$ 15.1	$ 44.2	$ 33.3
Net income (loss) per common share:
Basic (in dollars per share)	$ 0.07	$ 0.04	$ (2.16)	$ 0.10
Diluted (in dollars per share)	$ 0.06	$ 0.03	$ (2.16)	$ 0.08
Weighted average shares used in calculating net income (loss) per common share:
Basic (in shares)	268,251,790	115,067,552	253,850,972	114,754,298
Diluted (in shares)	320,832,913	165,887,964	253,850,972	167,809,324
Consolidated statements of comprehensive income
Net income	$ 18.4	$ 15.1	$ 44.2	$ 33.3
Other comprehensive income (loss):
Net change on derivatives designated as cash flow hedges, net of tax	(0.1)	0.8	0.4	(3.6)
Foreign currency translation adjustments	(0.6)	(0.2)	(1)	(2.3)
Comprehensive income	17.7	15.7	43.6	27.4
Basic:
Net income	18.4	15.1	44.2	33.3
Less dividends on preferred shares	0	(5.6)	(592.3)	(11)
Less income allocated to preferred shareholders	0	(4.7)	0	(11)
Net income (loss) available/allocated to common shareholders - basic	18.4	4.8	(548.1)	11.3
Diluted:
Net income	18.4	15.1	44.2	33.3
Less dividends on preferred shares	0	(5.6)	(592.3)	(11)
Less income allocated to preferred shareholders	0	(3.8)	0	(8.9)
Net income (loss) available/allocated to common shareholders - diluted	$ 18.4	$ 5.7	$ (548.1)	$ 13.4

Consolidated Statements of Op_2

Consolidated Statements of Operations and Comprehensive Income (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Income Statement [Abstract]
Revenue from related parties	$ 218.4	$ 206.4	$ 433.9	$ 414.8

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Millions	Total	Cumulative Effect, Period of Adoption, Adjustment	Cumulative Effect, Period of Adoption, Adjusted Balance	Common Stock	Common StockCumulative Effect, Period of Adoption, Adjusted Balance	Treasury Stock	Treasury StockCumulative Effect, Period of Adoption, Adjusted Balance	Additional Paid-In Capital	Additional Paid-In CapitalCumulative Effect, Period of Adoption, Adjusted Balance	Accumulated Deficit	Accumulated DeficitCumulative Effect, Period of Adoption, Adjustment	Accumulated DeficitCumulative Effect, Period of Adoption, Adjusted Balance	Accumulated Other Comprehensive Loss	Accumulated Other Comprehensive LossCumulative Effect, Period of Adoption, Adjusted Balance
Beginning Balance (in shares) at Dec. 31, 2019				127,807,546	127,807,546	13,786,266	13,786,266
Beginning Balance at Dec. 31, 2019	$ 18.1	$ (0.8)	$ 17.3	$ 1.3	$ 1.3	$ (73.6)	$ (73.6)	$ 372.7	$ 372.7	$ (277.8)	$ (0.8)	$ (278.6)	$ (4.5)	$ (4.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	4.8							4.8
Issuance of common stock related to share-based compensation plans (in shares)				1,720
Exercise of vested stock options (in shares)				553,520
Exercise of vested stock options	3.1							3.1
Dividends paid/accrued	(5.4)							(5.4)
Acquisition of treasury stock related to share-based compensation plans (in shares)						(545)
Net change on derivatives designated as cash flow hedges, net of tax	(4.4)												(4.4)
Foreign currency translation adjustments	(2.1)												(2.1)
Net income	18.2									18.2
Ending Balance (in shares) at Mar. 31, 2020				128,362,786		13,786,811
Ending Balance at Mar. 31, 2020	31.5			$ 1.3		$ (73.6)		375.2		(260.4)			(11)
Beginning Balance (in shares) at Dec. 31, 2019				127,807,546	127,807,546	13,786,266	13,786,266
Beginning Balance at Dec. 31, 2019	$ 18.1	$ (0.8)	$ 17.3	$ 1.3	$ 1.3	$ (73.6)	$ (73.6)	372.7	$ 372.7	(277.8)	$ (0.8)	$ (278.6)	(4.5)	$ (4.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Net change on derivatives designated as cash flow hedges, net of tax	$ (3.6)
Foreign currency translation adjustments	(2.3)
Net income	33.3
Ending Balance (in shares) at Jun. 30, 2020				129,289,960		13,915,172
Ending Balance at Jun. 30, 2020	46.1			$ 1.3		$ (74.7)		375.2		(245.3)			(10.4)
Beginning Balance (in shares) at Mar. 31, 2020				128,362,786		13,786,811
Beginning Balance at Mar. 31, 2020	31.5			$ 1.3		$ (73.6)		375.2		(260.4)			(11)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	4.4							4.4
Issuance of common stock related to share-based compensation plans (in shares)				463,038
Exercise of vested stock options (in shares)				464,136
Exercise of vested stock options	1.2			$ 0				1.2
Dividends paid/accrued	(5.6)							(5.6)
Acquisition of treasury stock related to share-based compensation plans (in shares)						(128,361)
Acquisition of treasury stock related to share-based compensation plans	(1.1)					$ (1.1)
Net change on derivatives designated as cash flow hedges, net of tax	0.8												0.8
Foreign currency translation adjustments	(0.2)												(0.2)
Net income	15.1									15.1
Ending Balance (in shares) at Jun. 30, 2020				129,289,960		13,915,172
Ending Balance at Jun. 30, 2020	46.1			$ 1.3		$ (74.7)		375.2		(245.3)			(10.4)
Beginning Balance (in shares) at Dec. 31, 2020				137,812,559		16,668,521
Beginning Balance at Dec. 31, 2020	87.9			$ 1.4		$ (139.2)		393.7		(161.5)			(6.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	12.8							12.8
Issuance of common stock related to share-based compensation plans (in shares)				6,497
Issuance of common stock (in shares)				324,212
Issuance of common stock	7							7
Exercise of vested stock options (in shares)				539,795
Exercise of vested stock options	3.5							3.5
Acquisition of treasury stock related to share-based compensation plans (in shares)						(2,201)
Net change on derivatives designated as cash flow hedges, net of tax	0.5												0.5
Foreign currency translation adjustments	(0.4)												(0.4)
Conversion of preferred shares (in shares)				117,706,400
Conversion of preferred shares	251.5			$ 1.2				250.3
Inducement dividend	(592.3)							(592.3)
Issuance of common stock related to inducement (in shares)				21,582,800
Issuance of common stock related to inducement	487.3			$ 0.2				487.1
Net income	25.8									25.8
Ending Balance (in shares) at Mar. 31, 2021				277,972,263		16,670,722
Ending Balance at Mar. 31, 2021	283.6			$ 2.8		$ (139.2)		562.1		(135.7)			(6.4)
Beginning Balance (in shares) at Dec. 31, 2020				137,812,559		16,668,521
Beginning Balance at Dec. 31, 2020	$ 87.9			$ 1.4		$ (139.2)		393.7		(161.5)			(6.5)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	us-gaap:AccountingStandardsUpdate201613Member
Exercise of vested stock options (in shares)	936,045
Net change on derivatives designated as cash flow hedges, net of tax	$ 0.4
Foreign currency translation adjustments	(1)
Net income	44.2
Ending Balance (in shares) at Jun. 30, 2021				295,658,397		16,838,554
Ending Balance at Jun. 30, 2021	322.1			$ 3		$ (143.7)		587.2		(117.3)			(7.1)
Beginning Balance (in shares) at Mar. 31, 2021				277,972,263		16,670,722
Beginning Balance at Mar. 31, 2021	283.6			$ 2.8		$ (139.2)		562.1		(135.7)			(6.4)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	24							24
Issuance of common stock related to share-based compensation plans (in shares)				539,884
Exercise of vested stock options (in shares)				396,250
Exercise of vested stock options	1.3							1.3
Acquisition of treasury stock related to share-based compensation plans (in shares)						(167,832)
Acquisition of treasury stock related to share-based compensation plans	(4.5)					$ (4.5)
Net change on derivatives designated as cash flow hedges, net of tax	(0.1)												(0.1)
Foreign currency translation adjustments	(0.6)												(0.6)
Exercise of warrants pursuant to cashless provisions (in shares)				16,750,000
Exercise of warrants pursuant to cashless provisions	0			$ 0.2				(0.2)
Net income	18.4									18.4
Ending Balance (in shares) at Jun. 30, 2021				295,658,397		16,838,554
Ending Balance at Jun. 30, 2021	$ 322.1			$ 3		$ (143.7)		$ 587.2		$ (117.3)			$ (7.1)

Consolidated Statements of St_2

Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended				12 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019
Accumulated Other Comprehensive Loss
Net change on derivatives designated as cash flow hedges, tax	$ 0	$ 0.2	$ 0.3	$ 1.5
Cumulative Effect, Period of Adoption, Adjustment
Impact of credit-loss standard adoption, tax					$ 0.3

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Operating activities
Net income	$ 44.2	$ 33.3
Adjustments to reconcile net income to net cash provided by operations:
Depreciation and amortization	35.5	33.6
Amortization of debt issuance costs	0.5	0.5
Share-based compensation	36.5	9.1
Loss on disposal and right-of-use asset write-downs	0.6	4.5
Provision for credit losses	0.2	1.7
Deferred income taxes	10.5	15.1
Non-cash lease expense	5.2	6
Changes in operating assets and liabilities:
Accounts receivable and related party accounts receivable	(8.8)	(5.4)
Prepaid expenses and other assets	(15.2)	(10.5)
Accounts payable	2.2	4.5
Accrued compensation and benefits	25	(44.2)
Lease liabilities	(7.4)	(5.9)
Other liabilities	(6.9)	12.7
Customer liabilities and customer liabilities - related party	6.4	(9.7)
Net cash provided by operating activities	128.5	45.3
Investing activities
Purchases of property, equipment, and software	(18.4)	(31.1)
Acquisition of SCI, net of cash acquired and earn-out provision	0	(189)
Proceeds from disposal of assets	2.6	0
Net cash used in investing activities	(15.8)	(220.1)
Financing activities
Repayment of senior secured debt and revolver	(12.9)	(10.5)
Payment of contingent consideration liability	(4.8)	0
Inducement of preferred stock conversion	(105)	0
Exercise of vested stock options	5.7	4.3
Shares withheld for taxes	(4.5)	(1.1)
Other	0	(5.7)
Net cash (used in) provided by financing activities	(121.5)	207.6
Effect of exchange rate changes in cash, cash equivalents and restricted cash	(0.6)	(1.2)
Net (decrease) increase in cash, cash equivalents and restricted cash	(9.4)	31.6
Cash, cash equivalents and restricted cash, at beginning of period	174.8	92.5
Cash, cash equivalents and restricted cash, at end of period	165.4	124.1
Supplemental disclosures of cash flow information
Accrued dividends payable to preferred stockholders	0	5.6
Accrued and other liabilities related to purchases of property, equipment and software	13.5	11.2
Accounts payable related to purchases of property, equipment and software	3.6	0.6
Interest paid	7.4	7.4
Income taxes paid	1.7	2.5
Income taxes refunded	0	0.2
Senior Term Loan
Financing activities
Borrowings on revolver	0	190.6
Senior Revolver
Financing activities
Borrowings on revolver	0	50
Repayment of senior secured debt and revolver	$ 0	$ (20)

Business Description and Basis

Business Description and Basis of Presentation	6 Months Ended
	Jun. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Basis of Presentation	Business Description and Basis of Presentation Business Description R1 RCM Inc. (the “Company”) is a leading provider of technology-driven solutions that transform the patient experience and financial performance of healthcare providers. The Company helps healthcare providers generate sustainable improvements in their operating margins and cash flows while also enhancing patient, physician, and staff satisfaction for its customers. Ascension On April 30, 2021, the Company and Ascension Health (“Ascension”) entered into Amendment No. 5 to the Master Professional Services Agreement (“A&R MPSA”), effective as of May 1, 2021, extending the agreement to April 30, 2031, among other amendments. For further information regarding the Company's business, including relationships with Ascension, TowerBrook Capital Partners (“TowerBrook”), and TCP-ASC ACHI Series LLLP (“TCP-ASC” or the “Investor”), refer to Note 1 of the Company's Annual Report on Form 10-K for the fiscal year ended December 31, 2020 (the “2020 Form 10-K”). VisitPay Acquisition On July 1, 2021, the Company completed the acquisition of iVinci Partners, LLC d/b/a VisitPay (“VisitPay”) pursuant to an Agreement and Plan of Merger dated as of May 3, 2021 by and among the Company, iVinci Partners, LLC, Vine Merger Sub, LLC, Flare Capital Partners I, L.P., Flare Capital Partners Investment Company, and Vine Sellers’ Representative, LLC (the “VisitPay Acquisition”). At the closing of the transaction, the Company acquired all of the outstanding equity interests of VisitPay. VisitPay is a provider of digital payment solutions. The Company acquired VisitPay for approximately $298.0 million in cash, subject to customary adjustments for working capital, cash, and debt. The Company funded the VisitPay Acquisition and related fees and expenses with the proceeds from borrowings under its amended and restated senior secured credit facilities and cash on hand. For more information on the amended and restated senior secured credit facilities, see Note 22, Subsequent Events. Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of June 30, 2021, the results of operations of the Company for the three and six months ended June 30, 2021 and 2020, and the cash flows of the Company for the six months ended June 30, 2021 and 2020. These financial statements include the accounts of R1 RCM Inc. and its wholly-owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with United States generally accepted accounting principles (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information, have been included. Operating results for the three and six months ended June 30, 2021 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2021.

Recent Accounting Pronouncement

Recent Accounting Pronouncements	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Recent Accounting Pronouncements	Recent Accounting Pronouncements Recently Issued Accounting Standards and Disclosures No new accounting pronouncements issued or effective during the fiscal year had, or is expected to have, a material impact on the Company’s consolidated financial statements.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	6 Months Ended
	Jun. 30, 2021
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	Fair Value of Financial Instruments The Company's accounting policy for fair values, including details of the fair value hierarchy levels, are outlined in Note 4 of the Company's 2020 Form 10-K. The carrying amounts of the Company’s financial instruments, which include financial assets such as cash and cash equivalents, restricted cash equivalents, accounts receivable, net, and certain other current assets, as well as financial liabilities such as accounts payable, accrued service costs, accrued compensation and benefits, and certain other accrued expenses, approximate their fair values, due to the short-term nature of these instruments. See Note 21, Derivative Financial Instruments, for a discussion of the fair value of the Company's forward currency derivative contracts and interest rate swaps.

Acquisitions

Acquisitions	6 Months Ended
	Jun. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Acquisitions	Acquisitions SCI On April 1, 2020, the Company completed the acquisition of scheduling.com, Inc. d/b/a SCI Solutions, Inc. (“SCI”). The SCI acquisition has been accounted for under ASC 805, Business Combinations. Accordingly, the accounts of the acquired company, after adjustments to reflect fair values assigned to assets and liabilities, have been included in the Company’s consolidated financial statements since the date of the SCI acquisition. The purchase price for the SCI acquisition was $190.0 million, subject to customary adjustments for cash, transaction expenses, earn-out consideration, and normalized working capital. The Company funded the purchase price for the SCI acquisition and the Company’s associated transaction expenses with a combination of cash on hand and the incurrence of additional indebtedness (see Note 11, Debt). The fair value of assets acquired and liabilities assumed is (in millions): Purchase Price Allocation Total purchase consideration $ 197.0 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 2.9 Accounts receivable 2.8 Prepaid expenses and other current assets 1.2 Property, equipment and software 0.3 Operating lease right-of-use assets 1.2 Intangible assets 86.1 Goodwill 125.8 Accounts payable (0.2) Current portion of customer liabilities (4.0) Accrued compensation and benefits (1.6) Current portion of operating lease liabilities (0.5) Other accrued expenses (0.4) Non-current portion of operating lease liabilities (0.7) Other non-current liabilities (5.0) Deferred income tax liabilities (10.9) Net assets acquired $ 197.0 Other non-current liabilities contained a note payable for $5.0 million. The Company repaid this note in the second quarter of 2020. The goodwill recognized is primarily attributable to synergies that are expected to be achieved from the integration of SCI. None of the goodwill is expected to be deductible for income tax purposes. The purchase price included an earn-out provision, which was dependent on achieving certain revenue and operational targets in the year following the acquisition, all of which were achieved. Based on projections at the time of acquisition, the earn-out was valued at $4.8 million. The full earn-out of $10.0 million was paid in the second quarter of 2021. Changes to the earn-out value were recorded as a component of other expenses. RevWorks On August 3, 2020, the Company completed the acquisition of RevWorks. The RevWorks acquisition has been accounted for under ASC 805, Business Combinations. Accordingly, the accounts of the acquired company, after adjustments to reflect estimated fair values assigned to assets and liabilities, have been included in the Company’s consolidated financial statements since the date of the RevWorks acquisition. The $30.0 million purchase consideration for the RevWorks acquisition (inclusive of working capital) consisted of a $5.0 million payment at closing and two deferred payments, each of $12.5 million and totaling $25.0 million, which are due and payable on the first and second anniversary of the closing date. The two deferred payments are contractual obligations of the Company; however, they are potentially effectively refundable to the Company contingent on the achievement of certain pre-existing customer revenue targets for the RevWorks business that were agreed in the purchase agreement. If such targets are not achieved, Cerner Corporation (“Cerner”) is required to return to the Company up to $25.0 million. At the time of the acquisition, the Company recorded a present value liability for the contractual deferred payments of $24.3 million, and recorded an asset for the contingently returnable consideration of $22.3 million, including $11.5 million in prepaid expenses and $10.8 million in other assets on the Consolidated Balance Sheets, which is measured at fair value. The Company reviewed the balances at June 30, 2021 and determined that the fair value remained the same. The assets acquired in the RevWorks acquisition consist primarily of customer relationships of approximately $2.8 million and fixed assets. There were no significant pre-closing liabilities of the RevWorks business included in the RevWorks acquisition. The fair value estimate of assets acquired and liabilities assumed are pending finalization of the valuation of contingent consideration. The goodwill recognized of approximately $3.6 million is primarily attributable to synergies that are expected to be achieved from the integration of RevWorks. Pro Forma Results The following table summarizes, on a pro forma basis, the combined results of the Company as though the SCI and RevWorks acquisitions had occurred as of January 1, 2019. These pro forma results are not necessarily indicative of either the actual consolidated results had the acquisitions occurred as of January 1, 2019 or of the future consolidated operating results for any period. Pro forma results are (in millions): Three Months Ended June 30, 2020 Six Months Ended June 30, 2020 Net services revenue $ 334.6 $ 684.1 Net income $ 19.5 $ 36.8 Adjustments were made to earnings to adjust depreciation and amortization to reflect the fair value of identified assets acquired, to record the effects of extinguishing the debt of SCI and replacing it with the debt of the Company, and to record the income tax effect of these adjustments.

Accounts Receivable and Allowan

Accounts Receivable and Allowance for Credit Losses	6 Months Ended
	Jun. 30, 2021
Receivables [Abstract]
Accounts Receivable and Allowance for Credit Losses	Accounts Receivable and Allowance for Credit Losses Accounts receivable is comprised of unpaid balances pertaining to modular services and end-to-end revenue cycle management (“RCM”) customers, net receivable balances for end-to-end RCM customers after considering cost reimbursements owed to such customers, including related accrued balances, and amounts due from physician RCM and practice management customers. The Company evaluates its accounts receivable for expected credit losses quarterly. The Company maintains an estimated allowance for credit losses to reduce its accounts receivable to the amount that it believes will be collected. This allowance is based on the Company’s historical experience, its assessment of each customer’s ability to pay, the length of time a balance has been outstanding, input from key Company resources assigned to each customer, the status of any ongoing operations with each applicable customer, and environmental factors such as significant shifts in the healthcare environment which the Company believes may have impacted or will impact its customers’ financial health and ability to pay. The full effects of COVID-19 on the Company’s customers continue to be uncertain. As a result, the Company’s future collection experience may differ from historical collection trends. The Company has presented the rollforward below on a consolidated basis as the currently expected credit losses for its large integrated healthcare system customers are not anticipated to be material. Movements in the allowance for credit losses are as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Beginning balance $ 3.9 $ 4.7 $ 3.8 $ 2.8 Cumulative effect of ASC 326 — — — 1.1 Provision 0.1 0.5 0.2 1.3 Write-offs (1.7) — (1.7) — Ending balance $ 2.3 $ 5.2 $ 2.3 $ 5.2

Property, Equipment and Softwar

Property, Equipment and Software	6 Months Ended
	Jun. 30, 2021
Property, Plant and Equipment [Abstract]
Property, Equipment and Software	Property, Equipment and Software Property, equipment and software consist of the following (in millions): June 30, 2021 December 31, 2020 Buildings and land $ 3.8 $ 4.6 Computer and other equipment 57.8 55.0 Leasehold improvements 23.1 23.2 Software 155.3 135.7 Office furniture 6.3 6.4 Property, equipment and software, gross 246.3 224.9 Less accumulated depreciation and amortization (156.5) (131.2) Property, equipment and software, net $ 89.8 $ 93.7 The following table summarizes the allocation of depreciation and amortization expense between cost of services and selling, general and administrative expenses (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Cost of services $ 12.5 $ 11.4 $ 25.2 $ 22.3 Selling, general and administrative 0.8 0.9 1.6 2.2 Total depreciation and amortization $ 13.3 $ 12.3 $ 26.8 $ 24.5

Leases

Leases	6 Months Ended
	Jun. 30, 2021
Leases [Abstract]
Leases	Leases The Company's accounting policy for leases, including the elections made as part of the adoption of ASC 842 effective January 1, 2019, are outlined in Note 8 of the Company's 2020 Form 10-K. The components of lease costs are as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Operating lease cost $ 4.0 $ 4.9 $ 8.1 $ 9.8 Sublease income (0.5) (0.5) (1.1) (1.1) Total lease cost $ 3.5 $ 4.4 $ 7.0 $ 8.7 Supplemental cash flow information related to leases are as follows (in millions): Six Months Ended June 30, 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 14.4 $ 10.1 Right-of-use assets obtained in exchange for operating lease obligations: 5.6 3.2 The Company presents all non-cash transactions related to adjustments to the lease liability or right-of-use asset as non-cash transactions. This includes all non-cash charges related to any modification or reassessment events triggering remeasurement, and obtaining new leases for non-cash consideration. Maturities of lease liabilities as of June 30, 2021 are as follows (in millions): Operating Leases Remainder of 2021 $ 8.8 2022 15.6 2023 14.8 2024 15.1 2025 15.1 2026 11.9 Thereafter 21.9 Total 103.2 Less: Imputed interest 27.2 Present value of lease liabilities $ 76.0
Leases	Leases The Company's accounting policy for leases, including the elections made as part of the adoption of ASC 842 effective January 1, 2019, are outlined in Note 8 of the Company's 2020 Form 10-K. The components of lease costs are as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Operating lease cost $ 4.0 $ 4.9 $ 8.1 $ 9.8 Sublease income (0.5) (0.5) (1.1) (1.1) Total lease cost $ 3.5 $ 4.4 $ 7.0 $ 8.7 Supplemental cash flow information related to leases are as follows (in millions): Six Months Ended June 30, 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 14.4 $ 10.1 Right-of-use assets obtained in exchange for operating lease obligations: 5.6 3.2 The Company presents all non-cash transactions related to adjustments to the lease liability or right-of-use asset as non-cash transactions. This includes all non-cash charges related to any modification or reassessment events triggering remeasurement, and obtaining new leases for non-cash consideration. Maturities of lease liabilities as of June 30, 2021 are as follows (in millions): Operating Leases Remainder of 2021 $ 8.8 2022 15.6 2023 14.8 2024 15.1 2025 15.1 2026 11.9 Thereafter 21.9 Total 103.2 Less: Imputed interest 27.2 Present value of lease liabilities $ 76.0

Intangible Assets

Intangible Assets	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets The following table provides the gross carrying value and accumulated amortization for each major class of intangible asset at June 30, 2021 and December 31, 2020 (in millions): June 30, 2021 December 31, 2020 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 97.7 $ (17.7) $ 80.0 $ 97.7 $ (14.7) $ 83.0 Technology 101.5 (19.3) 82.2 101.7 (13.6) 88.1 Total intangible assets $ 199.2 $ (37.0) $ 162.2 $ 199.4 $ (28.3) $ 171.1 Intangible asset amortization expense was $4.3 million and $8.7 million for the three and six months ended June 30, 2021, and $5.6 million and $9.1 million for the three and six months ended June 30, 2020. Estimated annual amortization expense related to intangible assets with definite lives as of June 30, 2021 is as follows (in millions): Remainder of 2021 $ 8.7 2022 17.5 2023 17.5 2024 15.7 2025 14.3 2026 14.3 Thereafter 74.2 Total $ 162.2

Goodwill

Goodwill	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	Goodwill Unless otherwise required, goodwill is tested for impairment annually in the fourth quarter. Changes in the carrying amount of goodwill for the six months ended June 30, 2021 were (in millions): Goodwill Balance as of December 31, 2020 $ 375.3 Measurement period adjustments 0.2 Balance as of June 30, 2021 $ 375.5

Revenue Recognition

Revenue Recognition	6 Months Ended
	Jun. 30, 2021
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition The Company follows the guidance under Topic 606, Revenue from Contracts with Customers (“Topic 606”). Revenue is measured based on consideration specified in a contract with a customer, and excludes any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contact term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. Disaggregation of Revenue In the following table, revenue is disaggregated by source (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Net operating fees $ 285.2 $ 287.8 $ 571.3 $ 568.7 Incentive fees 37.5 1.3 66.5 18.1 Other 30.7 25.6 58.2 48.4 Net services revenue $ 353.4 $ 314.7 $ 696.0 $ 635.2 Contract Balances The following table provides information about receivables, contract assets, and contract liabilities from contracts with customers (in millions): June 30, 2021 December 31, 2020 Receivables (1) $ 128.7 $ 122.2 Contract assets (2) 4.4 — Contract liabilities (2) 24.1 28.6 (1) Receivables are included in accounts receivable, net. The balance includes accounts receivable, net - related party. (2) Contract assets and contract liabilities are included in other current assets and customer liabilities, respectively. The contract liabilities balance contains related party amounts, including $2.3 million and $5.6 million of current customer liabilities and $16.4 million and $16.3 million of non-current customer liabilities as of June 30, 2021 and December 31, 2020, respectively. A receivable is recognized in the period the Company provides services when the Company’s right to consideration is unconditional. Payment terms on invoiced amounts are typically 30-60 days. The Company recognized revenue of $96.1 million and $87.0 million during the six months ended June 30, 2021 and 2020, which amounts were included in contract liabilities at the beginning of the respective periods. These revenue amounts include $88.1 million and $85.0 million for the six months ended June 30, 2021 and 2020, respectively, related to advanced billings which become accounts receivable and contract liabilities on the first day of the respective service period. Transaction Price Allocated to the Remaining Performance Obligation The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period (in millions). The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Other Remainder of 2021 $ 62.3 $ 23.9 $ 0.7 2022 73.5 4.7 0.8 2023 54.9 — — 2024 34.0 — — 2025 10.9 — — 2026 8.2 — — Thereafter 7.8 — — Total $ 251.6 $ 28.6 $ 1.5 The amounts presented in the table above include variable fee estimates for the non-cancellable term of the Company's physician groups RCM services contracts, fixed fees which are typically recognized ratably as the performance obligation is satisfied, and forecasted incentive fees which are measured cumulatively over the contractually defined performance period. Certain costs associated with the initial phases of customer contracts and the related transition of customer hospitals and physician groups are deferred. These fulfillment costs relate directly to the Company’s responsibilities under the corresponding customer contracts, generate or enhance resources of the Company that will be used in satisfying its performance obligations in the future, and are expected to be recovered through the margins realized. The following table summarizes the breakout of deferred contract costs (in millions): June 30, 2021 December 31, 2020 Prepaid expenses and other current assets $ 3.1 $ 4.5 Other assets 21.9 19.6 Total deferred contract costs $ 25.0 $ 24.1

Debt

Debt	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Debt	DebtThe carrying amounts of debt consist of the following (in millions): June 30, 2021 December 31, 2020 Senior Revolver $ 70.0 $ 70.0 Senior Term Loan 471.7 484.6 Unamortized discount and issuance costs (2.3) (2.6) Total debt 539.4 552.0 Less: Current maturities (38.7) (32.3) Total long-term debt $ 500.7 $ 519.7 Senior Secured Credit Facilities On June 26, 2019, the Company and certain of its subsidiaries entered into a senior credit agreement (the “Credit Agreement”) with Bank of America, N.A., as administrative agent, and the lenders named therein, for senior secured credit facilities (the “Senior Secured Credit Facilities”), consisting of a $325.0 million senior secured term loan facility (the “Senior Term Loan”) issued at 99.66% of par and a $100.0 million senior secured revolving credit facility (the “Senior Revolver”). On March 20, 2020, the Company entered into Amendment No. 1 to the Credit Agreement (the “Amendment”), pursuant to which the lenders named in the Amendment agreed to provide an additional $191.1 million incremental delayed-draw term loan facility (the “Incremental Term Loan”) on the same terms as its existing Senior Term Loan provided under the Credit Agreement. The Incremental Term Loan was drawn substantially concurrently with the closing of the SCI acquisition on April 1, 2020. The proceeds of the Incremental Term Loan were used to fund the purchase price for the SCI acquisition and related expenses. For further details on the closing, refer to Note 4, Acquisitions. The Incremental Term Loan had terms consistent with those of the Senior Term Loan, including with respect to interest, maturity, amortization, and prepayments and had the same affirmative and negative covenants and events of default as those applicable to the Senior Term Loan under the Credit Agreement. The drawing of the Incremental Term Loan increased the balance of the obligation due under the Senior Term Loan, and therefore is shown as one consolidated obligation. On January 13, 2021, the Company entered into Amendment No. 2 and Waiver to Credit Agreement (the “Second Amendment”), pursuant to which the lenders agreed (i) to waive the Company’s obligation to use the $135.0 million of net proceeds from the disposition of the Company’s emergency medical services business for purposes of reinvestments in useful assets of the Company, or to prepay the loans under the Credit Agreement, as otherwise required by the terms of the Credit Agreement, (ii) to amend the restricted payments covenant to permit the Company to make additional cash payments to the Investor in an amount not to exceed $105.0 million in connection with the preferred stock conversion (refer to Note 15. 8.00% Series A Convertible Preferred Stock) and reduce the “Available Amount” from which the Company can make certain investments, debt prepayments, or restricted payments by $105.0 million and (iii) that the excess cash flow sweep would begin with fiscal year ended December 31, 2021 instead of fiscal year ended December 31, 2020. The Senior Revolver included borrowing capacity available for letters of credit and for borrowings on same-day notice, referred to as the “swing loans.” Any issuance of letters of credit or making of a swing loan reduced the amount available under the revolving credit facility. As of June 30, 2021, the Company had $70.0 million in borrowings, $0.5 million letters of credit outstanding, and $29.5 million of availability under the Senior Revolver. Borrowings under the Senior Secured Credit Facilities bore interest, at the Company’s option, at: (i) an Alternate Base Rate (“ABR”) equal to the greater of (a) the prime rate of Bank of America, N.A., (b) the federal funds rate plus 0.50% per annum , and (c) the Eurodollar rate for an interest period of one-month beginning on such day plus 100 basis points, plus between 0.75% and 1.75% dependent on the Company's Net Leverage Ratio (provided that the Eurodollar rate applicable to the Term Loan Facility shall not be less than 0.00% per annum); or (ii) the Eurodollar rate (provided that the Eurodollar rate applicable to the Term Loan Facility shall not be less than 0.00% per annum), plus between 1.75% and 2.75%, dependent on the Company's Net Leverage Ratio. The interest rate as of June 30, 2021 was 2.35%. The Company was also required to pay an unused commitment fee to the lenders under the Senior Revolver at a rate between 0.30% and 0.50% of the average daily unutilized commitments thereunder dependent on the Company's net leverage ratio. The Credit Agreement contained a number of covenants that, among other things, restrict, subject to certain exceptions, the Company’s ability and the ability of its subsidiaries to: (i) incur additional indebtedness; (ii) create liens on assets; (iii) engage in mergers or consolidations; (iv) sell assets; (v) pay dividends and distributions or repurchase the Company’s capital stock; (vi) make investments, loans or advances; (vii) repay certain junior indebtedness; (viii) engage in certain transactions with affiliates; (ix) enter into sale and leaseback transactions; (x) amend material agreements governing certain of the Company’s junior indebtedness; (xi) change the Company’s lines of business; (xii) make certain acquisitions; and (xiii) limitations on the letter of credit cash collateral account. The Credit Agreement contained customary affirmative covenants and events of default. In addition, the Company was required to maintain minimum consolidated total net leverage and consolidated interest coverage ratios. The Company was in compliance with all of the covenants in the Credit Agreement as of June 30, 2021. On July 1, 2021, the Company entered into an amended and restated credit agreement (the “A&R Credit Agreement”) and used a portion of the proceeds thereof to refinance, in full, all existing debt under the Credit Agreement. For more information on the A&R Credit Agreement, see Note 22, Subsequent Events. Debt Maturities Scheduled maturities of the Company’s long-term debt are summarized as follows (in millions): Scheduled Maturities Remainder of 2021 $ 19.4 2022 38.7 2023 45.2 2024 438.4 Total $ 541.7 For further details on the Company's debt, refer to Note 13 of the Company's 2020 Form 10-K.

Share-Based Compensation

Share-Based Compensation	6 Months Ended
	Jun. 30, 2021
Share-based Payment Arrangement [Abstract]
Share-Based Compensation	Share-Based Compensation The share-based compensation expense relating to the Company’s stock options, restricted stock units (“RSUs”), and performance-based restricted stock units (“PBRSUs”) for the three months ended June 30, 2021 and 2020 was $23.8 million and $4.3 million, respectively, with related tax benefits of approximately $4.9 million and $0.7 million, respectively. The share-based compensation expense relating to the Company’s stock options, RSUs, and PBRSUs for the six months ended June 30, 2021 and 2020 was $36.5 million and $9.1 million, respectively, with related tax benefits of approximately $7.1 million and $1.4 million, respectively. The Company accounts for forfeitures as they occur. Excess tax benefits and shortfalls for share-based payments are recognized in income tax expense (benefit) and included in operating activities. The Company recognized $4.3 million and $1.1 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the three months ended June 30, 2021 and 2020, respectively. The Company recognized $6.6 million and $1.7 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the six months ended June 30, 2021 and 2020, respectively. Total share-based compensation costs that have been included in the Company’s consolidated statements of operations were as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Share-Based Compensation Expense Allocation Details: Cost of services $ 15.7 $ 1.5 $ 23.0 $ 3.4 Selling, general and administrative 8.1 2.8 13.5 5.7 Total share-based compensation expense $ 23.8 $ 4.3 $ 36.5 $ 9.1 The Company uses the Black-Scholes option pricing model to estimate the fair value of its service-based options as of their grant dates. The Company assesses current performance on performance-based PBRSUs by reviewing historical performance to date, along with any adjustments which have been approved to the reported performance, and changes to the projections to determine the probable outcome of the awards. The current estimates are then compared to the scoring metrics and any necessary adjustments are reflected in the current period to update share-based compensation expense to the current performance expectations. The following table sets forth the significant assumptions used in the Black-Scholes option pricing model and the calculation of share-based compensation expense for the six months ended June 30, 2021 and 2020: Six Months Ended June 30, 2021 2020 Expected dividend yield —% —% Risk-free interest rate 0.4% to 1.0% 0.4% to 1.7% Expected volatility 43% 43% Expected term (in years) 5.5 5.5 The risk-free interest rate input is based on U.S. Treasury instruments, and the expected volatility of the share price is based on review of the historical volatility levels of the Company’s common stock in conjunction with that of public companies that operate in similar industries or are similar in terms of stage of development or size and a projection of this information toward its future expected volatility. The Company used the simplified method to estimate the expected option life. The simplified method was used due to the lack of sufficient historical data available to provide a reasonable basis upon which to estimate the expected term of each stock option. Stock options A summary of the options activity during the six months ended June 30, 2021 is shown below: Options Weighted- Outstanding at December 31, 2020 6,220,971 $ 3.68 Granted 3,115 24.20 Exercised (936,045) 5.09 Canceled/forfeited (3,405) 3.85 Expired (7,000) 27.08 Outstanding at June 30, 2021 5,277,636 $ 3.41 Outstanding, vested and exercisable at June 30, 2021 5,205,819 $ 3.34 Outstanding, vested and exercisable at December 31, 2020 5,230,690 $ 3.73 Restricted stock units and performance-based restricted stock units A summary of the RSU and PBRSU activity during the six months ended June 30, 2021 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2020 2,108,447 2,917,071 $ 9.87 $ 11.35 Granted 1,610,710 849,915 25.45 26.53 Performance factor adjustment — 101,937 — 9.81 Vested (546,381) (305,811) 8.58 9.81 Forfeited (219,603) (206,484) 15.32 13.21 Outstanding and unvested at June 30, 2021 2,953,173 3,356,628 $ 18.20 $ 15.17 Shares surrendered for taxes for the six months ended June 30, 2021 170,033 — Cost of shares surrendered for taxes for the six months ended June 30, 2021 (in millions) $ 4.5 $ — Shares surrendered for taxes for the six months ended June 30, 2020 128,906 — Cost of shares surrendered for taxes for the six months ended June 30, 2020 (in millions) $ 1.1 $ — PBRSUs vest upon satisfaction of both time-based and performance-based conditions. Depending on the award, performance condition targets may include cumulative adjusted EBITDA, end-to-end RCM agreement growth, scored revenue growth, or other specific performance factors. Depending on the percentage level at which the performance-based conditions are satisfied, the number of shares vesting could be between 0% and 200% of the number of PBRSUs originally granted. Based on the established targets, the maximum number of shares that could vest for all outstanding PBRSUs is 6,375,432.

Other Expenses

Other Expenses	6 Months Ended
	Jun. 30, 2021
Other Income and Expenses [Abstract]
Other Expenses	Other Expenses Other expenses consist of the following (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Severance and related employee benefits $ 0.3 $ 1.9 $ 1.8 $ 3.0 Strategic initiatives (1) 1.9 8.5 8.4 11.7 Facility-exit charges (2) 1.4 4.5 2.9 4.9 Other (3) 6.2 3.1 9.7 7.1 Total other expenses $ 9.8 $ 18.0 $ 22.8 $ 26.7 (1) Costs related to evaluating, pursuing, and integrating acquisitions, performing portfolio and capital structure analyses and transactions, and other inorganic business projects as part of the Company’s growth strategy. Costs include vendor spend, employee time and expenses spent on activities, severance and retention amounts associated with integration activities, and changes to contingent consideration related to acquisitions. For the three and six months ended June 30, 2021, $0.0 million and $0.5 million of contingent consideration changes were included, respectively. (2) As part of evaluating its footprint, the Company has exited certain leased facilities. Costs include asset impairment charges and other costs related to exited leased facilities. (3) For the three and six months ended June 30, 2021, other includes $2.7 million and $4.4 million, respectively, of expenses related to the COVID-19 pandemic, inclusive of appreciation bonuses for the Company’s front-line employees, pandemic response mobilization efforts, telemedicine and testing costs for employees, and other costs related to the COVID-19 pandemic. For the three and six months ended June 30, 2020, includes $2.7 million and $5.3 million, respectively, of expenses related to the COVID-19 pandemic.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2021
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income tax provisions for interim periods are based on estimated annual income tax rates, adjusted to reflect the effects of any significant and infrequent or unusual items which are required to be discretely recognized within the current interim period. The effective tax rates in the periods presented are largely based upon the projected annual pre-tax earnings by jurisdiction and the allocation of certain expenses in various taxing jurisdictions where the Company conducts its business. These taxing jurisdictions apply a broad range of statutory income tax rates. The global intangible low-taxed income (“GILTI”) provisions impose taxes on foreign income in excess of a deemed return on tangible assets of foreign corporations. The Company elected to account for GILTI tax in the period in which it is incurred. The Company recognized income tax expense for the three and six months ended June 30, 2021 on the year-to-date pre-tax income. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for state taxes, GILTI, non-deductible expense, and discrete items. The Company recognized income tax expense for the three months ended June 30, 2020 on the year-to-date pre-tax income. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for GILTI plus the geographical mix of earnings, permanent differences, and discrete items. The income tax expense for the six months ended June 30, 2020 was higher than the amount derived by applying the federal statutory tax rate of 21% primarily due to GILTI and discrete items. The Company and its subsidiaries are subject to U.S. federal income tax as well as income tax of multiple state and foreign jurisdictions. U.S. federal income tax returns since 2017 are currently open for examination. State jurisdictions vary for open tax years. The statute of limitations for most states ranges from three

8.00% Series A Convertible Pref

8.00% Series A Convertible Preferred Stock	6 Months Ended
	Jun. 30, 2021
Temporary Equity Disclosure [Abstract]
8.00% Series A Convertible Preferred Stock	8.00% Series A Convertible Preferred Stock On January 15, 2021, TCP-ASC, a limited liability limited partnership jointly owned by Ascension Health Alliance, the parent entity of Ascension, and investment funds affiliated with TowerBrook, a related party, converted all of its 294,266 shares (the “Preferred Shares”) of preferred stock into 117,706,400 shares of common stock of the Company into which the Preferred Shares were convertible pursuant to the Certificate of Designation of the preferred stock, and, in consideration therefor, the Company (i) issued 21,582,800 additional shares of common stock to the Investor, and (ii) paid the Investor $105.0 million in cash. On January 19, 2021, the Company filed a Certificate of Elimination of 8.00% Series A Convertible Preferred Stock with the Secretary of State of the State of Delaware to eliminate the Certificate of Designations of the 8.00% Series A Convertible Preferred Stock. The consideration paid to induce the conversion was recorded as a dividend of $592.3 million and reduced income available to common shareholders in our earnings per share calculation. The dividend was calculated as the cash paid of $105.0 million plus the fair value on the conversion date of the additional 21,582,800 shares of common stock issued as consideration for the conversion. The following summarizes the preferred stock activity for the six months ended June 30, 2021 (in millions, except per share data): Preferred Stock Shares Issued and Outstanding Carrying Value Balance at December 31, 2020 288,497 $ 251.5 Dividends paid/accrued dividends 5,769 — Conversion of preferred stock (294,266) (251.5) Balance at June 30, 2021 — $ —

Earnings (Loss) Per Share

Earnings (Loss) Per Share	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	Earnings (Loss) Per ShareBasic net income per share is computed by dividing net income, less any dividends, accretion or decretion, redemption or induced conversion on the preferred stock, by the weighted average number of common shares outstanding during the period. As the preferred stock participates in dividends alongside the Company’s common stock (per their participating dividends), the preferred stock would constitute participating securities under ASC 260-10 and are applied to earnings per share using the two-class method. Under this method, all earnings (distributed and undistributed) are allocated to common shares and participating securities based on their respective rights to receive dividends. Diluted net income per share is calculated using the more dilutive of the if-converted or the two-class method. For the six months ended June 30, 2021 and the three and six months ended June 30, 2020, the two-class method was more dilutive and was computed by adjusting the denominator used in the basic net income per share computation by potentially dilutive securities outstanding during the period plus, when their effect is dilutive, incremental shares consisting of shares subject to stock options and shares issuable upon vesting of RSUs and PBRSUs. Basic and diluted net income (loss) per common share are calculated as follows (in millions, except share and per share data): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Basic EPS: Net income $ 18.4 $ 15.1 $ 44.2 $ 33.3 Less dividends on preferred shares (1) — (5.6) (592.3) (11.0) Less income allocated to preferred shareholders — (4.7) — (11.0) Net income (loss) available/(allocated) to common shareholders - basic $ 18.4 $ 4.8 $ (548.1) $ 11.3 Diluted EPS: Net income $ 18.4 $ 15.1 $ 44.2 $ 33.3 Less dividends on preferred shares (1) — (5.6) (592.3) (11.0) Less income allocated to preferred shareholders — (3.8) — (8.9) Net income (loss) available/(allocated) to common shareholders - diluted $ 18.4 $ 5.7 $ (548.1) $ 13.4 Basic weighted-average common shares 268,251,790 115,067,552 253,850,972 114,754,298 Add: Effect of dilutive equity awards 6,551,978 10,608,629 — 11,198,960 Add: Effect of dilutive warrants 46,029,145 40,211,783 — 41,856,066 Diluted weighted average common shares 320,832,913 165,887,964 253,850,972 167,809,324 Net income (loss) per common share (basic) $ 0.07 $ 0.04 $ (2.16) $ 0.10 Net income (loss) per common share (diluted) $ 0.06 $ 0.03 $ (2.16) $ 0.08 (1) The 2021 dividend on preferred shares includes amounts related to the conversion of the preferred shares. See Note 15, 8.00% Series A Convertible Preferred Stock, for more information. Because of their anti-dilutive effect, 386,079 and 14,606,241 common share equivalents comprised of stock options, PBRSUs, and RSUs have been excluded from the diluted earnings per share calculation for the three and six months ended June 30, 2021, respectively. Additionally, for the six months ended June 30, 2021, the Investor's and IHC Health Services, Inc.’s (“Intermountain”) exercisable warrants to acquire up to 40.5 million and 1.5 million shares, respectively, of the Company's common stock have been excluded from the diluted earnings per share calculation because they are anti-dilutive.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings Other than as described below, the Company is not presently a party to any material litigation or regulatory proceeding and is not aware of any pending or threatened litigation or regulatory proceeding against the Company which, individually or in the aggregate, could have a material adverse effect on its business, operating results, financial condition or cash flows. In May 2016, the Company was served with a False Claims Act case brought by a former emergency department service associate who worked at a hospital of one of the Company’s customers, MedStar Inc.’s Washington Hospital Center (“WHC”), along with WHC and three other hospitals that were PAS customers and a place holder, John Doe hospital, representing all PAS customers ( U.S. ex rel. Graziosi vs. Accretive Health, Inc. et. al.) , and seeking money damages, False Claims Act penalties, and plaintiff’s attorneys’ fees. The Third Amended Complaint alleges that the Company’s PAS business violates the federal False Claims Act. The case was originally filed under seal in 2013 in the federal district court in Chicago, was presented to the U.S. Attorney in Chicago, and the U.S. Attorney declined to intervene. The Company believes that it has meritorious defenses to all claims in the case and intends to vigorously defend itself against these claims. Both the Company’s and plaintiff’s motions for summary judgment were denied in December 2020, and the parties are presently conducting damages and expert discovery. Discovery and dispositive motions are expected to extend through January 2022, with trial, if necessary, in mid-to-late 2022. On April 13, 2021 and April 19, 2021, respectively, certain purported stockholders of the Company filed two complaints in the Delaware Court of Chancery regarding the Company’s January 15, 2021 recapitalization transaction with TCP-ASC. Both complaints allege that TCP-ASC, Ascension, and TowerBrook controlled the Company and breached their fiduciary duties by using that alleged control to force the Company to overpay in redeeming TCP-ASC’s preferred stock as part of the recapitalization transaction. The plaintiffs seek an unspecified amount of damages against TCP-ASC, Ascension, and TowerBrook. The plaintiffs also allege that the Company and TCP-ASC entered into amendments to the Investor Rights Agreement that the plaintiffs contend contains provisions that are void under the Company’s charter, bylaws, and the Delaware General Corporation Law. The plaintiffs seek a declaratory judgment that these amendments are invalid, as well as attorneys’ fees and costs. The Company believes that it has meritorious defenses to all claims against the Company and intends to vigorously defend itself against these claims.

Related Party Transactions

Related Party Transactions	6 Months Ended
	Jun. 30, 2021
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions This note encompasses transactions between Ascension and its affiliates, including AMITA Health, and the Company pursuant to the A&R MPSA, including all supplements, amendments, and other documents entered into in connection therewith. For further details on the Company's agreements with Ascension, see Note 1 and Note 18 of the Company's 2020 Form 10-K. Net services revenue from services provided to Ascension included in the Company’s consolidated statements of operations were (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Ascension $ 218.4 $ 206.4 $ 433.9 $ 414.8 Amounts included in the Company's consolidated balance sheets for Ascension are (in millions): June 30, 2021 December 31, 2020 Accounts receivable, net of $0.1 million and $0.1 million allowance - related party $ 31.9 $ 30.9 Current portion of customer liabilities $ 6.7 $ 15.3 Non-current portion of customer liabilities $ 16.4 $ 16.3 Total customer liabilities $ 23.1 $ 31.6 Since Ascension is the Company's largest customer, a significant percentage of the Company's cost of services is associated with providing services to Ascension. However, due to the nature of the Company's global business services and information technology operations, it is impractical to assign the dollar amount associated with services provided to Ascension. On May 27, 2021 and May 28, 2021, the Company issued 16,750,000 shares of common stock to TCP-ASC upon the cashless exercise of a warrant to purchase 19,535,145 shares of common stock at an exercise price of $3.50 per share based upon a market value of $24.54 to $24.64 per share as determined under the terms of the warrant.

Deferred Contract Costs

Deferred Contract Costs	6 Months Ended
	Jun. 30, 2021
Revenue from Contract with Customer [Abstract]
Deferred Contract Costs	Revenue Recognition The Company follows the guidance under Topic 606, Revenue from Contracts with Customers (“Topic 606”). Revenue is measured based on consideration specified in a contract with a customer, and excludes any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contact term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. Disaggregation of Revenue In the following table, revenue is disaggregated by source (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Net operating fees $ 285.2 $ 287.8 $ 571.3 $ 568.7 Incentive fees 37.5 1.3 66.5 18.1 Other 30.7 25.6 58.2 48.4 Net services revenue $ 353.4 $ 314.7 $ 696.0 $ 635.2 Contract Balances The following table provides information about receivables, contract assets, and contract liabilities from contracts with customers (in millions): June 30, 2021 December 31, 2020 Receivables (1) $ 128.7 $ 122.2 Contract assets (2) 4.4 — Contract liabilities (2) 24.1 28.6 (1) Receivables are included in accounts receivable, net. The balance includes accounts receivable, net - related party. (2) Contract assets and contract liabilities are included in other current assets and customer liabilities, respectively. The contract liabilities balance contains related party amounts, including $2.3 million and $5.6 million of current customer liabilities and $16.4 million and $16.3 million of non-current customer liabilities as of June 30, 2021 and December 31, 2020, respectively. A receivable is recognized in the period the Company provides services when the Company’s right to consideration is unconditional. Payment terms on invoiced amounts are typically 30-60 days. The Company recognized revenue of $96.1 million and $87.0 million during the six months ended June 30, 2021 and 2020, which amounts were included in contract liabilities at the beginning of the respective periods. These revenue amounts include $88.1 million and $85.0 million for the six months ended June 30, 2021 and 2020, respectively, related to advanced billings which become accounts receivable and contract liabilities on the first day of the respective service period. Transaction Price Allocated to the Remaining Performance Obligation The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period (in millions). The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Other Remainder of 2021 $ 62.3 $ 23.9 $ 0.7 2022 73.5 4.7 0.8 2023 54.9 — — 2024 34.0 — — 2025 10.9 — — 2026 8.2 — — Thereafter 7.8 — — Total $ 251.6 $ 28.6 $ 1.5 The amounts presented in the table above include variable fee estimates for the non-cancellable term of the Company's physician groups RCM services contracts, fixed fees which are typically recognized ratably as the performance obligation is satisfied, and forecasted incentive fees which are measured cumulatively over the contractually defined performance period. Certain costs associated with the initial phases of customer contracts and the related transition of customer hospitals and physician groups are deferred. These fulfillment costs relate directly to the Company’s responsibilities under the corresponding customer contracts, generate or enhance resources of the Company that will be used in satisfying its performance obligations in the future, and are expected to be recovered through the margins realized. The following table summarizes the breakout of deferred contract costs (in millions): June 30, 2021 December 31, 2020 Prepaid expenses and other current assets $ 3.1 $ 4.5 Other assets 21.9 19.6 Total deferred contract costs $ 25.0 $ 24.1

Segments and Customer Concentra

Segments and Customer Concentrations	6 Months Ended
	Jun. 30, 2021
Segment Reporting [Abstract]
Segments and Customer Concentrations	Segments and Customer Concentrations The Company has determined that it has a single operating segment in accordance with how its business activities are managed and evaluated. All of the Company’s significant operations are organized around the single business of providing end-to-end management services of revenue cycle operations for U.S.-based healthcare providers. Accordingly, for purposes of segment disclosures, the Company has only one reportable segment. Healthcare providers affiliated with Ascension have accounted for a significant portion of the Company’s net services revenue each year since the Company’s formation. For the three months ended June 30, 2021 and 2020, net services revenue from healthcare organizations affiliated with Ascension accounted for 62% and 66% of the Company's total net services revenue, respectively. For the six months ended June 30, 2021 and 2020, net services revenue from Ascension accounted for 62% and 65%, respectively. The loss of customers within the Ascension health system could have a material adverse impact on the Company’s operations. For the three months ended June 30, 2021 and 2020, Intermountain accounted for 13% and 14% of the Company's total net services revenue, respectively. For the six months ended June 30, 2021 and 2020, Intermountain accounted for 14% and 15% of the Company’s total net services revenue, respectively.

Derivative Financial Instrument

Derivative Financial Instruments	6 Months Ended
	Jun. 30, 2021
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments	Derivative Financial Instruments The Company utilizes cash flow hedges to manage its currency risk arising from its global delivery resources and to reduce variability in interest cash flows from its outstanding debt. As of June 30, 2021, the Company has recorded $0.2 million of unrealized gains and $1.5 million of unrealized losses in accumulated other comprehensive income for the foreign currency hedges and interest rate swaps, respectively. The Company estimates that $0.2 million of gains and $1.3 million of losses reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next 12 months for the foreign currency hedges and interest rate swaps, respectively. The amounts related to foreign currency hedges that were reclassified into cost of services were a net gain of $0.2 million and $0.6 million during the three and six month periods ended June 30, 2021, respectively, and a net loss of $0.6 million and $0.7 million during the three and six month periods ended June 30, 2020, respectively. The amounts related to the interest rate swaps that were reclassified into interest expense were a net loss of $0.3 million and $0.8 million during the three and six month periods ended June 30, 2021, respectively, and a net loss of $0.4 million and $0.3 million during the three and six month periods ended June 30, 2020, respectively. The Company classifies cash flows from its derivative programs as cash flows from operating activities in the consolidated statements of cash flows. As of June 30, 2021, the Company’s currency forward contracts have maturities extending no later than March 31, 2022. The Company's interest rate swaps extend no later than August of 2022. As of June 30, 2021, the notional amounts of the Company's open foreign currency forward contracts and interest rate swaps were approximately $67.5 million and $100.0 million, respectively. As of December 31, 2020, the notional amounts of the Company's open foreign currency forward contracts and interest rate swaps were approximately $55.9 million and $200.0 million, respectively. As of June 30, 2021, the Company held no derivatives, or non-derivative hedging instruments, that were designated in fair value or net investment hedges. Fair values for derivative financial instruments are based on prices computed using third-party valuation models and are classified as Level 2 in accordance with the three-level hierarchy of fair value measurements.

Subsequent Events

Subsequent Events	6 Months Ended
	Jun. 30, 2021
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events Amended and Restated Senior Credit Agreement In conjunction with the closing of the VisitPay Acquisition, the Company entered into the A&R Credit Agreement with Bank of America, N.A., as administrative agent, and the lenders named therein, governing the Company’s amended and restated senior secured credit facilities, consisting of a $700.0 million senior secured term loan and a $450.0 million senior secured revolving credit facility. Upon closing, the aggregate borrowings incurred under the senior secured revolving credit facility were $120.0 million. The proceeds from the A&R Credit Agreement, in addition to cash on hand, were used to (1) to refinance, in full, all existing indebtedness under the Credit Agreement, and amend and restate all commitments thereunder (the “Refinancing”), (2) to pay certain fees and expenses incurred in connection with the entry into the A&R Credit Agreement and the Refinancing, and (3) to fund the VisitPay Acquisition, and to pay the fees, premiums, expenses and other transaction costs incurred in connection therewith; and in the future, will be used to finance working capital needs of the Company and its subsidiaries for general corporate purposes.

Recent Accounting Pronounceme_2

Recent Accounting Pronouncements (Policies)	6 Months Ended
	Jun. 30, 2021
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of June 30, 2021, the results of operations of the Company for the three and six months ended June 30, 2021 and 2020, and the cash flows of the Company for the six months ended June 30, 2021 and 2020. These financial statements include the accounts of R1 RCM Inc. and its wholly-owned subsidiaries. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with United States generally accepted accounting principles (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information, have been included. Operating results for the three and six months ended June 30, 2021 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2021.
Recently Issued Accounting Standards and Disclosures	Recently Issued Accounting Standards and Disclosures No new accounting pronouncements issued or effective during the fiscal year had, or is expected to have, a material impact on the Company’s consolidated financial statements.
Accounts Receivable and Allowance for Credit Losses	Accounts Receivable and Allowance for Credit LossesAccounts receivable is comprised of unpaid balances pertaining to modular services and end-to-end revenue cycle management (“RCM”) customers, net receivable balances for end-to-end RCM customers after considering cost reimbursements owed to such customers, including related accrued balances, and amounts due from physician RCM and practice management customers.
Revenue Recognition	Revenue RecognitionThe Company follows the guidance under Topic 606, Revenue from Contracts with Customers (“Topic 606”). Revenue is measured based on consideration specified in a contract with a customer, and excludes any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contact term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved.

Acquisitions (Tables)

Acquisitions (Tables)	6 Months Ended
	Jun. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Schedule of Assets Acquired and Liabilities Assumed	The fair value of assets acquired and liabilities assumed is (in millions): Purchase Price Allocation Total purchase consideration $ 197.0 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 2.9 Accounts receivable 2.8 Prepaid expenses and other current assets 1.2 Property, equipment and software 0.3 Operating lease right-of-use assets 1.2 Intangible assets 86.1 Goodwill 125.8 Accounts payable (0.2) Current portion of customer liabilities (4.0) Accrued compensation and benefits (1.6) Current portion of operating lease liabilities (0.5) Other accrued expenses (0.4) Non-current portion of operating lease liabilities (0.7) Other non-current liabilities (5.0) Deferred income tax liabilities (10.9) Net assets acquired $ 197.0
Schedule of Pro Forma Results	The following table summarizes, on a pro forma basis, the combined results of the Company as though the SCI and RevWorks acquisitions had occurred as of January 1, 2019. These pro forma results are not necessarily indicative of either the actual consolidated results had the acquisitions occurred as of January 1, 2019 or of the future consolidated operating results for any period. Pro forma results are (in millions): Three Months Ended June 30, 2020 Six Months Ended June 30, 2020 Net services revenue $ 334.6 $ 684.1 Net income $ 19.5 $ 36.8

Accounts Receivable and Allow_2

Accounts Receivable and Allowance for Credit Losses (Tables)	6 Months Ended
	Jun. 30, 2021
Receivables [Abstract]
Schedule of Allowance for Credit Losses	Movements in the allowance for credit losses are as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Beginning balance $ 3.9 $ 4.7 $ 3.8 $ 2.8 Cumulative effect of ASC 326 — — — 1.1 Provision 0.1 0.5 0.2 1.3 Write-offs (1.7) — (1.7) — Ending balance $ 2.3 $ 5.2 $ 2.3 $ 5.2

Property, Equipment, and Softwa

Property, Equipment, and Software (Tables)	6 Months Ended
	Jun. 30, 2021
Property, Plant and Equipment [Abstract]
Schedule of Property, Equipment and Software	Property, equipment and software consist of the following (in millions): June 30, 2021 December 31, 2020 Buildings and land $ 3.8 $ 4.6 Computer and other equipment 57.8 55.0 Leasehold improvements 23.1 23.2 Software 155.3 135.7 Office furniture 6.3 6.4 Property, equipment and software, gross 246.3 224.9 Less accumulated depreciation and amortization (156.5) (131.2) Property, equipment and software, net $ 89.8 $ 93.7
Summary Depreciation and Amortization Expense	The following table summarizes the allocation of depreciation and amortization expense between cost of services and selling, general and administrative expenses (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Cost of services $ 12.5 $ 11.4 $ 25.2 $ 22.3 Selling, general and administrative 0.8 0.9 1.6 2.2 Total depreciation and amortization $ 13.3 $ 12.3 $ 26.8 $ 24.5

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2021
Leases [Abstract]
Schedules of Components of Lease Costs and Supplemental Cash Flow Information	The components of lease costs are as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Operating lease cost $ 4.0 $ 4.9 $ 8.1 $ 9.8 Sublease income (0.5) (0.5) (1.1) (1.1) Total lease cost $ 3.5 $ 4.4 $ 7.0 $ 8.7 Supplemental cash flow information related to leases are as follows (in millions): Six Months Ended June 30, 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 14.4 $ 10.1 Right-of-use assets obtained in exchange for operating lease obligations: 5.6 3.2
Schedule of Operating Lease Maturity	Maturities of lease liabilities as of June 30, 2021 are as follows (in millions): Operating Leases Remainder of 2021 $ 8.8 2022 15.6 2023 14.8 2024 15.1 2025 15.1 2026 11.9 Thereafter 21.9 Total 103.2 Less: Imputed interest 27.2 Present value of lease liabilities $ 76.0

Intangible Assets (Tables)

Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table provides the gross carrying value and accumulated amortization for each major class of intangible asset at June 30, 2021 and December 31, 2020 (in millions): June 30, 2021 December 31, 2020 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 97.7 $ (17.7) $ 80.0 $ 97.7 $ (14.7) $ 83.0 Technology 101.5 (19.3) 82.2 101.7 (13.6) 88.1 Total intangible assets $ 199.2 $ (37.0) $ 162.2 $ 199.4 $ (28.3) $ 171.1
Schedule of Estimated Annual Amortization Expense	Estimated annual amortization expense related to intangible assets with definite lives as of June 30, 2021 is as follows (in millions): Remainder of 2021 $ 8.7 2022 17.5 2023 17.5 2024 15.7 2025 14.3 2026 14.3 Thereafter 74.2 Total $ 162.2

Goodwill (Tables)

Goodwill (Tables)	6 Months Ended
	Jun. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Changes in Carrying Value of Goodwill	Changes in the carrying amount of goodwill for the six months ended June 30, 2021 were (in millions): Goodwill Balance as of December 31, 2020 $ 375.3 Measurement period adjustments 0.2 Balance as of June 30, 2021 $ 375.5

Revenue Recognition (Tables)

Revenue Recognition (Tables)	6 Months Ended
	Jun. 30, 2021
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregated Revenue By Source	In the following table, revenue is disaggregated by source (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Net operating fees $ 285.2 $ 287.8 $ 571.3 $ 568.7 Incentive fees 37.5 1.3 66.5 18.1 Other 30.7 25.6 58.2 48.4 Net services revenue $ 353.4 $ 314.7 $ 696.0 $ 635.2
Schedule of Assets and Liabilities	The following table provides information about receivables, contract assets, and contract liabilities from contracts with customers (in millions): June 30, 2021 December 31, 2020 Receivables (1) $ 128.7 $ 122.2 Contract assets (2) 4.4 — Contract liabilities (2) 24.1 28.6 (1) Receivables are included in accounts receivable, net. The balance includes accounts receivable, net - related party.
Schedule of Transaction Price Allocated to the Remaining Performance Obligation	The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period (in millions). The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Other Remainder of 2021 $ 62.3 $ 23.9 $ 0.7 2022 73.5 4.7 0.8 2023 54.9 — — 2024 34.0 — — 2025 10.9 — — 2026 8.2 — — Thereafter 7.8 — — Total $ 251.6 $ 28.6 $ 1.5

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2021
Debt Disclosure [Abstract]
Schedule of Carrying Values Long-Term Debt	The carrying amounts of debt consist of the following (in millions): June 30, 2021 December 31, 2020 Senior Revolver $ 70.0 $ 70.0 Senior Term Loan 471.7 484.6 Unamortized discount and issuance costs (2.3) (2.6) Total debt 539.4 552.0 Less: Current maturities (38.7) (32.3) Total long-term debt $ 500.7 $ 519.7
Scheduled Maturities of Long-term Debt	Scheduled maturities of the Company’s long-term debt are summarized as follows (in millions): Scheduled Maturities Remainder of 2021 $ 19.4 2022 38.7 2023 45.2 2024 438.4 Total $ 541.7

Share-Based Compensation (Table

Share-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2021
Share-based Payment Arrangement [Abstract]
Schedule of Share-based Compensation Expense	Total share-based compensation costs that have been included in the Company’s consolidated statements of operations were as follows (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Share-Based Compensation Expense Allocation Details: Cost of services $ 15.7 $ 1.5 $ 23.0 $ 3.4 Selling, general and administrative 8.1 2.8 13.5 5.7 Total share-based compensation expense $ 23.8 $ 4.3 $ 36.5 $ 9.1
Summary of Valuation Assumptions	The following table sets forth the significant assumptions used in the Black-Scholes option pricing model and the calculation of share-based compensation expense for the six months ended June 30, 2021 and 2020: Six Months Ended June 30, 2021 2020 Expected dividend yield —% —% Risk-free interest rate 0.4% to 1.0% 0.4% to 1.7% Expected volatility 43% 43% Expected term (in years) 5.5 5.5
Schedule of Stock Options Activity	A summary of the options activity during the six months ended June 30, 2021 is shown below: Options Weighted- Outstanding at December 31, 2020 6,220,971 $ 3.68 Granted 3,115 24.20 Exercised (936,045) 5.09 Canceled/forfeited (3,405) 3.85 Expired (7,000) 27.08 Outstanding at June 30, 2021 5,277,636 $ 3.41 Outstanding, vested and exercisable at June 30, 2021 5,205,819 $ 3.34 Outstanding, vested and exercisable at December 31, 2020 5,230,690 $ 3.73
Schedule of Non-Options Awards Activity	A summary of the RSU and PBRSU activity during the six months ended June 30, 2021 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2020 2,108,447 2,917,071 $ 9.87 $ 11.35 Granted 1,610,710 849,915 25.45 26.53 Performance factor adjustment — 101,937 — 9.81 Vested (546,381) (305,811) 8.58 9.81 Forfeited (219,603) (206,484) 15.32 13.21 Outstanding and unvested at June 30, 2021 2,953,173 3,356,628 $ 18.20 $ 15.17 Shares surrendered for taxes for the six months ended June 30, 2021 170,033 — Cost of shares surrendered for taxes for the six months ended June 30, 2021 (in millions) $ 4.5 $ — Shares surrendered for taxes for the six months ended June 30, 2020 128,906 — Cost of shares surrendered for taxes for the six months ended June 30, 2020 (in millions) $ 1.1 $ —

Other Expenses (Tables)

Other Expenses (Tables)	6 Months Ended
	Jun. 30, 2021
Other Income and Expenses [Abstract]
Schedule of Other Expenses	Other expenses consist of the following (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Severance and related employee benefits $ 0.3 $ 1.9 $ 1.8 $ 3.0 Strategic initiatives (1) 1.9 8.5 8.4 11.7 Facility-exit charges (2) 1.4 4.5 2.9 4.9 Other (3) 6.2 3.1 9.7 7.1 Total other expenses $ 9.8 $ 18.0 $ 22.8 $ 26.7 (1) Costs related to evaluating, pursuing, and integrating acquisitions, performing portfolio and capital structure analyses and transactions, and other inorganic business projects as part of the Company’s growth strategy. Costs include vendor spend, employee time and expenses spent on activities, severance and retention amounts associated with integration activities, and changes to contingent consideration related to acquisitions. For the three and six months ended June 30, 2021, $0.0 million and $0.5 million of contingent consideration changes were included, respectively. (2) As part of evaluating its footprint, the Company has exited certain leased facilities. Costs include asset impairment charges and other costs related to exited leased facilities. (3) For the three and six months ended June 30, 2021, other includes $2.7 million and $4.4 million, respectively, of expenses related to the COVID-19 pandemic, inclusive of appreciation bonuses for the Company’s front-line employees, pandemic response mobilization efforts, telemedicine and testing costs for employees, and other costs related to the COVID-19 pandemic. For the three and six months ended June 30, 2020, includes $2.7 million and $5.3 million, respectively, of expenses related to the COVID-19 pandemic.

8.00% Series A Convertible Pr_2

8.00% Series A Convertible Preferred Stock (Tables)	6 Months Ended
	Jun. 30, 2021
Temporary Equity Disclosure [Abstract]
Summary of Preferred Stock Activity	The following summarizes the preferred stock activity for the six months ended June 30, 2021 (in millions, except per share data): Preferred Stock Shares Issued and Outstanding Carrying Value Balance at December 31, 2020 288,497 $ 251.5 Dividends paid/accrued dividends 5,769 — Conversion of preferred stock (294,266) (251.5) Balance at June 30, 2021 — $ —

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	6 Months Ended
	Jun. 30, 2021
Earnings Per Share [Abstract]
Schedule of Basic and Diluted Net Income (Loss) Per Common Share	Basic and diluted net income (loss) per common share are calculated as follows (in millions, except share and per share data): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Basic EPS: Net income $ 18.4 $ 15.1 $ 44.2 $ 33.3 Less dividends on preferred shares (1) — (5.6) (592.3) (11.0) Less income allocated to preferred shareholders — (4.7) — (11.0) Net income (loss) available/(allocated) to common shareholders - basic $ 18.4 $ 4.8 $ (548.1) $ 11.3 Diluted EPS: Net income $ 18.4 $ 15.1 $ 44.2 $ 33.3 Less dividends on preferred shares (1) — (5.6) (592.3) (11.0) Less income allocated to preferred shareholders — (3.8) — (8.9) Net income (loss) available/(allocated) to common shareholders - diluted $ 18.4 $ 5.7 $ (548.1) $ 13.4 Basic weighted-average common shares 268,251,790 115,067,552 253,850,972 114,754,298 Add: Effect of dilutive equity awards 6,551,978 10,608,629 — 11,198,960 Add: Effect of dilutive warrants 46,029,145 40,211,783 — 41,856,066 Diluted weighted average common shares 320,832,913 165,887,964 253,850,972 167,809,324 Net income (loss) per common share (basic) $ 0.07 $ 0.04 $ (2.16) $ 0.10 Net income (loss) per common share (diluted) $ 0.06 $ 0.03 $ (2.16) $ 0.08 (1) The 2021 dividend on preferred shares includes amounts related to the conversion of the preferred shares. See Note 15, 8.00% Series A Convertible Preferred Stock, for more information.

Related Party Transactions (Tab

Related Party Transactions (Tables)	6 Months Ended
	Jun. 30, 2021
Related Party Transactions [Abstract]
Schedule of Related Party Transactions	Net services revenue from services provided to Ascension included in the Company’s consolidated statements of operations were (in millions): Three Months Ended June 30, Six Months Ended June 30, 2021 2020 2021 2020 Ascension $ 218.4 $ 206.4 $ 433.9 $ 414.8 Amounts included in the Company's consolidated balance sheets for Ascension are (in millions): June 30, 2021 December 31, 2020 Accounts receivable, net of $0.1 million and $0.1 million allowance - related party $ 31.9 $ 30.9 Current portion of customer liabilities $ 6.7 $ 15.3 Non-current portion of customer liabilities $ 16.4 $ 16.3 Total customer liabilities $ 23.1 $ 31.6

Deferred Contract Costs (Tables

Deferred Contract Costs (Tables)	6 Months Ended
	Jun. 30, 2021
Revenue from Contract with Customer [Abstract]
Summary of Deferred Contract Costs	The following table summarizes the breakout of deferred contract costs (in millions): June 30, 2021 December 31, 2020 Prepaid expenses and other current assets $ 3.1 $ 4.5 Other assets 21.9 19.6 Total deferred contract costs $ 25.0 $ 24.1

Business Description and Basi_2

Business Description and Basis of Presentation - Narrative (Details) $ in Millions	Jul. 01, 2021USD ($)
VisitPay | Subsequent Event
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Total purchase consideration	$ 298

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) $ in Millions	Sep. 03, 2022USD ($)	Sep. 03, 2021USD ($)	Aug. 03, 2020USD ($)payment	Apr. 01, 2020USD ($)	Jun. 30, 2021USD ($)	Jun. 30, 2021USD ($)	Jun. 30, 2020USD ($)	Sep. 03, 2022USD ($)	Dec. 31, 2020USD ($)
Business Acquisition [Line Items]
Earn-out provision, payment						$ 4.8	$ 0
Goodwill					$ 375.5	$ 375.5			$ 375.3
SCI Acquisition
Business Acquisition [Line Items]
Purchase price				$ 190
Other non-current liabilities, note payable				5
Purchase consideration				197
Goodwill				125.8
SCI Acquisition | Earn-out Provision
Business Acquisition [Line Items]
Earn-out provision, value				$ 4.8
Earn-out provision, payment					$ 10
RevWorks
Business Acquisition [Line Items]
Purchase consideration			$ 30
Purchase price, payment			$ 5
Number of deferred payments | payment			2
Contractual deferred payments			$ 24.3
Goodwill			3.6
RevWorks | Customer relationships
Business Acquisition [Line Items]
Assets acquired			2.8
RevWorks | Subsequent Event | Forecast
Business Acquisition [Line Items]
Purchase price, payment	$ 12.5	$ 12.5						$ 25
RevWorks | Cerner
Business Acquisition [Line Items]
Contingent consideration asset, (up to)			25
Asset, contingently returnable consideration			22.3
RevWorks | Cerner | Prepaid expenses and other current assets
Business Acquisition [Line Items]
Asset, contingently returnable consideration			11.5
RevWorks | Cerner | Other noncurrent assets
Business Acquisition [Line Items]
Asset, contingently returnable consideration			$ 10.8

Acquisitions - Fair Value of As

Acquisitions - Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions	Apr. 01, 2020	Jun. 30, 2021	Dec. 31, 2020
Allocation of consideration to assets acquired and liabilities assumed:
Goodwill		$ 375.5	$ 375.3
SCI Acquisition
Business Acquisition [Line Items]
Total purchase consideration	$ 197
Allocation of consideration to assets acquired and liabilities assumed:
Cash and cash equivalents	2.9
Accounts receivable	2.8
Prepaid expenses and other current assets	1.2
Property, equipment and software	0.3
Operating lease right-of-use assets	1.2
Intangible assets	86.1
Goodwill	125.8
Accounts payable	(0.2)
Current portion of customer liabilities	(4)
Accrued compensation and benefits	(1.6)
Current portion of operating lease liabilities	(0.5)
Other accrued expenses	(0.4)
Non-current portion of operating lease liabilities	(0.7)
Other non-current liabilities	(5)
Deferred income tax liabilities	(10.9)	$ (10.9)
Net assets acquired	$ 197

Acquisitions - Pro Forma Result

Acquisitions - Pro Forma Results (Details) - RevWorks - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2020
Business Acquisition [Line Items]
Net services revenue	$ 334.6	$ 684.1
Net income	$ 19.5	$ 36.8

Accounts Receivable and Allow_3

Accounts Receivable and Allowance for Credit Losses - Schedule of Allowance for Credit Losses (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 3.9	$ 4.7	$ 3.8	$ 2.8
Cumulative effect of ASC 326 adoption	2.3	5.2	$ 2.3	$ 5.2	$ 2.8
Accounting Standards Update [Extensible List]			us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member	us-gaap:AccountingStandardsUpdate201613Member
Provision	0.1	0.5	$ 0.2	$ 1.3
Write-offs	(1.7)	0	(1.7)	0
Ending balance	$ 2.3	5.2	$ 2.3	5.2	$ 2.8
Cumulative Effect, Period of Adoption, Adjustment
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance		$ 0		$ 1.1
Cumulative effect of ASC 326 adoption					1.1
Ending balance					$ 1.1

Property, Equipment, and Soft_2

Property, Equipment, and Software - Schedule of Property, Equipment and Software (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 246.3	$ 224.9
Less accumulated depreciation and amortization	(156.5)	(131.2)
Property, equipment and software, net	89.8	93.7
Buildings and land
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	3.8	4.6
Computer and other equipment
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	57.8	55
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	23.1	23.2
Software
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	155.3	135.7
Office furniture
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 6.3	$ 6.4

Property, Equipment, and Soft_3

Property, Equipment, and Software - Allocation of Depreciation and Amortization Expense between Cost of Services and Selling, General and Administrative Expenses (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 13.3	$ 12.3	$ 26.8	$ 24.5
Cost of services
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	12.5	11.4	25.2	22.3
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 0.8	$ 0.9	$ 1.6	$ 2.2

Leases - Schedule of Lease Cost

Leases - Schedule of Lease Costs (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Leases [Abstract]
Operating lease cost	$ 4	$ 4.9	$ 8.1	$ 9.8
Sublease income	(0.5)	(0.5)	(1.1)	(1.1)
Total lease cost	$ 3.5	$ 4.4	$ 7	$ 8.7

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$ 14.4	$ 10.1
Right-of-use assets obtained in exchange for operating lease obligations:	$ 5.6	$ 3.2

Leases - Schedule of Operating

Leases - Schedule of Operating and Finance Lease Maturity (Details) $ in Millions	Jun. 30, 2021USD ($)
Operating Leases
Remainder of 2021	$ 8.8
2022	15.6
2023	14.8
2024	15.1
2025	15.1
2026	11.9
Thereafter	21.9
Total	103.2
Less:
Imputed interest	27.2
Present value of lease liabilities	$ 76

Intangible Assets - Components

Intangible Assets - Components of Intangible Assets (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 199.2	$ 199.4
Accumulated Amortization	(37)	(28.3)
Total	162.2	171.1
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	97.7	97.7
Accumulated Amortization	(17.7)	(14.7)
Total	80	83
Technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	101.5	101.7
Accumulated Amortization	(19.3)	(13.6)
Total	$ 82.2	$ 88.1

Intangible Assets - Narrative (

Intangible Assets - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible asset amortization expense	$ 4.3	$ 5.6	$ 8.7	$ 9.1

Intangible Assets - Future Amor

Intangible Assets - Future Amortization (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
Remainder of 2021	$ 8.7
2022	17.5
2023	17.5
2024	15.7
2025	14.3
2026	14.3
Thereafter	74.2
Total	$ 162.2	$ 171.1

Goodwill - Schedule of Changes

Goodwill - Schedule of Changes in Carrying Value of Goodwill (Details) $ in Millions	6 Months Ended
	Jun. 30, 2021USD ($)
Goodwill [Roll Forward]
Balance as of December 31, 2020	$ 375.3
Measurement period adjustments	0.2
Balance as of June 30, 2021	$ 375.5

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregated Revenue by Source (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Disaggregation of Revenue [Line Items]
Net services revenue	$ 353.4	$ 314.7	$ 696	$ 635.2
Net operating fees
Disaggregation of Revenue [Line Items]
Net services revenue	285.2	287.8	571.3	568.7
Incentive fees
Disaggregation of Revenue [Line Items]
Net services revenue	37.5	1.3	66.5	18.1
Other
Disaggregation of Revenue [Line Items]
Net services revenue	$ 30.7	$ 25.6	$ 58.2	$ 48.4

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Contract Balances (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Receivables, including related party	$ 128.7	$ 122.2
Contract assets	4.4	0
Non-current customer liabilities, related party	16.4	16.3
Investor
Disaggregation of Revenue [Line Items]
Current customer liabilities, related party	2.3	5.6
Contract With Customer Liability
Disaggregation of Revenue [Line Items]
Contract liabilities	$ 24.1	$ 28.6

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Disaggregation of Revenue [Line Items]
Revenue recognized	$ 96.1	$ 87
Accounts Receivable
Disaggregation of Revenue [Line Items]
Revenue recognized, advanced billings	$ 88.1	$ 85

Revenue Recognition - Transacti

Revenue Recognition - Transaction Price Allocated to the Remaining Performance Obligation (Details) $ in Millions	Jun. 30, 2021USD ($)
Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 251.6
Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	28.6
Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 1.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-07-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	3 months
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-07-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 62.3
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-07-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	23.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-07-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 73.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	4.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2022-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 54.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2023-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 34
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 10.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 8.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 7.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Other
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0

Debt - Carrying Amounts of Debt

Debt - Carrying Amounts of Debt (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Long-term Debt	$ 541.7
Unamortized discount and issuance costs	(2.3)	$ (2.6)
Total debt	539.4	552
Less: Current maturities	(38.7)	(32.3)
Total long-term debt	500.7	519.7
Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Long-term Debt	70	70
Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Long-term Debt	$ 471.7	$ 484.6

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($)	Jan. 19, 2021	Jan. 15, 2021	Jun. 26, 2019	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020	Jan. 13, 2021	Mar. 20, 2020
Debt Instrument [Line Items]
Cash paid, stock conversion (not to exceed)				$ 105,000,000	$ 0
Long-term debt				$ 541,700,000
Redeemable Convertible Preferred Stock
Debt Instrument [Line Items]
Preferred stock, dividend rate (percentage)				8.00%		8.00%
TCP-ASC ACHI Series LLLP
Debt Instrument [Line Items]
Cash paid, stock conversion (not to exceed)	$ 105,000,000	$ 105,000,000
TCP-ASC ACHI Series LLLP | Redeemable Convertible Preferred Stock
Debt Instrument [Line Items]
Preferred stock, dividend rate (percentage)	8.00%	8.00%
Disposal Group, Disposed of by Sale, Not Discontinued Operations | EMS Disposition
Debt Instrument [Line Items]
Net proceeds from disposition, obligation waived							$ 135,000,000
Line of Credit
Debt Instrument [Line Items]
Interest rate				2.35%
Line of Credit | Minimum
Debt Instrument [Line Items]
Commitment fee			0.30%
Line of Credit | Maximum
Debt Instrument [Line Items]
Commitment fee			0.50%
Line of Credit | Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate basis			0.50%
Line of Credit | Eurodollar Rate
Debt Instrument [Line Items]
Variable rate basis, minimum			0.00%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One
Debt Instrument [Line Items]
Basis spread on variable rate basis			1.00%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate basis			0.75%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate basis			1.75%
Line of Credit | Eurodollar Rate | Interest Rate Option Two
Debt Instrument [Line Items]
Variable rate basis, minimum			0.00%
Line of Credit | Eurodollar Rate | Interest Rate Option Two | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate basis			1.75%
Line of Credit | Eurodollar Rate | Interest Rate Option Two | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate basis			2.75%
Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Credit agreement, maximum borrowing capacity			$ 325,000,000
Credit agreement, issuance percentage of par			99.66%
Long-term debt				$ 471,700,000		$ 484,600,000
Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Principle of debt issued			$ 100,000,000
Long-term debt				70,000,000		$ 70,000,000
Borrowing availability				29,500,000
Line of Credit | Incremental Term Loan
Debt Instrument [Line Items]
Additional borrowing capacity								$ 191,100,000
Line of credit, reduction to availability of funds for certain investments, debt prepayments or restricted payments							$ 105,000,000
Line of Credit | Letter of Credit
Debt Instrument [Line Items]
Long-term debt				$ 500,000

Debt - Scheduled Maturities of

Debt - Scheduled Maturities of Long-Term Debt (Details) $ in Millions	Jun. 30, 2021USD ($)
Debt Disclosure [Abstract]
Remainder of 2021	$ 19.4
2022	38.7
2023	45.2
2024	438.4
Total	$ 541.7

Share-Based Compensation - Narr

Share-Based Compensation - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 23.8	$ 4.3	$ 36.5	$ 9.1
Related tax benefits	4.9	0.7	7.1	1.4
Income tax benefit	$ 4.3	$ 1.1	$ 6.6	$ 1.7
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum exercisable (in shares)			6,375,432
Minimum | PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage			0.00%
Maximum | PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage			200.00%

Share-Based Compensation - Comp

Share-Based Compensation - Compensation Expense Allocation (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 23.8	$ 4.3	$ 36.5	$ 9.1
Cost of services
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	15.7	1.5	23	3.4
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 8.1	$ 2.8	$ 13.5	$ 5.7

Share-Based Compensation - Assu

Share-Based Compensation - Assumptions (Details)	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
Share-based Payment Arrangement [Abstract]
Expected dividend yield	0.00%	0.00%
Risk-free interest rate, minimum	0.40%	0.40%
Risk-free interest rate, maximum	1.00%	1.70%
Expected volatility	43.00%	43.00%
Expected term (in years)	5 years 6 months	5 years 6 months

Share-Based Compensation - Stoc

Share-Based Compensation - Stock Option Activity (Details)	6 Months Ended
	Jun. 30, 2021$ / sharesshares	Dec. 31, 2020$ / sharesshares
Options
Outstanding at beginning of period (in shares) | shares	6,220,971
Granted (in shares) | shares	3,115
Exercised (in shares) | shares	(936,045)
Canceled/forfeited (in shares) | shares	(3,405)
Expired (in shares) | shares	(7,000)
Outstanding at end of period (in shares) | shares	5,277,636
Outstanding, vested and exercisable at end of period (in shares) | shares	5,205,819	5,230,690
Weighted- Average Exercise Price
Outstanding at beginning of period (in dollars per share) | $ / shares	$ 3.68
Granted (in dollars per share) | $ / shares	24.20
Exercised (in dollars per share) | $ / shares	5.09
Canceled/forfeited (in dollars per share) | $ / shares	3.85
Expired (in dollars per share) | $ / shares	27.08
Outstanding at end of period (in dollars per share) | $ / shares	3.41
Outstanding, vested and exercisable at end of period (in dollars per share) | $ / shares	$ 3.34	$ 3.73

Share-Based Compensation - Othe

Share-Based Compensation - Other Than Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Millions	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020
RSUs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	2,108,447
Granted (in shares)	1,610,710
Performance factor adjustment (in shares)	0
Vested (in shares)	(546,381)
Forfeited (in shares)	(219,603)
Outstanding and unvested at end of period (in shares)	2,953,173
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 9.87
Granted (in dollars per share)	25.45
Performance factor adjustment (in dollars per share)	0
Vested (in dollars per share)	8.58
Forfeited (in dollars per share)	15.32
Outstanding and unvested at end of period (in dollars per share)	$ 18.20
Shares surrendered for taxes (in shares)	170,033	128,906
Cost of shares surrendered for taxes	$ 4.5	$ 1.1
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	2,917,071
Granted (in shares)	849,915
Performance factor adjustment (in shares)	101,937
Vested (in shares)	(305,811)
Forfeited (in shares)	(206,484)
Outstanding and unvested at end of period (in shares)	3,356,628
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 11.35
Granted (in dollars per share)	26.53
Performance factor adjustment (in dollars per share)	9.81
Vested (in dollars per share)	9.81
Forfeited (in dollars per share)	13.21
Outstanding and unvested at end of period (in dollars per share)	$ 15.17
Shares surrendered for taxes (in shares)	0	0
Cost of shares surrendered for taxes	$ 0	$ 0

Other Expenses - Schedule of Ot

Other Expenses - Schedule of Other Expenses (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Other Income and Expenses [Abstract]
Severance and related employee benefits	$ 0.3	$ 1.9	$ 1.8	$ 3
Strategic initiatives	1.9	8.5	8.4	11.7
Facility-exit charges	1.4	4.5	2.9	4.9
Other	6.2	3.1	9.7	7.1
Total other expenses	9.8	18	22.8	26.7
Contingent consideration changes included in strategic initiatives	0		0.5
COVID-19 related costs, included in Other	$ 2.7	$ 2.7	$ 4.4	$ 5.3

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020	Apr. 01, 2020
Income Tax Contingency [Line Items]
Federal statutory tax rate	21.00%	21.00%	21.00%	21.00%
Statute of limitations minimum			3 years
Statute of limitations maximum			6 years
Gross deferred tax assets					$ 146.1
Deferred tax assets related to operating loss carryforwards					$ 81.6
SCI Acquisition
Income Tax Contingency [Line Items]
Deferred tax assets related to operating loss carryforwards	$ 10.4		$ 10.4
Deferred income tax liabilities, net	10.9		10.9			$ 10.9
Deferred tax assets related to research and experimentation credits	$ 3.7		$ 3.7

8.00% Series A Convertible Pr_3

8.00% Series A Convertible Preferred Stock - Narrative (Details) - USD ($) $ in Millions	Jan. 19, 2021	Jan. 15, 2021	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
Temporary Equity [Line Items]
Cash paid, stock conversion (not to exceed)					$ 105	$ 0
Dividends	$ 592.3		$ 0	$ 5.6	$ 592.3	$ 11
TCP-ASC ACHI Series LLLP
Temporary Equity [Line Items]
Cash paid, stock conversion (not to exceed)	$ 105	$ 105
Redeemable Convertible Preferred Stock
Temporary Equity [Line Items]
Number of shares converted (in shares)					294,266
Preferred stock, dividend rate (percentage)					8.00%		8.00%
Redeemable Convertible Preferred Stock | TCP-ASC ACHI Series LLLP
Temporary Equity [Line Items]
Number of shares converted (in shares)		294,266
Preferred stock, dividend rate (percentage)	8.00%	8.00%
Common Stock | TCP-ASC ACHI Series LLLP
Temporary Equity [Line Items]
Number of shares issued in stock conversion (in shares)		117,706,400
Additional shares issued (in shares)	21,582,800

8.00% Series A Convertible Pr_4

8.00% Series A Convertible Preferred Stock - Schedule of Preferred Stock Activity (Details) - Redeemable Convertible Preferred Stock $ in Millions	6 Months Ended
	Jun. 30, 2021USD ($)shares
Shares Issued and Outstanding
Beginning Balance (in shares) | shares	288,497
Dividends paid/accrued dividends (in shares) | shares	5,769
Conversion of preferred stock (in shares) | shares	(294,266)
Ending Balance (in shares) | shares	0
Carrying Value
Beginning Balance | $	$ 251.5
Dividends paid/accrued dividends | $	0
Conversion of preferred stock | $	(251.5)
Ending Balance | $	$ 0

Earnings (Loss) Per Share - Com

Earnings (Loss) Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Millions	Jan. 19, 2021	Jan. 15, 2021	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
Basic EPS:
Net income			$ 18.4	$ 25.8	$ 15.1	$ 18.2	$ 44.2	$ 33.3
Less dividends on preferred shares	$ (592.3)		0		(5.6)		(592.3)	(11)
Less income allocated to preferred shareholders			0		(4.7)		0	(11)
Net income (loss) available/allocated to common shareholders - basic			18.4		4.8		(548.1)	11.3
Diluted EPS:
Less income allocated to preferred shareholders			0		(3.8)		0	(8.9)
Net income (loss) available/(allocated) to common shareholders - diluted			$ 18.4		$ 5.7		$ (548.1)	$ 13.4
Basic weighted-average common shares (in shares)			268,251,790		115,067,552		253,850,972	114,754,298
Add: Effect of dilutive equity awards (in shares)			6,551,978		10,608,629		0	11,198,960
Add: Effect of dilutive warrants (in shares)			46,029,145		40,211,783		0	41,856,066
Diluted weighted average common shares (in shares)			320,832,913		165,887,964		253,850,972	167,809,324
Net income (loss) per common share (basic) (in dollars per share)			$ 0.07		$ 0.04		$ (2.16)	$ 0.10
Net income (loss) per common share (diluted) (in dollars per share)			$ 0.06		$ 0.03		$ (2.16)	$ 0.08
Redeemable Convertible Preferred Stock
Diluted EPS:
Preferred stock, dividend rate (percentage)							8.00%		8.00%
TCP-ASC ACHI Series LLLP | Redeemable Convertible Preferred Stock
Diluted EPS:
Preferred stock, dividend rate (percentage)	8.00%	8.00%

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - shares	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	386,079	322,512	14,606,241	250,279
Warrant | Investor's
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)			40,500,000
Warrant | Intermountain
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)			1,500,000

Commitments and Contingencies -

Commitments and Contingencies - Narrative (Details)	Apr. 19, 2021claim
TCP-ASC Recapitalization Litigation | Pending Litigation
Loss Contingencies [Line Items]
Number of complaints filed	2

Related Party Transactions - Ne

Related Party Transactions - Net Services Revenue (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Related Party Transactions [Abstract]
Ascension	$ 218.4	$ 206.4	$ 433.9	$ 414.8

Related Party Transactions - Su

Related Party Transactions - Summary Amounts Included in Balance Sheet (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Related Party Transaction [Line Items]
Accounts receivable, net of $0.1 million and $0.1 million allowance - related party	$ 31.9	$ 30.9
Accounts receivable, allowance - related party	2.2	3.7
Ascension
Related Party Transaction [Line Items]
Accounts receivable, net of $0.1 million and $0.1 million allowance - related party	31.9	30.9
Accounts receivable, allowance - related party	0.1	0.1
Current portion of customer liabilities	6.7	15.3
Non-current portion of customer liabilities	16.4	16.3
Total customer liabilities	$ 23.1	$ 31.6

Related Party Transactions - Na

Related Party Transactions - Narrative (Details) - $ / shares	May 28, 2021	Jun. 30, 2021
Common Stock
Related Party Transaction [Line Items]
Exercise of warrants pursuant to cashless provisions (in shares)		16,750,000
Related Party | TCP-ASC
Related Party Transaction [Line Items]
Warrant exercise price (in dollars per share)	$ 3.50
Related Party | TCP-ASC | Minimum
Related Party Transaction [Line Items]
Warrant market value price (in dollars per share)	24.54
Related Party | TCP-ASC | Maximum
Related Party Transaction [Line Items]
Warrant market value price (in dollars per share)	$ 24.64
Related Party | TCP-ASC | Common Stock
Related Party Transaction [Line Items]
Exercise of warrants pursuant to cashless provisions (in shares)	16,750,000
Class of warrant or right, number of securities called by warrants or rights (in shares)	19,535,145

Deferred Contract Costs - Summa

Deferred Contract Costs - Summary of Deferred Contract Costs (Details) - USD ($) $ in Millions	Jun. 30, 2021	Dec. 31, 2020
Capitalized Contract Cost [Line Items]
Total deferred contract costs	$ 25	$ 24.1
Prepaid expenses and other current assets
Capitalized Contract Cost [Line Items]
Total deferred contract costs	3.1	4.5
Other assets
Capitalized Contract Cost [Line Items]
Total deferred contract costs	$ 21.9	$ 19.6

Deferred Contract Costs - Narra

Deferred Contract Costs - Narrative (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020
Revenue from Contract with Customer [Abstract]
Capitalized contract cost, amortization	$ 1,000,000	$ 1,200,000	$ 2,200,000	$ 2,300,000
Impairment losses	$ 0	$ 0	$ 0	$ 0

Segments and Customer Concent_2

Segments and Customer Concentrations - Narrative (Details) - segment	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
Segment Reporting Information [Line Items]
Number of operating segments			1
Number of reportable segments			1
Customer Concentration Risk | Revenue | Ascension
Segment Reporting Information [Line Items]
Concentration percentage	62.00%	66.00%	62.00%	65.00%
Customer Concentration Risk | Revenue | Intermountain Healthcare
Segment Reporting Information [Line Items]
Concentration percentage	13.00%	14.00%	14.00%	15.00%
Customer Concentration Risk | Accounts Receivable | Ascension
Segment Reporting Information [Line Items]
Concentration percentage			25.00%		25.00%

Derivative Financial Instrume_2

Derivative Financial Instruments - Narrative (Details) - Designated as Hedging Instrument - Cash Flow Hedging - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2021	Jun. 30, 2020	Jun. 30, 2021	Jun. 30, 2020	Dec. 31, 2020
Foreign Currency Hedges
Derivative [Line Items]
Unrealized gains (losses) reported in accumulated other comprehensive income			$ 0.2
Gains (losses) to be reclassified within next 12 months			0.2
Derivatives, net gain (loss) reclassified into cost of services	$ 0.2	$ (0.6)	0.6	$ (0.7)
Notional amount	67.5		67.5		$ 55.9
Interest Rate Swap
Derivative [Line Items]
Unrealized gains (losses) reported in accumulated other comprehensive income			(1.5)
Gains (losses) to be reclassified within next 12 months			(1.3)
Derivatives, net gain (loss) reclassified into cost of services	(0.3)	$ (0.4)	(0.8)	$ (0.3)
Notional amount	$ 100		$ 100		$ 200

Subsequent Events - Narrative (

Subsequent Events - Narrative (Details) - Line of Credit - USD ($)	Jul. 01, 2021	Jun. 26, 2019
Senior Term Loan
Subsequent Event [Line Items]
Credit agreement, maximum borrowing capacity		$ 325,000,000
Subsequent Event | Bank of America | Senior Term Loan
Subsequent Event [Line Items]
Credit agreement, maximum borrowing capacity	$ 700,000,000
Subsequent Event | Bank of America | Senior Revolver
Subsequent Event [Line Items]
Credit agreement, maximum borrowing capacity	450,000,000
Aggregate borrowings	$ 120,000,000