R1 RCM (RCM) 10-Q 5 Nov 24 2024 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2024	Nov. 01, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	001-41428
Entity Registrant Name	R1 RCM Inc. /DE
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	87-4340782
Entity Address, Address Line One	433 W. Ascension Way
Entity Address, Address Line Two	Suite 200
Entity Address, City or Town	Murray
Entity Address, State or Province	UT
Entity Address, Postal Zip Code	84123
City Area Code	312
Local Phone Number	324-7820
Title of 12(b) Security	Common stock, par value $0.01 per share
Trading Symbol	RCM
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filter Category	Large Accelerated Filer
Smaller Reporting Company	false
Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		422,394,189
Amendment Flag	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Entity Central Index Key	0001910851
Current Fiscal Year End Date	--12-31

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 167.3	$ 173.6
Accounts receivable, net	356	269.4
Current portion of contract assets, net	100.8	94.4
Prepaid expenses and other current assets	144.8	95.9
Total current assets	768.9	633.3
Property, equipment and software, net	209.3	173.7
Operating lease right-of-use assets	71.8	62.5
Non-current portion of contract assets, net	43.3	37.7
Non-current portion of deferred contract costs	34.3	30.4
Intangible assets, net	1,508.8	1,310.7
Goodwill	3,045.6	2,629.4
Deferred tax assets	10.8	10.9
Other assets	56.5	71.6
Total assets	5,749.3	4,960.2
Current liabilities:
Accounts payable	34.4	22.7
Accrued compensation and benefits	152.3	126.3
Current portion of operating lease liabilities	22.7	19.3
Current portion of long-term debt	72.8	67
Accrued expenses and other current liabilities	87.1	65.9
Total current liabilities	429.6	346.2
Non-current portion of operating lease liabilities	82.2	77.8
Long-term debt	2,136.7	1,570.5
Deferred tax liabilities	243.5	176.6
Other non-current liabilities	33.9	23.2
Total liabilities	2,938.2	2,208.8
Stockholders’ equity:
Common stock, $0.01 par value, 750,000,000 shares authorized, 448,087,269 shares issued and 422,116,481 shares outstanding at September 30, 2024; 750,000,000 shares authorized, 445,436,482 shares issued and 420,201,507 shares outstanding at December 31, 2023	4.5	4.5
Additional paid-in capital	3,334.7	3,197.4
Accumulated deficit	(199.3)	(136.7)
Accumulated other comprehensive loss	(11.3)	(5.9)
Treasury stock, at cost, 25,970,788 shares as of September 30, 2024; 25,234,975 shares as of December 31, 2023	(317.5)	(307.9)
Total stockholders’ equity	2,811.1	2,751.4
Total liabilities and stockholders’ equity	5,749.3	4,960.2
Nonrelated party
Current assets:
Accounts receivable, net	317.6	243.3
Current liabilities:
Current portion of customer liabilities	55	39.8
Non-current portion of customer liabilities	1.9	2.7
Related party
Current assets:
Accounts receivable, net	38.4	26.1
Current liabilities:
Current portion of customer liabilities	5.3	5.2
Non-current portion of customer liabilities	$ 10.4	$ 11.8

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Accounts receivable, allowance	$ 27.8	$ 48.3
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	750,000,000	750,000,000
Common stock, shares issued (in shares)	448,087,269	445,436,482
Common stock, shares outstanding (in shares)	422,116,481	420,201,507
Treasury stock, shares (in shares)	25,970,788	25,234,975
Nonrelated party
Accounts receivable, allowance	$ 27.7	$ 48.2
Related party
Accounts receivable, allowance	$ 0.1	$ 0.1

Consolidated Statements of Oper

Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Net services revenue ($199.8 million and $640.8 million for the three and nine months ended September 30, 2024 and $227.3 million and $660.4 million for the three and nine months ended September 30, 2023 from related party)	$ 656.8	$ 572.8	$ 1,888.6	$ 1,679.1
Operating expenses:
Cost of services	545.5	447.5	1,549.4	1,328.1
Selling, general and administrative	62.3	54.7	184.9	164.3
Other expenses	33.2	29.4	101.4	87.9
Total operating expenses	641	531.6	1,835.7	1,580.3
Income from operations	15.8	41.2	52.9	98.8
Net interest expense	43.2	32.1	128.1	95.3
Income (loss) before income tax provision (benefit)	(27.4)	9.1	(75.2)	3.5
Income tax provision (benefit)	(7.5)	7.8	(12.6)	1.6
Net income (loss)	$ (19.9)	$ 1.3	$ (62.6)	$ 1.9
Net income (loss) per common share:
Basic (in dollars per share)	$ (0.05)	$ 0	$ (0.15)	$ 0
Diluted (in dollars per share)	$ (0.05)	$ 0	$ (0.15)	$ 0
Weighted average shares used in calculating net income (loss) per common share:
Basic (in shares)	422,101,172	419,008,998	421,289,787	418,299,910
Diluted (in shares)	422,101,172	456,364,024	421,289,787	454,837,597
Consolidated statements of comprehensive income (loss)
Net income (loss)	$ (19.9)	$ 1.3	$ (62.6)	$ 1.9
Other comprehensive income (loss):
Net change on derivatives designated as cash flow hedges, net of tax	(4.1)	(0.8)	(4.5)	2.4
Foreign currency translation adjustments	(0.2)	(1.3)	(0.9)	(0.7)
Total other comprehensive income (loss), net of tax	(4.3)	(2.1)	(5.4)	1.7
Comprehensive income (loss)	$ (24.2)	$ (0.8)	$ (68)	$ 3.6

Consolidated Statements of Op_2

Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Net services revenue	$ 656.8	$ 572.8	$ 1,888.6	$ 1,679.1
Related party
Net services revenue	$ 199.8	$ 227.3	$ 640.8	$ 660.4

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity (Unaudited) - USD ($) $ in Millions	Total	CoyCo 2	Common Stock	Treasury Stock	Additional Paid-In Capital	Additional Paid-In Capital CoyCo 2	Accumulated Deficit	Accumulated Other Comprehensive Income (Loss)
Beginning Balance (in shares) at Dec. 31, 2022			439,950,125
Beginning Balance at Dec. 31, 2022	$ 2,702.5		$ 4.4	$ (281.8)	$ 3,123.3		$ (140)	$ (3.4)
Beginning Balance (in shares) at Dec. 31, 2022				(23,352,240)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	10.7	$ 1.8			10.7	$ 1.8
Issuance of common stock related to share-based compensation plans (in shares)			2,308,591
Exercise of vested stock options (in shares)			180,453
Exercise of vested stock options	0.5				0.5
Acquisition of treasury stock related to share-based compensation plans (in shares)				(910,566)
Acquisition of treasury stock related to share-based compensation plans	(13.2)			$ (13.2)
Net change on derivatives designated as cash flow hedges, net of tax	(1.7)							(1.7)
Foreign currency translation adjustments	0.5							0.5
Net income (loss)	1.6						1.6
Ending Balance (in shares) at Mar. 31, 2023			442,439,169
Ending Balance at Mar. 31, 2023	2,702.7		$ 4.4	$ (295)	3,136.3		(138.4)	(4.6)
Ending Balance (in shares) at Mar. 31, 2023				(24,262,806)
Beginning Balance (in shares) at Dec. 31, 2022			439,950,125
Beginning Balance at Dec. 31, 2022	2,702.5		$ 4.4	$ (281.8)	3,123.3		(140)	(3.4)
Beginning Balance (in shares) at Dec. 31, 2022				(23,352,240)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net change on derivatives designated as cash flow hedges, net of tax	2.4
Foreign currency translation adjustments	(0.7)
Net income (loss)	1.9
Ending Balance (in shares) at Sep. 30, 2023			443,699,047
Ending Balance at Sep. 30, 2023	2,743.4		$ 4.4	$ (301.2)	3,180		(138.1)	(1.7)
Ending Balance (in shares) at Sep. 30, 2023				(24,641,082)
Beginning Balance (in shares) at Mar. 31, 2023			442,439,169
Beginning Balance at Mar. 31, 2023	2,702.7		$ 4.4	$ (295)	3,136.3		(138.4)	(4.6)
Beginning Balance (in shares) at Mar. 31, 2023				(24,262,806)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	20.7	1.9			20.7	1.9
Issuance of common stock related to share-based compensation plans (in shares)			812,138
Exercise of vested stock options (in shares)			122,990	4,118
Exercise of vested stock options	0.4			$ (0.1)	0.5
Acquisition of treasury stock related to share-based compensation plans (in shares)				(295,994)
Acquisition of treasury stock related to share-based compensation plans	(4.7)			$ (4.7)
Net change on derivatives designated as cash flow hedges, net of tax	4.9							4.9
Foreign currency translation adjustments	0.1							0.1
Net income (loss)	(1)						(1)
Ending Balance (in shares) at Jun. 30, 2023			443,374,297
Ending Balance at Jun. 30, 2023	2,725		$ 4.4	$ (299.8)	3,159.4		(139.4)	0.4
Ending Balance (in shares) at Jun. 30, 2023				(24,562,918)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	18.7	1.7			18.7	1.7
Issuance of common stock related to share-based compensation plans (in shares)			225,616
Exercise of vested stock options (in shares)			99,134
Exercise of vested stock options	0.2				0.2
Acquisition of treasury stock related to share-based compensation plans (in shares)				(78,164)
Acquisition of treasury stock related to share-based compensation plans	(1.4)			$ (1.4)
Net change on derivatives designated as cash flow hedges, net of tax	(0.8)							(0.8)
Foreign currency translation adjustments	(1.3)							(1.3)
Net income (loss)	1.3						1.3
Ending Balance (in shares) at Sep. 30, 2023			443,699,047
Ending Balance at Sep. 30, 2023	$ 2,743.4		$ 4.4	$ (301.2)	3,180		(138.1)	(1.7)
Ending Balance (in shares) at Sep. 30, 2023				(24,641,082)
Beginning Balance (in shares) at Dec. 31, 2023	445,436,482		445,436,482
Beginning Balance at Dec. 31, 2023	$ 2,751.4		$ 4.5	$ (307.9)	3,197.4		(136.7)	(5.9)
Beginning Balance (in shares) at Dec. 31, 2023	(25,234,975)			(25,234,975)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	$ 30.6	1.8			30.6	1.8
Issuance of common stock related to share-based compensation plans (in shares)			517,734
Issuance of warrants	59.8				59.8
Exercise of vested stock options (in shares)			189,490
Exercise of vested stock options	0.6				0.6
Acquisition of treasury stock related to share-based compensation plans (in shares)				(179,040)
Acquisition of treasury stock related to share-based compensation plans	(2.6)			$ (2.6)
Refund of inducement dividend (see Note 12)	16.4				16.4
Net change on derivatives designated as cash flow hedges, net of tax	1.1							1.1
Foreign currency translation adjustments	(0.4)							(0.4)
Net income (loss)	(35.1)						(35.1)
Ending Balance (in shares) at Mar. 31, 2024			446,143,706
Ending Balance at Mar. 31, 2024	$ 2,823.6		$ 4.5	$ (310.5)	3,306.6		(171.8)	(5.2)
Ending Balance (in shares) at Mar. 31, 2024				(25,414,015)
Beginning Balance (in shares) at Dec. 31, 2023	445,436,482		445,436,482
Beginning Balance at Dec. 31, 2023	$ 2,751.4		$ 4.5	$ (307.9)	3,197.4		(136.7)	(5.9)
Beginning Balance (in shares) at Dec. 31, 2023	(25,234,975)			(25,234,975)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Exercise of vested stock options (in shares)	486,114
Net change on derivatives designated as cash flow hedges, net of tax	$ (4.5)
Foreign currency translation adjustments	(0.9)
Net income (loss)	$ (62.6)
Ending Balance (in shares) at Sep. 30, 2024	448,087,269		448,087,269
Ending Balance at Sep. 30, 2024	$ 2,811.1		$ 4.5	$ (317.5)	3,334.7		(199.3)	(11.3)
Ending Balance (in shares) at Sep. 30, 2024	(25,970,788)			(25,970,788)
Beginning Balance (in shares) at Mar. 31, 2024			446,143,706
Beginning Balance at Mar. 31, 2024	$ 2,823.6		$ 4.5	$ (310.5)	3,306.6		(171.8)	(5.2)
Beginning Balance (in shares) at Mar. 31, 2024				(25,414,015)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	9.7	1.7			9.7	1.7
Issuance of common stock related to share-based compensation plans (in shares)			1,358,019
Issuance of warrants	(0.4)				(0.4)
Exercise of vested stock options (in shares)			258,503
Exercise of vested stock options	0.7				0.7
Acquisition of treasury stock related to share-based compensation plans (in shares)				(452,146)
Acquisition of treasury stock related to share-based compensation plans	(5.7)			$ (5.7)
Net change on derivatives designated as cash flow hedges, net of tax	(1.5)							(1.5)
Foreign currency translation adjustments	(0.3)							(0.3)
Net income (loss)	(7.6)						(7.6)
Ending Balance (in shares) at Jun. 30, 2024			447,760,228
Ending Balance at Jun. 30, 2024	2,820.2		$ 4.5	$ (316.2)	3,318.3		(179.4)	(7)
Ending Balance (in shares) at Jun. 30, 2024				(25,866,161)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Share-based compensation expense	7	$ 9.2			7	$ 9.2
Issuance of common stock related to share-based compensation plans (in shares)			288,920
Exercise of vested stock options (in shares)			38,121
Exercise of vested stock options	0.2				0.2
Acquisition of treasury stock related to share-based compensation plans (in shares)				(104,627)
Acquisition of treasury stock related to share-based compensation plans	(1.3)			$ (1.3)
Net change on derivatives designated as cash flow hedges, net of tax	(4.1)							(4.1)
Foreign currency translation adjustments	(0.2)							(0.2)
Net income (loss)	$ (19.9)						(19.9)
Ending Balance (in shares) at Sep. 30, 2024	448,087,269		448,087,269
Ending Balance at Sep. 30, 2024	$ 2,811.1		$ 4.5	$ (317.5)	$ 3,334.7		$ (199.3)	$ (11.3)
Ending Balance (in shares) at Sep. 30, 2024	(25,970,788)			(25,970,788)

Consolidated Statements of St_2

Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - USD ($) $ in Millions	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Accumulated Other Comprehensive Income (Loss)
Net change on derivatives designated as cash flow hedges, tax	$ (1.4)	$ (0.4)	$ 0.3	$ 0.3	$ 1.6	$ 0.5

Consolidated Statements of Cash

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Operating activities
Net income (loss)	$ (62.6)	$ 1.9
Adjustments to reconcile net income (loss) to net cash provided by operating activities:
Depreciation and amortization	242.7	205.6
Amortization of debt issuance costs	5.7	4.3
Share-based compensation	46.8	48.9
CoyCo 2 share-based compensation	12.7	5.4
Loss on disposal and right-of-use asset write-downs	0.6	10.3
Provision for credit losses	3	24.1
Deferred income taxes	(13.9)	(1.5)
Non-cash lease expense	10.2	8.7
Other	4.7	3.6
Changes in operating assets and liabilities:
Accounts receivable and related party accounts receivable	(41.9)	(36.7)
Contract assets	(11.8)	(10)
Prepaid expenses and other assets	(44.6)	(22)
Accounts payable	5.8	(15)
Accrued compensation and benefits	4	12
Lease liabilities	(16.3)	(13.4)
Other liabilities	5.6	12.9
Customer liabilities and customer liabilities - related party	21.9	(17.8)
Net cash provided by operating activities	172.6	221.3
Investing activities
Purchases of property, equipment, and software	(83.6)	(81.1)
Acquisition of Acclara, net of cash acquired	(662)	0
Other	(7.1)	5.5
Net cash used in investing activities	(752.7)	(75.6)
Financing activities
Refund of inducement dividend	16.4	0
Exercise of vested stock options	1.4	1.3
Shares withheld for taxes	(9.7)	(20)
Other	(0.3)	5.3
Net cash provided by (used in) financing activities	574.3	(90.5)
Effect of exchange rate changes in cash, cash equivalents and restricted cash	(0.5)	(0.4)
Net (decrease) increase in cash, cash equivalents and restricted cash	(6.3)	54.8
Cash, cash equivalents and restricted cash, at beginning of period	173.6	110.1
Cash, cash equivalents and restricted cash, at end of period	167.3	164.9
Supplemental disclosures of cash flow information
Property, equipment and software purchases not paid	21.2	20.3
Noncash consideration paid for the acquisition of Acclara	59.8	0
Senior Term Loan
Financing activities
Issuance of senior secured debt, net of discount and issuance costs and borrowings on revolver	561.5	0
Repayment of senior secured debt and revolver	(54.6)	(37.1)
Senior revolver
Financing activities
Issuance of senior secured debt, net of discount and issuance costs and borrowings on revolver	155	30
Repayment of senior secured debt and revolver	(95)	(70)
Payment of equity issuance costs	$ (0.4)	$ 0

Business Description and Basis

Business Description and Basis of Presentation	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Basis of Presentation	Business Description and Basis of Presentation Business Description R1 RCM Inc. (the “Company”) is a leading provider of technology-driven solutions that transform the financial performance and patient experience for health systems, hospitals, and physician groups. The Company’s scalable operating models complement a healthcare organization’s infrastructure, driving sustainable improvements to net patient revenue and cash flows while driving revenue yield, reducing operating costs, and enhancing the patient experience. Acclara Acquisition On January 17, 2024, the Company completed the acquisition of the revenue cycle management (“RCM”) business (“Acclara”) of Providence Health & Services – Washington (“Providence”) and certain of its affiliates (the “Acclara Acquisition”). Concurrently with the closing of the acquisition and as part of the consideration thereof, the Company issued a warrant to acquire up to 12,192,000 shares of common stock, par value $0.01 per share, at an initial exercise price of $10.52 per share, of the Company to Providence (the “Providence Warrant”). The Company acquired 100% of the equity interests in Acclara. For further details on the total consideration paid, see Note 2, Acquisitions. The acquisition of Acclara extends the Company’s ability to deploy advanced technology solutions and drive execution to improve customer and patient outcomes. In conjunction with the acquisition, the Company began a 10-year partnership with Providence for comprehensive revenue cycle services that leverage the breadth of integrated technology and services capabilities of both the Company and Acclara. Take-Private Merger Agreement On July 31, 2024, the Company entered into an Agreement and Plan of Merger (the “Merger Agreement”) with Raven Acquisition Holdings, LLC, a Delaware limited liability company (“Parent”), and Project Raven Merger Sub, Inc., a Delaware corporation and wholly owned subsidiary of Parent (“Merger Sub”, and together with Parent, the “Buyer Parties”), providing for, among other things and on the terms and subject to the conditions set forth therein, the merger of Merger Sub with and into the Company, with the Company continuing as the surviving corporation (the “Merger”). If the Merger is consummated, the Company’s common stock will be de-listed from Nasdaq and de-registered under the Securities Exchange Act of 1934, as amended, as promptly as practicable following the closing of the Merger. Parent and Merger Sub are affiliates of Clayton, Dubilier & Rice, LLC and TowerBrook Capital Partners L.P., which is an affiliate of TCP-ASC ACHI Series LLLP (“TCP-ASC”). Prior to the closing of the Merger, one or more stockholders of the Company (collectively, the “Rollover Stockholders”) may each enter into a rollover agreement with Raven TopCo, L.P., a Delaware limited partnership and an indirect parent entity of Parent (“Holdings”), or any subsidiary of Holdings that is wholly owned prior to the closing (each, a “Holdings Subsidiary”), on terms mutually agreeable among Parent and the parties to such agreement (collectively, the “Rollover Agreements”), pursuant to which, among other things, each such Rollover Stockholder will, immediately prior to the closing, transfer or contribute a number of shares of common stock of the Company (the “Rollover Shares”) to Holdings or a Holdings subsidiary in exchange for equity interests of Holdings or such Holdings Subsidiary having an equivalent value, on the terms and subject to the conditions set forth in the applicable Rollover Agreement. The holders of the Rollover Shares, if any, will not be entitled to receive the per share consideration described below in respect of the Rollover Shares. At the effective time of the Merger each share of common stock of the Company outstanding as of immediately prior to the effective time of the Merger (other than shares held by the Company, its subsidiaries, Parent, Merger Sub or TCP-ASC or by stockholders who have properly and validly exercised their statutory rights of appraisal in respect of such shares in accordance with Section 262 of the General Corporation Law of the State of Delaware) will be cancelled and extinguished and automatically converted into the right to receive cash in an amount equal to $14.30, without interest thereon. On September 13, 2024, the waiting period applicable to the Merger under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, expired. The consummation of the Merger remains subject to the mutual conditions set forth in the Merger Agreement, including, but not limited to, the: (i) affirmative vote of the holders of a majority of all of the outstanding shares of common stock of the Company to adopt the Merger Agreement and (ii) the absence of any law or order restraining, enjoining or otherwise prohibiting the Merger. In addition, the obligation of each party to consummate the Merger is conditioned upon the other party’s representations and warranties being true and correct (subject to certain customary materiality exceptions) and the other party having performed in all material respects its covenants, obligations and conditions under the Merger Agreement. The obligation of the Buyer Parties to consummate the Merger is also subject to the absence of a Company Material Adverse Effect (as defined in the Merger Agreement). The Company agreed to pay Parent $250.0 million in cash upon the termination of the Merger Agreement under certain circumstances. Parent agreed to pay the Company $550.0 million in cash upon the termination of the Merger Agreement under certain other circumstances. Pursuant to the rules adopted by the SEC, the Company prepared and filed with the SEC, a Definitive Proxy Statement and amended Transaction Statement on Schedule 13E-3 (together with the Buyer Parties) on October 16, 2024, containing more information about the Merger Agreement and the Merger. The special meeting of stockholders to adopt the Merger Agreement and related matters is scheduled to be held virtually on November 14, 2024. Transaction costs incurred related to the Merger have been classified as Other Expenses in the Consolidated Statements of Operations and Comprehensive Income (Loss) (Unaudited). See Note 9, Other Expenses, for further details. Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company’s financial position as of September 30, 2024, the results of operations of the Company for the three and nine months ended September 30, 2024 and 2023, and the cash flows of the Company for the nine months ended September 30, 2024 and 2023. These financial statements include the accounts of R1 RCM Inc. and its wholly owned subsidiaries, including Acclara and its subsidiaries since the date of acquisition. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information, have been included. Operating results for the three and nine months ended September 30, 2024 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2024. When preparing financial statements in conformity with GAAP, the Company makes a number of significant estimates, assumptions, and judgments in the preparation of the financial statements. Actual results could differ from those estimates. For a discussion of the Company’s significant accounting policies and other information, the unaudited consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements included in the Company’s Form 10-K for the year ended December 31, 2023, filed with the SEC on February 27, 2024 (the “2023 Form 10-K”). Recently Issued Accounting Standards and Disclosures In June 2022, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2022-03, Fair Value Measurement (Topic 820): Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (“ASU 2022-03”). ASU 2022-03 clarifies that a contractual sale restriction on an equity security should not be considered in measuring the security’s fair value. The Company prospectively adopted ASU 2022-03 effective January 1, 2024. Adoption of the new standard required changes to the valuation method used in accounting for equity consideration in business combinations occurring after January 1, 2024. There were no current period changes to equity consideration related to prior transactions to be evaluated under this guidance. In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”). ASU 2023-07 expands annual and interim disclosure requirements for reportable segments, primarily through enhanced disclosures about significant segment expenses. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. The Company is currently in the process of determining the impact that ASU 2023-07 will have on its consolidated financial statement disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”). ASU 2023-09 expands the disclosure requirements for income taxes, specifically related to the rate reconciliation and income taxes paid. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024. The Company is currently in the process of determining the impact that ASU 2023-09 will have on its consolidated financial statement disclosures.

Acquisitions

Acquisitions	9 Months Ended
	Sep. 30, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Acquisitions	Acquisitions Assets acquired and liabilities assumed in a business combination are recorded at their estimated fair value on the date of the acquisition. The difference between the purchase price amount and the net fair value of assets acquired and liabilities assumed is recognized as goodwill on the balance sheet if the purchase price exceeds the estimated net fair value or as a bargain purchase gain on the income statement if the purchase price is less than the estimated net fair value. The allocation of the purchase price may be modified through the end of the measurement period, which is up to one year after the acquisition date, as more information is obtained about the fair value of assets acquired and liabilities assumed as of the date of acquisition. Acclara On January 17, 2024, the Company completed the acquisition of Acclara for a final purchase price of $786.1 million, inclusive of purchase price adjustments based on the final determination of the closing net working capital. The following table summarizes the fair value of the total consideration paid: Fair Value Cash consideration (1) $ 726.3 Issuance of Providence Warrant (2) 59.8 Total consideration $ 786.1 (1) Cash consideration includes the repayment of Acclara’s pre-existing credit facility at closing, which was not assumed by the Company. During the three months ended June 30, 2024, the Company finalized the closing net working capital as defined in the purchase agreement, which resulted in additional consideration due to the seller of $0.1 million that was paid in the third quarter of 2024. (2) The provisional, undiscounted fair value of the Providence Warrant was estimated using the Black-Scholes option pricing model. The warrant is subject to a three-year lock-up period and expires five years from the issuance date. The Company funded the cash portion of the consideration and associated transaction expenses with a combination of cash on hand and the incurrence of additional indebtedness. See Note 6, Debt. The purchase price has been provisionally allocated to assets acquired and liabilities assumed based on their estimated fair value as of the acquisition date. The fair value estimates are pending finalization of the valuation of intangible assets and income and non-income related taxes. Accordingly, management considers the balances shown in the following table to be preliminary, and there could be adjustments to the consolidated financial statements, including changes in our amortization expense related to the valuation of intangible assets acquired and their respective useful lives. The preliminary fair value of assets acquired and liabilities assumed is: Purchase Price Allocation Total purchase consideration $ 786.1 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 64.3 Accounts receivable 47.8 Property, equipment and software 6.6 Operating lease right-of-use assets 12.3 Intangible assets 374.0 Goodwill 416.2 Other assets 8.1 Accounts payable (4.6) Customer liabilities (1.2) Accrued compensation and benefits (21.8) Operating lease liabilities (16.2) Deferred income tax liabilities (82.4) Other liabilities (17.0) Net assets acquired $ 786.1 The intangible assets preliminarily identified in conjunction with the Acclara Acquisition are as follows: Useful Life Gross Carrying Value Customer Relationships 12 years $ 374.0 The goodwill recognized is primarily attributable to synergies that are expected to be achieved by leveraging the R1 operating model to deliver services to Acclara customers upon integration. None of the goodwill is expected to be deductible for income tax purposes. The change in the carrying amount of goodwill from December 31, 2023 to September 30, 2024 is solely attributable to the goodwill recognized in conjunction with the Acclara Acquisition. As part of the acquisition, the Company recognized an indemnification asset of $4.5 million for indirect tax and income tax related to potential pre-transaction close tax obligations of Acclara. The indemnification asset was valued with the assistance of third-party tax experts and is a best estimate based on information available to the Company at the closing of the transaction. If the pre-transaction close tax obligations exceed the amount of the indemnification asset, the seller is liable for the incremental amount. Included in the Consolidated Statements of Operations and Comprehensive Income (Loss) for the three and nine months ended September 30, 2024 are net services revenue of $71.5 million and $199.1 million and net income before income taxes of $4.9 million and $0.7 million, respectively, related to the operations of Acclara since the acquisition date of January 17, 2024. Measurement period adjustments The Company had various measurement period adjustments due to additional information received since the Acclara Acquisition. The significant adjustments included a $1.9 million decrease to taxes payable and a $2.2 million decrease in deferred tax liability related to a revised tax provision estimate. The offset of these adjustments was recorded to goodwill. Pro Forma Results The following table summarizes, on a pro forma basis, the combined results of the Company as though the Acclara Acquisition had occurred on January 1, 2023. These pro forma results are not necessarily indicative of the actual consolidated results had the acquisition occurred as of that date or of the future consolidated operating results for any period. Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Net services revenue $ 656.8 $ 646.5 $ 1,900.4 $ 1,911.3 Net loss $ (16.7) $ (17.7) $ (35.6) $ (76.5) Adjustments, net of the income tax effects, that were made to net loss related to (i) depreciation and amortization to reflect the fair value of identified assets acquired, (ii) share-based compensation expense for awards replaced in connection with the acquisition, (iii) paying off Acclara’s debt and incurrence of debt by the Company, (iv) the timing of acquisition-related costs, and (v) accounting policy alignment.

Intangible Assets

Intangible Assets	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	Intangible Assets The following table provides the gross carrying value and accumulated amortization for each major class of definite-lived intangible assets at September 30, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 791.9 $ (101.1) $ 690.8 $ 417.9 $ (60.5) $ 357.4 Technology 1,238.8 (424.3) 814.5 1,238.8 (299.5) 939.3 Trade name 23.5 (20.0) 3.5 23.5 (9.5) 14.0 Total intangible assets $ 2,054.2 $ (545.4) $ 1,508.8 $ 1,680.2 $ (369.5) $ 1,310.7 The fair value of the identifiable intangible assets was determined in the period of their acquisition utilizing an income approach to derive the present value of future cash flows from developed technology, customer relationships, and trade name. Intangible asset amortization expense was $58.6 million and $175.9 million for the three and nine months ended September 30, 2024, respectively, and $50.4 million and $151.7 million for the three and nine months ended September 30, 2023, respectively. Amortization expense for intangible assets is included in cost of services on the Company’s Consolidated Statements of Operations and Comprehensive Income (Loss). The Company has no indefinite-lived intangible assets. Estimated annual amortization expense related to intangible assets with definite lives as of September 30, 2024 is as follows: Remainder of 2024 $ 58.6 2025 220.0 2026 219.4 2027 219.4 2028 219.3 2029 141.8 Thereafter 430.3 Total $ 1,508.8

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition Revenue is measured based on consideration specified in a contract with a customer, and presented net of any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contract term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved. Disaggregation of Revenue In the following table, revenue is disaggregated by source of revenue: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Net operating fees $ 413.0 $ 368.0 $ 1,169.1 $ 1,086.8 Incentive fees 22.4 30.1 59.7 84.5 Modular and other fees (1) 221.4 174.7 659.8 507.8 Net services revenue $ 656.8 $ 572.8 $ 1,888.6 $ 1,679.1 (1) Modular and other fees is comprised of service fees related to solutions focused on revenue recovery, clinical integrity, revenue optimization, and regulatory navigation as well as functional outsourcing solutions focused on driving revenue cycle improvements. Contract Balances The following table provides information about contract assets, net and contract liabilities from contracts with customers: September 30, 2024 December 31, 2023 Contract assets, net Current $ 100.8 $ 94.4 Non-current 43.3 37.7 Total contract assets, net $ 144.1 $ 132.1 Contract liabilities Current (1) $ 12.1 $ 9.1 Non-current (2) 12.3 14.5 Total contract liabilities $ 24.4 $ 23.6 (1) Current contract liabilities include $2.2 million and $2.4 million classified in the current portion of customer liabilities - related party as of September 30, 2024 and December 31, 2023, respectively. (2) Non-current contract liabilities include $10.4 million and $11.8 million classified in the non-current portion of customer liabilities - related party as of September 30, 2024 and December 31, 2023, respectively. Significant changes in the carrying amount of contract assets, net for the nine months ended September 30, 2024 were as follows: Contract Assets, net Balance as of December 31, 2023 $ 132.1 Revenue recognized 299.6 Amounts transferred to Accounts receivable, net (287.1) Write-offs (1) (0.5) Balance as of September 30, 2024 $ 144.1 (1) During the three months ended March 31, 2024, the Company wrote off the contract asset balance related to a private physician-owned for-profit healthcare network in the United States, who filed a voluntary petition for relief under Chapter 11 of the U.S. Bankruptcy Code on May 6, 2024. Contract Liabilities Balance as of December 31, 2023 $ (23.6) Advanced billings as of January 1, 2024 (1) (69.6) Advanced billings recognized 69.6 Additions (12.6) Revenue recognized (2) 11.8 Balance as of September 30, 2024 $ (24.4) (1) The Company records advanced billings to contract liabilities and accounts receivable on the first day of the respective service period, which billings are earned during the quarter. (2) Revenue recognized includes $1.7 million and $6.7 million of revenue recognition for the three and nine months ended September 30, 2024, respectively, relating to the contract liabilities balance at the beginning of the period. Transaction Price Allocated to the Remaining Performance Obligations The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period. The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Remainder of 2024 $ 36.8 $ 14.4 2025 78.2 24.5 2026 51.7 — 2027 13.4 — 2028 5.6 — 2029 1.9 — Thereafter 2.5 — Total $ 190.1 $ 38.9 The amounts presented in the table above include variable fee estimates of the Company’s physician group RCM services contracts, fixed fees, and forecasted incentive fees. Fixed fees are typically recognized ratably as the performance obligation is satisfied and forecasted incentive fees are measured cumulatively over the contractually defined performance period.

Accounts Receivable and Allowan

Accounts Receivable and Allowance for Credit Losses	9 Months Ended
	Sep. 30, 2024
Receivables [Abstract]
Accounts Receivable and Allowance for Credit Losses	Accounts Receivable and Allowance for Credit Losses Accounts receivable is comprised of invoiced and unbilled balances due from modular services and end-to-end RCM customers, which are presented net after considering cost reimbursements owed to end-to-end RCM customers. September 30, 2024 December 31, 2023 Billed receivables $ 268.1 $ 218.5 Unbilled receivables 115.7 99.2 Allowance for credit losses (27.8) (48.3) Total accounts receivable, net (1) $ 356.0 $ 269.4 (1) Includes $38.4 million and $26.1 million for accounts receivable - related party, net as of September 30, 2024, and December 31, 2023, respectively. The Company evaluates its accounts receivable for expected credit losses monthly. Accounts receivable due from end-to-end RCM customers are evaluated individually as it was determined that the unique nature and scope of our operating partner agreements make the circumstances around credit losses dissimilar. Accounts receivable due from modular service customers are evaluated using the pooling approach due to the homogeneous population of the receivables. The Company maintains an estimated allowance for credit losses to reduce its accounts receivable to the amount that it believes will be collected. This allowance is based on the Company’s historical experience, the length of time a balance has been outstanding, and the Company’s assessment of each customer’s ability to pay, which is based on input from key Company personnel assigned to the customer, the status of ongoing operations with the customer, and business and industry factors, such as significant shifts in the healthcare environment that could impact the customer’s financial health. Changes in the allowance for credit losses on a consolidated basis related to accounts receivable are as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Beginning balance $ 26.6 $ 31.6 $ 48.3 $ 15.2 Provision (recoveries) (1) 1.4 7.5 3.2 24.1 Write-offs (2) (0.2) (0.9) (23.7) (1.1) Ending balance $ 27.8 $ 38.2 $ 27.8 $ 38.2 (1) During the nine months ended September 30, 2023, the Company increased the allowance for credit losses by $11.6 million to fully reserve the outstanding accounts receivable exposure for the physician RCM customer that ceased operations and is in the process of liquidation pursuant to a Chapter 11 plan approved by the bankruptcy court in March 2024. (2) During the nine months ended September 30, 2024, the Company had $23.7 million in write-offs, which primarily related to the balance previously fully reserved in 2023 of the physician RCM customer that ceased operations in the third quarter of 2023 and is in the process of liquidation pursuant to a Chapter 11 plan approved by the bankruptcy court in March 2024.

Debt

Debt	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Debt	Debt The carrying amounts of debt consist of the following: September 30, 2024 December 31, 2023 Senior Revolver (1) $ 60.0 $ — Term A Loans 1,116.0 1,162.5 Term B Loans 1,060.6 493.8 Unamortized discount and issuance costs (27.1) (18.8) Total debt 2,209.5 1,637.5 Less: Current maturities (72.8) (67.0) Total long-term debt $ 2,136.7 $ 1,570.5 (1) As of September 30, 2024, the Company had $60.0 million in borrowings outstanding, $1.4 million letters of credit outstanding, and $538.6 million of availability under the $600.0 million senior secured revolving credit facility (“Senior Revolver”). Second Amendment to the Second A&R Credit Agreement In conjunction with the closing of the Acclara Acquisition, the Company entered into Amendment No. 2 (the “Second Amendment”) to the second amended and restated credit agreement (the “Second A&R Credit Agreement”) executed on June 21, 2022. For further details on the Second A&R Credit Agreement, see Note 10 of the audited consolidated financial statements included in the Company’s 2023 Form 10-K. Pursuant to the Second Amendment, among certain other amendments, the lenders named in the Second Amendment agreed, severally and not jointly, to extend additional borrowings in the form of Term B Loans (the “Incremental Term B Loans” and together with the then existing senior secured term B loan, the “Term B Loans”) to the Company in an aggregate principal amount equal to $575.0 million. The Company used the proceeds of the Incremental Term B Loans, together with cash on hand and borrowings of $80.0 million under the Senior Revolver, to finance (i) the cash consideration for the Acclara Acquisition and (ii) fees and costs incurred in connection with the acquisition and related transactions. In conjunction with entering into the Second Amendment, the Company incurred $10.6 million and capitalized $5.7 million of debt issuance costs. The initial senior secured term A loan (the “Existing Term A Loan”) and Senior Revolver mature on July 1, 2026, the incremental senior secured term A loan (together with the Existing Term A Loan, the “Term A Loans”) matures on June 21, 2027, and the Term B Loans mature on June 21, 2029. The variable interest rate as of September 30, 2024 was 7.10% for the Term A Loans and Senior Revolver and 7.85% for the Term B Loans. The Second A&R Credit Agreement contains a number of financial and non-financial covenants. The Company was in compliance with all of the covenants in the Second A&R Credit Agreement as of September 30, 2024. The obligations under the Second A&R Credit Agreement are secured by a pledge of 100% of the capital stock of certain domestic subsidiaries owned by the Company and a security interest in substantially all of the Company’s tangible and intangible assets and the tangible and intangible assets of certain domestic subsidiaries. Debt Maturities Scheduled maturities of the Company’s long-term debt are summarized as follows: Scheduled Maturities Remainder of 2024 $ 18.1 2025 72.8 2026 684.1 2027 436.1 2028 10.8 2029 1,014.7 Total $ 2,236.6

Derivative Financial Instrument

Derivative Financial Instruments	9 Months Ended
	Sep. 30, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments	Derivative Financial Instruments The Company utilizes cash flow hedges to manage its currency risk arising from its global business services centers. As of September 30, 2024, the Company had recorded $0.2 million of unrealized gains in accumulated other comprehensive loss related to foreign currency hedges. The Company estimates that $0.2 million of gains reported in accumulated other comprehensive loss are expected to be reclassified into cost of services within the next 12 months. The net gains reclassified into cost of services were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 $ — $ 0.5 $ 0.1 $ 1.3 As of September 30, 2024, the Company’s foreign currency forward contracts designated as cash flow hedges had maturities extending no later than December 31, 2024, and had a total notional value of $53.2 million. The Company also utilizes cash flow hedges to reduce variability in interest cash flows from its outstanding debt. As of September 30, 2024, the Company had recorded $3.8 million of unrealized gains in accumulated other comprehensive loss related to interest rate swaps. The Company estimates that $3.8 million of gains reported in accumulated other comprehensive loss are expected to be reclassified into earnings within the next 12 months. The net gains reclassified into interest expense were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 $ 3.0 $ 2.8 $ 8.9 $ 7.2 As of September 30, 2024, the Company’s interest rate swaps extended no later than June 30, 2025, and had a total notional value of $500.0 million. The Company also utilizes fair value hedges to manage its currency risk arising from its global business services centers. These contracts typically have a term of one month in order to manage currency risks between the timing of transaction costs and payment. For the three and nine months ended September 30, 2024, respectively, the Company had recognized $0.1 million and $0.1 million of gains in earnings related to foreign currency forward contracts designated as fair value hedges. The Company had no outstanding fair value hedges as of September 30, 2024. The fair value of derivative instruments designated as fair value hedges was $0.0 million of unrealized gains as of December 31, 2023. The classification of the fair value of derivative instruments designated as hedges within the Consolidated Balance Sheets as of September 30, 2024 and December 31, 2023 were as follows: September 30, 2024 December 31, 2023 Foreign currency forward contracts Prepaid expenses and other current assets $ 0.2 $ 0.5 Other accrued expenses — — Total foreign currency forward contracts $ 0.2 $ 0.5 Interest rate swaps Prepaid expenses and other current assets $ 3.8 $ 8.7 Other assets — 0.9 Total interest rate swaps $ 3.8 $ 9.6 As of September 30, 2024 and December 31, 2023, respectively, the accumulated gain, net of tax, recognized in accumulated other comprehensive loss was $3.0 million and $7.5 million. The Company classifies cash flows from its derivative programs as cash flows from operating activities in the Consolidated Statements of Cash Flows. Fair values for derivative financial instruments are based on prices computed using third-party valuation models and are classified as Level 2 in accordance with the three-level hierarchy of fair value measurements.

Share-Based Compensation

Share-Based Compensation	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Share-Based Compensation	Share-Based Compensation The total share-based compensation expense relating to the Company’s stock options, RSUs, and performance-based restricted stock units (“PBRSUs”) that has been included in the Company’s Consolidated Statements of Operations and Comprehensive Income (Loss) was as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Share-Based Compensation Expense Allocation Details: Cost of services $ 6.9 $ 12.4 $ 30.8 $ 32.1 Selling, general and administrative 9.1 7.7 28.7 22.2 Total share-based compensation expense (1) $ 16.0 $ 20.1 $ 59.5 $ 54.3 Related tax benefits $ 1.5 $ 4.2 $ 11.1 $ 11.5 (1) Included in total share-based compensation expense are (i) $9.2 million and $12.7 million, of share-based compensation expense for the three and nine months ended September 30, 2024, respectively, of CoyCo 2, L.P., a shareholder of the Company (“CoyCo 2”), and (ii) $1.7 million and $5.4 million, respectively, of share-based compensation expense of CoyCo 2 for the three and nine months ended September 30, 2023. This expense relates to equity awards held by certain Cloudmed employees that were modified as part of the Company’s acquisition of Revint Holdings, LLC (“Cloudmed”) into awards of CoyCo 2 and were granted for services that benefit the Company’s operations. During the three months ended September 30, 2024, the share-based compensation expense related to these equity awards was accelerated on a prospective basis as a result of the anticipated closing of the Merger. The Company accounts for forfeitures as they occur. Excess tax benefits and shortfalls for share-based payments are recognized in income tax expense and included in operating activities. The Company recognized the following income tax expense/(benefit) associated with vesting and exercises of equity awards: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 $ 0.4 $ (0.1) $ 1.1 $ (1.3) The Company uses the Black-Scholes option pricing model to estimate the fair value of its service-based options as of their grant dates. The volatility for the options was calculated based on an analysis of historical volatility. The Company assesses progress and achievement on PBRSUs by reviewing historical performance to date, along with any adjustments which have been approved by the Human Capital Committee of the Company’s Board of Directors to the reported performance, and latest projections to determine the probable outcome of the awards. The current estimates are then compared to the scoring metrics and any necessary adjustments are reflected in the current period to update share-based compensation expense to the current performance expectations. A Monte Carlo simulation was used to estimate the fair value of the Unvested Units (as defined in the 2023 Form 10-K), which are being amortized over a period of 4 years on a straight-line basis. The volatility for the Unvested Units was calculated based on an analysis of historical and implied volatility. Stock options A summary of the activity relating to stock options during the nine months ended September 30, 2024 is shown below: Options Weighted- Outstanding at December 31, 2023 2,647,202 $ 3.41 Exercised (486,114) 2.95 Outstanding at September 30, 2024 2,161,088 $ 3.52 Outstanding, vested and exercisable at September 30, 2024 2,161,088 $ 3.52 Outstanding, vested and exercisable at December 31, 2023 2,647,202 $ 3.41 Restricted stock units and performance-based restricted stock units A summary of the activity relating to RSUs and PBRSUs during the nine months ended September 30, 2024 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2023 3,330,236 6,128,821 $ 17.66 $ 19.36 Granted 4,000,127 1,529,657 11.09 12.59 Vested (1,701,746) (462,927) 15.12 26.65 Forfeited (534,436) (485,770) 13.55 17.95 Outstanding and unvested at September 30, 2024 5,094,181 6,709,781 $ 13.78 $ 17.42 Shares surrendered for taxes for the nine months ended September 30, 2024 573,263 162,550 Cost of shares surrendered for taxes for the nine months ended September 30, 2024 (in millions) $ 7.2 $ 2.4 Shares surrendered for taxes for the nine months ended September 30, 2023 381,066 903,658 Cost of shares surrendered for taxes for the nine months ended September 30, 2023 (in millions) $ 6.2 $ 13.1 RSUs granted during the nine months ended September 30, 2024, include an aggregate 1,983,791 RSUs of the Company that were issued upon consummation of the Acclara Acquisition to replace outstanding unvested options of Acclara. The Company’s RSU and PBRSU agreements allow employees to surrender to the Company shares of common stock upon vesting of their RSUs and PBRSUs in lieu of their payment of the required personal employment-related taxes. Shares surrendered for payment of personal employment-related taxes are held in treasury. Outstanding PBRSUs vest upon satisfaction of both time-based and performance-based conditions. Depending on the award, performance condition targets may include cumulative adjusted EBITDA, end-to-end RCM agreement growth, modular sales revenue, or other specific performance factors. Depending on the percentage level at which the performance-based conditions are satisfied, the number of shares vesting could be between 0% and 200% of the number of PBRSUs originally granted. Based on the established targets, the maximum number of shares that could vest for all outstanding PBRSUs is 13,419,562.

Other Expenses

Other Expenses	9 Months Ended
	Sep. 30, 2024
Other Income and Expenses [Abstract]
Other Expenses	Other Expenses Other expenses are incurred in connection with acquisition and integration initiatives, exit activities, strategic and transformation initiatives to improve our business alignment and cost structure, review of strategic alternatives, stockholder litigation, and for the three months ended September 30, 2024, costs related to the proposed Merger. The following table summarizes the other expenses recognized for the three and nine months ended September 30, 2024 and 2023. Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Business acquisition costs (1) $ — $ 1.4 $ 15.1 $ 3.5 Integration costs (2) 4.4 6.1 27.1 30.0 Technology transformation (3) 2.8 4.5 20.9 11.8 Strategic initiatives (4) — 13.0 0.5 23.8 Facility-related charges (5) 1.8 7.2 4.9 15.7 Other (6) 24.2 (2.8) 32.9 3.1 Total other expenses $ 33.2 $ 29.4 $ 101.4 $ 87.9 (1) Costs, including legal, consulting, insurance premiums, and bank fees, that directly relate to the due diligence and closing of business acquisitions and include changes to contingent consideration, if applicable. Costs also include compensation expenses associated with the close of the transactions. (2) Costs reflect efforts to integrate acquired businesses from a systems, processes, and people perspective and to achieve synergies expected from business acquisitions. Costs include consulting fees, IT vendor spend, severance, and certain payroll costs. (3) Costs relate to projects underway to create a new platform that consolidates the Cloudmed and R1 customer solutions and migrates them to a cloud environment to reduce onboarding costs and accelerate the delivery of value to the Company’s customers. These projects are expected to be completed in 2025. Certain project costs incurred qualify for capitalization and have been recorded on the Consolidated Balance Sheet. For the nine months ended September 30, 2024, costs include a $6.3 million one-time vendor termination fee to migrate to the cloud. (4) Costs primarily relate to business restructuring activities as part of the Company’s growth strategy and include consulting costs, compensation costs of employees dedicated to the Company’s strategic growth efforts, and severance. In 2023, these costs included changes in contingent consideration and retention costs related to acquisitions completed by Cloudmed prior to being acquired by R1. (5) As part of evaluating its real estate footprint in relation to acquisitions and remote work practices adopted following COVID, the Company has exited certain facilities. Costs include asset impairment charges, early termination fees, and other costs related to exited facilities that will continue over the duration of the lease term. (6) For the three and nine months ended September 30, 2024, costs primarily related to legal and other advisor fees associated with the strategic alternatives review conducted by a special committee formed by the Board of Directors on March 11, 2024, which concluded with the Board of Directors’ approval of the Merger Agreement on July 31, 2024. See Note 1, Business Description and Basis of Presentation, for further details regarding the Merger Agreement. During the three months ended September 30, 2024, the Company incurred professional service fees and other expenses related to the proposed Merger. For the three and nine months ended September 30, 2023, costs include net insurance reimbursements and net expenses, respectively, related to the Company’s stockholder litigation. For further details regarding the Company’s stockholder litigation, see Note 18, Commitments and Contingencies, to the consolidated financial statements included in the 2023 Form 10-K.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes Income tax provisions for interim periods are based on estimated annual income tax rates, adjusted to reflect the effects of any significant and infrequent or unusual items which are required to be discretely recognized within the current interim period. The effective tax rates in the periods presented are largely based upon the projected annual pre-tax earnings by jurisdiction and the allocation of certain expenses in various taxing jurisdictions where the Company conducts its business. These taxing jurisdictions apply a broad range of statutory income tax rates. The global intangible low-taxed income (“GILTI”) provisions impose taxes on foreign income in excess of a deemed return on tangible assets of foreign corporations. The Company elected to account for GILTI tax in the period in which it is incurred. The Company recognized income tax benefit for the three and nine months ended September 30, 2024 on the year-to-date pre-tax loss. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for foreign taxes, state taxes, non-deductible expenses, and discrete items. The Company recognized income tax expense for the three and nine months ended September 30, 2023 on the year-to-date pre-tax income. The deviation from the federal statutory tax rate of 21% is primarily attributable to recognizing the provisions for foreign taxes, state taxes, non-deductible expenses, and discrete items. The Company and its subsidiaries are subject to U.S. federal income tax as well as income tax of multiple state and foreign jurisdictions. U.S. federal income tax returns since 2021 are currently open for examination. State jurisdictions vary for open tax years. The statute of limitations for most states ranges from three

Earnings (Loss) Per Share

Earnings (Loss) Per Share	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	Earnings (Loss) Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding during the period. Diluted net income (loss) per share is calculated by adjusting the denominator used in the basic net income (loss) per share computation by potentially dilutive securities outstanding during the period plus, when their effect is dilutive, incremental shares consisting of shares subject to stock options and shares issuable upon vesting of RSUs and PBRSUs. Basic and diluted net income (loss) per common share are calculated as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Net income (loss) $ (19.9) $ 1.3 $ (62.6) $ 1.9 Basic weighted-average common shares 422,101,172 419,008,998 421,289,787 418,299,910 Add: Effect of dilutive equity awards — 4,345,149 — 4,234,933 Add: Effect of dilutive warrants — 33,009,877 — 32,302,754 Diluted weighted average common shares 422,101,172 456,364,024 421,289,787 454,837,597 Net income (loss) per common share (basic) $ (0.05) $ — $ (0.15) $ — Net income (loss) per common share (diluted) $ (0.05) $ — $ (0.15) $ — Because of their anti-dilutive effect, 20,674,831 and 20,674,831 common share equivalents comprised of stock options, PBRSUs, and RSUs have been excluded from the diluted earnings per share calculation for the three and nine months ended September 30, 2024, respectively. Additionally, for the three and nine months ended September 30, 2024, TCP-ASC’s, IHC Health Services, Inc.’s (“Intermountain”), and Providence’s exercisable warrants to acquire up to 40.5 million, 1.5 million, and 12.2 million shares, respectively, of the Company’s common stock were excluded from the diluted earnings per share calculation because they were anti-dilutive. For the three and nine months ended September 30, 2023, 705,982 and 589,077 common share equivalents, respectively, were excluded from the diluted earnings per share calculation because of their anti-dilutive effect.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Legal Proceedings Other than as described below, the Company is not presently a party to any material litigation or regulatory proceeding and is not aware of any pending or threatened litigation or regulatory proceeding against the Company which, individually or in the aggregate, could have a material adverse effect on its business, operating results, financial condition or cash flows. Graziosi v R1 RCM Inc. In May 2016, the Company was served with a False Claims Act (“FCA”) case brought by a former emergency department service associate who worked at a hospital of one of the Company’s customers, MedStar Inc.’s Washington Hospital Center (“WHC”), along with WHC and three other hospitals that were PAS customers and a place holder, John Doe hospital, representing all PAS customers (U.S. ex rel. Graziosi vs. Accretive Health, Inc. et. al.), and seeking money damages, FCA penalties, and attorneys’ fees. The Third Amended Complaint alleges that the Company’s PAS business violates the federal FCA. The case was originally filed under seal in 2013 in the federal district court in Chicago and was presented to the U.S. Attorney in Chicago, and the U.S. Attorney declined to intervene. Both the Company’s and plaintiff’s motions for summary judgment were denied in December 2020, and the parties have completed damage and expert discovery. Additional dispositive motions are expected to extend through the remainder of 2024, with trial, if necessary, likely to be scheduled in 2025. The Company believes it has meritorious defenses to all claims in the case and is vigorously defending itself against these claims. Merger-Related Demand Letters and Complaint The Company has received demand letters from several purported stockholders relating to books and records requests pursuant to Section 220 of the Delaware General Corporation Law, alleged disclosure deficiencies in the proxy statement related to the Merger, or appraisal pursuant to Section 262 of the Delaware General Corporation Law, and a complaint filed in New York state court alleging negligence against R1, R1’s directors, and other parties to the Merger. No assurances can be made as to the outcome of such demands, complaint, or other future actions.

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2024
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions This note includes, among others, transactions between Ascension Health (“Ascension”) and its affiliates and the Company pursuant to the Master Professional Services Agreement, including all supplements, amendments, and other documents entered into in connection therewith (the “Amended and Restated Master Professional Services Agreement”). For further details on the Company’s agreements with Ascension, see Note 1 and Note 19 of the 2023 Form 10-K. In conjunction with the Cloudmed acquisition, New Mountain Capital, L.L.C. (“New Mountain”) became a related party. There were no material transactions with New Mountain and its affiliates subsequent to the Cloudmed acquisition. Net services revenue from services provided to Ascension, as well as corresponding accounts receivable and customer liabilities are presented in the Consolidated Statements of Operations and Comprehensive Income (Loss) and the Consolidated Balance Sheets. Since Ascension is the Company’s largest customer, a significant percentage of the Company’s cost of services is associated with providing services to Ascension. However, due to the nature of the Company’s global business services and information technology operations, it is impracticable to assign the dollar amount associated with services provided to Ascension. In response to the 2024 cyberattacks that impacted the ability to obtain data needed for base fee and incentive fee calculations, the Company and Ascension agreed to an alternative measurement and calculation approach for these fees as permitted under the Amended and Restated Master Professional Services Agreement (the “MPSA”) in certain circumstances that impact the economics of one or more of the parties or frustrates the ability of a party to perform its obligations under the MPSA, through no fault of its own. For the six months ended June 30, 2024, performance scores achieved by the Company prior to the cyberattacks were used in the determination of incentive fee revenue. In September 2024, the parties agreed to a fixed fee arrangement for incentive fee revenue for Ascension’s fiscal year ending June 30, 2025. The objective of these modifications is for incentive fee revenue to be more consistent with that of the periods before the cyber events occurred. For base fee revenue recognized during the three months ended September 30, 2024, it was agreed that cash deposits would be substituted for cash postings for the period when the system was unavailable. There has been no delay in payment of fees and no extended payment terms granted. On July 31, 2024, the Company entered into an Agreement and Plan of Merger relating to a take-private transaction, with affiliates of Clayton, Dubilier & Rice, LLC and TowerBrook Capital Partners L.P., which is an affiliate of TCP-ASC. See Note 1, Business Description and Basis of Presentation. Also on July 31, 2024, TCP-ASC executed a voting agreement (the “Voting Agreement”) in favor of the Company, pursuant to which TCP-ASC agreed, among other things, to (i) vote all of its shares of Company common stock in favor of the approval and adoption of the Merger Agreement and the Merger, and (ii) vote all of its shares of the Company common stock against any proposal made in opposition to the Merger Agreement or the Merger.

Segments and Customer Concentra

Segments and Customer Concentrations	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Segments and Customer Concentrations	Segments and Customer Concentrations The Company has determined that it has a single operating segment in accordance with the way that management operates and views the business. All of the Company’s significant operations are organized around the single business of providing management services of revenue cycle operations for U.S.-based healthcare providers. Accordingly, for purposes of segment disclosures, the Company has only one operating and reportable segment. Customers comprising greater than 10% of net services revenue are as follows: Three Months Ended September 30, Nine Months Ended September 30, Customer Name 2024 2023 2024 2023 Ascension and its affiliates 30 % 40 % 34 % 39 % Intermountain Health 10 % 11 % 10 % 11 % The loss of facilities within the Ascension health system or Intermountain Health could have a material adverse impact on the Company’s operations. As of September 30, 2024 and December 31, 2023, the Company had a concentration of credit risk with Ascension, representing 11% and 10% of accounts receivable, respectively.

Supplemental Financial Informat

Supplemental Financial Information	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Supplemental Financial Information	Supplemental Financial Information The following table summarizes the allocation of depreciation and amortization expense related to property, equipment and software between cost of services and selling, general and administrative expenses: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Cost of services $ 23.1 $ 20.0 $ 63.1 $ 52.9 Selling, general and administrative 0.8 0.4 1.7 1.0 Total depreciation and amortization $ 23.9 $ 20.4 $ 64.8 $ 53.9 Finance lease right-of-use assets are included in property, equipment and software, net, and the current and non-current portion of financing lease liabilities are included in accrued expenses and other current liabilities and other non-current liabilities, respectively, on the Consolidated Balance Sheets. Supplemental cash flow information related to leases are as follows: Nine Months Ended September 30, 2024 2023 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 22.0 $ 19.2 Operating cash flows for finance leases 0.1 — Financing cash flows for finance leases 0.3 0.2 Right-of-use assets obtained in exchange lease obligations: Operating leases 20.2 3.8 Finance leases 8.1 —

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Millions	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net income (loss)	$ (19.9)	$ (7.6)	$ (35.1)	$ 1.3	$ (1)	$ 1.6	$ (62.6)	$ 1.9

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Business Description and Basi_2

Business Description and Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited consolidated financial statements reflect the Company’s financial position as of September 30, 2024, the results of operations of the Company for the three and nine months ended September 30, 2024 and 2023, and the cash flows of the Company for the nine months ended September 30, 2024 and 2023. These financial statements include the accounts of R1 RCM Inc. and its wholly owned subsidiaries, including Acclara and its subsidiaries since the date of acquisition. All material intercompany amounts have been eliminated in consolidation. These financial statements have been prepared in accordance with generally accepted accounting principles in the United States (“GAAP”) for interim financial reporting and as required by the rules and regulations of the U.S. Securities and Exchange Commission (the “SEC”). Accordingly, certain information and footnote disclosures required for complete financial statements are not included herein. In the opinion of management, all adjustments, consisting of normal recurring adjustments, considered necessary for a fair presentation of the interim financial information, have been included. Operating results for the three and nine months ended September 30, 2024 are not necessarily indicative of the results that may be expected for any other interim period or for the fiscal year ending December 31, 2024.
Recently Issued Accounting Standards and Disclosures	Recently Issued Accounting Standards and Disclosures In June 2022, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2022-03, Fair Value Measurement (Topic 820): Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions (“ASU 2022-03”). ASU 2022-03 clarifies that a contractual sale restriction on an equity security should not be considered in measuring the security’s fair value. The Company prospectively adopted ASU 2022-03 effective January 1, 2024. Adoption of the new standard required changes to the valuation method used in accounting for equity consideration in business combinations occurring after January 1, 2024. There were no current period changes to equity consideration related to prior transactions to be evaluated under this guidance. In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”). ASU 2023-07 expands annual and interim disclosure requirements for reportable segments, primarily through enhanced disclosures about significant segment expenses. ASU 2023-07 is effective for fiscal years beginning after December 15, 2023, and for interim periods within fiscal years beginning after December 15, 2024. The Company is currently in the process of determining the impact that ASU 2023-07 will have on its consolidated financial statement disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”). ASU 2023-09 expands the disclosure requirements for income taxes, specifically related to the rate reconciliation and income taxes paid. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024. The Company is currently in the process of determining the impact that ASU 2023-09 will have on its consolidated financial statement disclosures.
Revenue Recognition	Revenue Recognition Revenue is measured based on consideration specified in a contract with a customer, and presented net of any sales incentives and amounts collected on behalf of third parties. The Company recognizes revenue when it satisfies a performance obligation by transferring control over a service to a customer, which is typically over the contract term. Estimates of variable consideration are included in revenue to the extent that it is probable that a significant reversal of cumulative revenue will not occur once the uncertainty is resolved.

Acquisitions (Tables)

Acquisitions (Tables)	9 Months Ended
	Sep. 30, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Schedule of Acquisitions	The following table summarizes the fair value of the total consideration paid: Fair Value Cash consideration (1) $ 726.3 Issuance of Providence Warrant (2) 59.8 Total consideration $ 786.1 (1) Cash consideration includes the repayment of Acclara’s pre-existing credit facility at closing, which was not assumed by the Company. During the three months ended June 30, 2024, the Company finalized the closing net working capital as defined in the purchase agreement, which resulted in additional consideration due to the seller of $0.1 million that was paid in the third quarter of 2024. (2) The provisional, undiscounted fair value of the Providence Warrant was estimated using the Black-Scholes option pricing model. The warrant is subject to a three-year lock-up period and expires five years from the issuance date.
Schedule of Fair Value of Assets Acquired and Liabilities Assumed	The preliminary fair value of assets acquired and liabilities assumed is: Purchase Price Allocation Total purchase consideration $ 786.1 Allocation of consideration to assets acquired and liabilities assumed: Cash and cash equivalents $ 64.3 Accounts receivable 47.8 Property, equipment and software 6.6 Operating lease right-of-use assets 12.3 Intangible assets 374.0 Goodwill 416.2 Other assets 8.1 Accounts payable (4.6) Customer liabilities (1.2) Accrued compensation and benefits (21.8) Operating lease liabilities (16.2) Deferred income tax liabilities (82.4) Other liabilities (17.0) Net assets acquired $ 786.1
Schedule of Intangible Assets Identified with Acquisition	The intangible assets preliminarily identified in conjunction with the Acclara Acquisition are as follows: Useful Life Gross Carrying Value Customer Relationships 12 years $ 374.0
Schedule of Pro Forma Results	The following table summarizes, on a pro forma basis, the combined results of the Company as though the Acclara Acquisition had occurred on January 1, 2023. These pro forma results are not necessarily indicative of the actual consolidated results had the acquisition occurred as of that date or of the future consolidated operating results for any period. Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Net services revenue $ 656.8 $ 646.5 $ 1,900.4 $ 1,911.3 Net loss $ (16.7) $ (17.7) $ (35.6) $ (76.5)

Intangible Assets (Tables)

Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table provides the gross carrying value and accumulated amortization for each major class of definite-lived intangible assets at September 30, 2024 and December 31, 2023: September 30, 2024 December 31, 2023 Gross Carrying Value Accumulated Amortization Net Book Value Gross Carrying Value Accumulated Amortization Net Book Value Customer relationships $ 791.9 $ (101.1) $ 690.8 $ 417.9 $ (60.5) $ 357.4 Technology 1,238.8 (424.3) 814.5 1,238.8 (299.5) 939.3 Trade name 23.5 (20.0) 3.5 23.5 (9.5) 14.0 Total intangible assets $ 2,054.2 $ (545.4) $ 1,508.8 $ 1,680.2 $ (369.5) $ 1,310.7
Schedule of Estimated Annual Amortization Expense	Estimated annual amortization expense related to intangible assets with definite lives as of September 30, 2024 is as follows: Remainder of 2024 $ 58.6 2025 220.0 2026 219.4 2027 219.4 2028 219.3 2029 141.8 Thereafter 430.3 Total $ 1,508.8

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregated Revenue By Source	In the following table, revenue is disaggregated by source of revenue: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Net operating fees $ 413.0 $ 368.0 $ 1,169.1 $ 1,086.8 Incentive fees 22.4 30.1 59.7 84.5 Modular and other fees (1) 221.4 174.7 659.8 507.8 Net services revenue $ 656.8 $ 572.8 $ 1,888.6 $ 1,679.1 (1) Modular and other fees is comprised of service fees related to solutions focused on revenue recovery, clinical integrity, revenue optimization, and regulatory navigation as well as functional outsourcing solutions focused on driving revenue cycle improvements.
Schedule of Contract Assets and Contract Liabilities	The following table provides information about contract assets, net and contract liabilities from contracts with customers: September 30, 2024 December 31, 2023 Contract assets, net Current $ 100.8 $ 94.4 Non-current 43.3 37.7 Total contract assets, net $ 144.1 $ 132.1 Contract liabilities Current (1) $ 12.1 $ 9.1 Non-current (2) 12.3 14.5 Total contract liabilities $ 24.4 $ 23.6 (1) Current contract liabilities include $2.2 million and $2.4 million classified in the current portion of customer liabilities - related party as of September 30, 2024 and December 31, 2023, respectively. (2) Non-current contract liabilities include $10.4 million and $11.8 million classified in the non-current portion of customer liabilities - related party as of September 30, 2024 and December 31, 2023, respectively. Significant changes in the carrying amount of contract assets, net for the nine months ended September 30, 2024 were as follows: Contract Assets, net Balance as of December 31, 2023 $ 132.1 Revenue recognized 299.6 Amounts transferred to Accounts receivable, net (287.1) Write-offs (1) (0.5) Balance as of September 30, 2024 $ 144.1 (1) During the three months ended March 31, 2024, the Company wrote off the contract asset balance related to a private physician-owned for-profit healthcare network in the United States, who filed a voluntary petition for relief under Chapter 11 of the U.S. Bankruptcy Code on May 6, 2024. Contract Liabilities Balance as of December 31, 2023 $ (23.6) Advanced billings as of January 1, 2024 (1) (69.6) Advanced billings recognized 69.6 Additions (12.6) Revenue recognized (2) 11.8 Balance as of September 30, 2024 $ (24.4) (1) The Company records advanced billings to contract liabilities and accounts receivable on the first day of the respective service period, which billings are earned during the quarter. (2) Revenue recognized includes $1.7 million and $6.7 million of revenue recognition for the three and nine months ended September 30, 2024, respectively, relating to the contract liabilities balance at the beginning of the period.
Schedule of Transaction Price Allocated to the Remaining Performance Obligation	The following table includes estimated revenue expected to be recognized in the future related to performance obligations that are unsatisfied (or partially unsatisfied) at the end of the reporting period. The estimated revenue does not include amounts of variable consideration that are constrained. Net operating fees Incentive fees Remainder of 2024 $ 36.8 $ 14.4 2025 78.2 24.5 2026 51.7 — 2027 13.4 — 2028 5.6 — 2029 1.9 — Thereafter 2.5 — Total $ 190.1 $ 38.9

Accounts Receivable and Allow_2

Accounts Receivable and Allowance for Credit Losses (Tables)	9 Months Ended
	Sep. 30, 2024
Receivables [Abstract]
Schedule of the Components of Account Receivable	Accounts receivable is comprised of invoiced and unbilled balances due from modular services and end-to-end RCM customers, which are presented net after considering cost reimbursements owed to end-to-end RCM customers. September 30, 2024 December 31, 2023 Billed receivables $ 268.1 $ 218.5 Unbilled receivables 115.7 99.2 Allowance for credit losses (27.8) (48.3) Total accounts receivable, net (1) $ 356.0 $ 269.4 (1) Includes $38.4 million and $26.1 million for accounts receivable - related party, net as of September 30, 2024, and December 31, 2023, respectively.
Schedule of Allowance for Credit Losses	Changes in the allowance for credit losses on a consolidated basis related to accounts receivable are as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Beginning balance $ 26.6 $ 31.6 $ 48.3 $ 15.2 Provision (recoveries) (1) 1.4 7.5 3.2 24.1 Write-offs (2) (0.2) (0.9) (23.7) (1.1) Ending balance $ 27.8 $ 38.2 $ 27.8 $ 38.2 (1) During the nine months ended September 30, 2023, the Company increased the allowance for credit losses by $11.6 million to fully reserve the outstanding accounts receivable exposure for the physician RCM customer that ceased operations and is in the process of liquidation pursuant to a Chapter 11 plan approved by the bankruptcy court in March 2024. (2) During the nine months ended September 30, 2024, the Company had $23.7 million in write-offs, which primarily related to the balance previously fully reserved in 2023 of the physician RCM customer that ceased operations in the third quarter of 2023 and is in the process of liquidation pursuant to a Chapter 11 plan approved by the bankruptcy court in March 2024.

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Schedule of Carrying Values Long-Term Debt	The carrying amounts of debt consist of the following: September 30, 2024 December 31, 2023 Senior Revolver (1) $ 60.0 $ — Term A Loans 1,116.0 1,162.5 Term B Loans 1,060.6 493.8 Unamortized discount and issuance costs (27.1) (18.8) Total debt 2,209.5 1,637.5 Less: Current maturities (72.8) (67.0) Total long-term debt $ 2,136.7 $ 1,570.5 (1) As of September 30, 2024, the Company had $60.0 million in borrowings outstanding, $1.4 million letters of credit outstanding, and $538.6 million of availability under the $600.0 million senior secured revolving credit facility (“Senior Revolver”).
Scheduled Maturities of Long-term Debt	Scheduled maturities of the Company’s long-term debt are summarized as follows: Scheduled Maturities Remainder of 2024 $ 18.1 2025 72.8 2026 684.1 2027 436.1 2028 10.8 2029 1,014.7 Total $ 2,236.6

Derivative Financial Instrume_2

Derivative Financial Instruments (Tables)	9 Months Ended
	Sep. 30, 2024
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Derivative Instruments, Gains	The net gains reclassified into cost of services were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 $ — $ 0.5 $ 0.1 $ 1.3 The net gains reclassified into interest expense were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 $ 3.0 $ 2.8 $ 8.9 $ 7.2
Schedule of Derivatives Instruments Statements of Financial Performance and Financial Position, Location	The classification of the fair value of derivative instruments designated as hedges within the Consolidated Balance Sheets as of September 30, 2024 and December 31, 2023 were as follows: September 30, 2024 December 31, 2023 Foreign currency forward contracts Prepaid expenses and other current assets $ 0.2 $ 0.5 Other accrued expenses — — Total foreign currency forward contracts $ 0.2 $ 0.5 Interest rate swaps Prepaid expenses and other current assets $ 3.8 $ 8.7 Other assets — 0.9 Total interest rate swaps $ 3.8 $ 9.6

Share-Based Compensation (Table

Share-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement [Abstract]
Schedule of Share-based Compensation Expense	The total share-based compensation expense relating to the Company’s stock options, RSUs, and performance-based restricted stock units (“PBRSUs”) that has been included in the Company’s Consolidated Statements of Operations and Comprehensive Income (Loss) was as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Share-Based Compensation Expense Allocation Details: Cost of services $ 6.9 $ 12.4 $ 30.8 $ 32.1 Selling, general and administrative 9.1 7.7 28.7 22.2 Total share-based compensation expense (1) $ 16.0 $ 20.1 $ 59.5 $ 54.3 Related tax benefits $ 1.5 $ 4.2 $ 11.1 $ 11.5 (1) Included in total share-based compensation expense are (i) $9.2 million and $12.7 million, of share-based compensation expense for the three and nine months ended September 30, 2024, respectively, of CoyCo 2, L.P., a shareholder of the Company (“CoyCo 2”), and (ii) $1.7 million and $5.4 million, respectively, of share-based compensation expense of CoyCo 2 for the three and nine months ended September 30, 2023. This expense relates to equity awards held by certain Cloudmed employees that were modified as part of the Company’s acquisition of Revint Holdings, LLC (“Cloudmed”) into awards of CoyCo 2 and were granted for services that benefit the Company’s operations. During the three months ended September 30, 2024, the share-based compensation expense related to these equity awards was accelerated on a prospective basis as a result of the anticipated closing of the Merger.
Schedule of Income Tax Expense/(Benefit)	The Company recognized the following income tax expense/(benefit) associated with vesting and exercises of equity awards: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 $ 0.4 $ (0.1) $ 1.1 $ (1.3)
Schedule of Share-Based Compensation Arrangements by Share-Based Payment Award	A summary of the activity relating to stock options during the nine months ended September 30, 2024 is shown below: Options Weighted- Outstanding at December 31, 2023 2,647,202 $ 3.41 Exercised (486,114) 2.95 Outstanding at September 30, 2024 2,161,088 $ 3.52 Outstanding, vested and exercisable at September 30, 2024 2,161,088 $ 3.52 Outstanding, vested and exercisable at December 31, 2023 2,647,202 $ 3.41 A summary of the activity relating to RSUs and PBRSUs during the nine months ended September 30, 2024 is shown below: Weighted- RSUs PBRSUs RSU PBRSU Outstanding and unvested at December 31, 2023 3,330,236 6,128,821 $ 17.66 $ 19.36 Granted 4,000,127 1,529,657 11.09 12.59 Vested (1,701,746) (462,927) 15.12 26.65 Forfeited (534,436) (485,770) 13.55 17.95 Outstanding and unvested at September 30, 2024 5,094,181 6,709,781 $ 13.78 $ 17.42 Shares surrendered for taxes for the nine months ended September 30, 2024 573,263 162,550 Cost of shares surrendered for taxes for the nine months ended September 30, 2024 (in millions) $ 7.2 $ 2.4 Shares surrendered for taxes for the nine months ended September 30, 2023 381,066 903,658 Cost of shares surrendered for taxes for the nine months ended September 30, 2023 (in millions) $ 6.2 $ 13.1

Other Expenses (Tables)

Other Expenses (Tables)	9 Months Ended
	Sep. 30, 2024
Other Income and Expenses [Abstract]
Schedule of Other Expenses	The following table summarizes the other expenses recognized for the three and nine months ended September 30, 2024 and 2023. Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Business acquisition costs (1) $ — $ 1.4 $ 15.1 $ 3.5 Integration costs (2) 4.4 6.1 27.1 30.0 Technology transformation (3) 2.8 4.5 20.9 11.8 Strategic initiatives (4) — 13.0 0.5 23.8 Facility-related charges (5) 1.8 7.2 4.9 15.7 Other (6) 24.2 (2.8) 32.9 3.1 Total other expenses $ 33.2 $ 29.4 $ 101.4 $ 87.9 (1) Costs, including legal, consulting, insurance premiums, and bank fees, that directly relate to the due diligence and closing of business acquisitions and include changes to contingent consideration, if applicable. Costs also include compensation expenses associated with the close of the transactions. (2) Costs reflect efforts to integrate acquired businesses from a systems, processes, and people perspective and to achieve synergies expected from business acquisitions. Costs include consulting fees, IT vendor spend, severance, and certain payroll costs. (3) Costs relate to projects underway to create a new platform that consolidates the Cloudmed and R1 customer solutions and migrates them to a cloud environment to reduce onboarding costs and accelerate the delivery of value to the Company’s customers. These projects are expected to be completed in 2025. Certain project costs incurred qualify for capitalization and have been recorded on the Consolidated Balance Sheet. For the nine months ended September 30, 2024, costs include a $6.3 million one-time vendor termination fee to migrate to the cloud. (4) Costs primarily relate to business restructuring activities as part of the Company’s growth strategy and include consulting costs, compensation costs of employees dedicated to the Company’s strategic growth efforts, and severance. In 2023, these costs included changes in contingent consideration and retention costs related to acquisitions completed by Cloudmed prior to being acquired by R1. (5) As part of evaluating its real estate footprint in relation to acquisitions and remote work practices adopted following COVID, the Company has exited certain facilities. Costs include asset impairment charges, early termination fees, and other costs related to exited facilities that will continue over the duration of the lease term. (6) For the three and nine months ended September 30, 2024, costs primarily related to legal and other advisor fees associated with the strategic alternatives review conducted by a special committee formed by the Board of Directors on March 11, 2024, which concluded with the Board of Directors’ approval of the Merger Agreement on July 31, 2024. See Note 1, Business Description and Basis of Presentation, for further details regarding the Merger Agreement. During the three months ended September 30, 2024, the Company incurred professional service fees and other expenses related to the proposed Merger. For the three and nine months ended September 30, 2023, costs include net insurance reimbursements and net expenses, respectively, related to the Company’s stockholder litigation. For further details regarding the Company’s stockholder litigation, see Note 18, Commitments and Contingencies, to the consolidated financial statements included in the 2023 Form 10-K.

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Schedule of Basic and Diluted Net Income (Loss) Per Common Share	Basic and diluted net income (loss) per common share are calculated as follows: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Net income (loss) $ (19.9) $ 1.3 $ (62.6) $ 1.9 Basic weighted-average common shares 422,101,172 419,008,998 421,289,787 418,299,910 Add: Effect of dilutive equity awards — 4,345,149 — 4,234,933 Add: Effect of dilutive warrants — 33,009,877 — 32,302,754 Diluted weighted average common shares 422,101,172 456,364,024 421,289,787 454,837,597 Net income (loss) per common share (basic) $ (0.05) $ — $ (0.15) $ — Net income (loss) per common share (diluted) $ (0.05) $ — $ (0.15) $ —

Segments and Customer Concent_2

Segments and Customer Concentrations (Tables)	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Schedule of Customer Concentration, Net Services Revenue	Customers comprising greater than 10% of net services revenue are as follows: Three Months Ended September 30, Nine Months Ended September 30, Customer Name 2024 2023 2024 2023 Ascension and its affiliates 30 % 40 % 34 % 39 % Intermountain Health 10 % 11 % 10 % 11 %

Supplemental Financial Inform_2

Supplemental Financial Information (Tables)	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Depreciation and Amortization Expense	The following table summarizes the allocation of depreciation and amortization expense related to property, equipment and software between cost of services and selling, general and administrative expenses: Three Months Ended September 30, Nine Months Ended September 30, 2024 2023 2024 2023 Cost of services $ 23.1 $ 20.0 $ 63.1 $ 52.9 Selling, general and administrative 0.8 0.4 1.7 1.0 Total depreciation and amortization $ 23.9 $ 20.4 $ 64.8 $ 53.9
Schedule of Cash Flow, Supplemental Cash Flow Information	Supplemental cash flow information related to leases are as follows: Nine Months Ended September 30, 2024 2023 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows for operating leases $ 22.0 $ 19.2 Operating cash flows for finance leases 0.1 — Financing cash flows for finance leases 0.3 0.2 Right-of-use assets obtained in exchange lease obligations: Operating leases 20.2 3.8 Finance leases 8.1 —

Business Description and Basi_3

Business Description and Basis of Presentation - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions	Sep. 16, 2024	Jan. 17, 2024	Sep. 30, 2024	Jul. 31, 2024	Dec. 31, 2023
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Common stock, shares outstanding (in shares)			422,116,481		420,201,507
Common stock, par value (in dollars per share)			$ 0.01		$ 0.01
Raven Acquisition Holdings, LLC
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Share price (in dollars per share)				$ 14.30
Termination fee paid to parent	$ 250
Termination fee paid to the company	$ 550
Acclara
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Common stock, shares outstanding (in shares)		12,192,000
Common stock, par value (in dollars per share)		$ 0.01
Initial exercise price (in dollars per share)		$ 10.52
Percentage of voting interest acquired		100%
Partnership agreement term		10 years

Acquisitions - Narrative (Detai

Acquisitions - Narrative (Details) - Acclara - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024	Jan. 17, 2024
Business Acquisition [Line Items]
Indemnification asset			$ 4.5
Net services revenue	$ 71.5	$ 199.1
Net loss before income taxes, since acquisition date	$ 4.9	0.7
Revision of prior period, adjustment
Business Acquisition [Line Items]
Tax payable		1.9
Deferred tax liability		$ 2.2

Acquisitions - Fair Value Total

Acquisitions - Fair Value Total Consideration Paid (Details) - Acclara - USD ($) $ in Millions		3 Months Ended
	Jan. 17, 2024	Sep. 30, 2024
Business Acquisition [Line Items]
Cash consideration	$ 726.3
Issuance of Providence Warrant	59.8
Total consideration	$ 786.1
Additional consideration		$ 0.1
Acclara
Business Acquisition [Line Items]
Lock-up period (in year)	3 years
Lock-up period term (in year)	5 years

Acquisitions - Fair Value of As

Acquisitions - Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Millions	Jan. 17, 2024	Sep. 30, 2024	Dec. 31, 2023
Allocation of consideration to assets acquired and liabilities assumed:
Goodwill		$ 3,045.6	$ 2,629.4
Acclara
Business Combination, Recognized Identifiable Assets Acquired, Goodwill, and Liabilities Assumed, Net [Abstract]
Total purchase consideration	$ 786.1
Allocation of consideration to assets acquired and liabilities assumed:
Cash and cash equivalents	64.3
Accounts receivable	47.8
Property, equipment and software	6.6
Operating lease right-of-use assets	12.3
Intangible assets	374
Goodwill	416.2
Other assets	8.1
Accounts payable	(4.6)
Customer liabilities	(1.2)
Accrued compensation and benefits	(21.8)
Operating lease liabilities	(16.2)
Deferred income tax liabilities	(82.4)
Other liabilities	(17)
Net assets acquired	$ 786.1

Acquisitions - Schedule of Inta

Acquisitions - Schedule of Intangible Assets Information (Details) - Acclara - Customer Relationships $ in Millions	Jan. 17, 2024 USD ($)
Business Acquisition [Line Items]
Useful Life	12 years
Gross Carrying Value	$ 374

Acquisitions - Pro Forma Result

Acquisitions - Pro Forma Results (Details) - Acclara - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Business Acquisition [Line Items]
Net services revenue	$ 656.8	$ 646.5	$ 1,900.4	$ 1,911.3
Net loss	$ (16.7)	$ (17.7)	$ (35.6)	$ (76.5)

Intangible Assets - Components

Intangible Assets - Components of Intangible Assets (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 2,054.2	$ 1,680.2
Accumulated Amortization	(545.4)	(369.5)
Net Book Value	1,508.8	1,310.7
Customer relationships
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	791.9	417.9
Accumulated Amortization	(101.1)	(60.5)
Net Book Value	690.8	357.4
Technology
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	1,238.8	1,238.8
Accumulated Amortization	(424.3)	(299.5)
Net Book Value	814.5	939.3
Trade name
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Value	23.5	23.5
Accumulated Amortization	(20)	(9.5)
Net Book Value	$ 3.5	$ 14

Intangible Assets - Narrative (

Intangible Assets - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible asset amortization expense	$ 58.6	$ 50.4	$ 175.9	$ 151.7

Intangible Assets - Future Amor

Intangible Assets - Future Amortization (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
Remainder of 2024	$ 58.6
2025	220
2026	219.4
2027	219.4
2028	219.3
2029	141.8
Thereafter	430.3
Net Book Value	$ 1,508.8	$ 1,310.7

Revenue Recognition - Disaggreg

Revenue Recognition - Disaggregated Revenue by Source (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Net services revenue	$ 656.8	$ 572.8	$ 1,888.6	$ 1,679.1
Net operating fees
Disaggregation of Revenue [Line Items]
Net services revenue	413	368	1,169.1	1,086.8
Incentive fees
Disaggregation of Revenue [Line Items]
Net services revenue	22.4	30.1	59.7	84.5
Modular and other fee
Disaggregation of Revenue [Line Items]
Net services revenue	$ 221.4	$ 174.7	$ 659.8	$ 507.8

Revenue Recognition - Contract

Revenue Recognition - Contract Balances (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Contract assets, net
Current	$ 100.8	$ 94.4
Non-current	43.3	37.7
Total contract assets, net	144.1	132.1
Contract liabilities
Current	12.1	9.1
Non-current	12.3	14.5
Total contract liabilities	24.4	23.6
Related party
Contract liabilities
Current	2.2	2.4
Non-current	$ 10.4	$ 11.8

Revenue Recognition - Changes t

Revenue Recognition - Changes to Contract Assets (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024
Contract Assets, net
Balance as of December 31, 2023		$ 132.1
Revenue recognized		299.6
Amounts transferred to Accounts receivable, net		(287.1)
Write-offs		(0.5)
Balance as of September 30, 2024	$ 144.1	144.1
Contract Liabilities
Balance as of December 31, 2023		(23.6)
Advanced billings		(69.6)
Advanced billings recognized		69.6
Additions		(12.6)
Revenue recognized		11.8
Balance as of September 30, 2024	(24.4)	(24.4)
Revenue recognized	$ 1.7	$ 6.7

Revenue Recognition - Transacti

Revenue Recognition - Transaction Price Allocated to the Remaining Performance Obligation (Details) $ in Millions	Sep. 30, 2024 USD ($)
Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 190.1
Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 38.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-10-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	3 months
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-10-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 36.8
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2024-10-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 14.4
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 78.2
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2025-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 24.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 51.7
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2026-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 13.4
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2027-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 5.6
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2028-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period	1 year
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 1.9
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2029-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2030-01-01
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, period
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2030-01-01 | Net operating fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 2.5
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction, Start Date [Axis]: 2030-01-01 | Incentive fees
Revenue, Remaining Performance Obligation, Expected Timing of Satisfaction [Line Items]
Revenue expected to be recognized in the future related to unsatisfied performance obligations, amount	$ 0

Accounts Receivable and Allow_3

Accounts Receivable and Allowance for Credit Losses - Components of Receivables, Net (Details) - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Accounts, Notes, Loans and Financing Receivable [Line Items]
Billed receivables	$ 268.1	$ 218.5
Unbilled receivables	115.7	99.2
Allowance for credit losses	(27.8)	(48.3)
Total accounts receivable, net	356	269.4
Related party
Accounts, Notes, Loans and Financing Receivable [Line Items]
Allowance for credit losses	(0.1)	(0.1)
Total accounts receivable, net	$ 38.4	$ 26.1

Accounts Receivable and Allow_4

Accounts Receivable and Allowance for Credit Losses - Rollforward (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance	$ 26.6	$ 31.6	$ 48.3	$ 15.2
Provision (recoveries)	1.4	7.5	3.2	24.1
Write-offs	(0.2)	(0.9)	(23.7)	(1.1)
Ending balance	27.8	38.2	27.8	38.2
Increase in allowance for uncollectible amounts				11.6
Write-offs	$ 0.2	$ 0.9	$ 23.7	$ 1.1

Debt - Carrying Amounts of Debt

Debt - Carrying Amounts of Debt (Details) - USD ($)	Sep. 30, 2024	Dec. 31, 2023	Jun. 21, 2022
Debt Instrument [Line Items]
Long-term debt	$ 2,236,600,000
Unamortized discount and issuance costs	(27,100,000)	$ (18,800,000)
Total debt	2,209,500,000	1,637,500,000
Less: Current maturities	(72,800,000)	(67,000,000)
Total long-term debt	2,136,700,000	1,570,500,000
Line of credit | Senior revolver
Debt Instrument [Line Items]
Long-term debt	60,000,000	0
Borrowing availability	538,600,000
Line of credit | Senior revolver | Second A&R Credit Agreement
Debt Instrument [Line Items]
Credit agreement, maximum borrowing capacity			$ 600,000,000
Line of credit | Term A Loans
Debt Instrument [Line Items]
Long-term debt	1,116,000,000	1,162,500,000
Line of credit | Term B Loans
Debt Instrument [Line Items]
Long-term debt	1,060,600,000	$ 493,800,000
Line of credit | Letters of credit
Debt Instrument [Line Items]
Long-term debt	$ 1,400,000

Debt - Narrative (Details)

Debt - Narrative (Details) - Line of credit - USD ($)	Sep. 30, 2024	Jan. 17, 2024	Jun. 21, 2022
Second A&R Credit Agreement
Debt Instrument [Line Items]
Debt covenant, secured obligation pledged, capital stock of certain domestic subsidiaries, percent			100%
Incremental Term B Loans | Credit Agreement
Debt Instrument [Line Items]
Principal of debt issued		$ 575,000,000
Senior revolver | Senior Revolving Credit Facility
Debt Instrument [Line Items]
Credit agreement, maximum borrowing capacity		80,000,000
Senior revolver | Second A&R Credit Agreement
Debt Instrument [Line Items]
Credit agreement, maximum borrowing capacity			$ 600,000,000
Debt issuance costs incurred		10,600,000
Debt issuance costs, capitalized		$ 5,700,000
Variable interest rate (as a percent)	7.10%
Term A Loans | Second A&R Credit Agreement
Debt Instrument [Line Items]
Variable interest rate (as a percent)	7.10%
Term B Loans | Second A&R Credit Agreement
Debt Instrument [Line Items]
Variable interest rate (as a percent)	7.85%

Debt - Maturities of Long-Term

Debt - Maturities of Long-Term Debt (Details) $ in Millions	Sep. 30, 2024 USD ($)
Debt Disclosure [Abstract]
Remainder of 2024	$ 18.1
2025	72.8
2026	684.1
2027	436.1
2028	10.8
2029	1,014.7
Total	$ 2,236.6

Derivative Financial Instrume_3

Derivative Financial Instruments - Narrative (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Sep. 30, 2024	Dec. 31, 2023
Derivative [Line Items]
Accumulated gain, net of tax, recognized in other comprehensive loss		$ 3	$ 7.5
Foreign currency hedges | Cash flow hedging | Designated as hedging instrument
Derivative [Line Items]
Gain reported in accumulated other comprehensive income		0.2
Gain to be reclassified within next 12 months		0.2
Notional amount	$ 53.2	53.2
Foreign currency hedges | Fair Value Hedging | Designated as hedging instrument
Derivative [Line Items]
Gains in earnings	0.1	0.1
Unrealized gain on fair value hedging instruments			$ 0
Interest rate swaps | Cash flow hedging | Designated as hedging instrument
Derivative [Line Items]
Gain reported in accumulated other comprehensive income		3.8
Gain to be reclassified within next 12 months		3.8
Notional amount	$ 500	$ 500

Derivative Financial Instrume_4

Derivative Financial Instruments - Derivative Gain (Loss) (Details) - Cash flow hedging - Designated as hedging instrument - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Foreign currency forward contracts
Derivative [Line Items]
Derivatives, net gain (loss) reclassified	$ 0	$ 0.5	$ 0.1	$ 1.3
Interest rate swaps
Derivative [Line Items]
Derivatives, net gain (loss) reclassified	$ 3	$ 2.8	$ 8.9	$ 7.2

Derivative Financial Instrume_5

Derivative Financial Instruments- Schedule Of Derivative Instruments as Hedged on Consolidated Balance Sheets (Details) - Cash flow hedging - Designated as hedging instrument - USD ($) $ in Millions	Sep. 30, 2024	Dec. 31, 2023
Foreign currency forward contracts
Derivative [Line Items]
Derivative asset, current	$ 0.2	$ 0.5
Derivative liability	0	0
Derivative, fair value, net	0.2	0.5
Interest rate swaps
Derivative [Line Items]
Derivative asset, current	3.8	8.7
Derivative asset, noncurrent	0	0.9
Derivative, fair value, net	$ 3.8	$ 9.6

Share-Based Compensation - Comp

Share-Based Compensation - Compensation Expense Allocation (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 16	$ 20.1	$ 59.5	$ 54.3
Related tax benefits	1.5	4.2	11.1	11.5
CoyCo 2
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Share-based compensation expense capitalized to deferred contract costs	9.2	1.7	12.7	5.4
Cost of services
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	6.9	12.4	30.8	32.1
Selling, general and administrative
Employee Service Share-based Compensation, Allocation of Recognized Period Costs [Line Items]
Total share-based compensation expense	$ 9.1	$ 7.7	$ 28.7	$ 22.2

Share-Based Compensation - Inco

Share-Based Compensation - Income Tax Benefits (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Income tax benefit	$ 0.4	$ (0.1)	$ 1.1	$ (1.3)

Share-Based Compensation - Narr

Share-Based Compensation - Narrative (Details)	9 Months Ended
	Sep. 30, 2024 shares
Management Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Nonvested award, cost not yet recognized, period for recognition (in years)	4 years
RSUs | Acclara
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Replacement awards issued to Acclara equity award holders (in shares)	1,983,791
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum exercisable (in shares)	13,419,562
PBRSUs | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage	0%
PBRSUs | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares vesting if targets conditions met, potential percentage	200%

Share-Based Compensation - Stoc

Share-Based Compensation - Stock Options Activity (Details)	9 Months Ended
	Sep. 30, 2024 $ / shares shares	Dec. 31, 2023 $ / shares shares
Options
Outstanding at beginning of period (in shares) | shares	2,647,202
Exercised (in shares) | shares	(486,114)
Outstanding at end of period (in shares) | shares	2,161,088
Outstanding, vested and exercisable at end of period (in shares) | shares	2,161,088	2,647,202
Weighted- Average Exercise Price
Outstanding at beginning of period (in dollars per share) | $ / shares	$ 3.41
Exercised (in dollars per share) | $ / shares	2.95
Outstanding at end of period (in dollars per share) | $ / shares	3.52
Outstanding, vested and exercisable at end of period (in dollars per share) | $ / shares	$ 3.52	$ 3.41

Share-Based Compensation - Othe

Share-Based Compensation - Other Than Stock Options Activity (Details) - USD ($) $ / shares in Units, $ in Millions	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
RSUs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	3,330,236
Granted (in shares)	4,000,127
Vested (in shares)	(1,701,746)
Forfeited (in shares)	(534,436)
Outstanding and unvested at end of period (in shares)	5,094,181
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 17.66
Granted (in dollars per share)	11.09
Vested (in dollars per share)	15.12
Forfeited (in dollars per share)	13.55
Outstanding and unvested at end of period (in dollars per share)	$ 13.78
Shares surrendered for taxes (in shares)	573,263	381,066
Cost of shares surrendered for taxes	$ 7.2	$ 6.2
PBRSUs
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Outstanding and unvested at beginning of period (in shares)	6,128,821
Granted (in shares)	1,529,657
Vested (in shares)	(462,927)
Forfeited (in shares)	(485,770)
Outstanding and unvested at end of period (in shares)	6,709,781
Weighted- Average Grant Date Fair Value
Outstanding and unvested at beginning of period (in dollars per share)	$ 19.36
Granted (in dollars per share)	12.59
Vested (in dollars per share)	26.65
Forfeited (in dollars per share)	17.95
Outstanding and unvested at end of period (in dollars per share)	$ 17.42
Shares surrendered for taxes (in shares)	162,550	903,658
Cost of shares surrendered for taxes	$ 2.4	$ 13.1

Other Expenses - Schedule of Ot

Other Expenses - Schedule of Other Expenses (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Other Income and Expenses [Abstract]
Business acquisition costs	$ 0	$ 1.4	$ 15.1	$ 3.5
Integration costs	4.4	6.1	27.1	30
Technology transformation	2.8	4.5	20.9	11.8
Strategic initiatives	0	13	0.5	23.8
Facility-related charges	1.8	7.2	4.9	15.7
Other	24.2	(2.8)	32.9	3.1
Total other expenses	$ 33.2	$ 29.4	101.4	$ 87.9
Vendor termination fee			$ 6.3

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Income Tax Disclosure [Abstract]
Statute of limitations minimum (in years)	3 years
Statute of limitations maximum (in years)	6 years
Gross deferred tax assets		$ 137.9
Deferred tax assets related to operating loss carryforwards		$ 23.7

Earnings (Loss) Per Share - Com

Earnings (Loss) Per Share - Computation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Net income (loss)	$ (19.9)	$ 1.3	$ (62.6)	$ 1.9
Net income (loss)	$ (19.9)	$ 1.3	$ (62.6)	$ 1.9
Basic weighted-average common shares (in shares)	422,101,172	419,008,998	421,289,787	418,299,910
Add: Effect of dilutive equity awards (in shares)	0	4,345,149	0	4,234,933
Add: Effect of dilutive warrants (in shares)	0	33,009,877	0	32,302,754
Diluted weighted average common shares (in shares)	422,101,172	456,364,024	421,289,787	454,837,597
Net income (loss) per common share (basic) (in dollars per share)	$ (0.05)	$ 0	$ (0.15)	$ 0
Net income (loss) per common share (diluted) (in dollars per share)	$ (0.05)	$ 0	$ (0.15)	$ 0

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	20,674,831	705,982	20,674,831	589,077
Warrant | TCP-ASC ACHI Series LLLP
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	40,500,000		40,500,000
Warrant | Intermountain
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	1,500,000		1,500,000
Warrant | Providence’s
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive common share equivalents (in shares)	12,200,000		12,200,000

Commitments and Contingencies -

Commitments and Contingencies - Narrative (Details)	1 Months Ended
	May 31, 2016 plaintiff
Commitments and Contingencies Disclosure [Abstract]
Number of plaintiffs	1
Number of additional plaintiffs	3

Segments and Customer Concent_3

Segments and Customer Concentrations - Narrative (Details) - segment	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Segment Reporting Information [Line Items]
Number of operating segments	1
Number of reporting segments	1
Ascension and its affiliates | Accounts receivable | Customer concentration risk
Segment Reporting Information [Line Items]
Concentration percentage (as a percent)	11%	10%

Segments and Customer Concent_4

Segments and Customer Concentrations - Concentration Risk by Customer (Details) - Revenue - Customer concentration risk	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Ascension and its affiliates
Concentration Risk [Line Items]
Concentration percentage (as a percent)	30%	40%	34%	39%
Intermountain Health
Concentration Risk [Line Items]
Concentration percentage (as a percent)	10%	11%	10%	11%

Supplemental Financial Inform_3

Supplemental Financial Information - Depreciation and Amortization Expense (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 23.9	$ 20.4	$ 64.8	$ 53.9
Cost of services
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	23.1	20	63.1	52.9
Selling, general and administrative
Property, Plant and Equipment [Line Items]
Total depreciation and amortization	$ 0.8	$ 0.4	$ 1.7	$ 1

Supplemental Financial Inform_4

Supplemental Financial Information - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows for operating leases	$ 22	$ 19.2
Operating cash flows for finance leases	0.1	0
Financing cash flows for finance leases	0.3	0.2
Right-of-use assets obtained in exchange for operating lease obligations	20.2	3.8
Right-of-use asset obtained in exchange for finance lease obligations	$ 8.1	$ 0