R1 RCM 10-Q 2 Nov 21 2021 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2021	Oct. 29, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 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)		277,604,245
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Entity Central Index Key	0001472595
Current Fiscal Year End Date	--12-31

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 158.7	$ 173.8
Accounts receivable, net of $2.3 million and $3.7 million allowance	113.8	91.3
Accounts receivable, net of $0.1 million and $0.1 million allowance - related party	29.2	30.9
Prepaid expenses and other current assets	62.9	59.4
Total current assets	364.6	355.4
Property, equipment and software, net	99.3	93.7
Operating lease right-of-use assets	57.4	57.8
Intangible assets, net	272.4	171.1
Goodwill	551.9	375.3
Non-current deferred tax assets	55.8	73.7
Non-current portion of restricted cash equivalents	0.5	1
Other assets	81.5	61
Total assets	1,483.4	1,189
Current liabilities:
Accounts payable	22.5	18.2
Current portion of customer liabilities	51.7	16.7
Current portion of customer liabilities - related party	7.6	15.3
Accrued compensation and benefits	86.6	51.9
Current portion of operating lease liabilities	11.8	12.2
Current portion of long-term debt	17.5	32.3
Other accrued expenses	59.7	59.7
Total current liabilities	257.4	206.3
Non-current portion of customer liabilities	4.4	0
Non-current portion of customer liabilities - related party	15.9	16.3
Non-current portion of operating lease liabilities	64	71
Long-term debt	779.1	519.7
Other non-current liabilities	28.5	36.3
Total liabilities	1,149.3	849.6
8.00% Series A convertible preferred stock, par value $0.01, no shares authorized, issued or outstanding as of September 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, 295,885,508 shares issued and 277,492,322 shares outstanding at September 30, 2021; 137,812,559 shares issued and 121,144,038 shares outstanding at December 31, 2020	3	1.4
Additional paid-in capital	613.7	393.7
Accumulated deficit	(100.3)	(161.5)
Accumulated other comprehensive loss	(6.6)	(6.5)
Treasury stock, at cost, 18,393,186 shares as of September 30, 2021; 16,668,521 shares as of December 31, 2020	(175.7)	(139.2)
Total stockholders’ equity	334.1	87.9
Total liabilities and stockholders’ equity	$ 1,483.4	$ 1,189

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2021	Dec. 31, 2020
Accounts receivable, allowance	$ 2.3	$ 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)	295,885,508	137,812,559
Common stock, shares outstanding (in shares)	277,492,322	121,144,038
Treasury stock, shares (in shares)	18,393,186	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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Statement [Abstract]
Net services revenue ($227.5 million and $661.4 million for the three and nine months ended September 30, 2021, respectively, and $193.4 million and $608.2 million for the three and nine months ended September 30, 2020, respectively, from related party)	$ 379.7	$ 307.2	$ 1,075.7	$ 942.4
Operating expenses:
Cost of services	304	255.2	858.2	757.4
Selling, general and administrative	33.2	25.7	87.8	74.5
Other expenses	11.4	15.7	34.2	42.4
Total operating expenses	348.6	296.6	980.2	874.3
Income from operations	31.1	10.6	95.5	68.1
Net interest expense	6.5	4.4	13.8	13
Income before income tax provision	24.6	6.2	81.7	55.1
Income tax provision	7.6	1	20.5	16.6
Net income	$ 17	$ 5.2	$ 61.2	$ 38.5
Net income (loss) per common share:
Basic (in dollars per share)	$ 0.06	$ 0	$ (2.03)	$ 0.10
Diluted (in dollars per share)	$ 0.05	$ 0	$ (2.03)	$ 0.08
Weighted average shares used in calculating net income (loss) per common share:
Basic (in shares)	278,655,269	115,976,377	262,209,929	115,164,631
Diluted (in shares)	320,617,086	115,976,377	262,209,929	171,178,086
Consolidated statements of comprehensive income
Net income	$ 17	$ 5.2	$ 61.2	$ 38.5
Other comprehensive income (loss):
Net change on derivatives designated as cash flow hedges, net of tax	0.5	1.1	0.9	(2.5)
Foreign currency translation adjustments	0	1.4	(1)	(0.9)
Total other comprehensive income (loss), net of tax	0.5	2.5	(0.1)	(3.4)
Comprehensive income	17.5	7.7	61.1	35.1
Basic:
Net income	17	5.2	61.2	38.5
Less dividends on preferred shares	0	(5.6)	(592.3)	(16.6)
Less income allocated to preferred shareholders	0	0	0	(10.9)
Net income (loss) available/allocated to common shareholders - basic	17	(0.4)	(531.1)	11
Diluted:
Net income	17	5.2	61.2	38.5
Less dividends on preferred shares	0	(5.6)	(592.3)	(16.6)
Less income allocated to preferred shareholders	0	0	0	(8.7)
Net income (loss) available/allocated to common shareholders - diluted	$ 17	$ (0.4)	$ (531.1)	$ 13.2

Consolidated Statements of Op_2

Consolidated Statements of Operations and Comprehensive Income (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Statement [Abstract]
Revenue from related parties	$ 227.5	$ 193.4	$ 661.4	$ 608.2

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]	Accounting Standards Update 2016-13 [Member]
Net change on derivatives designated as cash flow hedges, net of tax	$ (2.5)
Foreign currency translation adjustments	(0.9)
Net income	38.5
Ending Balance (in shares) at Sep. 30, 2020				130,412,966		13,919,939
Ending Balance at Sep. 30, 2020	62.5			$ 1.3		$ (74.8)		384		(240.1)			(7.9)
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							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)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Accounting Standards Update [Extensible List]	Accounting Standards Update 2016-13 [Member]
Share-based compensation expense	$ 6.8							6.8
Issuance of common stock related to share-based compensation plans (in shares)				14,015
Exercise of vested stock options (in shares)				1,108,991
Exercise of vested stock options	7.6							7.6
Dividends paid/accrued	(5.6)							(5.6)
Acquisition of treasury stock related to share-based compensation plans (in shares)						(4,767)
Acquisition of treasury stock related to share-based compensation plans	(0.1)					$ (0.1)
Net change on derivatives designated as cash flow hedges, net of tax	1.1												1.1
Foreign currency translation adjustments	1.4												1.4
Net income	5.2									5.2
Ending Balance (in shares) at Sep. 30, 2020				130,412,966		13,919,939
Ending Balance at Sep. 30, 2020	62.5			$ 1.3		$ (74.8)		384		(240.1)			(7.9)
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]
Exercise of vested stock options (in shares)	1,108,632
Net change on derivatives designated as cash flow hedges, net of tax	$ 0.9
Foreign currency translation adjustments	(1)
Net income	61.2
Ending Balance (in shares) at Sep. 30, 2021				295,885,508		18,393,186
Ending Balance at Sep. 30, 2021	334.1			$ 3		$ (175.7)		613.7		(100.3)			(6.6)
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)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	25.8							25.8
Issuance of common stock related to share-based compensation plans (in shares)				54,524
Exercise of vested stock options (in shares)				172,587
Exercise of vested stock options	0.7							0.7
Acquisition of treasury stock related to share-based compensation plans (in shares)						(16,555)
Acquisition of treasury stock related to share-based compensation plans	$ (0.3)					$ (0.3)
Repurchases of common stock (in shares)	(1,538,077)
Repurchases of common stock	$ (31.7)
Net change on derivatives designated as cash flow hedges, net of tax	0.5												0.5
Foreign currency translation adjustments	0
Net income	17									17
Ending Balance (in shares) at Sep. 30, 2021				295,885,508		18,393,186
Ending Balance at Sep. 30, 2021	$ 334.1			$ 3		$ (175.7)		$ 613.7		$ (100.3)			$ (6.6)

Consolidated Statements of St_2

Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - USD ($) $ in Millions	Dec. 31, 2019	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020
Accumulated Other Comprehensive Loss
Net change on derivatives designated as cash flow hedges, tax		$ 0.1	$ 0	$ 0.2	$ 0.4	$ 0.3	$ 1.5
Cumulative Effect, Period of Adoption, Adjustment
Cumulative effect of ASC 326 adoption, tax	$ 0.3

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Operating activities
Net income	$ 61.2	$ 38.5
Adjustments to reconcile net income to net cash provided by operations:
Depreciation and amortization	56.8	50.9
Amortization of debt issuance costs	0.8	0.8
Share-based compensation	62	15.9
(Gain)/loss on disposal and right-of-use asset write-downs	(0.3)	5.1
Provision for credit losses	0.6	1.3
Deferred income taxes	18	16.2
Non-cash lease expense	7.4	8.7
Other	0.8	1.6
Changes in operating assets and liabilities:
Accounts receivable and related party accounts receivable	(18.8)	(47.2)
Prepaid expenses and other assets	(19.8)	(11.8)
Accounts payable	4.5	1.9
Accrued compensation and benefits	34.3	(36.1)
Lease liabilities	(9.9)	(7.8)
Other liabilities	(8.9)	22.5
Customer liabilities and customer liabilities - related party	30.1	(10)
Net cash provided by operating activities	218.8	50.5
Investing activities
Purchases of property, equipment, and software	(33.4)	(42.3)
Acquisition of SCI, net of cash acquired and earn-out provision	0	(189)
Acquisition of RevWorks, net of contingent consideration	0	(5)
Acquisition of VisitPay, net of cash acquired	(294.7)	0
Proceeds from disposal of assets	2.6	0
Net cash used in investing activities	(325.5)	(236.3)
Financing activities
Payment of debt issuance costs	(1.9)	0
Payment of contingent consideration liability	(4.8)	0
Deferred payment related to acquisition of RevWorks	(12.5)	0
Inducement of preferred stock conversion	(105)	0
Exercise of vested stock options	6.3	11
Purchase of treasury stock	(29.5)	0
Shares withheld for taxes	(4.8)	(7.5)
Other	(0.1)	(5.8)
Net cash provided by financing activities	91.7	201.3
Effect of exchange rate changes in cash, cash equivalents and restricted cash	(0.6)	(0.7)
Net (decrease) increase in cash, cash equivalents and restricted cash	(15.6)	14.8
Cash, cash equivalents and restricted cash, at beginning of period	174.8	92.5
Cash, cash equivalents and restricted cash, at end of period	159.2	107.3
Supplemental disclosures of cash flow information
Accrued dividends payable to preferred stockholders	0	5.6
Property, equipment and software purchases not paid	25.7	10.9
Senior Term Loan
Financing activities
Issuance of senior secured debt, net of discount and borrowings on revolver	698.6	190.6
Repayment of senior secured debt and revolver	(484.6)	(17)
Senior Revolver
Financing activities
Issuance of senior secured debt, net of discount and borrowings on revolver	120	50
Repayment of senior secured debt and revolver	$ (90)	$ (20)

Business Description and Basis

Business Description and Basis of Presentation	9 Months Ended
	Sep. 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 all the outstanding equity interests of iVinci Partners, LLC d/b/a VisitPay (“VisitPay”), a provider of digital payment solutions located in Idaho, 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”). VisitPay’s proprietary analytics are designed to deliver consistent and compliant financing options that meet the unique needs of each patient and their family. VisitPay’s payment platform is purpose-built for healthcare with integrations across all major acute and ambulatory billing systems. The combination of the Company and VisitPay will enable the Company to increase price transparency, provide flexible and personalized payment options, and enhance big data analytics. Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of September 30, 2021, the results of operations of the Company for the three and nine months ended September 30, 2021 and 2020, and the cash flows of the Company for the nine months ended September 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 nine months ended September 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. When preparing financial statements in conformity with GAAP, the Company makes a number of significant estimates, assumptions, and judgments in the preparation of the financial statements. Actual results could differ from those estimates. For a more complete discussion of the Company’s significant accounting policies and other information, the unaudited consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements included in the Company's 2020 Form 10-K. Recently Issued Accounting Standards and Disclosures No new accounting pronouncements issued or effective during the fiscal year had, or are expected to have, a material impact on the Company’s consolidated financial statements.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	9 Months Ended
	Sep. 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 and liabilities such as cash and cash equivalents, restricted cash equivalents, accounts receivable, net, accounts payable, accrued service costs, accrued compensation and benefits, and certain other current assets and accrued expenses, approximate their fair values, due to their short-term nature. See Note 11, Derivative Financial Instruments, for a discussion of the fair value of the Company's forward currency derivative contracts and interest rate swaps.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Acquisitions	Acquisitions Assets acquired and liabilities assumed in a business combination are recorded at their estimated fair value on the date of the acquisition. The difference between the purchase price amount and the net fair value of assets acquired and liabilities assumed is recognized as goodwill on the balance sheet if the purchase price exceeds the estimated net fair value or as a bargain purchase gain on the income statement if the purchase price is less than the estimated net fair value. The allocation of the purchase price may be modified up to one year after the acquisition date as more information is obtained about the fair value of assets acquired and liabilities assumed. VisitPay On July 1, 2021, the Company completed the acquisition of VisitPay. The purchase price for the VisitPay Acquisition was $305.4 million. The Company funded the purchase price for the VisitPay Acquisition and the Company’s associated transaction expenses with a combination of cash on hand and the incurrence of additional indebtedness (see Note 10, Debt). The purchase price has been provisionally allocated to assets acquired and liabilities assumed based on their established fair value as of the acquisition date. The fair value estimate of assets acquired and liabilities assumed is pending the completion of multiple elements, including gathering further information about the identification and completeness of all assets and liabilities acquired, the finalization of an independent appraisal and valuation of fair value of the assets acquired and liabilities assumed, and final review by the Company's management. Accordingly, management considers the balances shown in the following table to be preliminary. Some of the more significant amounts that are not yet finalized relate to the fair value of intangible assets and income and non-income related taxes. Accordingly, there could be adjustments to the consolidated financial statements, including changes in our amortization expense related to the valuation of intangible assets acquired and their respective useful lives, among other adjustments. The preliminary fair value of assets acquired and liabilities assumed is (in millions): Purchase Price Allocation Total purchase consideration $ 305.4 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 10.7 Accounts receivable 4.7 Prepaid expenses and other current assets 0.4 Property, equipment and software 0.3 Operating lease right-of-use assets 1.7 Deferred income tax assets 0.9 Intangible assets 117.3 Goodwill 176.4 Accounts payable (0.5) Current portion of customer liabilities (1.1) Accrued compensation and benefits (0.7) Current portion of operating lease liabilities (0.4) Other accrued expenses (2.0) Non-current portion of customer liabilities (1.0) Non-current portion of operating lease liabilities (1.3) Net assets acquired $ 305.4 The intangible assets preliminarily identified in conjunction with the VisitPay Acquisition are as follows: Useful Life Gross Carrying Value Customer Relationships 10 years $ 2.3 Technology 11 years $ 114.0 Tradename 3 years $ 1.0 The goodwill recognized is primarily attributable to synergies that are expected to be achieved from the integration of VisitPay. The goodwill recognized in the acquisition will be partially deductible for income tax purposes. Included in the Consolidated Statements of Operations and Comprehensive Income for the three and nine months ended September 30, 2021 are net sales of $5.2 million and net loss before income taxes of $3.5 million related to the operations of VisitPay since the acquisition date of July 1, 2021. During 2020, the Company acquired the following businesses: Company Name Description of the Business Description of the Acquisition SCHEDULING.COM, INC. d/b/a SCI Solutions, Inc. (“SCI”) Provider of software-as-a-service (“SaaS”)-based scheduling and patient access solutions Purchased all outstanding equity interests RevWorks services business (acquired from Cerner Corporation) Provider of revenue cycle management services Purchased certain assets relating to the RevWorks services business There have been no significant purchase accounting adjustments to the fair value of assets acquired or the liabilities assumed in connection with the SCI and RevWorks acquisitions as disclosed in Note 5 of the Company’s 2020 Form 10-K. The purchase price for SCI included contingent consideration that was based on achieving certain revenue and operational targets in the year following the acquisition, which had a fair value of $4.8 million at the time of acquisition. During the nine months ended September 30, 2021, the maximum amount of contingent consideration of $10.0 million was finalized and paid. Changes to the fair value of the contingent consideration were recorded as a component of other expenses. With respect to the RevWorks acquisition, the Company paid the first deferred payment of $12.5 million in the third quarter of 2021. There is one remaining deferred payment of $12.5 million which is payable on the second anniversary of the closing date (August 2022), and is included in other accrued expenses on the Consolidated Balance Sheets as of September 30, 2021. At the time of the acquisition, the Company recorded a present value liability for the contractual deferred payments of $24.3 million. The two deferred payments related to the RevWorks acquisition are contractual obligations of the Company; however, they are potentially fully refundable to the Company if certain RevWorks customer revenue targets defined in the purchase agreement for the first two years following the acquisition are not achieved. The Company has recorded an asset for the fair value of the contingently returnable consideration of $22.3 million, including $10.5 million in prepaid expenses and other current assets and $11.8 million in other assets on the Consolidated Balance Sheets as of September 30, 2021. Pro Forma Results The following table summarizes, on a pro forma basis, the combined results of the Company as though the VisitPay Acquisition had occurred as of January 1, 2020 and the SCI and RevWorks acquisitions had occurred as of January 1, 2019. These pro forma results are not necessarily indicative of the actual consolidated results had the acquisitions occurred as of those dates or of the future consolidated operating results for any period. Pro forma results are (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net services revenue $ 379.7 $ 310.6 $ 1,083.0 $ 998.1 Net income (loss) $ 18.7 $ (4.0) $ 56.9 $ 34.8 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 the acquired companies and replacing it with the debt of the Company, to adjust timing of acquisition related costs incurred by the Company, and to record the income tax effect of these adjustments.

Accounts Receivable and Allowan

Accounts Receivable and Allowance for Credit Losses	9 Months Ended
	Sep. 30, 2021
Receivables [Abstract]
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. 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. Even though the full effects of the 2019 Novel Coronavirus (“COVID-19”) on the Company’s customers continue to be uncertain, at this time, the Company does not believe there is incremental collection risk for customer receivables as a result of COVID-19. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Beginning balance $ 2.3 $ 5.2 $ 3.8 $ 2.8 Cumulative effect of ASC 326 — — — 1.1 Provision (recoveries) 0.4 (0.8) 0.6 0.5 Amounts reclassified to held for sale (1) — (0.6) — (0.6) Write-offs (0.3) (0.1) (2.0) (0.1) Ending balance $ 2.4 $ 3.7 $ 2.4 $ 3.7 (1) Relates to the disposition of the Company’s emergency medical services (“EMS”) business in October 2020. The EMS business was classified as held for sale as of September 30, 2020.

Property, Equipment and Softwar

Property, Equipment and Software	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Buildings and land $ 3.8 $ 4.6 Computer and other equipment 59.0 55.0 Leasehold improvements 23.3 23.2 Software 177.1 135.7 Office furniture 6.5 6.4 Property, equipment and software, gross 269.7 224.9 Less accumulated depreciation and amortization (170.4) (131.2) Property, equipment and software, net $ 99.3 $ 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Cost of services $ 13.6 $ 11.8 $ 38.8 $ 34.1 Selling, general and administrative 0.6 1.0 2.2 3.2 Total depreciation and amortization $ 14.2 $ 12.8 $ 41.0 $ 37.3

Leases

Leases	9 Months Ended
	Sep. 30, 2021
Leases [Abstract]
Leases	Leases The components of lease costs are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Operating lease cost $ 4.0 $ 4.3 $ 12.1 $ 14.1 Sublease income (0.6) (0.6) (1.7) (1.7) Total lease cost $ 3.4 $ 3.7 $ 10.4 $ 12.4 Supplemental cash flow information related to leases are as follows (in millions): Nine Months Ended September 30, 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 18.6 $ 15.2 Right-of-use assets obtained in exchange for operating lease obligations: 13.6 3.4 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 September 30, 2021 are as follows (in millions): Operating Leases Remainder of 2021 $ 4.5 2022 16.7 2023 14.6 2024 14.6 2025 14.7 2026 11.4 Thereafter 25.0 Total 101.5 Less: Imputed interest 25.7 Present value of lease liabilities $ 75.8 .
Leases	Leases The components of lease costs are as follows (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Operating lease cost $ 4.0 $ 4.3 $ 12.1 $ 14.1 Sublease income (0.6) (0.6) (1.7) (1.7) Total lease cost $ 3.4 $ 3.7 $ 10.4 $ 12.4 Supplemental cash flow information related to leases are as follows (in millions): Nine Months Ended September 30, 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 18.6 $ 15.2 Right-of-use assets obtained in exchange for operating lease obligations: 13.6 3.4 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 September 30, 2021 are as follows (in millions): Operating Leases Remainder of 2021 $ 4.5 2022 16.7 2023 14.6 2024 14.6 2025 14.7 2026 11.4 Thereafter 25.0 Total 101.5 Less: Imputed interest 25.7 Present value of lease liabilities $ 75.8 .

Intangible Assets

Intangible Assets	9 Months Ended
	Sep. 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 September 30, 2021 and December 31, 2020 (in millions): September 30, 2021 December 31, 2020 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 100.0 $ (19.2) $ 80.8 $ 97.7 $ (14.7) $ 83.0 Technology 215.5 (24.8) 190.7 101.7 (13.6) 88.1 Tradename 1.0 (0.1) 0.9 — — — Total intangible assets $ 316.5 $ (44.1) $ 272.4 $ 199.4 $ (28.3) $ 171.1 Intangible asset amortization expense was $7.1 million and $15.8 million for the three and nine months ended September 30, 2021, and $4.5 million and $13.6 million for the three and nine months ended September 30, 2020. Estimated annual amortization expense related to intangible assets with definite lives as of September 30, 2021 is as follows (in millions): Remainder of 2021 $ 7.1 2022 28.4 2023 28.4 2024 26.5 2025 24.9 2026 24.9 Thereafter 132.2 Total $ 272.4

Goodwill

Goodwill	9 Months Ended
	Sep. 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 nine months ended September 30, 2021 were (in millions): Goodwill Balance as of December 31, 2020 $ 375.3 Acquisitions 176.4 Measurement period adjustments 0.2 Balance as of September 30, 2021 $ 551.9

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2021
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue RecognitionRevenue is measured based on consideration specified in a contract with a customer, and presented net of 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net operating fees $ 308.5 $ 253.7 $ 879.8 $ 822.4 Incentive fees 41.5 25.1 108.0 43.2 Other (1) 29.7 28.4 87.9 76.8 Net services revenue $ 379.7 $ 307.2 $ 1,075.7 $ 942.4 (1) Other revenue primarily consists of physician advisory services (“PAS”), practice management services, and revenue related to Entri modular services. Contract Balances The following table provides information about contract liabilities from contracts with customers (in millions): September 30, 2021 December 31, 2020 Contract liabilities 29.4 28.6 Contract liabilities are included in other customer liabilities and contains related party amounts, including $2.3 million and $5.6 million of current customer liabilities and $15.9 million and $16.3 million of non-current customer liabilities as of September 30, 2021 and December 31, 2020, respectively. There were no contract assets as of September 30, 2021 and December 31, 2020. 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 $99.7 million and $88.0 million during the nine months ended September 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 nine months ended September 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 $ 35.8 $ 21.4 $ 0.7 2022 104.6 25.0 0.8 2023 81.3 — — 2024 57.7 — — 2025 34.3 — — 2026 34.3 — — Thereafter 162.3 — — Total $ 510.3 $ 46.4 $ 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. September 30, 2021 December 31, 2020 Prepaid expenses and other current assets $ 3.2 $ 4.5 Other assets 22.8 19.6 Total deferred contract costs $ 26.0 $ 24.1

Debt

Debt	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Debt	Debt The carrying amounts of debt consist of the following (in millions): September 30, 2021 December 31, 2020 Senior Revolver (1) $ 100.0 $ 70.0 Senior Term Loan 700.0 484.6 Unamortized discount and issuance costs (3.4) (2.6) Total debt 796.6 552.0 Less: Current maturities (17.5) (32.3) Total long-term debt $ 779.1 $ 519.7 (1) As of September 30, 2021, the Company had $100.0 million in borrowings, $0.5 million letters of credit outstanding, and $349.5 million of availability under the Senior Revolver. Amended and Restated Senior Secured Credit Facilities On July 1, 2021, the Company and certain of its subsidiaries entered into an amended and restated senior credit agreement (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 (the “Senior Secured Credit Facilities”), consisting of a $700.0 million senior secured term loan facility (the “Senior Term Loan”) and a $450.0 million senior secured revolving credit facility (the “Senior Revolver”). Borrowings under the Senior Secured Credit Facilities bear 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 0.25% and 1.25% dependent on the Company's net leverage ratio (provided that the Eurodollar rate applicable to the Senior Term Loan shall not be less than 0.00% per annum); or (ii) the Eurodollar rate (provided that the Eurodollar rate applicable to the Senior Term Loan shall not be less than 0.00% per annum), plus between 1.25% and 2.25%, dependent on the Company's net leverage ratio. The interest rate as of September 30, 2021 was 2.33%. The Company is also required to pay an unused commitment fee to the lenders under the Senior Revolver at a rate between 0.20% and 0.40% of the average daily unutilized commitments thereunder dependent on the Company's net leverage ratio. The A&R Credit Agreement contains a number of financial and non-financial covenants. The Company was in compliance with all of the covenants in the A&R Credit Agreement as of September 30, 2021. The obligations under the A&R Credit Agreement are secured by a pledge of 100% of the capital stock of certain domestic subsidiaries owned by the Company and a security interest in substantially all of the Company’s tangible and intangible assets and the tangible and intangible assets of certain domestic subsidiaries. In connection with the entry into the A&R Credit Agreement, the Company used all of the proceeds, in addition to cash on hand, to refinance, in full, all existing debt under the Company’s 2019 credit agreement and to fund the VisitPay Acquisition. Debt amounts presented as of December 31, 2020 were incurred under the 2019 credit agreement. Debt Maturities Scheduled maturities of the Company’s long-term debt are summarized as follows (in millions): Scheduled Maturities Remainder of 2021 $ 4.4 2022 17.5 2023 21.9 2024 35.0 2025 35.0 2026 686.2 Total $ 800.0 For further details on the Company's 2019 credit agreement, refer to Note 13 of the Company's 2020 Form 10-K.

Derivative Financial Instrument

Derivative Financial Instruments	9 Months Ended
	Sep. 30, 2021
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments	Derivative Financial InstrumentsThe Company utilizes cash flow hedges to manage its currency risk arising from its global delivery resources. As of September 30, 2021, the Company has recorded $0.7 million of unrealized gains in accumulated other comprehensive income related to foreign currency hedges. The Company estimates that $0.7 million of gains reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next 12 months. Amounts reclassified into cost of services were a net gain of $0.4 million and $1.0 million during the three and nine month periods ended September 30, 2021, respectively, and a net loss of $0.1 million and $0.8 million during the three and nine month periods ended September 30, 2020, respectively. As of September 30, 2021, the Company’s currency forward contracts have maturities extending no later than March 31, 2022, and had total notional amounts of $40.2 million. The Company also utilizes cash flow hedges to reduce variability in interest cash flows from its outstanding debt. As of September 30, 2021, the Company has recorded $1.2 million of unrealized losses in accumulated other comprehensive income related to interest rate swaps. The Company estimates that $1.2 million of losses reported in accumulated other comprehensive income are expected to be reclassified into earnings within the next 12 months. Amounts reclassified into interest expense were a net loss of $0.3 million and $1.1 million during the three and nine month periods ended September 30, 2021, respectively, and a net loss of $0.5 million and $0.8 million during the three and nine month periods ended September 30, 2020, respectively. As of September 30, 2021, the Company's interest rate swaps extend no later than August 31, 2022, and had total notional amounts of $100.0 million. The Company classifies cash flows from its derivative programs as cash flows from operating activities in the consolidated statements of cash flows. 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.

Share-Based Compensation

Share-Based Compensation	9 Months Ended
	Sep. 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 September 30, 2021 and 2020 was $25.5 million and $6.8 million, respectively, with related tax benefits of approximately $5.1 million and $1.2 million, respectively. The share-based compensation expense relating to the Company’s stock options, RSUs, and PBRSUs for the nine months ended September 30, 2021 and 2020 was $62.0 million and $15.9 million, respectively, with related tax benefits of approximately $12.2 million and $2.6 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 $0.6 million and $1.2 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the three months ended September 30, 2021 and 2020, respectively. The Company recognized $7.2 million and $2.9 million of income tax benefit from windfalls associated with vesting and exercises of equity awards for the nine months ended September 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Share-Based Compensation Expense Allocation Details: Cost of services $ 15.8 $ 2.7 $ 38.8 $ 6.1 Selling, general and administrative 9.7 4.1 23.2 9.8 Total share-based compensation expense $ 25.5 $ 6.8 $ 62.0 $ 15.9 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 nine months ended September 30, 2021 and 2020: Nine Months Ended September 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 nine months ended September 30, 2021 is shown below: Options Weighted- Outstanding at December 31, 2020 6,220,971 $ 3.68 Granted 4,775 23.60 Exercised (1,108,632) 4.90 Canceled/forfeited (10,888) 6.02 Expired (7,000) 27.08 Outstanding at September 30, 2021 5,099,226 $ 3.40 Outstanding, vested and exercisable at September 30, 2021 5,069,288 $ 3.35 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 nine months ended September 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 2,179,823 1,071,431 24.41 25.36 Performance factor adjustment — 101,937 — 9.81 Vested (600,905) (305,811) 8.74 9.81 Forfeited (325,118) (225,019) 15.36 13.22 Outstanding and unvested at September 30, 2021 3,362,247 3,559,609 $ 18.97 $ 15.53 Shares surrendered for taxes for the nine months ended September 30, 2021 186,588 — Cost of shares surrendered for taxes for the nine months ended September 30, 2021 (in millions) $ 4.8 $ — Shares surrendered for taxes for the nine months ended September 30, 2020 133,673 — Cost of shares surrendered for taxes for the nine months ended September 30, 2020 (in millions) $ 1.2 $ — 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 6,693,815.

Other Expenses

Other Expenses	9 Months Ended
	Sep. 30, 2021
Other Income and Expenses [Abstract]
Other Expenses	Other Expenses Other expenses are incurred in connection with acquisition and integration costs, various exit activities, transformation initiatives, and organizational changes to improve our business alignment and cost structure. The following table summarizes the other expenses (income) recognized for the three and nine months ended September 30, 2021 and 2020. Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Severance and related employee benefits $ 0.3 $ 2.5 $ 2.1 $ 5.5 Strategic initiatives (1) 4.8 6.5 13.2 18.2 Transitioned employees restructuring expense (2) 3.2 — 3.2 (0.2) Facility-exit charges (3) — 2.5 2.9 7.4 Other (4) 3.1 4.2 12.8 11.5 Total other expenses $ 11.4 $ 15.7 $ 34.2 $ 42.4 (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 nine months ended September 30, 2021, $0.0 million and $0.5 million of contingent consideration changes were included, respectively. (2) As part of the transition of personnel to the Company under certain operating partner model contracts, the Company has agreed to reimburse, or directly pay the affected employees, for certain severance and retention costs related to certain employees who will not be transitioned to the Company, or whose jobs will be relocated after the employee transitions to the Company. (3) 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. (4) For the three and nine months ended September 30, 2021, other includes $2.7 million and $7.1 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 nine months ended September 30, 2020, includes $2.6 million and $7.9 million, respectively, of expenses related to the COVID-19 pandemic.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 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 nine months ended September 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 September 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 nine months ended September 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 At December 31, 2020, the Company had gross deferred tax assets of $146.1 million, of which $81.6 million related to net operating loss (“NOL”) carryforwards. The majority of the Company's carryforwards were generated in 2014 and 2016. The Company expects to be profitable, allowing the Company to utilize its NOL carryforward and other deferred tax assets.

8.00% Series A Convertible Pref

8.00% Series A Convertible Preferred Stock	9 Months Ended
	Sep. 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 table summarizes the preferred stock activity for the nine months ended September 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 September 30, 2021 — $ —

Earnings (Loss) Per Share

Earnings (Loss) Per Share	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	Earnings (Loss) Per Share Basic 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 nine months ended September 30, 2021 and the three and nine months ended September 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Basic EPS: Net income $ 17.0 $ 5.2 $ 61.2 $ 38.5 Less dividends on preferred shares (1) — (5.6) (592.3) (16.6) Less income allocated to preferred shareholders — — — (10.9) Net income (loss) available/(allocated) to common shareholders - basic $ 17.0 $ (0.4) $ (531.1) $ 11.0 Diluted EPS: Net income $ 17.0 $ 5.2 $ 61.2 $ 38.5 Less dividends on preferred shares (1) — (5.6) (592.3) (16.6) Less income allocated to preferred shareholders — — — (8.7) Net income (loss) available/(allocated) to common shareholders - diluted $ 17.0 $ (0.4) $ (531.1) $ 13.2 Basic weighted-average common shares 278,655,269 115,976,377 262,209,929 115,164,631 Add: Effect of dilutive equity awards 7,281,436 — — 12,293,285 Add: Effect of dilutive warrants 34,680,381 — — 43,720,170 Diluted weighted average common shares 320,617,086 115,976,377 262,209,929 171,178,086 Net income (loss) per common share (basic) $ 0.06 $ — $ (2.03) $ 0.10 Net income (loss) per common share (diluted) $ 0.05 $ — $ (2.03) $ 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, 890,717 and 15,155,288 common share equivalents comprised of stock options, PBRSUs, and RSUs have been excluded from the diluted earnings per share calculation for the three and nine months ended September 30, 2021, respectively. Additionally, for the nine months ended September 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. For the three and nine months ended September 30, 2020, 21,350,755 and 95,210 common share equivalents have been excluded from the diluted earnings per share calculation because of their anti-dilutive effect. Additionally, for the three months ended September 30, 2020, the Investor's and Intermountain’s exercisable warrants to acquire up to 60.0 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	9 Months Ended
	Sep. 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 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	9 Months Ended
	Sep. 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, as well as corresponding accounts receivable and customer liabilities are presented in the Consolidated Statements of Operations and Comprehensive Income and the Consolidated Balance Sheets. 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	9 Months Ended
	Sep. 30, 2021
Revenue from Contract with Customer [Abstract]
Deferred Contract Costs	Revenue RecognitionRevenue is measured based on consideration specified in a contract with a customer, and presented net of 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net operating fees $ 308.5 $ 253.7 $ 879.8 $ 822.4 Incentive fees 41.5 25.1 108.0 43.2 Other (1) 29.7 28.4 87.9 76.8 Net services revenue $ 379.7 $ 307.2 $ 1,075.7 $ 942.4 (1) Other revenue primarily consists of physician advisory services (“PAS”), practice management services, and revenue related to Entri modular services. Contract Balances The following table provides information about contract liabilities from contracts with customers (in millions): September 30, 2021 December 31, 2020 Contract liabilities 29.4 28.6 Contract liabilities are included in other customer liabilities and contains related party amounts, including $2.3 million and $5.6 million of current customer liabilities and $15.9 million and $16.3 million of non-current customer liabilities as of September 30, 2021 and December 31, 2020, respectively. There were no contract assets as of September 30, 2021 and December 31, 2020. 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 $99.7 million and $88.0 million during the nine months ended September 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 nine months ended September 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 $ 35.8 $ 21.4 $ 0.7 2022 104.6 25.0 0.8 2023 81.3 — — 2024 57.7 — — 2025 34.3 — — 2026 34.3 — — Thereafter 162.3 — — Total $ 510.3 $ 46.4 $ 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. September 30, 2021 December 31, 2020 Prepaid expenses and other current assets $ 3.2 $ 4.5 Other assets 22.8 19.6 Total deferred contract costs $ 26.0 $ 24.1

Segments and Customer Concentra

Segments and Customer Concentrations	9 Months Ended
	Sep. 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 September 30, 2021 and 2020, net services revenue from healthcare organizations affiliated with Ascension accounted for 60% and 63% of the Company's total net services revenue, respectively. For the nine months ended September 30, 2021 and 2020, net services revenue from Ascension accounted for 61% 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 September 30, 2021 and 2020, Intermountain accounted for 14% and 12% of the Company's total net services revenue, respectively. For the nine months ended September 30, 2021 and 2020, Intermountain accounted for 14% of the Company’s total net services revenue. As of September 30, 2021 and December 31, 2020, the Company had a concentration of credit risk with Ascension accounting for 20% and 25% of accounts receivable, respectively.

Business Description and Basi_2

Business Description and Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company's financial position as of September 30, 2021, the results of operations of the Company for the three and nine months ended September 30, 2021 and 2020, and the cash flows of the Company for the nine months ended September 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 nine months ended September 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 are 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 RecognitionRevenue is measured based on consideration specified in a contract with a customer, and presented net of 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)	9 Months Ended
	Sep. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Schedule of Assets Acquired and Liabilities Assumed	The preliminary fair value of assets acquired and liabilities assumed is (in millions): Purchase Price Allocation Total purchase consideration $ 305.4 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 10.7 Accounts receivable 4.7 Prepaid expenses and other current assets 0.4 Property, equipment and software 0.3 Operating lease right-of-use assets 1.7 Deferred income tax assets 0.9 Intangible assets 117.3 Goodwill 176.4 Accounts payable (0.5) Current portion of customer liabilities (1.1) Accrued compensation and benefits (0.7) Current portion of operating lease liabilities (0.4) Other accrued expenses (2.0) Non-current portion of customer liabilities (1.0) Non-current portion of operating lease liabilities (1.3) Net assets acquired $ 305.4
Schedule of Intangible Assets Identified with Acquisition	The intangible assets preliminarily identified in conjunction with the VisitPay Acquisition are as follows: Useful Life Gross Carrying Value Customer Relationships 10 years $ 2.3 Technology 11 years $ 114.0 Tradename 3 years $ 1.0
Schedule of Acquisitions	During 2020, the Company acquired the following businesses: Company Name Description of the Business Description of the Acquisition SCHEDULING.COM, INC. d/b/a SCI Solutions, Inc. (“SCI”) Provider of software-as-a-service (“SaaS”)-based scheduling and patient access solutions Purchased all outstanding equity interests RevWorks services business (acquired from Cerner Corporation) Provider of revenue cycle management services Purchased certain assets relating to the RevWorks services business
Schedule of Pro Forma Results	The following table summarizes, on a pro forma basis, the combined results of the Company as though the VisitPay Acquisition had occurred as of January 1, 2020 and the SCI and RevWorks acquisitions had occurred as of January 1, 2019. These pro forma results are not necessarily indicative of the actual consolidated results had the acquisitions occurred as of those dates or of the future consolidated operating results for any period. Pro forma results are (in millions): Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net services revenue $ 379.7 $ 310.6 $ 1,083.0 $ 998.1 Net income (loss) $ 18.7 $ (4.0) $ 56.9 $ 34.8

Accounts Receivable and Allow_2

Accounts Receivable and Allowance for Credit Losses (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Beginning balance $ 2.3 $ 5.2 $ 3.8 $ 2.8 Cumulative effect of ASC 326 — — — 1.1 Provision (recoveries) 0.4 (0.8) 0.6 0.5 Amounts reclassified to held for sale (1) — (0.6) — (0.6) Write-offs (0.3) (0.1) (2.0) (0.1) Ending balance $ 2.4 $ 3.7 $ 2.4 $ 3.7 (1) Relates to the disposition of the Company’s emergency medical services (“EMS”) business in October 2020. The EMS business was classified as held for sale as of September 30, 2020.

Property, Equipment, and Softwa

Property, Equipment, and Software (Tables)	9 Months Ended
	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Schedule of Property, Equipment and Software	Property, equipment and software consist of the following (in millions): September 30, 2021 December 31, 2020 Buildings and land $ 3.8 $ 4.6 Computer and other equipment 59.0 55.0 Leasehold improvements 23.3 23.2 Software 177.1 135.7 Office furniture 6.5 6.4 Property, equipment and software, gross 269.7 224.9 Less accumulated depreciation and amortization (170.4) (131.2) Property, equipment and software, net $ 99.3 $ 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Cost of services $ 13.6 $ 11.8 $ 38.8 $ 34.1 Selling, general and administrative 0.6 1.0 2.2 3.2 Total depreciation and amortization $ 14.2 $ 12.8 $ 41.0 $ 37.3

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Operating lease cost $ 4.0 $ 4.3 $ 12.1 $ 14.1 Sublease income (0.6) (0.6) (1.7) (1.7) Total lease cost $ 3.4 $ 3.7 $ 10.4 $ 12.4 Supplemental cash flow information related to leases are as follows (in millions): Nine Months Ended September 30, 2021 2020 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 18.6 $ 15.2 Right-of-use assets obtained in exchange for operating lease obligations: 13.6 3.4
Schedule of Operating Lease Maturity	Maturities of lease liabilities as of September 30, 2021 are as follows (in millions): Operating Leases Remainder of 2021 $ 4.5 2022 16.7 2023 14.6 2024 14.6 2025 14.7 2026 11.4 Thereafter 25.0 Total 101.5 Less: Imputed interest 25.7 Present value of lease liabilities $ 75.8 .

Intangible Assets (Tables)

Intangible Assets (Tables)	9 Months Ended
	Sep. 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 September 30, 2021 and December 31, 2020 (in millions): September 30, 2021 December 31, 2020 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 100.0 $ (19.2) $ 80.8 $ 97.7 $ (14.7) $ 83.0 Technology 215.5 (24.8) 190.7 101.7 (13.6) 88.1 Tradename 1.0 (0.1) 0.9 — — — Total intangible assets $ 316.5 $ (44.1) $ 272.4 $ 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 September 30, 2021 is as follows (in millions): Remainder of 2021 $ 7.1 2022 28.4 2023 28.4 2024 26.5 2025 24.9 2026 24.9 Thereafter 132.2 Total $ 272.4

Goodwill (Tables)

Goodwill (Tables)	9 Months Ended
	Sep. 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 nine months ended September 30, 2021 were (in millions): Goodwill Balance as of December 31, 2020 $ 375.3 Acquisitions 176.4 Measurement period adjustments 0.2 Balance as of September 30, 2021 $ 551.9

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Net operating fees $ 308.5 $ 253.7 $ 879.8 $ 822.4 Incentive fees 41.5 25.1 108.0 43.2 Other (1) 29.7 28.4 87.9 76.8 Net services revenue $ 379.7 $ 307.2 $ 1,075.7 $ 942.4 (1) Other revenue primarily consists of physician advisory services (“PAS”), practice management services, and revenue related to Entri modular services.
Schedule of Assets and Liabilities	The following table provides information about contract liabilities from contracts with customers (in millions): September 30, 2021 December 31, 2020 Contract liabilities 29.4 28.6
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 $ 35.8 $ 21.4 $ 0.7 2022 104.6 25.0 0.8 2023 81.3 — — 2024 57.7 — — 2025 34.3 — — 2026 34.3 — — Thereafter 162.3 — — Total $ 510.3 $ 46.4 $ 1.5

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2021
Debt Disclosure [Abstract]
Schedule of Carrying Values Long-Term Debt	The carrying amounts of debt consist of the following (in millions): September 30, 2021 December 31, 2020 Senior Revolver (1) $ 100.0 $ 70.0 Senior Term Loan 700.0 484.6 Unamortized discount and issuance costs (3.4) (2.6) Total debt 796.6 552.0 Less: Current maturities (17.5) (32.3) Total long-term debt $ 779.1 $ 519.7 (1) As of September 30, 2021, the Company had $100.0 million in borrowings, $0.5 million letters of credit outstanding, and $349.5 million of availability under the Senior Revolver.
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 $ 4.4 2022 17.5 2023 21.9 2024 35.0 2025 35.0 2026 686.2 Total $ 800.0

Share-Based Compensation (Table

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Share-Based Compensation Expense Allocation Details: Cost of services $ 15.8 $ 2.7 $ 38.8 $ 6.1 Selling, general and administrative 9.7 4.1 23.2 9.8 Total share-based compensation expense $ 25.5 $ 6.8 $ 62.0 $ 15.9
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 nine months ended September 30, 2021 and 2020: Nine Months Ended September 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 nine months ended September 30, 2021 is shown below: Options Weighted- Outstanding at December 31, 2020 6,220,971 $ 3.68 Granted 4,775 23.60 Exercised (1,108,632) 4.90 Canceled/forfeited (10,888) 6.02 Expired (7,000) 27.08 Outstanding at September 30, 2021 5,099,226 $ 3.40 Outstanding, vested and exercisable at September 30, 2021 5,069,288 $ 3.35 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 nine months ended September 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 2,179,823 1,071,431 24.41 25.36 Performance factor adjustment — 101,937 — 9.81 Vested (600,905) (305,811) 8.74 9.81 Forfeited (325,118) (225,019) 15.36 13.22 Outstanding and unvested at September 30, 2021 3,362,247 3,559,609 $ 18.97 $ 15.53 Shares surrendered for taxes for the nine months ended September 30, 2021 186,588 — Cost of shares surrendered for taxes for the nine months ended September 30, 2021 (in millions) $ 4.8 $ — Shares surrendered for taxes for the nine months ended September 30, 2020 133,673 — Cost of shares surrendered for taxes for the nine months ended September 30, 2020 (in millions) $ 1.2 $ —

Other Expenses (Tables)

Other Expenses (Tables)	9 Months Ended
	Sep. 30, 2021
Other Income and Expenses [Abstract]
Schedule of Other Expenses	The following table summarizes the other expenses (income) recognized for the three and nine months ended September 30, 2021 and 2020. Three Months Ended September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Severance and related employee benefits $ 0.3 $ 2.5 $ 2.1 $ 5.5 Strategic initiatives (1) 4.8 6.5 13.2 18.2 Transitioned employees restructuring expense (2) 3.2 — 3.2 (0.2) Facility-exit charges (3) — 2.5 2.9 7.4 Other (4) 3.1 4.2 12.8 11.5 Total other expenses $ 11.4 $ 15.7 $ 34.2 $ 42.4 (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 nine months ended September 30, 2021, $0.0 million and $0.5 million of contingent consideration changes were included, respectively. (2) As part of the transition of personnel to the Company under certain operating partner model contracts, the Company has agreed to reimburse, or directly pay the affected employees, for certain severance and retention costs related to certain employees who will not be transitioned to the Company, or whose jobs will be relocated after the employee transitions to the Company. (3) 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. (4) For the three and nine months ended September 30, 2021, other includes $2.7 million and $7.1 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 nine months ended September 30, 2020, includes $2.6 million and $7.9 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)	9 Months Ended
	Sep. 30, 2021
Temporary Equity Disclosure [Abstract]
Summary of Preferred Stock Activity	The following table summarizes the preferred stock activity for the nine months ended September 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 September 30, 2021 — $ —

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	9 Months Ended
	Sep. 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 September 30, Nine Months Ended September 30, 2021 2020 2021 2020 Basic EPS: Net income $ 17.0 $ 5.2 $ 61.2 $ 38.5 Less dividends on preferred shares (1) — (5.6) (592.3) (16.6) Less income allocated to preferred shareholders — — — (10.9) Net income (loss) available/(allocated) to common shareholders - basic $ 17.0 $ (0.4) $ (531.1) $ 11.0 Diluted EPS: Net income $ 17.0 $ 5.2 $ 61.2 $ 38.5 Less dividends on preferred shares (1) — (5.6) (592.3) (16.6) Less income allocated to preferred shareholders — — — (8.7) Net income (loss) available/(allocated) to common shareholders - diluted $ 17.0 $ (0.4) $ (531.1) $ 13.2 Basic weighted-average common shares 278,655,269 115,976,377 262,209,929 115,164,631 Add: Effect of dilutive equity awards 7,281,436 — — 12,293,285 Add: Effect of dilutive warrants 34,680,381 — — 43,720,170 Diluted weighted average common shares 320,617,086 115,976,377 262,209,929 171,178,086 Net income (loss) per common share (basic) $ 0.06 $ — $ (2.03) $ 0.10 Net income (loss) per common share (diluted) $ 0.05 $ — $ (2.03) $ 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.

Deferred Contract Costs (Tables

Deferred Contract Costs (Tables)	9 Months Ended
	Sep. 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): September 30, 2021 December 31, 2020 Prepaid expenses and other current assets $ 3.2 $ 4.5 Other assets 22.8 19.6 Total deferred contract costs $ 26.0 $ 24.1

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) $ in Millions	Sep. 03, 2022USD ($)	Jul. 01, 2021USD ($)	Aug. 03, 2020USD ($)payment	Sep. 30, 2021USD ($)payment	Sep. 30, 2021USD ($)payment	Sep. 30, 2020USD ($)	Apr. 01, 2020USD ($)
Business Acquisition [Line Items]
Earn-out provision, payment					$ 4.8	$ 0
Payments to acquire business					12.5	$ 0
VisitPay
Business Acquisition [Line Items]
Purchase consideration		$ 305.4
Net sales, since acquisition date				$ 5.2	5.2
Net income, before income taxes, since acquisition date				3.5	3.5
SCI | Earn-out Provision
Business Acquisition [Line Items]
Earn-out provision, value							$ 4.8
Earn-out provision, payment					$ 10
RevWorks
Business Acquisition [Line Items]
Payments to acquire business				$ 12.5
Number of deferred payments | payment			2	1	1
Contractual deferred payments			$ 24.3
Payments to acquire business, number of payments, refund period, if circumstances met			2 years
Asset, contingently returnable consideration			$ 22.3
RevWorks | Prepaid expenses
Business Acquisition [Line Items]
Asset, contingently returnable consideration			10.5
RevWorks | Other assets
Business Acquisition [Line Items]
Asset, contingently returnable consideration			$ 11.8
RevWorks | Subsequent Event | Forecast
Business Acquisition [Line Items]
Payments to acquire business	$ 12.5

Acquisitions - Fair Value of As

Acquisitions - Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions	Jul. 01, 2021	Sep. 30, 2021	Dec. 31, 2020
Allocation of consideration to assets acquired and liabilities assumed:
Goodwill		$ 551.9	$ 375.3
VisitPay
Business Acquisition [Line Items]
Total purchase consideration	$ 305.4
Allocation of consideration to assets acquired and liabilities assumed:
Cash and cash equivalents	10.7
Accounts receivable	4.7
Prepaid expenses and other current assets	0.4
Property, equipment and software	0.3
Operating lease right-of-use assets	1.7
Deferred income tax assets	0.9
Intangible assets	117.3
Goodwill	176.4
Accounts payable	(0.5)
Current portion of customer liabilities	(1.1)
Accrued compensation and benefits	(0.7)
Current portion of operating lease liabilities	(0.4)
Other accrued expenses	(2)
Non-current portion of customer liabilities	(1)
Non-current portion of operating lease liabilities	(1.3)
Net assets acquired	$ 305.4

Acquisitions - Schedule of Inta

Acquisitions - Schedule of Intangible Assets Information (Details) - VisitPay $ in Millions	Jul. 01, 2021USD ($)
Customer Relationships
Business Acquisition [Line Items]
Useful Life	10 years
Gross Carrying Value	$ 2.3
Technology
Business Acquisition [Line Items]
Useful Life	11 years
Gross Carrying Value	$ 114
Tradename
Business Acquisition [Line Items]
Useful Life	3 years
Gross Carrying Value	$ 1

Acquisitions - Pro Forma Result

Acquisitions - Pro Forma Results (Details) - VisitPay, SCI, and RevWorks Acquisitions - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Business Acquisition [Line Items]
Net services revenue	$ 379.7	$ 310.6	$ 1,083	$ 998.1
Net income (loss)	$ 18.7	$ (4)	$ 56.9	$ 34.8

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		9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 2.3	$ 5.2	$ 3.8	$ 2.8
Cumulative effect of ASC 326 adoption	2.4	$ 3.7	2.4	$ 3.7	$ 2.8
Accounting Standards Update [Extensible List]		Accounting Standards Update 2016-13 [Member]		Accounting Standards Update 2016-13 [Member]	Accounting Standards Update 2016-13 [Member]
Provision (recoveries)	0.4	$ (0.8)	0.6	$ 0.5
Amounts reclassified to held for sale	0	(0.6)	0	(0.6)
Write-offs	(0.3)	(0.1)	(2)	(0.1)
Ending balance	$ 2.4	3.7	$ 2.4	3.7	$ 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	Sep. 30, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 269.7	$ 224.9
Less accumulated depreciation and amortization	(170.4)	(131.2)
Property, equipment and software, net	99.3	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	59	55
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	23.3	23.2
Software
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	177.1	135.7
Office furniture
Property, Plant and Equipment [Line Items]
Property, equipment and software, gross	$ 6.5	$ 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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 14.2	$ 12.8	$ 41	$ 37.3
Cost of services
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	13.6	11.8	38.8	34.1
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 0.6	$ 1	$ 2.2	$ 3.2

Leases - Schedule of Lease Cost

Leases - Schedule of Lease Costs (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Leases [Abstract]
Operating lease cost	$ 4	$ 4.3	$ 12.1	$ 14.1
Sublease income	(0.6)	(0.6)	(1.7)	(1.7)
Total lease cost	$ 3.4	$ 3.7	$ 10.4	$ 12.4

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$ 18.6	$ 15.2
Right-of-use assets obtained in exchange for operating lease obligations:	$ 13.6	$ 3.4

Leases - Schedule of Operating

Leases - Schedule of Operating and Finance Lease Maturity (Details) $ in Millions	Sep. 30, 2021USD ($)
Operating Leases
Remainder of 2021	$ 4.5
2022	16.7
2023	14.6
2024	14.6
2025	14.7
2026	11.4
Thereafter	25
Total	101.5
Less:
Imputed interest	25.7
Present value of lease liabilities	$ 75.8

Intangible Assets - Components

Intangible Assets - Components of Intangible Assets (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 316.5	$ 199.4
Accumulated Amortization	(44.1)	(28.3)
Total	272.4	171.1
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	100	97.7
Accumulated Amortization	(19.2)	(14.7)
Total	80.8	83
Technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	215.5	101.7
Accumulated Amortization	(24.8)	(13.6)
Total	190.7	88.1
Tradename
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	1	0
Accumulated Amortization	(0.1)	0
Total	$ 0.9	$ 0

Intangible Assets - Narrative (

Intangible Assets - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible asset amortization expense	$ 7.1	$ 4.5	$ 15.8	$ 13.6

Intangible Assets - Future Amor

Intangible Assets - Future Amortization (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
Remainder of 2021	$ 7.1
2022	28.4
2023	28.4
2024	26.5
2025	24.9
2026	24.9
Thereafter	132.2
Total	$ 272.4	$ 171.1

Goodwill - Schedule of Changes

Goodwill - Schedule of Changes in Carrying Value of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2021USD ($)
Goodwill [Roll Forward]
Balance as of December 31, 2020	$ 375,300
Acquisitions	176,400
Measurement period adjustments	200
Balance as of September 30, 2021	$ 551,900

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregated Revenue by Source (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Disaggregation of Revenue [Line Items]
Net services revenue	$ 379.7	$ 307.2	$ 1,075.7	$ 942.4
Net operating fees
Disaggregation of Revenue [Line Items]
Net services revenue	308.5	253.7	879.8	822.4
Incentive fees
Disaggregation of Revenue [Line Items]
Net services revenue	41.5	25.1	108	43.2
Other
Disaggregation of Revenue [Line Items]
Net services revenue	$ 29.7	$ 28.4	$ 87.9	$ 76.8

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Contract Balances (Details) - USD ($) $ in Millions	Sep. 30, 2021	Dec. 31, 2020
Contract With Customer Liability
Disaggregation of Revenue [Line Items]
Contract liabilities	$ 29.4	$ 28.6

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($)	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Disaggregation of Revenue [Line Items]
Non-current customer liabilities, related party	$ 15,900,000		$ 16,300,000
Contract assets	0		0
Revenue recognized	99,700,000	$ 88,000,000
Accounts Receivable
Disaggregation of Revenue [Line Items]
Revenue recognized, advanced billings	88,100,000	$ 85,000,000
Investor
Disaggregation of Revenue [Line Items]
Current customer liabilities, related party	$ 2,300,000		$ 5,600,000

Revenue Recognition - Transacti

Revenue Recognition - Transaction Price Allocated to the Remaining Performance Obligation (Details) $ in Millions	Sep. 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	$ 510.3
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	46.4
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]: 2021-10-01
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]: 2021-10-01 | 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	$ 35.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-10-01 | 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	21.4
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2021-10-01 | 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	$ 104.6
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	25
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	$ 81.3
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	$ 57.7
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	$ 34.3
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	$ 34.3
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	$ 162.3
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	Sep. 30, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Long-term debt	$ 800
Unamortized discount and issuance costs	(3.4)	$ (2.6)
Total debt	796.6	552
Less: Current maturities	(17.5)	(32.3)
Total long-term debt	779.1	519.7
Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Long-term debt	100	70
Borrowing availability	349.5
Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Long-term debt	700	$ 484.6
Line of Credit | Letter of Credit
Debt Instrument [Line Items]
Long-term debt	$ 0.5

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($)	Jun. 26, 2019	Sep. 30, 2021	Jul. 01, 2021
Line of Credit
Debt Instrument [Line Items]
Interest rate		2.33%
Line of Credit | Minimum
Debt Instrument [Line Items]
Commitment fee	0.20%
Line of Credit | Maximum
Debt Instrument [Line Items]
Commitment fee	0.40%
Line of Credit | Federal Funds Rate
Debt Instrument [Line Items]
Basis spread on variable rate basis	0.50%
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	0.25%
Line of Credit | Eurodollar Rate | Interest Rate Option - Basis Spread One | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate basis	1.25%
Line of Credit | Eurodollar Rate | Interest Rate Option Two | Minimum
Debt Instrument [Line Items]
Basis spread on variable rate basis	1.25%
Line of Credit | Eurodollar Rate | Interest Rate Option Two | Maximum
Debt Instrument [Line Items]
Basis spread on variable rate basis	2.25%
Line of Credit | Senior Term Loan | Eurodollar Rate
Debt Instrument [Line Items]
Variable rate basis, minimum	0.00%
Line of Credit | Senior Term Loan | Eurodollar Rate | Interest Rate Option Two
Debt Instrument [Line Items]
Variable rate basis, minimum	0.00%
A&R Credit Agreement
Debt Instrument [Line Items]
Debt covenant, secured obligation pledged, capital stock of certain domestic subsidiaries, percent			100.00%
A&R Credit Agreement | Line of Credit | Senior Term Loan
Debt Instrument [Line Items]
Principle of debt issued			$ 700,000,000
A&R Credit Agreement | Line of Credit | Senior Revolver
Debt Instrument [Line Items]
Principle of debt issued			$ 450,000,000

Debt - Scheduled Maturities of

Debt - Scheduled Maturities of Long-Term Debt (Details) $ in Millions	Sep. 30, 2021USD ($)
Debt Disclosure [Abstract]
Remainder of 2021	$ 4.4
2022	17.5
2023	21.9
2024	35
2025	35
2026	686.2
Total	$ 800

Derivative Financial Instrume_2

Derivative Financial Instruments - Narrative (Details) - Designated as Hedging Instrument - Cash Flow Hedging - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Foreign Currency Hedges
Derivative [Line Items]
Unrealized gains (losses) reported in accumulated other comprehensive income			$ 700,000
Gains (losses) to be reclassified within next 12 months			700,000
Derivatives, net gain (loss) reclassified	$ 400,000	$ (100,000)	1,000,000	$ (800,000)
Notional amount	40,200,000		40,200,000
Interest Rate Swap
Derivative [Line Items]
Unrealized gains (losses) reported in accumulated other comprehensive income			(1,200,000)
Gains (losses) to be reclassified within next 12 months			(1,200,000)
Derivatives, net gain (loss) reclassified	(300,000)	$ (500,000)	(1,100,000)	$ (800,000)
Notional amount	$ 100,000,000		$ 100,000,000

Share-Based Compensation - Narr

Share-Based Compensation - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 25.5	$ 6.8	$ 62	$ 15.9
Related tax benefits	5.1	1.2	12.2	2.6
Income tax benefit	$ 0.6	$ 1.2	$ 7.2	$ 2.9
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum exercisable (in shares)			6,693,815
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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 25.5	$ 6.8	$ 62	$ 15.9
Cost of services
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	15.8	2.7	38.8	6.1
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 9.7	$ 4.1	$ 23.2	$ 9.8

Share-Based Compensation - Assu

Share-Based Compensation - Assumptions (Details)	9 Months Ended
	Sep. 30, 2021	Sep. 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)	9 Months Ended
	Sep. 30, 2021$ / sharesshares	Dec. 31, 2020$ / sharesshares
Options
Outstanding at beginning of period (in shares) | shares	6,220,971
Granted (in shares) | shares	4,775
Exercised (in shares) | shares	(1,108,632)
Canceled/forfeited (in shares) | shares	(10,888)
Expired (in shares) | shares	(7,000)
Outstanding at end of period (in shares) | shares	5,099,226
Outstanding, vested and exercisable at end of period (in shares) | shares	5,069,288	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	23.60
Exercised (in dollars per share) | $ / shares	4.90
Canceled/forfeited (in dollars per share) | $ / shares	6.02
Expired (in dollars per share) | $ / shares	27.08
Outstanding at end of period (in dollars per share) | $ / shares	3.40
Outstanding, vested and exercisable at end of period (in dollars per share) | $ / shares	$ 3.35	$ 3.73

Share-Based Compensation - Othe

Share-Based Compensation - Other Than Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Millions	9 Months Ended
	Sep. 30, 2021	Sep. 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)	2,179,823
Performance factor adjustment (in shares)	0
Vested (in shares)	(600,905)
Forfeited (in shares)	(325,118)
Outstanding and unvested at end of period (in shares)	3,362,247
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 9.87
Granted (in dollars per share)	24.41
Performance factor adjustment (in dollars per share)	0
Vested (in dollars per share)	8.74
Forfeited (in dollars per share)	15.36
Outstanding and unvested at end of period (in dollars per share)	$ 18.97
Shares surrendered for taxes (in shares)	186,588	133,673
Cost of shares surrendered for taxes	$ 4.8	$ 1.2
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)	1,071,431
Performance factor adjustment (in shares)	101,937
Vested (in shares)	(305,811)
Forfeited (in shares)	(225,019)
Outstanding and unvested at end of period (in shares)	3,559,609
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 11.35
Granted (in dollars per share)	25.36
Performance factor adjustment (in dollars per share)	9.81
Vested (in dollars per share)	9.81
Forfeited (in dollars per share)	13.22
Outstanding and unvested at end of period (in dollars per share)	$ 15.53
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		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Other Income and Expenses [Abstract]
Severance and related employee benefits	$ 0.3	$ 2.5	$ 2.1	$ 5.5
Strategic initiatives	4.8	6.5	13.2	18.2
Transitioned employees restructuring expense	3.2	0	3.2	(0.2)
Facility-exit charges	0	2.5	2.9	7.4
Other	3.1	4.2	12.8	11.5
Total other expenses	11.4	15.7	34.2	42.4
Contingent consideration changes included in strategic initiatives	0		0.5
COVID-19 related costs, included in Other	$ 2.7	$ 2.6	$ 7.1	$ 7.9

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 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
VisitPay
Income Tax Contingency [Line Items]
Deferred tax assets related to operating loss carryforwards	$ 0.9		$ 0.9

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	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Temporary Equity [Line Items]
Cash paid, stock conversion (not to exceed)					$ 105	$ 0
Dividends			$ 0	$ 5.6	$ 592.3	$ 16.6
TCP-ASC ACHI Series LLLP
Temporary Equity [Line Items]
Cash paid, stock conversion (not to exceed)		$ 105
Dividends	$ 592.3
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%
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	9 Months Ended
	Sep. 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	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Basic EPS:
Net income		$ 17	$ 18.4	$ 25.8	$ 5.2	$ 15.1	$ 18.2	$ 61.2	$ 38.5
Less dividends on preferred shares		0			(5.6)			(592.3)	(16.6)
Less income allocated to preferred shareholders		0			0			0	(10.9)
Net income (loss) available/allocated to common shareholders - basic		17			(0.4)			(531.1)	11
Diluted EPS:
Less income allocated to preferred shareholders		0			0			0	(8.7)
Net income (loss) available/allocated to common shareholders - diluted		$ 17			$ (0.4)			$ (531.1)	$ 13.2
Basic weighted-average common shares (in shares)		278,655,269			115,976,377			262,209,929	115,164,631
Add: Effect of dilutive equity awards (in shares)		7,281,436			0			0	12,293,285
Add: Effect of dilutive warrants (in shares)		34,680,381			0			0	43,720,170
Diluted weighted average common shares (in shares)		320,617,086			115,976,377			262,209,929	171,178,086
Net income (loss) per common share (basic) (in dollars per share)		$ 0.06			$ 0			$ (2.03)	$ 0.10
Net income (loss) per common share (diluted) (in dollars per share)		$ 0.05			$ 0			$ (2.03)	$ 0.08
Redeemable Convertible Preferred Stock
Diluted EPS:
Preferred stock, dividend rate (percentage)								8.00%		8.00%
TCP-ASC ACHI Series LLLP
Basic EPS:
Less dividends on preferred shares	$ (592.3)
TCP-ASC ACHI Series LLLP | Redeemable Convertible Preferred Stock
Diluted EPS:
Preferred stock, dividend rate (percentage)	8.00%

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	890,717	21,350,755	15,155,288	95,210
Warrant | Investor's
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)		60,000,000	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 - 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	Sep. 30, 2021	Dec. 31, 2020
Capitalized Contract Cost [Line Items]
Total deferred contract costs	$ 26	$ 24.1
Prepaid expenses and other current assets
Capitalized Contract Cost [Line Items]
Total deferred contract costs	3.2	4.5
Other assets
Capitalized Contract Cost [Line Items]
Total deferred contract costs	$ 22.8	$ 19.6

Deferred Contract Costs - Narra

Deferred Contract Costs - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Revenue from Contract with Customer [Abstract]
Capitalized contract cost, amortization	$ 900,000	$ 1,300,000	$ 3,100,000	$ 3,600,000
Impairment losses	$ 0	$ 0	$ 0	$ 0

Segments and Customer Concent_2

Segments and Customer Concentrations - Narrative (Details) - segment	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 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	60.00%	63.00%	61.00%	65.00%
Customer Concentration Risk | Revenue | Intermountain Healthcare
Segment Reporting Information [Line Items]
Concentration percentage	14.00%	12.00%	14.00%	14.00%
Customer Concentration Risk | Accounts Receivable | Ascension
Segment Reporting Information [Line Items]
Concentration percentage			20.00%		25.00%