Tabula Rasa HealthCare (TRHC) 10-Q 7 May 21 2021 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2021	Apr. 23, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2021
Document Transition Report	false
Entity File Number	001-37888
Entity Registrant Name	Tabula Rasa HealthCare, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	46-5726437
Entity Address, Address Line One	228 Strawbridge Drive, Suite 100
Entity Address, City or Town	Moorestown
Entity Address, State or Province	NJ
Entity Address, Postal Zip Code	08057
City Area Code	866
Local Phone Number	648 - 2767
Title of 12(b) Security	Common Stock
Trading Symbol	TRHC
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		24,843,284
Entity Central Index Key	0001651561
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q1
Amendment Flag	false

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Current assets:
Cash	$ 16,899	$ 23,362
Restricted cash	3,294	5,170
Accounts receivable, net of allowance of $324 and $224, respectively	29,365	32,516
Inventories	4,084	4,261
Prepaid expenses	3,933	3,739
Client claims receivable	15,336	14,412
Other current assets	11,972	9,752
Total current assets	84,883	93,212
Property and equipment, net	14,240	15,070
Operating lease right-of-use assets	21,047	21,711
Software development costs, net	30,745	27,882
Goodwill	170,835	170,862
Intangible assets, net	175,755	183,094
Other assets	5,085	2,609
Total assets	502,590	514,440
Current liabilities:
Current portion of finance leases	1	4
Current operating lease liabilities	4,238	4,402
Acquisition-related contingent consideration		166
Acquisition-related notes payable	9,340	16,662
Accounts payable	6,730	11,245
Client claims payable	6,075	7,773
Accrued expenses and other liabilities	35,164	31,968
Total current liabilities	61,548	72,220
Line of credit	17,500	10,000
Long-term debt, net	318,316	239,285
Noncurrent operating lease liabilities	19,836	20,381
Deferred income tax liability, net	1,063	3,354
Other long-term liabilities	703	671
Total liabilities	418,966	345,911
Commitments and contingencies (Note 16)
Stockholders' equity:
Preferred stock, $0.0001 par value; 10,000,000 shares authorized; no shares issued and outstanding at March 31, 2021 and December 31, 2020
Common stock, $0.0001 par value; 100,000,000 shares authorized, 25,077,681 and 24,222,674 shares issued and 24,840,805 and 24,004,896 shares outstanding at March 31, 2021 and December 31, 2020, respectively	2	2
Treasury stock, at cost; 217,778 and 175,689 shares at December 31, 2020 and December 31, 2019, respectively	4,292	4,018
Additional paid-in capital	288,698	352,445
Accumulated deficit	(200,784)	(179,900)
Total stockholders' equity	83,624	168,529
Total liabilities and stockholders' equity	$ 502,590	$ 514,440

CONSOLIDATED BALANCE SHEETS (pa

CONSOLIDATED BALANCE SHEETS (parenthetical) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
CONSOLIDATED BALANCE SHEETS
Allowance for accounts receivable	$ 324	$ 224
Preferred stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.0001	$ 0.0001
Common stock, shares authorized	100,000,000	100,000,000
Common stock, shares issued	25,077,681	24,222,674
Common stock, shares outstanding	24,840,805	24,004,896
Treasury stock (in shares)	236,876	217,778

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Revenue:
Total revenue	$ 76,680	$ 72,827
Cost of revenue, exclusive of depreciation and amortization shown below:
Total cost of revenue, exclusive of depreciation and amortization	54,027	48,073
Operating expenses:
Research and development	3,987	4,828
Sales and marketing	6,245	5,540
General and administrative	17,542	16,967
Change in fair value of acquisition-related contingent consideration expense		700
Depreciation and amortization	11,625	9,913
Total operating expenses	39,399	37,948
Loss from operations	(16,746)	(13,194)
Other expense
Interest expense, net	2,547	4,610
Loss before income taxes	(19,293)	(17,804)
Income tax expense (benefit)	199	(3,367)
Net loss	$ (19,492)	$ (14,437)
Net loss per share, basic and diluted (in dollars per share)	$ (0.85)	$ (0.68)
Weighted average common shares outstanding, basic and diluted (in shares)	23,010,531	21,374,897
Product
Revenue:
Total revenue	$ 41,978	$ 37,087
Cost of revenue, exclusive of depreciation and amortization shown below:
Total cost of revenue, exclusive of depreciation and amortization	31,471	27,199
Service
Revenue:
Total revenue	34,702	35,740
Cost of revenue, exclusive of depreciation and amortization shown below:
Total cost of revenue, exclusive of depreciation and amortization	$ 22,556	$ 20,874

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Common Stock	Treasury Stock	Additional Paid-in CapitalCumulative Effect, Period of Adoption, Adjustment	Additional Paid-in Capital	Accumulated DeficitCumulative Effect, Period of Adoption, Adjustment	Accumulated Deficit	Cumulative Effect, Period of Adoption, Adjustment	Total
Balance at beginning of period at Dec. 31, 2019	$ 2	$ (3,865)		$ 288,345		$ (98,934)		$ 185,548
Balance at beginning of period (in shares) at Dec. 31, 2019	22,496,999	(175,689)
Increase (Decrease) in Stockholders' Equity
Issuance of common stock awards (in shares)	14,386
Issuance of restricted stock (in shares)	388,108
Forfeitures of restricted shares (in shares)		(33,371)
Exercise of stock options, net of shares withheld		$ (91)		1,244				1,153
Exercise of stock options, net of shares withheld (in shares)	116,288	(1,681)
Share adjustment		12,500
Stock-based compensation expense				7,137				7,137
Net loss						(14,437)		(14,437)
Balance at end of period at Mar. 31, 2020	$ 2	$ (3,956)		296,726		(113,371)		179,401
Balance at end of period (in shares) at Mar. 31, 2020	23,015,781	(198,241)
Balance at beginning of period at Dec. 31, 2020	$ 2	$ (4,018)	$ (74,850)	352,445	$ (1,392)	(179,900)	$ (76,242)	168,529
Balance at beginning of period (in shares) at Dec. 31, 2020	24,222,674	(217,778)
Increase (Decrease) in Stockholders' Equity
Issuance of common stock awards (in shares)	1,416
Issuance of restricted stock (in shares)	629,088
Forfeitures of restricted shares (in shares)		(12,880)
Exercise of stock options, net of shares withheld		$ (274)		2,501				2,227
Exercise of stock options, net of shares withheld (in shares)	224,503	(6,218)
Stock-based compensation expense				8,602				8,602
Net loss						(19,492)		(19,492)
Balance at end of period at Mar. 31, 2021	$ 2	$ (4,292)		$ 288,698		$ (200,784)		$ 83,624
Balance at end of period (in shares) at Mar. 31, 2021	25,077,681	(236,876)

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Cash flows from operating activities:
Net loss	$ (19,492)	$ (14,437)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	11,625	9,913
Amortization of deferred financing costs and debt discount	635	3,252
Deferred taxes	174	(3,367)
Stock-based compensation	8,602	7,137
Change in fair value of acquisition-related contingent consideration		700
Acquisition-related contingent consideration paid	(67)
Changes in operating assets and liabilities, net of effect from acquisitions:
Accounts receivable, net	3,151	(7,114)
Inventories	177	(1,435)
Prepaid expenses and other current assets	(1,247)	4,625
Client claims receivables	(924)
Other assets	(2,610)	54
Accounts payable	(4,448)	1,528
Accrued expenses and other liabilities	2,012	(1,633)
Client claims payables	(1,698)
Other long-term liabilities	32	(20)
Net cash used in operating activities	(4,078)	(797)
Cash flows from investing activities:
Purchases of property and equipment	(522)	(763)
Software development costs	(5,863)	(4,228)
Net cash used in investing activities	(6,385)	(4,991)
Cash flows from financing activities:
Proceeds from exercise of stock options	2,226	1,153
Borrowings on line of credit	7,500
Payment of acquisition-related notes payable	(7,500)
Payments of acquisition-related contingent consideration	(99)
Repayments of long-term debt and finance leases	(3)	(49)
Net cash provided by financing activities	2,124	1,104
Net decrease in cash and restricted cash	(8,339)	(4,684)
Cash and restricted cash, beginning of period	28,532	46,581
Cash and restricted cash, end of period	20,193	41,897
Supplemental disclosure of cash flow information:
Purchases of property and equipment and software development included in accounts payable and accrued expenses	116	223
Cash paid for interest	3,045	2,844
Cash paid for taxes	3	49
Interest costs capitalized to property and equipment and software development costs	$ 57	$ 64

CONSOLIDATED STATEMENTS OF CA_2

CONSOLIDATED STATEMENTS OF CASH FLOWS (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019
Reconciliation of cash and restricted cash:
Cash	$ 16,899	$ 23,362	$ 38,134
Restricted cash	3,294	5,170	3,763
Total cash and restricted cash	$ 20,193	$ 28,532	$ 41,897	$ 46,581

Nature of Business

Nature of Business	3 Months Ended
	Mar. 31, 2021
Nature of Business
Nature of Business	1. Nature of Business ​ Tabula Rasa HealthCare, Inc. (the “Company”) is a healthcare technology company advancing the safe use of medications by creating solutions designed to empower pharmacists, providers, and patients to optimize medication regimens. The Company’s advanced proprietary technology, MedWise®, identifies the cause of medication-related problems, including adverse drug events, so healthcare professionals can minimize harm and reduce medication-related risks. Adverse drug events are a large and growing problem with medication therapy, costing an estimated $528 billion annually in the United States (“U.S.”) and resulting in more than 275,000 deaths per year in the U.S. in 2018. The Company’s software and services help improve patient outcomes and lower healthcare costs through reduced hospitalizations, emergency department visits, and healthcare utilization. In order to deliver its services, the Company has developed an extensive clinical tele-pharmacy network, with seven call centers across the U.S., a number of which are tethered to academic institutions. The Company serves a number of different organizations within the healthcare industry, including more than 280 health plans, nearly 14,000 pharmacies, nearly 300 hospitals, and more than 130 at-risk provider groups, the majority of which are PACE organizations. ​

Basis of Presentation, Summary

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements	3 Months Ended
	Mar. 31, 2021
Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements
Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements	2. Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements ​ Basis of Presentation ​ The accompanying unaudited consolidated financial statements of the Company have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (the “SEC”) regarding interim financial reporting. The unaudited interim consolidated financial statements have been prepared on the same basis as the annual audited consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting of normal recurring accruals and adjustments) necessary to present fairly the Company's interim consolidated financial position for the periods indicated. The interim results for the three months ended March 31, 2021 are not necessarily indicative of results to be expected for the year ending December 31, 2021, any other interim periods, or any future year or period. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the audited consolidated financial statements and accompanying notes included in the Company’s annual report on Form 10-K filed on February 26, 2021 (“2020 Form 10-K”). ​ The Company operates its business through two segments, CareVention HealthCare and MedWise HealthCare. See Note 17 for a discussion of the Company’s reportable segments. ​ Risks Related to the COVID-19 Pandemic On January 30, 2020, the World Health Organization (“WHO”) announced a global health emergency caused by a new strain of coronavirus (“COVID-19”), originating in Wuhan, China and the risks to the international community. In March 2020, the WHO classified the COVID-19 outbreak as a pandemic (“COVID-19 pandemic), based on the rapid increase in exposure globally. The full impact of the COVID-19 pandemic continues to evolve as of the date these consolidated financial statements were issued. As such, the full magnitude of the impact that the pandemic will have on the Company’s future results of operations remains uncertain. Management is actively monitoring the global situation and the ramification on the Company’s financial condition, liquidity, operations, suppliers, industry, and workforce. Given the daily evolution of the COVID-19 pandemic and the global responses to curb its spread, the Company is not able to estimate the effects that the COVID-19 pandemic may have on the Company’s results of operations, financial condition, or liquidity for 2021. However, the Company is dependent on its workforce to sell and deliver its products and services. Social distancing and shelter-in-place directives could impact the Company’s ability to deploy its workforce effectively. These same developments may affect the operations of the Company’s suppliers and customers, as their own workforces and operations are disrupted by this virus. ​ As a result of the ongoing COVID-19 pandemic, the Company has experienced challenges with revenue growth. During 2020, the pandemic had delayed the closing of contracts across both the Company’s CareVention HealthCare and MedWise HealthCare segments and, in some cases, shifted project priorities and timelines, which management believed resulted in fewer business wins during 2020 and reduced future revenue. Overall census growth for Programs of All-Inclusive Care for the Elderly (“PACE”) had remained below historical levels during 2020 and into the first quarter of 2021, which has affected the Company’s CareVention HealthCare segment growth. During 2020, the Company’s MedWise HealthCare segment had experienced delays in the timing of implementation and closing of new business and a negative impact from COVID-19 on medication adherence initiatives. The Company does not yet know the full extent of potential delays or impacts on its business, financing or other activities, or on the broader healthcare industry or the global economy as a whole. These effects could have a material impact on the Company’s liquidity, capital resources, operations and business and those of the third parties on which it relies. ​ Summary of Significant Accounting Policies ​ There have been no changes to the Company's significant accounting policies described in the 2020 Form 10-K that have had a material impact on the consolidated financial statements and related notes. ​ Recent Accounting Pronouncements ​ In August 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40) ​ Under ASC 470-20 Debt with Conversion and Other Options ​ ASU 2020-06 allows adoption through either a modified retrospective method or fully retrospective method of transition. The Company early adopted ASU 2020-06 effective January 1, 2021 using the modified retrospective method. In applying the modified retrospective transition method, the cumulative effect of the accounting change is recognized as an adjustment to the opening balance of retained earnings at the date of adoption. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. See Note 12 for further details on the 2026 Notes.

Revenue

Revenue	3 Months Ended
	Mar. 31, 2021
Revenue
Revenue	3. Revenue ​ The Company generates revenue from its CareVention HealthCare and MedWise HealthCare segments. See Note 17 for additional discussion of the Company’s reportable segments. ​ Client contracts generally have a term of one 0 ​ The Company does not disclose the amount of variable consideration that the Company expects to recognize in future periods as the variable consideration in the Company’s contracts is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct good or service that forms part of a single performance obligation, and the terms of that variable consideration relate specifically to the Company’s efforts to transfer the distinct service, or to a specific outcome from transferring the distinct service. The Company’s contracts primarily include monthly fees associated with unspecified quantities of members, claims, medication safety reviews, or user subscriptions that fluctuate throughout the contract. See below for a description of the Company’s revenues by segment. ​ CareVention HealthCare ​ PACE Product Revenue ​ The Company provides medication fulfillment pharmacy services to PACE, and, while the majority of medications are routinely filled in order to treat chronic conditions, the mix and quantity of medications can vary. Revenue from medication fulfillment services is generally billed monthly or weekly, depending on whether the PACE organization is contracted with a pharmacy benefit manager, and recognized when medications are delivered and control has passed to the client. At the time of delivery, the Company has performed substantially all of its performance obligations under its client contracts. The Company does not experience a significant level of returns or reshipments. ​ PACE Solutions ​ The Company provides medication safety services and health plan management services to PACE organizations. These services include risk adjustment services, third party administration services, pharmacy benefit management (“PBM”) solutions, and electronic health records software. Revenue related to these services primarily consists of a fixed monthly fee assessed based on number of members served (“per member per month”), a fee for each claim adjudicated, and subscription fees. These fees are recognized when the Company satisfies its performance obligation to stand ready to provide PACE services, which occurs when the Company’s clients have access to the PACE services. The Company generally bills for PACE services on a monthly basis. ​ MedWise HealthCare ​ Product Revenue ​ The Company provides COVID-19 test kits to pharmacies and other clients. Revenue from the sale of these products is generally billed when test kits are shipped and is recognized as the Company satisfies its performance obligations to deliver the test kits and provide the test results. The Company does not experience a significant level of returns or reshipments. ​ Medication Safety Services ​ The Company provides medication safety services, which include identification of high-risk individuals, medication regimen reviews including patient and prescriber counseling, and targeted interventions to increase adherence and close gaps in care. Revenue related to these services primarily consists of per member per month fees and fees for each medication review and assessment completed. Revenue is recognized when the Company satisfies its performance obligation to stand ready to provide medication safety services, which occurs when the Company’s clients have access to the medication safety services, and when medication reviews and assessments are completed. The Company generally bills for the medication safety services on a monthly basis. ​ Software Subscription ​ ​ Disaggregation of Revenue ​ In the following table, revenue is disaggregated by reportable segment. Substantially all of the Company’s revenue is recognized in the U.S. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, ​ ​ ​ 2021 ​ ​ 2020 CareVention HealthCare: ​ ​ ​ ​ ​ ​ PACE product revenue ​ $ 41,842 ​ $ 37,087 PACE solutions ​ ​ 13,919 ​ ​ 11,571 ​ ​ $ 55,761 ​ $ 48,658 MedWise HealthCare: ​ ​ ​ ​ ​ ​ Product revenue ​ $ 136 ​ $ — Medication safety services ​ ​ 10,725 ​ ​ 14,320 Software subscription and services ​ ​ 10,058 ​ ​ 9,849 ​ ​ $ 20,919 ​ $ 24,169 Total revenue ​ $ 76,680 ​ $ 72,827 ​ Contract Balances ​ Assets and liabilities related to the Company’s contracts are reported on a contract-by-contract basis at the end of each reporting period. Contract balances consist of contract assets and contract liabilities. Contract assets are recorded when the right to consideration for services is conditional on something other than the passage of time. Contract assets relating to unbilled receivables are transferred to accounts receivable when the right to consideration becomes unconditional. Contract assets are classified as current or non-current based on the timing of the Company’s rights to the unconditional payments. Contract assets are generally classified as current and recorded within other current assets on the Company’s consolidated balance sheets. ​ Contract liabilities include advance customer payments and billings in excess of revenue recognized. The Company generally classifies contract liabilities in accrued expenses and other current liabilities and in other long-term liabilities on the Company’s consolidated balance sheets. The Company anticipates that it will satisfy most of its performance obligations associated with its contract liabilities within one year. ​ The following table provides information about the Company’s contract assets and contract liabilities from contracts with clients as of March 31, 2021 and December 31, 2020. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, ​ December 31, ​ ​ 2021 2020 Contract assets ​ $ 8,948 ​ $ 7,601 Contract liabilities ​ ​ 5,287 ​ ​ 3,876 ​ Significant changes in the contract assets and the contract liabilities balances during the period are as follows: ​ ​ ​ ​ ​ ​ ​ March 31, ​ ​ 2021 Contract assets: ​ ​ ​ Contract assets, beginning of period ​ $ 7,601 Decreases due to cash received ​ ​ (6,121) Changes to the contract assets at the beginning of the period as a result of changes in estimates ​ ​ 2,654 Changes during the period, net of reclassifications to receivables ​ ​ 4,814 Contract assets, end of period ​ $ 8,948 ​ ​ ​ ​ Contract liabilities: ​ ​ ​ Contract liabilities, beginning of period ​ $ 3,876 Revenue recognized that was included in the contract liabilities balance at the beginning of the period ​ ​ (2,288) Increases due to cash received, excluding amounts recognized as revenue during the period ​ ​ 3,699 Contract liabilities, end of period ​ $ 5,287 ​ During the three months ended March 31, 2020, the Company recognized $2,618 of revenue that was included in the December 31, 2019 contract liability balance of $4,930.

Net Loss per Share

Net Loss per Share	3 Months Ended
	Mar. 31, 2021
Net Loss per Share
Net Loss per Share	4. Net Loss per Share ​ Basic and diluted net loss per share is computed by dividing net loss by the weighted average number of shares of common stock of the Company outstanding during the period. ​ The following table presents the calculation of basic and diluted net loss per share for the Company’s common stock: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, ​ 2021 2020 Numerator (basic and diluted): ​ ​ ​ ​ ​ Net loss ​ $ (19,492) ​ $ (14,437) Denominator (basic and diluted): ​ ​ ​ ​ ​ ​ Weighted average shares of common stock outstanding, basic and diluted ​ ​ 23,010,531 ​ ​ 21,374,897 Net loss per share, basic and diluted ​ $ (0.85) ​ $ (0.68) ​ The following potential common shares, presented based on amounts outstanding for the three months ended March 31, 2021 and 2020, were excluded from the calculation of diluted net loss per share for the periods indicated because including them would have had an anti-dilutive effect. ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, ​ 2021 2020 Stock options to purchase common stock ​ 1,846,707 ​ 2,627,493 Unvested restricted stock ​ 1,651,806 ​ 1,314,635 Common stock warrants ​ 4,646,393 ​ 4,646,393 Conversion of convertible senior subordinated notes ​ 4,646,393 ​ — Contingently issuable shares ​ — ​ 63,320 ​ ​ 12,791,299 ​ 8,651,841 ​ ​ For the three months ended March 31, 2021, shares related to the conversion of the convertible senior subordinated notes were included in the table above under the if-converted method. For the three months ended March 31, 2020, shares associated with the conversion of the convertible senior subordinated notes were excluded from the table above as the Company assumed the notes would be settled entirely or partly in cash.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2021
Acquisitions
Acquisitions	5. Acquisitions ​ Personica ​ On October 5, 2020, the Company entered into a Membership Interest Purchase Agreement (the “Purchase Agreement”) with TRHC Group, Personica Holdings, Inc., a Wisconsin corporation, and other seller parties, whereby the Company completed the acquisition of all the issued and outstanding membership interests of Personica, LLC, a Delaware limited liability company (“Personica”), and its subsidiaries, a provider of PBM solutions and pharmacy services, including 340B and Medicare Part D administration solutions to the PACE market. The purchase price consisted of (i) cash consideration of $10,000, subject to certain customary post-closing adjustments, (ii) the issuance of 555,555 shares of the Company’s common stock valued at $23,589, and (iii) the delivery of promissory notes (collectively, the “Notes”) for the payment of (a) $7,500 in cash paid in January 2021, (b) $5,500 in cash paid in April 2021, and (c) $4,000 in cash within two business days following October 5, 2021. The Company may set off amounts due under the Notes to the extent the Company is entitled to indemnification under the Purchase Agreement or in respect of adjustments to the purchase price. ​ Revenue from Personica includes medication fulfillment pharmacy services to PACE organizations. Revenue for these services, and the related costs, is recognized when medications are delivered and control has passed to the client, and is included in product revenue and cost of revenue – product cost, respectively, in the Company’s consolidated statements of operations. Revenue from Personica is also comprised of monthly fees per adjudicated claim for PBM solutions. Revenue for these services, and the related costs, is recognized each month as performance obligations are satisfied and costs are incurred, and is included in service revenue and cost of revenue – service cost, respectively, in the Company’s consolidated statements of operations. ​ The Company continues to evaluate the fair value of certain assets acquired and liabilities assumed related to the acquisition. Additional information, which existed as of the acquisition date, but was at that time unknown to the Company, may become known during the remainder of the measurement period. Changes to amounts recorded as a result of the final determination may result in a corresponding adjustment to these assets and liabilities, including goodwill. The determination of the estimated fair values of all assets acquired is expected to be completed within one year from the date of acquisition. ​ Pro forma ​ The unaudited pro forma results presented below include the results of the Personica acquisition as if it had been consummated as of January 1, 2019. The unaudited pro forma results include the amortization associated with acquired intangible assets, interest expense on the debt incurred to fund these acquisitions, stock-based compensation expense related to equity awards granted to employees of the acquired companies, and the estimated tax effect of adjustments to income (loss) before income taxes. Material nonrecurring charges, including direct acquisition costs, directly attributable to the transactions are excluded. In addition, the unaudited pro forma results do not include any expected benefits of the acquisitions. Accordingly, the unaudited pro forma results are not necessarily indicative of either future results of operations or results that might have been achieved had the acquisition been consummated as of January 1, 2019. ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, ​ 2020 Revenue ​ $ 75,671 Net loss ​ ​ (14,206) ​

Other Current Assets

Other Current Assets	3 Months Ended
	Mar. 31, 2021
Other Current Assets
Other Current Assets	6. Other Current Assets ​ As of March 31, 2021 and December 31, 2020, other current assets consisted of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Contract assets ​ $ 8,948 ​ $ 7,601 Non-trade receivables ​ ​ 1,421 ​ ​ 647 Other ​ ​ 1,603 ​ ​ 1,504 Total other current assets ​ $ 11,972 ​ $ 9,752 ​

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2021
Property and Equipment.
Property and Equipment	7. Property and Equipment ​ Accumulated depreciation was $19,205 and $17,922 as of March 31, 2021 and December 31, 2020, respectively. Depreciation expense on property and equipment for the three months ended March 31, 2021 and 2020 was $1,283 and $1,268 , respectively. ​

Software Development Costs

Software Development Costs	3 Months Ended
	Mar. 31, 2021
Software Development Costs
Software Development Costs	8. Software Development Costs ​ The Company capitalizes certain costs incurred in connection with obtaining or developing its proprietary software platforms, which are used to support its service contracts, including external direct costs of material and services, payroll costs for employees directly involved with the software development, and interest expense related to the borrowings attributable to software development. As of March 31, 2021 31, ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Software development costs $ 54,414 ​ $ 48,548 Less: accumulated amortization ​ (23,669) ​ ​ (20,666) Software development costs, net $ 30,745 ​ $ 27,882 ​ ​ ​ ​ ​ ​ Capitalized software development costs included above not yet subject to amortization $ 5,823 ​ $ 4,382 ​ Amortization expense for the three months ended March 31, 2021 and 2020 was $3,003 and $1,823, respectively.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	3 Months Ended
	Mar. 31, 2021
Goodwill and Intangible Assets
Goodwill and Intangible Assets	9. Goodwill and Intangible Assets ​ The Company’s goodwill and related changes during the three months ended of March 31, 2021 were as follows: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ CareVention HealthCare ​ ​ MedWise HealthCare ​ ​ Total Balance at January 1, 2021 $ 115,350 ​ $ 55,512 ​ $ 170,862 Adjustments to goodwill related to prior year acquisition ​ (27) ​ ​ — ​ ​ (27) Balance at March 31, 2021 $ 115,323 ​ $ 55,512 ​ $ 170,835 ​ Intangible assets consisted of the following as of March 31, 2021 and December 31, 2020: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted Average ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amortization Period ​ ​ ​ ​ Accumulated ​ Intangible ​ (in years) Gross Value Amortization Assets, net March 31, 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Trade names ​ 3.6 ​ $ 11,955 ​ $ (8,844) ​ $ 3,111 Client relationships ​ 12.2 ​ ​ 152,654 ​ ​ (35,591) ​ ​ 117,063 Non-competition agreements ​ 5.0 ​ ​ 6,892 ​ ​ (4,321) ​ ​ 2,571 Developed technology ​ 8.0 ​ ​ 67,369 ​ ​ (27,054) ​ ​ 40,315 Patient database ​ 5.0 ​ ​ 21,700 ​ ​ (9,042) ​ ​ 12,658 Domain name ​ 10.0 ​ ​ 59 ​ ​ (22) ​ ​ 37 Total intangible assets ​ ​ ​ $ 260,629 ​ $ (84,874) ​ $ 175,755 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted Average ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amortization Period ​ ​ ​ ​ Accumulated ​ Intangible ​ (in years) Gross Value Amortization Assets, net December 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Trade names ​ 3.7 ​ $ 11,955 ​ $ (8,286) ​ $ 3,669 Client relationships ​ 12.2 ​ ​ 152,654 ​ ​ (32,437) ​ ​ 120,217 Non-competition agreements ​ 5.0 ​ ​ 6,892 ​ ​ (3,976) ​ ​ 2,916 Developed technology ​ 8.0 ​ ​ 67,369 ​ ​ (24,858) ​ ​ 42,511 Patient database ​ 5.0 ​ ​ 21,700 ​ ​ (7,957) ​ ​ 13,743 Domain name ​ 10.0 ​ ​ 59 ​ ​ (21) ​ ​ 38 Total intangible assets ​ ​ ​ $ 260,629 ​ $ (77,535) ​ $ 183,094 ​ Amortization expense for intangible assets for the three months ended March 31, 2021 and 2020 was $7,339 and $6,822, respectively. ​ The estimated amortization expense for the remainder of 2021 and each of the next five years and thereafter is as follows: ​ ​ ​ ​ ​ Years Ending December 31, ​ ​ 2021 (April 1 - December 31) $ 21,105 2022 ​ ​ 27,089 2023 ​ ​ 25,804 2024 ​ ​ 18,521 2025 ​ ​ 14,038 2026 ​ ​ 12,830 Thereafter ​ ​ 56,368 Total estimated amortization expense ​ $ 175,755 ​

Notes Payable Related to Acquis

Notes Payable Related to Acquisition	3 Months Ended
	Mar. 31, 2021
Notes Payable Related to Acquisition
Notes Payable Related to Acquisition	10. Notes Payable Related to Acquisition ​ On October 5, 2020, as part of the consideration of the Personica acquisition, the Company entered into promissory notes in the aggregate principal amount of $17,000 payable to the owners of Personica (see Note 5). The Notes bear an interest rate of 3.25% and are payable as follows: (a) $7,500 in cash, which was paid in January 2021, (b) $5,500 in cash, which was paid in April 2021, and (c) $4,000 in cash within two business days following October 5, 2021. The Notes were recorded at their aggregate acquisition-date fair value of $16,355 and are being accreted up to their face values over their respective terms using the effective-interest method. For the three months ended March 31, 2021, the Company recognized $254 of interest expense related to the Notes, of which $76 was paid or accrued and $178 was the non-cash accretion of the discounts recorded. As of March 31, 2021 and December 31, 2020, the Notes had a fair value of $9,340 and $16,662, respectively. ​

Accrued Expenses and Other Liab

Accrued Expenses and Other Liabilities	3 Months Ended
	Mar. 31, 2021
Accrued Expenses and Other Liabilities
Accrued Expenses and Other Liabilities	11. Accrued Expenses and Other Liabilities ​ As of March 31, 2021 and December 31, 2020, accrued expenses and other liabilities consisted of the following: ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Employee related expenses ​ $ 8,260 ​ $ 8,218 Contract liability ​ ​ 4,584 ​ ​ 3,205 Customer deposits ​ ​ 904 ​ ​ 904 Client funds obligations* ​ ​ 3,294 ​ ​ 5,170 Contract labor ​ ​ 1,644 ​ ​ 1,374 Interest ​ ​ 2,637 ​ ​ 3,690 Professional fees ​ ​ 533 ​ ​ 572 Consideration payable to customer ​ ​ 9,921 ​ ​ 5,968 Non-income taxes payable ​ ​ 161 ​ ​ 151 Other expenses ​ ​ 3,226 ​ ​ 2,716 Total accrued expenses and other liabilities ​ $ 35,164 ​ $ 31,968 ​ *This amount represents clients’ funds held by the Company, with an offsetting amount included in restricted cash.

Lines of Credit and Long-Term D

Lines of Credit and Long-Term Debt	3 Months Ended
	Mar. 31, 2021
Lines of Credit and Long-Term Debt
Lines of Credit and Long-Term Debt	12. Lines of Credit and Long-Term Debt ​ (a) Lines of Credit ​ On September 6, 2017, the Company entered into an Amended and Restated Loan and Security Agreement (the “2015 Line of Credit”), whereby the Company amended and restated its revolving line of credit, originally entered into with Bridge Bank (now Western Alliance Bank) in 2015 and had subsequently amended. The 2015 Line of Credit provided for borrowing availability in an aggregate amount up to $60,000 to be used for general corporate purposes, with a $1,000 sublimit for cash management services, letters of credit and foreign exchange transactions. The 2015 Line of Credit matured pursuant to its terms on December 6, 2020. ​ On December 18, 2020, the Company and its subsidiaries entered into a Loan and Security Agreement with Western Alliance Bank, which provides for a $120,000 secured revolving credit facility, with a $1,000 sublimit for cash management services and letters of credit and foreign exchange transactions (the “2020 Credit Facility”), and replaced the 2015 Line of Credit. ​ Amounts under the 2020 Credit Facility may be borrowed, repaid, and re-borrowed from time to time until the maturity date on May 16, 2025, and may be used for, among other things, working capital and other general corporate purposes. Loans under the 2020 Credit Facility will bear interest at a rate equal to the LIBOR rate plus 3.25%. The obligations under the 2020 Credit Facility are secured by all of the Company’s assets, subject to certain exceptions and exclusions as set forth in the Loan and Security Agreement. ​ The Loan and Security Agreement contains certain affirmative and negative covenants that are binding on the Company, including, but not limited to, restrictions (subject to specified exceptions and qualifications) on the Company’s ability to incur indebtedness, create liens, merge or consolidate, make dispositions, pay dividends or make distributions, make investments, pay any subordinated indebtedness, enter into certain transactions with affiliates, or make capital expenditures. In addition, the Loan and Security Agreement imposes certain financial covenants, including that the Company (i) maintain unrestricted cash balances with Western Alliance Bank, plus amounts available for draw under the 2020 Credit Facility of at least $10,000 at all times, and (ii) maintain a leverage ratio of less than 3.00:1.00, on a trailing twelve-month basis, measured quarterly. The 2020 Credit Facility is subject to a commitment fee of 0.50% of the total commitment under the 2020 Credit Facility payable on the closing date, and 0.25% of the total commitment under the 2020 Credit Facility payable on each anniversary thereafter. Additionally, the 2020 Credit Facility is subject to an unused line fee. ​ As of March 31, 2021, the Company was in compliance with all of the financial covenants related to the 2020 Credit Facility, and management expects that the Company will be able to maintain compliance with its covenants. ​ As of March 31, 2021, the Company had $17,500 outstanding under the 2020 Credit Facility, plus an outstanding letter of credit of $100 issued in connection with the Company’s lease agreement for its office space in Moorestown, NJ. The letter of credit renews annually and expires in September 2027, and reduces amounts available under the 2020 Credit Facility. As of March 31, 2021, amounts available for borrowings under the 2020 Credit Facility were $102,400. ​ As of March 31, 2021, the interest rate on the 2020 Credit Facility was 3.36% and the effective rate for the unused line fee was 0.45%. Interest expense on the 2020 Credit Facility was $261 for the three months ended March 31, 2021. As of March 31, 2020, the interest rate on the 2015 Line of Credit was 5.58%. No interest expense was incurred for the three months ended March 31, 2020 as there were no aggregate borrowings outstanding during the three months ended March 31, 2020. ​ In connection with the 2020 Credit Facility, the Company recorded deferred financing costs of $1,176. The Company is amortizing the deferred financing costs associated with the 2020 Credit Facility to interest expense using the effective-interest method over the term of the 2020 Credit Facility. The Company amortized $133 to interest expense for the three months ended March 31, 2021. During the three months ended March 31, 2020, the Company amortized $100 to interest expense for deferred financing costs related to the 2015 Line of Credit. Deferred financing costs of $1,005 and $1,156, net of accumulated amortization, are included in other assets on the accompanying consolidated balance sheets as of March 31, 2021 and December 31, 2020, respectively. ​ (b) Convertible Senior Subordinated Notes ​ On February 12, 2019, the Company issued and sold an aggregate principal amount of $325,000 of 1.75% convertible senior subordinated notes (the “2026 Notes”) in a private placement pursuant to Rule 144A under the Securities Act of 1933, as amended. The 2026 Notes bear interest at a rate of 1.75% per year, payable semiannually in arrears on February 15 and August 15 of each year, beginning on August 15, 2019. The notes will mature on February 15, 2026, unless earlier converted or repurchased. The initial conversion rate for the notes is 14.2966 shares of the Company’s common stock per $1 principal amount of notes. This conversion rate is equal to an initial conversion price of approximately $69.95 per share of the Company’s common stock. ​ Holders may convert all or any portion of their at any time prior to the close of business on the business day immediately preceding August 15, 2025 only under the following circumstances: (1) during any calendar quarter commencing after March 31, 2019 (and only during such calendar quarter), if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any five consecutive trading day period (the measurement period) in which the trading price (as defined in the indenture governing the 2026 Notes) per $1 principal amount of 2026 Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events, including certain distributions, the occurrence of a fundamental change or make-whole fundamental change (as defined in the indenture governing the 2026 Notes) or a transaction resulting in the Company’s common stock converting into other securities or property or assets. On or after August 15, 2025 until the close of business on the first scheduled trading day immediately preceding the maturity date, a holder may convert all or any portion of its 2026 Notes regardless of the foregoing circumstances. Upon conversion, the Company will pay or deliver shares of our common stock, cash or a combination thereof at the Company’s option. As of March 31, 2021, none of the conditions allowing holders of the 2026 Notes to convert had been met. ​ In the initial accounting for the issuance of the 2026 Notes, the Company separated the 2026 Notes into liability and equity components. The carrying amount of the equity component representing the conversion option was $102,900 and was determined by deducting the fair value of the liability component from the par value of the 2026 Notes. The equity component was not remeasured as long as it continued to meet the conditions for equity classification. The initial associated deferred tax effect of $25,884 was recorded as a reduction of additional paid-in capital because the equity component was not currently expected to be deductible for income tax purposes. The excess of the principal amount of the liability component over its carrying amount (“debt discount”) was amortized to interest expense over the term of the 2026 Notes at an effective interest rate of 8.05% over the contractual term. Debt issuance costs related to the 2026 Notes of $9,372 were allocated to the liability and equity components of the 2026 Notes based on their relative values. Issuance costs attributable to the liability component were $6,405 and were amortized to interest expense using the effective interest method over the contractual term. Issuance costs attributable to the equity component were netted with the equity component in stockholders’ equity. ​ As described in Note 2, the Company adopted ASU 2020-06 using the modified retrospective method effective January 1, 2021. E ebt issuance costs related to the 2026 Notes of $7,008 were allocated to the liability component of the 2026 Notes and will be amortized to interest expense using the effective interest method over the contractual term, resulting in ​ During the three months ended March 31, 2021, the Company recognized $1,746 of interest expense related to the 2026 Notes, of which $1,422 was paid or accrued, and $324 was non-cash accretion of the debt discounts recorded. During the three months ended March 31, 2020, under the previous accounting standard, the Company recognized $4,573 of interest expense related to the 2026 Notes, of which $1,421 was paid or accrued, and $3,152 was non-cash accretion of the debt discounts recorded. ​ In addition, unpaid additional interest payable as a result of the failure to remove the restrictive legend on the 2026 Convertible Notes had accrued on the 2026 Convertible Notes from and including February 17, 2020, but ceased accruing on February 16, 2021 as a result of the restrictive legend being removed. The Company recorded $212 of additional interest expense for the three months ended March 31, 2021 and the total amount of accrued additional interest was $1,625 as of March 31, 2021. As a result, t otal accrued interest payable related to the 2026 Notes was $2,336 as of March 31, 2021, which is included in accrued expenses and other liabilities on the consolidated balance sheets. The 2026 Notes have a carrying value of $318,316 as of March 31, 2021. ​ The 2026 Notes are classified as long-term debt on the Company’s consolidated balance sheets, and will be until such Notes are within one year of maturity ​ (c) Convertible Note Hedge and Warrant Transactions ​ In connection with the offering of the 2026 Notes, the Company entered into convertible note hedge transactions with affiliates of certain of the initial purchasers (the “option counterparties”) of the 2026 Notes pursuant to the terms of call option confirmations. The Company has the option to purchase a total of 4,646,393 shares of its common stock at a price of approximately As these instruments are considered indexed to the Company's own stock and are considered equity classified, the convertible note hedges and warrants are recorded in stockholders’ equity, are not accounted for as derivatives and are not remeasured each reporting period. The net costs incurred in connection with the convertible note hedge and warrant transactions were recorded as a reduction to additional paid-in capital on the Company’s consolidated balance sheets. ​ The convertible note hedge transactions are expected generally to reduce the potential dilution to the Company’s common stock upon conversion of the 2026 Notes and/or offset any potential cash payments the Company is required to make in excess of the principal amount of converted 2026 Notes, as the case may be. The warrant transactions could separately have a dilutive effect on the Company’s common stock to the extent that the market price per share of the Company’s common stock exceeds the strike price of the warrants. ​ As of March 31, 2021, no warrants have been exercised and all warrants to purchase shares of the Company’s common stock were outstanding. ​ (d) Long-Term Debt ​ The following table represents the total long-term debt obligations of the Company at March 31, 2021 and December 31, 2020: ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Convertible senior subordinated notes ​ $ 325,000 ​ $ 325,000 Unamortized discount, including debt issuance costs, on convertible senior subordinated notes ​ ​ (6,684) ​ ​ (85,715) Convertible senior subordinated notes, net ​ ​ 318,316 ​ ​ 239,285 Finance leases ​ ​ 1 ​ ​ 4 Total long-term debt and finance leases, net ​ ​ 318,317 ​ ​ 239,289 Less current portion of finance leases ​ ​ (1) ​ ​ (4) Total long-term debt, net ​ $ 318,316 ​ $ 239,285 ​

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2021
Income Taxes
Income Taxes	13. Income Taxes ​ On February 12, 2021, the Company received a private letter ruling from the Internal Revenue Service, which determined, based on information submitted and representations made by the Company, that the Company met the requirements to deduct the interest expense resulting from the amortization of the debt discount associated with the 2026 Notes. As a result, during the three months ended March 31, 2021, the Company recorded a deferred tax asset of $23,628 and a corresponding $23,628 increase to its valuation allowance. As of March 31, 2021, the Company has recorded a full valuation allowance against its deferred tax assets. ​ For the three months ended March 31, 2021, the Company recorded income tax expense of $199 primarily related to indefinite-lived deferred tax liabilities for goodwill amortization, which resulted in an effective tax rate of (1.0)%. The effective tax rate differs from the U.S. statutory tax rate primarily due to the full valuation allowance recorded that is currently limiting the realizability of our net deferred tax assets as of March 31, 2021. Accordingly, the tax benefit was limited due to unbenefited losses in the three months ended March 31, 2021. ​ For the three months ended March 31, 2020, the Company recorded an income tax benefit of $3,367, which resulted in an effective tax rate of 18.9%. The tax benefit primarily consisted of $3,031 based on the estimated effective tax rate for the full year and $336 of windfall tax benefits generated from the vesting of restricted stock, disqualifying dispositions and exercising of nonqualified stock options during the period. ​

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2021
Stock-Based Compensation
Stock-Based Compensation	14. Stock-Based Compensation ​ In September 2016, the Company adopted the 2016 Equity Compensation Plan ( ​ Restricted Common Stock ​ The following table summarizes the restricted stock award activity under the 2016 Plan for the three months ended March 31, 2021: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ average ​ ​ Number ​ grant-date ​ of shares fair value Outstanding at December 31, 2020 ​ 1,386,908 ​ ​ 44.14 Granted ​ 629,088 ​ ​ 54.92 Vested ​ (351,310) ​ ​ 49.42 Forfeited ​ (12,880) ​ ​ 57.48 Outstanding at March 31, 2021 ​ 1,651,806 ​ $ 47.02 ​ For the three months ended March 31, 2021 and 2020, $6,275 and $4,139 of expense was recognized related to restricted stock awards, excluding performance-based restricted stock awards described below, respectively. As of March 31, 2021, there was unrecognized compensation expense of $65,755 related to non-vested restricted stock awards, excluding performance-based restricted stock awards described below, under the 2016 Plan, which is expected to be recognized over a weighted average period of 3.1 years. ​ Performance-Based Stock Award ​ On May 4, 2020, pursuant to the 2016 Plan, the Board approved grants totaling 10,686 shares of restricted stock to an employee. The grants vest subject to certain performance conditions being achieved during the two-year period ending March 2, 2022. The awards have a grant-date fair value of $56.14 per share based on the Company’s closing stock price on the grant date. Stock-based compensation costs associated with these grants are recognized over the service period based upon the Company’s assessment of the probability that the performance conditions will be achieved. The Company recognized no stock-based compensation expense related to these grants for the three months ended March 31, 2021 as the achievement of the underlying performance conditions was considered unlikely. As of March 31, 2021, there was $600 of unrecognized compensation expense related to these performance-based restricted stock awards. ​ On October 29, 2020, pursuant to the 2016 Plan, the Board approved grants totaling 26,400 shares of restricted stock to certain employees. The grants vest subject to the achievement of certain milestones. The awards have a grant-date fair value of $35.95 per share based on the Company’s closing stock price on the grant date. Stock-based compensation costs associated with these grants are recognized over the service period based upon the Company’s assessment of the probability that the performance conditions will be achieved. The Company recognized $214 of stock-based compensation expense related to these grants for the three months ended March 31, 2021. As of March 31, 2021, there was $583 of unrecognized compensation expense related to these performance-based restricted stock awards. ​ Other Stock Awards ​ During the first quarter of 2021, the Board approved the grant of stock awards to certain non-employee directors and to a consultant pursuant to the 2016 Plan. The awards provided for the issuance of 1,416 shares of the Company’s common stock, which immediately vested on the grant date. These grants had a weighted average grant-date fair value of $40.85 per share. For the three months ended March 31, 2021, the Company recorded $58 of expense related to these stock awards. ​ During the first quarter of 2020, the Board approved the grant of stock awards to select employees pursuant to the 2016 Plan. The awards provided for the issuance of 9,386 shares of the Company’s common stock, which immediately vested on the grant date. These grants had a weighted average grant-date fair value of $52.29 per share. For the three months ended March 31, 2020, the Company recorded $491 of expense related to these stock awards. ​ Stock Options ​ The Company recorded $2,055 and $2,507 of stock-based compensation expense related to employee and non-employee stock options for the three months ended March 31, 2021 and 2020, respectively. The Company records forfeitures as they occur. ​ The table below sets forth the weighted average assumptions for employee grants during the three months ended March 31, 2021 and 2020: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, Valuation assumptions: 2021 2020 Expected volatility ​ 58.57 % ​ 56.10 % Expected term (years) ​ 5.48 ​ ​ 5.25 ​ Risk-free interest rate ​ 0.50 % ​ 1.22 % Dividend yield ​ — ​ ​ — ​ ​ The weighted average grant date fair value of employee options granted during the three months ended March 31, 2021 and 2020 was $28.26 and $33.78 per share, respectively. ​ The following table summarizes stock option activity under the 2016 Plan for the three months ended March 31, 2021: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ ​ ​ ​ Weighted ​ average ​ ​ ​ ​ ​ ​ ​ average ​ remaining ​ Aggregate ​ ​ Number ​ exercise ​ contractual ​ intrinsic ​ of shares price term value Outstanding at December 31, 2020 ​ 2,096,556 ​ ​ 27.74 ​ ​ ​ ​ Granted ​ 2,500 ​ ​ 55.01 ​ ​ ​ ​ ​ Exercised ​ (224,503) ​ ​ 11.14 ​ ​ ​ ​ ​ Forfeited ​ (27,846) ​ ​ 39.51 ​ ​ ​ ​ ​ Outstanding at March 31, 2021 ​ 1,846,707 ​ $ 29.62 ​ 6.1 ​ $ 37,286 Options vested and expected to vest at March 31, 2021 ​ 1,846,707 ​ $ 29.62 ​ 6.1 ​ $ 37,286 Exercisable at March 31, 2021 ​ 1,479,329 ​ $ 24.29 ​ 5.7 ​ $ 36,092 ​ The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the Company’s closing stock price or estimated fair value on the last trading day of the fiscal quarter for those stock options that had exercise prices lower than the fair value of the Company's common stock. This amount changes based on the fair market value of the Company’s stock. The total intrinsic value of options exercised during the three months ended March 31, 2021 and 2020 was $7,768 and $4,581, respectively. ​ As of March 31, 2021, there was $10,833 of total unrecognized compensation cost related to nonvested stock options granted under the 2016 Plan, which is expected to be recognized over a weighted average period of 1.7 years. ​ Cash received from option exercises for the three months ended March 31, 2021 and 2020 was $2,226 and $1,153, respectively. ​ The Company recorded total stock-based compensation expense for the three months ended March 31, 2021 and 2020 in the following expense categories of its consolidated statements of operations: ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ March 31, ​ 2021 2020 Cost of revenue - product $ 259 ​ $ 182 Cost of revenue - service ​ 1,079 ​ ​ 763 Research and development ​ 1,435 ​ ​ 1,409 Sales and marketing ​ 1,068 ​ ​ 528 General and administrative ​ 4,761 ​ ​ 4,255 Total stock-based compensation expense $ 8,602 ​ $ 7,137 ​

Fair Value Measurements

Fair Value Measurements	3 Months Ended
	Mar. 31, 2021
Fair Value Measurements
Fair Value Measurements	15. Fair Value Measurements ​ The Company’s financial instruments consist of accounts receivable, contract assets, accounts payable, contract liabilities, accrued expenses, acquisition-related contingent consideration, acquisition-related notes payable, line of credit, and long-term debt, which includes the Company’s convertible senior subordinated notes and finance leases. The carrying values of accounts receivable, contract assets, accounts payable, contract liabilities, accrued expenses, and acquisition-related notes payable are representative of their fair value due to the relatively short-term nature of those instruments. See below for additional information on the Company’s convertible senior subordinated notes. ​ In connection with the 2018 acquisition of the Cognify business, additional consideration was payable by the Company based on a multiple of the excess of certain PACE solutions’ 2021 revenues and Adjusted EBITDA over their 2018 revenues and Adjusted EBITDA, as defined in the stock purchase agreement. The Cognify acquisition-related contingent consideration, which was liability-classified, was recorded at the estimated fair value at the acquisition date of October 19, 2018. The Company, with the assistance of a third-party appraiser, utilized a Monte Carlo simulation to derive estimates of the contingent consideration payments as of the acquisition date and at each subsequent reporting period. ​ The acquisition-related contingent consideration liability represented the estimated fair value of the additional cash and equity consideration payable that was contingent upon the achievement of certain financial and performance milestones. In accordance with ASC 805, Business Combinations ​ The acquisition-related contingent consideration was measured at fair value on a recurring basis and included the use of significant unobservable inputs, hence, these instruments represented Level 3 measurements within the fair value hierarchy. During the third quarter of 2020, pursuant to the terms of the stock purchase agreement, the Company elected to accelerate the payment of the acquisition-related contingent consideration for an aggregate payment amount of $13,413. Due to the accelerated payment of the Cognify acquisition-related contingent consideration, the acquisition-related contingent consideration payment amount was fixed and was no longer classified within the fair value hierarchy. The acquisition-related contingent consideration was partially paid during 2020 by cash payments of $6,394 and the issuance of 135,434 shares of the Company’s common stock, with a fair value of $6,853. The Company made the final cash payment of $166 in full satisfaction of the remaining acquisition-related contingent consideration liability in January 2021. ​ During the three months ended March 31, 2020, the Company recorded a $700 charge for the change in the fair value of Cognify acquisition-related contingent consideration primarily due to a decreased discount period to the final measurement date. ​ The following table presents the financial instruments that are not carried at fair value but require fair value disclosure as of March 31, 2021: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Face Value Carrying Value Fair Value 1.75% Convertible Senior Subordinated Notes due 2026 ​ $ 325,000 ​ $ 318,316 ​ $ 325,133 ​ The fair value of the 2026 Notes at each balance sheet date is determined based on recent quoted market prices for these notes which is a Level 2 measurement. As discussed in Note 12, the 2026 Notes are carried at their aggregate face value of $325,000 , less any unamortized debt issuance costs.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2021
Commitments and Contingencies
Commitments and Contingencies	16. Commitments and Contingencies ​ (a) Legal Proceedings ​ The Company is not currently involved in any significant claims or legal actions that, in the opinion of management, are expected to have a material adverse impact on the Company. ​ (b) Vendor Purchase Agreements ​ On March 29, 2019, the Company entered into an Affiliated Pharmacy Agreement and Pharmaceutical Program Supply Agreement (the “Prior Thrifty Drug Agreements”) with Thrifty Drug Stores, Inc. (“Thrifty Drug”). On July 1, 2020, the Company entered into a new Affiliated Pharmacy Agreement and Pharmaceutical Program Supply Agreement with Thrifty Drug (the “Thrifty Drug Agreements”) to replace the Prior Thrifty Drug Agreements, which, among other things, extended the Company’s agreement with Thrifty Drug through September 30, 2023. Pursuant to the terms of the Thrifty Drug Agreements, the Company has agreed to purchase not less than 98% of the Company’s total prescription product requirements from Thrifty Drug. The Company commenced purchasing prescription products under the Prior Thrifty Drug Agreements in May 2019 and has continued to do so under the Thrifty Drug Agreements beginning in July 2020. Both the Prior Thrifty Drug Agreements and the Thrifty Drug Agreements authorize Thrifty Drug to hold a security interest in all of the products purchased by the Company under the respective agreements. ​ As of March 31, 2021 and December 31, 2020 the Company had $1,285 and $1,985 due to Thrifty Drug as a result of prescription drug purchases. ​ In December 2019, the Company entered into an updated agreement with its data aggregation partner related to the Company’s pharmacy cost management services. The agreement is effective January 1, 2020 with a three-year term expiring December 31, 2022 and commits the Company to a monthly minimum purchase obligation of $30. ​ ​

Segment Reporting

Segment Reporting	3 Months Ended
	Mar. 31, 2021
Segment Reporting
Segment Reporting	17. Segment Reporting ​ The Company operates its business through two segments. The Company's chief operating decision maker (“CODM”), the Chief Executive Officer, allocates resources and assesses performance based upon financial information at the reportable segment level. Substantially all revenues are generated and substantially all tangible assets are held in the U.S. The Company classifies its operations into two reportable segments as follows: ​ CareVention HealthCare primarily provides services to PACE organizations that include medication fulfillment pharmacy services and PACE solutions such as medication safety services, pharmacy benefit management solutions, and health plan management services . ​ MedWise HealthCare clients include health plans, pharmacies, and non-PACE healthcare providers. Services provided to these clients include medication safety services and software subscription solutions, . ​ Shared services primarily consist of unallocated corporate sales and marketing expenses and general and administrative expenses associated with the management and administration of the Company’s business objectives. ​ The CODM uses revenue in accordance with U.S. GAAP and Adjusted EBITDA as the relevant segment performance measures to evaluate the performance of the segments and allocate resources. ​ Adjusted EBITDA is a segment performance financial measure that offers a useful view of the overall operation of the Company’s businesses and may be different from similarly titled segment performance financial measures used by other companies. ​ Adjusted EBITDA consists of net loss plus certain other expenses, which includes interest expense, income tax expense or benefit, depreciation and amortization, change in fair value of acquisition-related contingent consideration expense, acquisition-related expense, and stock-based compensation expense. The Company ​ Management considers revenue and Adjusted EBITDA to be the appropriate metrics to evaluate and compare the ongoing operating performance of the Company’s segments on a consistent basis across reporting periods as they eliminate the effect of items which are not indicative of each segment's core operating performance. ​ The following tables present the Company’s segment information: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ CareVention HealthCare ​ MedWise HealthCare ​ Consolidated Revenue: ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ Product revenue ​ $ 41,842 ​ $ 136 ​ $ 41,978 Service revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ PACE solutions ​ ​ 13,919 ​ ​ — ​ ​ 13,919 Medication safety services ​ ​ — ​ ​ 10,725 ​ ​ 10,725 Software subscription and services ​ ​ — ​ ​ 10,058 ​ ​ 10,058 Total service revenue ​ ​ 13,919 ​ ​ 20,783 ​ ​ 34,702 Total revenue ​ $ 55,761 ​ $ 20,919 ​ $ 76,680 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ Product revenue ​ $ 37,087 ​ $ — ​ $ 37,087 Service revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ PACE solutions ​ ​ 11,571 ​ ​ — ​ ​ 11,571 Medication safety services ​ ​ — ​ ​ 14,320 ​ ​ 14,320 Software subscription and services ​ ​ — ​ ​ 9,849 ​ ​ 9,849 Total service revenue ​ ​ 11,571 ​ ​ 24,169 ​ ​ 35,740 Total revenue ​ $ 48,658 ​ $ 24,169 ​ $ 72,827 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ CareVention HealthCare ​ MedWise HealthCare ​ Shared Services ​ Consolidated Adjusted EBITDA (loss): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Adjusted EBITDA (loss) ​ $ 12,910 ​ $ 1,864 ​ $ (11,175) ​ $ 3,599 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Adjusted EBITDA (loss) ​ $ 11,748 ​ $ 2,831 ​ $ (9,772) ​ $ 4,807 ​ The following table presents the Company’s reconciliation of the segments’ total Adjusted EBITDA to net loss as presented in the consolidated statements of operations: ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, ​ 2021 2020 Reconciliation of net loss to Adjusted EBITDA ​ ​ ​ ​ ​ ​ Net loss ​ $ (19,492) ​ $ (14,437) Add: ​ ​ ​ ​ ​ ​ Interest expense, net ​ ​ 2,547 ​ ​ 4,610 Income tax expense (benefit) ​ ​ 199 ​ ​ (3,367) Depreciation and amortization ​ ​ 11,625 ​ ​ 9,913 Change in fair value of acquisition-related contingent consideration expense ​ ​ — ​ ​ 700 Acquisition-related expense ​ ​ 118 ​ ​ 251 Stock-based compensation expense ​ ​ 8,602 ​ ​ 7,137 Adjusted EBITDA ​ $ 3,599 ​ $ 4,807 ​ Asset information by segment is not a key measure of performance used by the CODM. Accordingly, the Company has not disclosed asset information by segment.

Basis of Presentation, Summar_2

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements (Policies)	3 Months Ended
	Mar. 31, 2021
Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements
Basis of Presentation	Basis of Presentation ​ The accompanying unaudited consolidated financial statements of the Company have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (the “SEC”) regarding interim financial reporting. The unaudited interim consolidated financial statements have been prepared on the same basis as the annual audited consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting of normal recurring accruals and adjustments) necessary to present fairly the Company's interim consolidated financial position for the periods indicated. The interim results for the three months ended March 31, 2021 are not necessarily indicative of results to be expected for the year ending December 31, 2021, any other interim periods, or any future year or period. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the audited consolidated financial statements and accompanying notes included in the Company’s annual report on Form 10-K filed on February 26, 2021 (“2020 Form 10-K”). ​ The Company operates its business through two segments, CareVention HealthCare and MedWise HealthCare. See Note 17 for a discussion of the Company’s reportable segments.
Risks Related to the COVID-19 Pandemic	Risks Related to the COVID-19 Pandemic On January 30, 2020, the World Health Organization (“WHO”) announced a global health emergency caused by a new strain of coronavirus (“COVID-19”), originating in Wuhan, China and the risks to the international community. In March 2020, the WHO classified the COVID-19 outbreak as a pandemic (“COVID-19 pandemic), based on the rapid increase in exposure globally. The full impact of the COVID-19 pandemic continues to evolve as of the date these consolidated financial statements were issued. As such, the full magnitude of the impact that the pandemic will have on the Company’s future results of operations remains uncertain. Management is actively monitoring the global situation and the ramification on the Company’s financial condition, liquidity, operations, suppliers, industry, and workforce. Given the daily evolution of the COVID-19 pandemic and the global responses to curb its spread, the Company is not able to estimate the effects that the COVID-19 pandemic may have on the Company’s results of operations, financial condition, or liquidity for 2021. However, the Company is dependent on its workforce to sell and deliver its products and services. Social distancing and shelter-in-place directives could impact the Company’s ability to deploy its workforce effectively. These same developments may affect the operations of the Company’s suppliers and customers, as their own workforces and operations are disrupted by this virus. ​ As a result of the ongoing COVID-19 pandemic, the Company has experienced challenges with revenue growth. During 2020, the pandemic had delayed the closing of contracts across both the Company’s CareVention HealthCare and MedWise HealthCare segments and, in some cases, shifted project priorities and timelines, which management believed resulted in fewer business wins during 2020 and reduced future revenue. Overall census growth for Programs of All-Inclusive Care for the Elderly (“PACE”) had remained below historical levels during 2020 and into the first quarter of 2021, which has affected the Company’s CareVention HealthCare segment growth. During 2020, the Company’s MedWise HealthCare segment had experienced delays in the timing of implementation and closing of new business and a negative impact from COVID-19 on medication adherence initiatives. The Company does not yet know the full extent of potential delays or impacts on its business, financing or other activities, or on the broader healthcare industry or the global economy as a whole. These effects could have a material impact on the Company’s liquidity, capital resources, operations and business and those of the third parties on which it relies.
Recent Accounting Pronouncements	Recent Accounting Pronouncements ​ In August 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40) ​ Under ASC 470-20 Debt with Conversion and Other Options ​ ASU 2020-06 allows adoption through either a modified retrospective method or fully retrospective method of transition. The Company early adopted ASU 2020-06 effective January 1, 2021 using the modified retrospective method. In applying the modified retrospective transition method, the cumulative effect of the accounting change is recognized as an adjustment to the opening balance of retained earnings at the date of adoption. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. See Note 12 for further details on the 2026 Notes.

Revenue (Tables)

Revenue (Tables)	3 Months Ended
	Mar. 31, 2021
Revenue
Schedule of disaggregation of revenue	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, ​ ​ ​ 2021 ​ ​ 2020 CareVention HealthCare: ​ ​ ​ ​ ​ ​ PACE product revenue ​ $ 41,842 ​ $ 37,087 PACE solutions ​ ​ 13,919 ​ ​ 11,571 ​ ​ $ 55,761 ​ $ 48,658 MedWise HealthCare: ​ ​ ​ ​ ​ ​ Product revenue ​ $ 136 ​ $ — Medication safety services ​ ​ 10,725 ​ ​ 14,320 Software subscription and services ​ ​ 10,058 ​ ​ 9,849 ​ ​ $ 20,919 ​ $ 24,169 Total revenue ​ $ 76,680 ​ $ 72,827
Schedule of contract assets and contract liabilities from contracts with customers	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, ​ December 31, ​ ​ 2021 2020 Contract assets ​ $ 8,948 ​ $ 7,601 Contract liabilities ​ ​ 5,287 ​ ​ 3,876
Schedule of significant changes in the contract assets and the contract liabilities balances	​ ​ ​ ​ ​ ​ ​ March 31, ​ ​ 2021 Contract assets: ​ ​ ​ Contract assets, beginning of period ​ $ 7,601 Decreases due to cash received ​ ​ (6,121) Changes to the contract assets at the beginning of the period as a result of changes in estimates ​ ​ 2,654 Changes during the period, net of reclassifications to receivables ​ ​ 4,814 Contract assets, end of period ​ $ 8,948 ​ ​ ​ ​ Contract liabilities: ​ ​ ​ Contract liabilities, beginning of period ​ $ 3,876 Revenue recognized that was included in the contract liabilities balance at the beginning of the period ​ ​ (2,288) Increases due to cash received, excluding amounts recognized as revenue during the period ​ ​ 3,699 Contract liabilities, end of period ​ $ 5,287

Net Loss per Share (Tables)

Net Loss per Share (Tables)	3 Months Ended
	Mar. 31, 2021
Net Loss per Share
Schedule of calculation of basic and diluted net (loss) income per share	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, ​ 2021 2020 Numerator (basic and diluted): ​ ​ ​ ​ ​ Net loss ​ $ (19,492) ​ $ (14,437) Denominator (basic and diluted): ​ ​ ​ ​ ​ ​ Weighted average shares of common stock outstanding, basic and diluted ​ ​ 23,010,531 ​ ​ 21,374,897 Net loss per share, basic and diluted ​ $ (0.85) ​ $ (0.68)
Schedule of shares excluded from the calculation of diluted net loss per share attributable to common stockholders	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, ​ 2021 2020 Stock options to purchase common stock ​ 1,846,707 ​ 2,627,493 Unvested restricted stock ​ 1,651,806 ​ 1,314,635 Common stock warrants ​ 4,646,393 ​ 4,646,393 Conversion of convertible senior subordinated notes ​ 4,646,393 ​ — Contingently issuable shares ​ — ​ 63,320 ​ ​ 12,791,299 ​ 8,651,841

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2021
Acquisitions
Schedule of proforma results	​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, ​ 2020 Revenue ​ $ 75,671 Net loss ​ ​ (14,206)

Other Current Assets (Tables)

Other Current Assets (Tables)	3 Months Ended
	Mar. 31, 2021
Other Current Assets
Schedule of Other Current Assets	​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Contract assets ​ $ 8,948 ​ $ 7,601 Non-trade receivables ​ ​ 1,421 ​ ​ 647 Other ​ ​ 1,603 ​ ​ 1,504 Total other current assets ​ $ 11,972 ​ $ 9,752

Software Development Costs (Tab

Software Development Costs (Tables)	3 Months Ended
	Mar. 31, 2021
Software Development Costs
Schedule of capitalized software costs	​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Software development costs $ 54,414 ​ $ 48,548 Less: accumulated amortization ​ (23,669) ​ ​ (20,666) Software development costs, net $ 30,745 ​ $ 27,882 ​ ​ ​ ​ ​ ​ Capitalized software development costs included above not yet subject to amortization $ 5,823 ​ $ 4,382

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2021
Goodwill and Intangible Assets
Schedule of goodwill	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ CareVention HealthCare ​ ​ MedWise HealthCare ​ ​ Total Balance at January 1, 2021 $ 115,350 ​ $ 55,512 ​ $ 170,862 Adjustments to goodwill related to prior year acquisition ​ (27) ​ ​ — ​ ​ (27) Balance at March 31, 2021 $ 115,323 ​ $ 55,512 ​ $ 170,835
Schedule of intangible assets	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted Average ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amortization Period ​ ​ ​ ​ Accumulated ​ Intangible ​ (in years) Gross Value Amortization Assets, net March 31, 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Trade names ​ 3.6 ​ $ 11,955 ​ $ (8,844) ​ $ 3,111 Client relationships ​ 12.2 ​ ​ 152,654 ​ ​ (35,591) ​ ​ 117,063 Non-competition agreements ​ 5.0 ​ ​ 6,892 ​ ​ (4,321) ​ ​ 2,571 Developed technology ​ 8.0 ​ ​ 67,369 ​ ​ (27,054) ​ ​ 40,315 Patient database ​ 5.0 ​ ​ 21,700 ​ ​ (9,042) ​ ​ 12,658 Domain name ​ 10.0 ​ ​ 59 ​ ​ (22) ​ ​ 37 Total intangible assets ​ ​ ​ $ 260,629 ​ $ (84,874) ​ $ 175,755 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted Average ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Amortization Period ​ ​ ​ ​ Accumulated ​ Intangible ​ (in years) Gross Value Amortization Assets, net December 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Trade names ​ 3.7 ​ $ 11,955 ​ $ (8,286) ​ $ 3,669 Client relationships ​ 12.2 ​ ​ 152,654 ​ ​ (32,437) ​ ​ 120,217 Non-competition agreements ​ 5.0 ​ ​ 6,892 ​ ​ (3,976) ​ ​ 2,916 Developed technology ​ 8.0 ​ ​ 67,369 ​ ​ (24,858) ​ ​ 42,511 Patient database ​ 5.0 ​ ​ 21,700 ​ ​ (7,957) ​ ​ 13,743 Domain name ​ 10.0 ​ ​ 59 ​ ​ (21) ​ ​ 38 Total intangible assets ​ ​ ​ $ 260,629 ​ $ (77,535) ​ $ 183,094
Schedule of estimated amortization expense	​ ​ ​ ​ ​ Years Ending December 31, ​ ​ 2021 (April 1 - December 31) $ 21,105 2022 ​ ​ 27,089 2023 ​ ​ 25,804 2024 ​ ​ 18,521 2025 ​ ​ 14,038 2026 ​ ​ 12,830 Thereafter ​ ​ 56,368 Total estimated amortization expense ​ $ 175,755

Accrued Expenses and Other Li_2

Accrued Expenses and Other Liabilities (Tables)	3 Months Ended
	Mar. 31, 2021
Accrued Expenses and Other Liabilities
Schedule of accrued expenses and other liabilities	​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Employee related expenses ​ $ 8,260 ​ $ 8,218 Contract liability ​ ​ 4,584 ​ ​ 3,205 Customer deposits ​ ​ 904 ​ ​ 904 Client funds obligations* ​ ​ 3,294 ​ ​ 5,170 Contract labor ​ ​ 1,644 ​ ​ 1,374 Interest ​ ​ 2,637 ​ ​ 3,690 Professional fees ​ ​ 533 ​ ​ 572 Consideration payable to customer ​ ​ 9,921 ​ ​ 5,968 Non-income taxes payable ​ ​ 161 ​ ​ 151 Other expenses ​ ​ 3,226 ​ ​ 2,716 Total accrued expenses and other liabilities ​ $ 35,164 ​ $ 31,968

Lines of Credit and Long-Term_2

Lines of Credit and Long-Term Debt (Tables)	3 Months Ended
	Mar. 31, 2021
Lines of Credit and Long-Term Debt
Schedule of long-term debt obligations	​ ​ ​ ​ ​ ​ ​ ​ ​ March 31, 2021 December 31, 2020 Convertible senior subordinated notes ​ $ 325,000 ​ $ 325,000 Unamortized discount, including debt issuance costs, on convertible senior subordinated notes ​ ​ (6,684) ​ ​ (85,715) Convertible senior subordinated notes, net ​ ​ 318,316 ​ ​ 239,285 Finance leases ​ ​ 1 ​ ​ 4 Total long-term debt and finance leases, net ​ ​ 318,317 ​ ​ 239,289 Less current portion of finance leases ​ ​ (1) ​ ​ (4) Total long-term debt, net ​ $ 318,316 ​ $ 239,285

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2021
Stock-Based Compensation
Summary of restricted stock award activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ average ​ ​ Number ​ grant-date ​ of shares fair value Outstanding at December 31, 2020 ​ 1,386,908 ​ ​ 44.14 Granted ​ 629,088 ​ ​ 54.92 Vested ​ (351,310) ​ ​ 49.42 Forfeited ​ (12,880) ​ ​ 57.48 Outstanding at March 31, 2021 ​ 1,651,806 ​ $ 47.02
Schedule of weighted average assumptions for employee grants	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ ​ March 31, Valuation assumptions: 2021 2020 Expected volatility ​ 58.57 % ​ 56.10 % Expected term (years) ​ 5.48 ​ ​ 5.25 ​ Risk-free interest rate ​ 0.50 % ​ 1.22 % Dividend yield ​ — ​ ​ — ​
Summary of stock option activity	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Weighted ​ ​ ​ ​ ​ ​ ​ Weighted ​ average ​ ​ ​ ​ ​ ​ ​ average ​ remaining ​ Aggregate ​ ​ Number ​ exercise ​ contractual ​ intrinsic ​ of shares price term value Outstanding at December 31, 2020 ​ 2,096,556 ​ ​ 27.74 ​ ​ ​ ​ Granted ​ 2,500 ​ ​ 55.01 ​ ​ ​ ​ ​ Exercised ​ (224,503) ​ ​ 11.14 ​ ​ ​ ​ ​ Forfeited ​ (27,846) ​ ​ 39.51 ​ ​ ​ ​ ​ Outstanding at March 31, 2021 ​ 1,846,707 ​ $ 29.62 ​ 6.1 ​ $ 37,286 Options vested and expected to vest at March 31, 2021 ​ 1,846,707 ​ $ 29.62 ​ 6.1 ​ $ 37,286 Exercisable at March 31, 2021 ​ 1,479,329 ​ $ 24.29 ​ 5.7 ​ $ 36,092
Schedule of recorded stock-based compensation expense related to stock options	​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended ​ March 31, ​ 2021 2020 Cost of revenue - product $ 259 ​ $ 182 Cost of revenue - service ​ 1,079 ​ ​ 763 Research and development ​ 1,435 ​ ​ 1,409 Sales and marketing ​ 1,068 ​ ​ 528 General and administrative ​ 4,761 ​ ​ 4,255 Total stock-based compensation expense $ 8,602 ​ $ 7,137

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
	Mar. 31, 2021
Fair Value Measurements
Schedule of carrying value and fair value of financial instruments	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Face Value Carrying Value Fair Value 1.75% Convertible Senior Subordinated Notes due 2026 ​ $ 325,000 ​ $ 318,316 ​ $ 325,133

Segment Reporting (Tables)

Segment Reporting (Tables)	3 Months Ended
	Mar. 31, 2021
Segment Reporting
Schedule of reportable operating segment information	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ CareVention HealthCare ​ MedWise HealthCare ​ Consolidated Revenue: ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ Product revenue ​ $ 41,842 ​ $ 136 ​ $ 41,978 Service revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ PACE solutions ​ ​ 13,919 ​ ​ — ​ ​ 13,919 Medication safety services ​ ​ — ​ ​ 10,725 ​ ​ 10,725 Software subscription and services ​ ​ — ​ ​ 10,058 ​ ​ 10,058 Total service revenue ​ ​ 13,919 ​ ​ 20,783 ​ ​ 34,702 Total revenue ​ $ 55,761 ​ $ 20,919 ​ $ 76,680 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ Product revenue ​ $ 37,087 ​ $ — ​ $ 37,087 Service revenue ​ ​ ​ ​ ​ ​ ​ ​ ​ PACE solutions ​ ​ 11,571 ​ ​ — ​ ​ 11,571 Medication safety services ​ ​ — ​ ​ 14,320 ​ ​ 14,320 Software subscription and services ​ ​ — ​ ​ 9,849 ​ ​ 9,849 Total service revenue ​ ​ 11,571 ​ ​ 24,169 ​ ​ 35,740 Total revenue ​ $ 48,658 ​ $ 24,169 ​ $ 72,827 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ CareVention HealthCare ​ MedWise HealthCare ​ Shared Services ​ Consolidated Adjusted EBITDA (loss): ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2021 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Adjusted EBITDA (loss) ​ $ 12,910 ​ $ 1,864 ​ $ (11,175) ​ $ 3,599 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, 2020 ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Adjusted EBITDA (loss) ​ $ 11,748 ​ $ 2,831 ​ $ (9,772) ​ $ 4,807
Schedules of reconciliation of net loss to Adjusted EBITDA	​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Three Months Ended March 31, ​ 2021 2020 Reconciliation of net loss to Adjusted EBITDA ​ ​ ​ ​ ​ ​ Net loss ​ $ (19,492) ​ $ (14,437) Add: ​ ​ ​ ​ ​ ​ Interest expense, net ​ ​ 2,547 ​ ​ 4,610 Income tax expense (benefit) ​ ​ 199 ​ ​ (3,367) Depreciation and amortization ​ ​ 11,625 ​ ​ 9,913 Change in fair value of acquisition-related contingent consideration expense ​ ​ — ​ ​ 700 Acquisition-related expense ​ ​ 118 ​ ​ 251 Stock-based compensation expense ​ ​ 8,602 ​ ​ 7,137 Adjusted EBITDA ​ $ 3,599 ​ $ 4,807

Nature of Business (Details)

Nature of Business (Details) pharmacy in Thousands, individual in Thousands, $ in Billions	3 Months Ended
	Mar. 31, 2021USD ($)itemInstitutionplanpharmacyindividual
Nature of Business
Estimated U.S. annual cost for adverse drug events | $	$ 528
Number of call centers	7
Minimum
Nature of Business
Estimated annual deaths in U.S. due to adverse drug events | individual	275
Health plans | Minimum
Nature of Business
Number of organizations served | plan	280
Pharmacies
Nature of Business
Number of organizations served | pharmacy	14
Hospitals
Nature of Business
Number of organizations served | Institution	300
At-risk provider-based groups | Minimum
Nature of Business
Number of organizations served	130

Basis of Presentation, Summar_3

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements - Basis of Presentation (Details)	3 Months Ended
	Mar. 31, 2021segment
Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements
Number of operating segment	2

Basis of Presentation, Summar_4

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements - Recent Accounting Pronouncements (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Jan. 01, 2021	Dec. 31, 2020	Mar. 31, 2020	Dec. 31, 2019	Feb. 12, 2019
Recent Accounting Pronouncements
Stockholders' Equity Attributable to Parent	$ 83,624		$ 168,529	$ 179,401	$ 185,548
Additional paid-in capital	288,698		352,445
Deferred tax liability, net	1,063		3,354
Accumulated deficit	$ (200,784)		(179,900)
Convertible Senior Subordinated Notes
Recent Accounting Pronouncements
Interest rate (as a percent)	1.75%					1.75%
Long term debt, net	$ 318,316		239,285
Accounting Standards Update 2020-06
Recent Accounting Pronouncements
Change in Accounting Principle, Accounting Standards Update, Adopted		true
Change in Accounting Principle, Accounting Standards Update, Early Adoption		true
Cumulative Effect, Period of Adoption, Adjustment
Recent Accounting Pronouncements
Stockholders' Equity Attributable to Parent			(76,242)
Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06
Recent Accounting Pronouncements
Additional paid-in capital			(74,850)
Deferred tax liability, net			(2,465)
Accumulated deficit			(1,392)
Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06 | Convertible Senior Subordinated Notes
Recent Accounting Pronouncements
Long term debt, net			$ 78,707

Revenue - General (Details)

Revenue - General (Details)	3 Months Ended
	Mar. 31, 2021
Minimum
Contract with customer
Contract term	1 year
Termination notice period	0 days
Maximum
Contract with customer
Contract term	5 years
Termination notice period	180 days

Revenue - Disaggregation (Detai

Revenue - Disaggregation (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Disaggregation of revenue
Total revenue	$ 76,680	$ 72,827
Product
Disaggregation of revenue
Total revenue	41,978	37,087
Service
Disaggregation of revenue
Total revenue	34,702	35,740
PACE solutions
Disaggregation of revenue
Total revenue	13,919	11,571
Medication safety services
Disaggregation of revenue
Total revenue	10,725	14,320
Software subscription and services
Disaggregation of revenue
Total revenue	10,058	9,849
CareVention HealthCare
Disaggregation of revenue
Total revenue	55,761	48,658
CareVention HealthCare | Product
Disaggregation of revenue
Total revenue	41,842	37,087
CareVention HealthCare | PACE product revenue
Disaggregation of revenue
Total revenue	41,842	37,087
CareVention HealthCare | Service
Disaggregation of revenue
Total revenue	13,919	11,571
CareVention HealthCare | PACE solutions
Disaggregation of revenue
Total revenue	13,919	11,571
MedWise HealthCare
Disaggregation of revenue
Total revenue	20,919	24,169
MedWise HealthCare | Product
Disaggregation of revenue
Total revenue	136
MedWise HealthCare | Service
Disaggregation of revenue
Total revenue	20,783	24,169
MedWise HealthCare | Medication safety services
Disaggregation of revenue
Total revenue	10,725	14,320
MedWise HealthCare | Software subscription and services
Disaggregation of revenue
Total revenue	$ 10,058	$ 9,849

Revenue - Contract Balances (De

Revenue - Contract Balances (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Contract Balances
Contract assets	$ 8,948	$ 7,601
Contract liabilities	$ 5,287	$ 3,876	$ 4,930

Revenue - Change in contract ba

Revenue - Change in contract balances (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Contract assets:
Contract assets, beginning of period	$ 7,601
Decreases due to cash received	(6,121)
Changes to the contract assets at the beginning of the period as a result of changes in estimates	2,654
Changes during the period, net of reclassifications to receivables	4,814
Contract assets, end of period	8,948
Contract liabilities:
Contract liabilities, beginning of period	3,876	$ 4,930
Revenue recognized that was included in the contract liabilities balance at the beginning of the period	(2,288)	$ (2,618)
Increases due to cash received, excluding amounts recognized as revenue during the period	3,699
Contract liabilities, end of period	$ 5,287

Net Loss per Share - EPS (Detai

Net Loss per Share - EPS (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Numerator (basic and diluted):
Net loss, basic	$ (19,492)	$ (14,437)
Net loss, diluted	$ (19,492)	$ (14,437)
Denominator (basic and diluted):
Weighted average common shares outstanding, basic and diluted (in shares)	23,010,531	21,374,897
Net loss per share, basic and diluted (in dollars per share)	$ (0.85)	$ (0.68)

Net Loss per Share - Anti-dilut

Net Loss per Share - Anti-dilutive Securities (Details) - shares	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Securities excluded from the calculation of diluted net loss per share attributable to common stockholders
Amount of antidilutive securities excluded from computation of earnings per share	12,791,299	8,651,841
Stock options
Securities excluded from the calculation of diluted net loss per share attributable to common stockholders
Amount of antidilutive securities excluded from computation of earnings per share	1,846,707	2,627,493
Restricted stock
Securities excluded from the calculation of diluted net loss per share attributable to common stockholders
Amount of antidilutive securities excluded from computation of earnings per share	1,651,806	1,314,635
Common stock warrants/Convertible note warrants
Securities excluded from the calculation of diluted net loss per share attributable to common stockholders
Amount of antidilutive securities excluded from computation of earnings per share	4,646,393	4,646,393
Option indexed to own shares, convertible senior subordinated notes
Securities excluded from the calculation of diluted net loss per share attributable to common stockholders
Amount of antidilutive securities excluded from computation of earnings per share	4,646,393
Contingently issuable shares
Securities excluded from the calculation of diluted net loss per share attributable to common stockholders
Amount of antidilutive securities excluded from computation of earnings per share		63,320

Acquisitions - Personica (Detai

Acquisitions - Personica (Details) - Personica, LLC $ in Thousands	Oct. 05, 2020USD ($)Dshares
Acquisition
Cash consideration	$ 10,000
Issuance of common stock (in shares) | shares	555,555
Purchase price consideration
Stock consideration at closing	$ 23,589
Note, Due January 1, 2021
Acquisition
Amount of promissory notes	7,500
Note, Due April 1, 2021
Acquisition
Amount of promissory notes	5,500
Note, Due October 5, 2021
Acquisition
Amount of promissory notes	$ 4,000
Number of business days from due date within which promissory note must be paid | D	2

Acquisitions - Pro forma (unaud

Acquisitions - Pro forma (unaudited) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)
Acquisitions
Revenue	$ 75,671
Net loss	$ (14,206)

Other Current Assets (Details)

Other Current Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Other Current Assets
Contract assets	$ 8,948	$ 7,601
Non-trade receivables	1,421	647
Other	1,603	1,504
Total other current assets	$ 11,972	$ 9,752

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Property and Equipment
Property and equipment, net	$ 14,240		$ 15,070
Depreciation and amortization	11,625	$ 9,913
Property and equipment
Property and Equipment
Accumulated depreciation	19,205		$ 17,922
Depreciation and amortization	$ 1,283	$ 1,268

Software Development Costs (Det

Software Development Costs (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Software Development Costs
Software development costs	$ 54,414		$ 48,548
Less: accumulated amortization	(23,669)		(20,666)
Software development costs, net	30,745		27,882
Capitalized software development costs included above not yet subject to amortization	5,823		$ 4,382
Amortization expense	$ 3,003	$ 1,823

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Goodwill (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)
Goodwill and related changes
Goodwill at beginning of period	$ 170,862
Adjustments to goodwill related to prior year acquisitions	(27)
Goodwill at end of period	170,835
CareVention HealthCare
Goodwill and related changes
Goodwill at beginning of period	115,350
Adjustments to goodwill related to prior year acquisitions	(27)
Goodwill at end of period	115,323
MedWise HealthCare
Goodwill and related changes
Goodwill at beginning of period	55,512
Goodwill at end of period	$ 55,512

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Intangible assets (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020
Intangible Assets
Gross Value	$ 260,629		$ 260,629
Accumulated Amortization	(84,874)		(77,535)
Intangible Assets, net	175,755		$ 183,094
Amortization expense	$ 7,339	$ 6,822
Trade name
Intangible Assets
Weighted Average Amortization Period	3 years 7 months 6 days		3 years 8 months 12 days
Gross Value	$ 11,955		$ 11,955
Accumulated Amortization	(8,844)		(8,286)
Intangible Assets, net	$ 3,111		$ 3,669
Client relationships
Intangible Assets
Weighted Average Amortization Period	12 years 2 months 12 days		12 years 2 months 12 days
Gross Value	$ 152,654		$ 152,654
Accumulated Amortization	(35,591)		(32,437)
Intangible Assets, net	$ 117,063		$ 120,217
Non-competition agreement
Intangible Assets
Weighted Average Amortization Period	5 years		5 years
Gross Value	$ 6,892		$ 6,892
Accumulated Amortization	(4,321)		(3,976)
Intangible Assets, net	$ 2,571		$ 2,916
Developed technology
Intangible Assets
Weighted Average Amortization Period	8 years		8 years
Gross Value	$ 67,369		$ 67,369
Accumulated Amortization	(27,054)		(24,858)
Intangible Assets, net	$ 40,315		$ 42,511
Patient database
Intangible Assets
Weighted Average Amortization Period	5 years		5 years
Gross Value	$ 21,700		$ 21,700
Accumulated Amortization	(9,042)		(7,957)
Intangible Assets, net	$ 12,658		$ 13,743
Domain name
Intangible Assets
Weighted Average Amortization Period	10 years		10 years
Gross Value	$ 59		$ 59
Accumulated Amortization	(22)		(21)
Intangible Assets, net	$ 37		$ 38

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Amortization (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Estimated amortization expense
2021 (April 1 - December 31)	$ 21,105
2022	27,089
2023	25,804
2024	18,521
2025	14,038
2026	12,830
Thereafter	56,368
Total estimated amortization expense	$ 175,755	$ 183,094

Notes Payable Related to Acqu_2

Notes Payable Related to Acquisition (Details) $ in Thousands	Oct. 05, 2020USD ($)D	Mar. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Notes Payable Related to Acquisition
Acquisition-related notes payable		$ 9,340	$ 16,662
Accrued interest payable		2,637	3,690
Notes | Personica, LLC
Notes Payable Related to Acquisition
Amount of promissory notes	$ 17,000
Interest rate (as a percent)	3.25%
Acquisition-related notes payable	$ 16,355	9,340	$ 16,662
Interest expense		254
Accrued interest payable		76
Amortization of discount to interest expense		$ 178
Note, Due January 1, 2021 | Personica, LLC
Notes Payable Related to Acquisition
Amount of promissory notes	7,500
Note, Due April 1, 2021 | Personica, LLC
Notes Payable Related to Acquisition
Amount of promissory notes	5,500
Note, Due October 5, 2021 | Personica, LLC
Notes Payable Related to Acquisition
Amount of promissory notes	$ 4,000
Number of business days from due date within which promissory note must be paid | D	2

Accrued Expenses and Other Li_3

Accrued Expenses and Other Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Accrued Expenses and Other Liabilities
Employee related expenses	$ 8,260	$ 8,218
Contract liability	4,584	3,205
Customer deposits	904	904
Client funds obligations	3,294	5,170
Contract labor	1,644	1,374
Interest	2,637	3,690
Professional fees	533	572
Consideration payable to customer	9,921	5,968
Non-income taxes payable	161	151
Other expenses	3,226	2,716
Total accrued expenses and other liabilities	$ 35,164	$ 31,968

Lines of Credit and Long-Term_3

Lines of Credit and Long-Term Debt - Lines of Credit (Details) - USD ($) $ in Thousands	Dec. 18, 2020	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Sep. 06, 2017
Lines of Credit
Amortization of deferred financing costs to interest expense		$ 133	$ 100
Deferred financing costs, net		1,005		$ 1,156
2020 Credit Facility and 2015 Line of Credit
Lines of Credit
Interest expense		261	0
Aggregate borrowings outstanding during the period			$ 0
2015 Line of Credit
Lines of Credit
Maximum borrowing capacity					$ 60,000
Sublimit of loan					$ 1,000
Letter of credit outstanding		100
Interest rate (as a percent)			5.58%
2020 Credit Facility
Lines of Credit
Maximum borrowing capacity	$ 120,000
Sublimit of loan	1,000
Amount available to be maintained for draw	$ 10,000,000
Trailing period	12 months
Commitment fee at closing (as a percent)	0.50%
Commitment fee payable on each anniversary (as a percent)	0.25%
Aggregate borrowings outstanding		17,500
Amounts available for borrowings		$ 102,400
Interest rate (as a percent)		3.36%
Effective rate, unused line fee (as a percent)		0.45%
Deferred financing costs, gross		$ 1,176
2020 Credit Facility | Maximum
Lines of Credit
Leverage ratio	3
2020 Credit Facility | LIBOR
Lines of Credit
Spread on variable rate (as a percent)	3.25%

Lines of Credit and Long-Term_4

Lines of Credit and Long-Term Debt - Convertible Senior Subordinated Notes (Details) $ / shares in Units, $ in Thousands	Feb. 12, 2019USD ($)D$ / shares	Mar. 31, 2021USD ($)	Mar. 31, 2020USD ($)	Jan. 01, 2021	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Lines of Credit and Long-Term Debt
Fair value of notes amortized to interest expense		$ 133	$ 100
Cash paid for interest		3,045	2,844
Accrued interest payable		2,637			$ 3,690
Stockholders' equity		83,624	179,401		168,529	$ 185,548
Additional paid-in capital		288,698			352,445
Deferred income tax liability, net		1,063			3,354
Accumulated deficit		(200,784)			(179,900)
Convertible Senior Subordinated Notes
Lines of Credit and Long-Term Debt
Aggregate borrowings	$ 325,000	$ 325,000
Interest rate (as a percent)	1.75%	1.75%
Initial conversion rate	0.0142966
Initial conversion price | $ / shares	$ 69.95
Principal amount	$ 1
Carrying amount of the equity component representing the conversion option	102,900
Deferred tax effect	$ 25,884
Effective interest rate	8.05%			2.20%
Debt issuance costs	$ 9,372
Issuance costs attributable to the liability component	$ 6,405
Interest expense		$ 1,746	4,573
Increase in accrued interest		1,422	1,421
Interest Payable		1,625
Non-cash accretion of the debt discounts		324	$ 3,152
Long term debt, net		318,316			239,285
Accrued interest payable		2,336
Amount of additional interest payable		$ 212
Convertible Senior Subordinated Notes | Debt Conversion Scenario One
Lines of Credit and Long-Term Debt
Trading days | D	20
Consecutive trading days | D	30
Stock price trigger percentage (as a percent)	130.00%
Convertible Senior Subordinated Notes | Debt Conversion Scenario Two
Lines of Credit and Long-Term Debt
Trading days | D	5
Consecutive trading days | D	5
Principal amount	$ 1
Stock price trigger percentage (as a percent)	98.00%
Cumulative Effect, Period of Adoption, Adjustment
Lines of Credit and Long-Term Debt
Stockholders' equity					(76,242)
Cumulative Effect, Period of Adoption, Adjustment | Accounting Standards Update 2020-06
Lines of Credit and Long-Term Debt
Additional paid-in capital					(74,850)
Deferred income tax liability, net					(2,465)
Accumulated deficit					(1,392)
Cumulative Effect, Period of Adoption, Adjustment | Convertible Senior Subordinated Notes | Accounting Standards Update 2020-06
Lines of Credit and Long-Term Debt
Long term debt, net					78,707
Cumulative Effect, Period of Adoption, Adjusted Balance | Accounting Standards Update 2020-06
Lines of Credit and Long-Term Debt
Issuance costs attributable to the liability component					$ 7,008

Lines of Credit and Long-Term_5

Lines of Credit and Long-Term Debt - Convertible Note Hedge and Warrant Transactions (Details) - USD ($) $ / shares in Units, $ in Thousands	Feb. 12, 2019	Mar. 31, 2021
Warrants and options indexed to Company's stock
Warrants exercised		0
Option indexed to own shares, convertible senior subordinated notes
Warrants and options indexed to Company's stock
Options indexed to Company's stock (in shares)	4,646,393
Price of options indexed to Company's stock (in dollars per share)	$ 105.58
Proceeds from sale of warrants	$ 65,910
Common stock warrants/Convertible note warrants
Warrants and options indexed to Company's stock
Option to purchase	4,646,393
Exercise price (in dollars per share)	$ 69.95
Premiums paid for the note hedges	$ 101,660

Lines of Credit and Long-Term_6

Lines of Credit and Long-Term Debt - Long-term debt (Details) - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020
Capital Lease Obligations
Finance leases	$ 1	$ 4
Total long-term debt and finance leases, net	318,317	239,289
Less current portion of finance leases	(1)	(4)
Total long-term debt, net	318,316	239,285
Convertible Senior Subordinated Notes
Capital Lease Obligations
Convertible senior subordinated notes	325,000	325,000
Unamortized discount, including debt issuance costs, on convertible senior subordinated notes	(6,684)	(85,715)
Convertible senior subordinated notes, net	$ 318,316	$ 239,285

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Income Taxes
Excess tax benefits	$ 23,628
Increase (decrease) valuation allowance	23,628
Income tax expense (benefit)	$ 199	$ (3,367)
Effective tax rate (as a percent)	(1.00%)	18.90%
Tax benefit based on estimated effective tax rate for the full year		$ 3,031
Income tax benefit, Tax windfall		$ 336

Stock-Based Compensation - Plan

Stock-Based Compensation - Plans (Details) - 2016 Plan - shares	Jan. 02, 2021	Sep. 30, 2016	Mar. 31, 2021
Stock-Based Compensation
Automatic increase on share reserve (as a percent)		5.00%
Additional shares authorized	1,200,244
Available for future grant (in shares)			1,785,765

Stock-Based Compensation - Rest

Stock-Based Compensation - Restricted Common Stock (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Weighted average grant date fair value
Stock-based compensation expense (in dollars)	$ 8,602	$ 7,137
Restricted stock
Number of shares
Outstanding at beginning of period (in shares)	1,386,908
Granted (in shares)	629,088
Vested (in shares)	(351,310)
Forfeited (in shares)	(12,880)
Outstanding at end of period (in shares)	1,651,806
Weighted average grant date fair value
Outstanding at beginning of period (in dollars per share)	$ 44.14
Granted (in dollars per share)	54.92
Vested (in dollars per share)	49.42
Forfeited (in dollars per share)	57.48
Outstanding at end of period (in dollars per share	$ 47.02
Stock-based compensation expense (in dollars)	$ 6,275	$ 4,139
Unrecognized compensation expense (in dollars)	$ 65,755
Weighted average period expected to be recognized	3 years 1 month 6 days

Stock-Based Compensation - Perf

Stock-Based Compensation - Performance Based Equity Awards (Details) - USD ($) $ / shares in Units, $ in Thousands	Oct. 29, 2020	May 04, 2020	Mar. 31, 2021	Mar. 31, 2020
Stock-Based Compensation
Stock- based stock awards expense			$ 8,602	$ 7,137
Performance-Based Stock Awards | Award Date, May 4, 2020
Stock-Based Compensation
Granted (in shares)		10,686
Vesting period		2 years
Weighted average grant-date fair value (in dollars per share)		$ 56.14
Stock- based stock awards expense			0
Unrecognized compensation expense (in dollars)			600
Performance-Based Stock Awards | Award Date, October 29, 2020
Stock-Based Compensation
Granted (in shares)	26,400
Weighted average grant-date fair value (in dollars per share)	$ 35.95
Stock- based stock awards expense			214
Unrecognized compensation expense (in dollars)			$ 583

Stock-Based Compensation - Othe

Stock-Based Compensation - Other Stock Awards (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Stock-Based Compensation
Stock-based compensation expense (in dollars)	$ 8,602	$ 7,137
Other stock awards
Stock-Based Compensation
Issuance of common stock awards (in shares)	1,416	9,386
Weighted average grant-date fair value (in dollars per share)	$ 40.85	$ 52.29
Stock-based compensation expense (in dollars)	$ 58	$ 491

Stock-Based Compensation - Opti

Stock-Based Compensation - Options Valuation (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Stock-Based Compensation
Stock-based compensation expense (in dollars)	$ 8,602	$ 7,137
Stock options
Stock-Based Compensation
Stock-based compensation expense (in dollars)	$ 2,055	$ 2,507
Valuation assumptions:
Expected volatility (as a percent)	58.57%	56.10%
Expected term (years)	5 years 5 months 23 days	5 years 3 months
Risk-free interest rate (as a percent)	0.50%	1.22%
Weighted average grant-date fair value (in dollars per share)	$ 28.26	$ 33.78

Stock-Based Compensation - Op_2

Stock-Based Compensation - Options Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Number of shares
Outstanding at beginning of period (in shares)	2,096,556
Granted (in shares)	2,500
Exercised (in shares)	(224,503)
Forfeited (in shares)	(27,846)
Outstanding at end of the period (in shares)	1,846,707
Options vested and expected to vest at end of the period (in shares)	1,846,707
Exercisable at end of period (in shares)	1,479,329
Weighted average exercise price
Outstanding at beginning of period (in dollars per share)	$ 27.74
Granted (in dollars per share)	55.01
Exercised (in dollars per share)	11.14
Forfeited (in dollars per share)	39.51
Outstanding at end of period (in dollars per share)	29.62
Options vested and expected to vest at end of period (in dollars per share)	29.62
Exercisable at end of period (in dollars per share)	$ 24.29
Weighted average remaining contractual term
Outstanding	6 years 1 month 6 days
Options vested and expected to vest at of the period	6 years 1 month 6 days
Exercisable	5 years 8 months 12 days
Aggregate intrinsic value
Outstanding (in dollars)	$ 37,286
Options vested and expected to vest at end of period (in dollars)	37,286
Exercisable (in dollars)	36,092
Additional disclosures
Intrinsic value of options exercised (in dollars)	7,768	$ 4,581
Proceeds from stock options exercised (in dollars)	2,226	$ 1,153
Stock options
Additional disclosures
Unrecognized compensation cost (in dollars)	$ 10,833
Weighted average period expected to be recognized	1 year 8 months 12 days

Stock-Based Compensation - Expe

Stock-Based Compensation - Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Stock-based compensation expense
Stock-based compensation expense (in dollars)	$ 8,602	$ 7,137
Cost of revenue - product
Stock-based compensation expense
Stock-based compensation expense (in dollars)	259	182
Cost of revenue - service
Stock-based compensation expense
Stock-based compensation expense (in dollars)	1,079	763
Research and development
Stock-based compensation expense
Stock-based compensation expense (in dollars)	1,435	1,409
Sales and marketing
Stock-based compensation expense
Stock-based compensation expense (in dollars)	1,068	528
General and administrative
Stock-based compensation expense
Stock-based compensation expense (in dollars)	$ 4,761	$ 4,255

Fair Value Measurements - Conti

Fair Value Measurements - Contingent consideration (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended
	Jan. 31, 2021	Mar. 31, 2021	Sep. 30, 2020	Mar. 31, 2020
Change in fair value
Payments of contingent consideration		$ 99
Change in fair value of acquisition-related contingent consideration expense				$ 700
Cognify, Inc
Change in fair value
Amount of accelerated payment paid or to be paid			$ 13,413
Payments of contingent consideration	$ 166		$ 6,394
Issuance of common stock (in shares)			135,434
Estimated fair value of contingent consideration			$ 6,853
Change in fair value of acquisition-related contingent consideration expense				$ 700

Fair Value Measurements - Finan

Fair Value Measurements - Financial Instruments (Details) - Convertible Senior Subordinated Notes - USD ($) $ in Thousands	Mar. 31, 2021	Dec. 31, 2020	Feb. 12, 2019
Fair Value Measurements
Interest rate (as a percent)	1.75%		1.75%
Face value	$ 325,000		$ 325,000
Amount before unaccreted debt discount and unamortized debt issuance costs	325,000	$ 325,000
Carrying Value
Fair Value Measurements
Debt instrument	318,316
Fair Value
Fair Value Measurements
Debt instrument	$ 325,133

Commitments and Contingencies -

Commitments and Contingencies - Vendor Purchase Agreements (Details) - USD ($) $ in Thousands	Jan. 01, 2020	Mar. 29, 2019	Mar. 31, 2021	Dec. 31, 2020
Thrifty Drug Stores, Inc.
Purchase Agreements
Purchase obligation (as a percent)		98.00%
Amount due as a result of prescription drug purchases			$ 1,285	$ 1,985
Data aggregation partner
Purchase Agreements
Purchase obligation period	3 years
Monthly minimum purchase obligation	$ 30

Segment Reporting - Revenue (De

Segment Reporting - Revenue (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2021USD ($)segment	Mar. 31, 2020USD ($)
Segment Reporting
Number of operating segment | segment	2
Number of reportable segment | segment	2
Total revenue	$ 76,680	$ 72,827
Product
Segment Reporting
Total revenue	41,978	37,087
Service
Segment Reporting
Total revenue	34,702	35,740
PACE solutions
Segment Reporting
Total revenue	13,919	11,571
Medication safety services
Segment Reporting
Total revenue	10,725	14,320
Software subscription and services
Segment Reporting
Total revenue	10,058	9,849
CareVention HealthCare
Segment Reporting
Total revenue	55,761	48,658
CareVention HealthCare | Product
Segment Reporting
Total revenue	41,842	37,087
CareVention HealthCare | Service
Segment Reporting
Total revenue	13,919	11,571
CareVention HealthCare | PACE solutions
Segment Reporting
Total revenue	13,919	11,571
MedWise HealthCare
Segment Reporting
Total revenue	20,919	24,169
MedWise HealthCare | Product
Segment Reporting
Total revenue	136
MedWise HealthCare | Service
Segment Reporting
Total revenue	20,783	24,169
MedWise HealthCare | Medication safety services
Segment Reporting
Total revenue	10,725	14,320
MedWise HealthCare | Software subscription and services
Segment Reporting
Total revenue	$ 10,058	$ 9,849

Segment Reporting - EBITDA (Det

Segment Reporting - EBITDA (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Segment Reporting
Adjusted EBITDA (loss)	$ 3,599	$ 4,807
Shared Services
Segment Reporting
Adjusted EBITDA (loss)	(11,175)	(9,772)
CareVention HealthCare | Operating Segments
Segment Reporting
Adjusted EBITDA (loss)	12,910	11,748
MedWise HealthCare | Operating Segments
Segment Reporting
Adjusted EBITDA (loss)	$ 1,864	$ 2,831

Segment Reporting - Reconciliat

Segment Reporting - Reconciliation of net loss to Adjusted EBITDA (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2021	Mar. 31, 2020
Reconciliation of net loss to Adjusted EBITDA
Net loss	$ (19,492)	$ (14,437)
Interest expense, net	2,547	4,610
Income tax expense (benefit)	199	(3,367)
Depreciation and amortization	11,625	9,913
Change in fair value of acquisition-related contingent consideration expense		700
Acquisition-related expense	118	251
Stock-based compensation expense	8,602	7,137
Adjusted EBITDA	$ 3,599	$ 4,807