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Cano Health Announces Financial Results for the Third Quarter 2022

(PRNewsfoto/Cano Health, LLC)

News provided by

Cano Health, Inc.

Nov 09, 2022, 16:05 ET

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MIAMI, Nov. 9, 2022 /PRNewswire/ -- Cano Health, Inc. ("Cano Health" or the "Company") (NYSE: CANO), a leading value-based primary care provider and population health company, today announced financial results for the third quarter ended September 30, 2022.

Third Quarter Financial Results

  • Total membership of 294,596, including 168,346 Medicare capitated members, an increase of 40% year-over-year for both
  • Total revenue of $665.0 million, an increase of 33% year-over-year
  • Net loss of $(112.0) million, unfavorably impacted by a $65.7 million fair value adjustment of warrant liabilities
  • Adjusted EBITDA1 of $42.5 million, compared to $13.6 million in the third quarter of 2021, an increase of 211% year over year

The Company continues to demonstrate financial and operational improvement year-over-year, with higher revenue, an improved medical cost ratio2, or MCR, and a higher Adjusted EBITDA margin. Total third-party medical costs per member per month, or PMPM, were better than expected in the third quarter, however, capitated revenue PMPM was approximately (5%) lower than the prior year and approximately (9%) lower than the second quarter of 2022, primarily due to a lower-than-expected capitated rates from new patients. This resulted in a higher medical cost ratio in the quarter than expected. The MCR was 78.2% in the third quarter, compared to 80.5% in the prior year, primarily driven by lower third-party medical costs PMPM, which more than offset the decline in capitated revenue PMPM.

"Cano Health delivered improved profitability while achieving steady organic growth," said Dr. Marlow Hernandez, Chairman and Chief Executive Officer at Cano Health.  "While financial results were below our expectations due to lower revenue from new membership growth, existing membership performed in line with expectations.  As these new members integrate into our care platform, we expect they will perform similarly to existing members in future periods.  In response to our rapid growth and the higher cost of capital in the current economic environment, we are optimizing key areas of the business to leverage existing assets and prioritize cash flow.  We are confident Cano Health's operating model will continue to deliver better health outcomes for our patients and sustainable long-term value creation for our shareholders."

______________________

(1) Adjusted EBITDA is a non-GAAP financial measure. A reconciliation of this non-GAAP financial measure to its most directly comparable GAAP financial measure is provided in the Reconciliation of Non-GAAP Adjusted EBITDA table included in this press release. An explanation of this measure and how it is calculated is also included under the heading "Non-GAAP Financial Measures."

(2) Medical Claims Expense Ratio (MCR) is calculated as third-party medical expense divided by capitated revenue

Guidance

The Company is updating its guidance for full year 2022 provided on August 9, 2022.  The updated guidance for full year 2022 is as follows:

  • Membership in the range of 300,000 to 305,000, unchanged from the prior guidance range
  • Total revenue in the range of $2.70 billion to $2.75 billion, a decrease from the prior guidance range of $2.85 billion to $2.90 billion, primarily driven by lower-than-expected capitated revenue PMPM from new members
  • Total medical cost ratio (MCR) in the range of 79.5% to 80.5%, an increase from the prior range of 78.0% to 79.0%, driven by the aforementioned lower-than-expected capitated revenue PMPM from new members
    • The second half of 2022 is still expected to be lower than total MCR in the first half of 2022, primarily driven by normal seasonality in medical costs and cost recoveries
  • Adjusted EBITDA of approximately $150 million to $160 million, a decrease from the prior guidance of approximately $200 million
  • The Company added eight medical centers in the quarter, bringing total medical centers to 151, as of September 30, 2022, and 162 as of November 9, 2022; the Company expects to operate 170 by the end of 2022, a decrease from the prior guidance of 184 to 189, consistent with the focus on cash flow improvement

As of November 4, 2022, the Company had approximately 245 million shares of Class A common stock and 250 million shares of Class B common stock issued and outstanding. Total share count for the purposes of calculating market capitalization was approximately 494 million.

Conference Call Information

Cano Health will host a conference call today at 5:00 PM ET to review the Company's business and financial results for the third quarter ended September 30, 2022.

To access the live call and webcast, please dial (888) 660-6359 for U.S. participants, or +1 (929) 203-0867 for international participants, and reference the Cano Health Third Quarter 2022 Earnings Conference Call and Conference ID 8371699. The conference call will also be webcast live in the "Events & Presentations" section of the Investor page of the Cano Health website.

A replay will be available in the "Events & Presentations" section of the Cano Health website for on-demand listening shortly after the completion of the call and will be available for 30 days.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Forward-looking statements relate to future events and involve known and unknown risks, uncertainties and other factors which are, in some cases, beyond our control and could materially affect actual results, performance or achievements. Such forward-looking statement include, without limitation, our anticipated results of operations, including our financial guidance for the 2022 fiscal year, our business strategies, our projected costs, prospects and plans, and other aspects of our operations or operating results. These forward-looking statements generally can be identified by phrases such as "will," "expects," "anticipates," "foresees," "forecasts," "estimates" or other words or phrases of similar import. It is uncertain whether any of the events anticipated by the forward-looking statements will transpire or occur, or if any of them do, what impact they will have on our results of operations and financial condition. Important risks and uncertainties that could cause our actual results and financial condition to differ materially from those indicated in forward-looking statements include, among others, changes in market or industry conditions, regulatory environment, competitive conditions, and receptivity to our services; changes in our strategy, future operations, prospects and plans; developments and uncertainties related to the Direct Contracting Entity ("DCE") DCE program; adverse effects on the Company's business as a result of the restatement of our previously issued financial statements; our ability to realize expected financial results, including with respect to patient membership, total revenue and earnings; our ability to predict and control our medical cost ratio; our ability to grow market share in existing markets or enter into new markets and continue our growth; our ability to integrate our acquisitions and achieve desired synergies; our ability to maintain our relationships with health plans and other key payors; the impact of COVID-19 on our business and results of operations; our future capital requirements and sources and uses of cash, including funds to satisfy our liquidity needs; and our ability to recruit and retain qualified team members and independent physicians. For a detailed discussion of the risks and uncertainties that could cause our actual results to differ materially from those expressed or implied by the forward-looking statements, please refer to our filings with the Securities and Exchange Commission (the "SEC"). All information provided in this press release is as of the date hereof, and we undertake no duty to update or revise this information unless required by law.

Non-GAAP Financial Measures

This press release contains certain non-GAAP financial measures as defined by the SEC rules. EBITDA and Adjusted EBITDA have not been prepared in accordance with United States generally accepted accounting principles ("GAAP"). EBITDA is defined as net income (loss) before interest, income taxes, depreciation and amortization. Adjusted EBITDA is defined as EBITDA, adjusted to add back the effect of certain expenses, such as stock-based compensation expense, de novo losses (consisting of costs associated with the ramp up of new medical centers and losses incurred for the twelve months after the opening of a new facility), acquisition transaction costs (consisting of transaction costs and corporate development payroll costs), restructuring and other charges, fair value adjustments in contingent consideration, loss on extinguishment of debt, and changes in fair value of warrant liabilities. We believe these non-GAAP financial measures provide an additional tool for investors to use in evaluating ongoing operating results and trends and in comparing our financial measures with other similar companies. We do not consider these non-GAAP measures in isolation or as an alternative to financial measures determined in accordance with GAAP.

These non-GAAP financial measures are subject to inherent limitations as they reflect the exercise of judgments by management about which expense, income and other items are excluded or included in determining these non-GAAP financial measures. In addition, other companies may calculate non-GAAP financial measures differently or may use other measures to evaluate their performance, all of which could reduce the usefulness of our non-GAAP financial measures as tools for comparison. A reconciliation of those measures to their most directly comparable GAAP measures is available under the heading "Reconciliation of Non-GAAP Measures." 

The Company has not reconciled its expectations as to non-GAAP measures in future periods to their most directly comparable GAAP measure because certain costs and expenses are outside of its control or cannot be reasonably predicted.  Accordingly, reconciliation is not available without unreasonable effort, although it is important to note that these factors could be material to the Company's results computed in accordance with GAAP.

About Cano Health 

Cano Health (NYSE: CANO) is a high-touch, technology-powered healthcare company delivering personalized, value-based primary care to more than 290,000 members. With its headquarters in Miami, Florida, Cano Health is transforming healthcare by delivering primary care that measurably improves the health, wellness, and quality of life of its patients and the communities it serves. Founded in 2009, Cano Health has more than 4,500 employees, and operates primary care medical centers and supports affiliated providers in nine states and Puerto Rico. For more information,  visit canohealth.com or investors.canohealth.com.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

UNAUDITED

 
 

Three Months Ended September 30,

 

Nine Months Ended September 30,

(in thousands, except share and per share data)

2022

 

2021

 

2022

 

2021

Revenue:

             

Capitated revenue

$             625,895

 

$             473,763

 

$          1,955,739

 

$          1,064,604

Fee-for-service and other revenue

39,133

 

25,168

 

102,804

 

52,510

Total revenue

665,028

 

498,931

 

2,058,543

 

1,117,114

Operating expenses:

             

Third-party medical costs

489,565

 

381,316

 

1,566,661

 

868,177

Direct patient expense

63,867

 

50,368

 

177,190

 

120,212

Selling, general and administrative expenses

111,765

 

76,618

 

314,617

 

158,786

Depreciation and amortization expense

25,343

 

16,955

 

64,215

 

30,746

Transaction costs and other

5,033

 

11,206

 

19,616

 

36,274

Change in fair value of contingent
consideration

900

 

(3,940)

 

(9,525)

 

(4,152)

Total operating expenses

696,473

 

532,523

 

2,132,774

 

1,210,043

Income (loss) from operations

(31,445)

 

(33,592)

 

(74,231)

 

(92,929)

Other income and expense:

             

Interest expense

(16,451)

 

(16,023)

 

(42,868)

 

(36,363)

Interest income

4

 

1

 

7

 

4

Loss on extinguishment of debt

—

 

—

 

(1,428)

 

(13,225)

Change in fair value of warrant liabilities

(65,721)

 

(14,650)

 

(8,383)

 

24,565

Other income (expense)

354

 

(29)

 

884

 

(54)

Total other income (expense)

(81,814)

 

(30,701)

 

(51,788)

 

(25,073)

Net income (loss) before income tax expense

(113,259)

 

(64,293)

 

(126,019)

 

(118,002)

Income tax expense (benefit)

(1,248)

 

547

 

641

 

(762)

Net income (loss)

$           (112,011)

 

$              (64,840)

 

$            (126,660)

 

$           (117,240)

Net income (loss) attributable to non-
controlling interests

(57,783)

 

(41,602)

 

(67,759)

 

(98,559)

Net income (loss) attributable to Class A
common stockholders

$             (54,228)

 

$             (23,238)

 

$             (58,901)

 

$             (18,681)

               

Net income (loss) per share attributable to Class
A common stockholders, basic

$                  (0.23)

 

$                  (0.14)

 

$                  (0.28)

 

$                  (0.11)

Net income (loss) per share attributable to Class
A common stockholders, diluted

$                 (0.23)

 

$                 (0.14)

 

$                 (0.28)

 

$                 (0.16)

Weighted-average shares used in computation
of earnings per share:

             

Basic

232,314,170

 

170,871,429

 

211,408,974

 

168,100,210

Diluted

232,314,170

 

477,255,983

 

211,408,974

 

169,312,258

CONDENSED CONSOLIDATED BALANCE SHEETS

UNAUDITED

 
   

As of,

(in thousands)

 

September 30,
2022

 

December 31,
2021

Assets

       

Current assets:

       

Cash, cash equivalents and restricted cash

 

$           24,097

 

$         163,170

Accounts receivable, net of unpaid service provider costs

 

202,037

 

133,433

Prepaid expenses and other current assets

 

78,833

 

20,632

Total current assets

 

304,967

 

317,235

Property and equipment, net

 

125,513

 

85,261

Operating lease right of use assets

 

171,442

 

132,173

Goodwill

 

787,885

 

769,667

Payor relationships, net

 

565,213

 

576,648

Other intangibles, net

 

231,368

 

248,973

Other assets

 

9,751

 

13,582

Total assets

 

$      2,196,139

 

$      2,143,539

Liabilities and stockholders' equity

       

Current liabilities:

       

Current portion of notes payable

 

$             6,444

 

$             6,493

Current portion of finance lease liabilities

 

1,595

 

1,295

Current portion of contingent consideration

 

5,700

 

3,123

Accounts payable and accrued expenses

 

110,301

 

80,829

Current portions due to sellers

 

2,038

 

17,357

Current portion operating lease liabilities

 

24,946

 

15,275

Other current liabilities

 

34,537

 

36,664

Total current liabilities

 

185,561

 

161,036

Notes payable, net of current portion and debt issuance costs

 

914,394

 

915,266

Long term portion of operating lease liabilities

 

160,479

 

122,935

Warrants liabilities

 

88,528

 

80,144

Long term portion of finance lease liabilities

 

3,139

 

2,181

Contingent consideration

 

28,000

 

35,300

Other liabilities

 

33,004

 

28,109

Total liabilities

 

1,413,105

 

1,344,971

Stockholders' Equity

       

Shares of Class A common stock

 

24

 

18

Shares of Class B common stock

 

25

 

30

Additional paid-in capital

 

544,106

 

397,443

Accumulated deficit

 

(137,661)

 

(78,760)

Total Stockholders' Equity before non-controlling interests

 

406,494

 

318,731

Non-controlling interests

 

376,540

 

479,837

Total Stockholders' Equity

 

783,034

 

798,568

Total Liabilities and Stockholders' Equity

 

$      2,196,139

 

$      2,143,539

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

UNAUDITED

 
   

Nine Months Ended
September 30,

(in thousands)

 

2022

 

2021

Cash Flows from Operating Activities:

       

Net loss

 

$       (126,660)

 

$       (117,240)

Adjustments to reconcile net loss to net cash used in operating activities:

       

Depreciation and amortization expense

 

64,215

 

30,746

Change in fair value of contingent consideration

 

(9,525)

 

(4,152)

Change in fair value of warrant liabilities

 

8,383

 

(24,565)

Loss on extinguishment of debt

 

1,428

 

13,225

Amortization of debt issuance costs

 

2,743

 

4,162

Non-cash lease expense

 

8,367

 

—

Class A shares issued for bonus award

 

2,194

 

—

Stock-based compensation

 

42,641

 

13,131

Changes in operating assets and liabilities:

       

Accounts receivable, net

 

(75,913)

 

(25,494)

Other assets

 

10,885

 

(9,874)

Prepaid expenses and other current assets

 

(47,492)

 

(22,603)

Interest accrued due to seller

 

100

 

1,208

Accounts payable and accrued expenses

 

30,955

 

40,620

Other liabilities

 

3,521

 

6,343

Net cash provided by (used in) operating activities

 

(84,158)

 

(94,493)

Cash Flows from Investing Activities:

       

Purchase of property and equipment

 

(39,061)

 

(23,221)

Acquisitions of subsidiaries including non-compete intangibles, net of cash acquired

 

(4,995)

 

(1,065,479)

Payments to sellers

 

(4,097)

 

(24,148)

Net cash provided by (used in) investing activities

 

(48,153)

 

(1,112,848)

Cash Flows from Financing Activities:

       

Business Combination and PIPE financing

 

—

 

935,362

Payments of long-term debt

 

(4,833)

 

(656,294)

Debt issuance costs

 

(88)

 

(16,489)

Proceeds from long-term debt

 

—

 

1,120,000

Proceeds from revolving line of credit

 

25,000

 

—

Repayments of revolving line of credit

 

(25,000)

 

—

Proceeds from insurance financing arrangements

 

2,529

 

1,702

Payments of principal on insurance financing arrangements

 

(2,070)

 

(1,419)

Principal payments under finance leases

 

(1,037)

 

(233)

Repayment of equipment loans

 

(385)

 

(316)

Employee stock purchase plan withholding tax payments

 

(878)

 

—

Other

 

—

 

134

Net cash provided by (used in) financing activities

 

(6,762)

 

1,382,447

         

Net increase (decrease) in cash, cash equivalents and restricted cash

 

(139,073)

 

175,106

Cash, cash equivalents and restricted cash at beginning of year

 

163,170

 

33,807

Cash, cash equivalents and restricted cash at end of period

 

$           24,097

 

$        208,913

Reconciliation of Non-GAAP

Adjusted EBITDA

UNAUDITED

 
 

Three Months Ended
September 30,

 

Nine Months Ended

September 30,

(in thousands)

2022

 

2021

 

2022

 

2021

Net loss

$ (112,011)

 

$   (64,840)

 

$ (126,660)

 

$ (117,240)

Interest income

(4)

 

(1)

 

(7)

 

(4)

Interest expense

16,451

 

16,023

 

42,868

 

36,363

Income tax expense (benefit)

(1,248)

 

547

 

641

 

(762)

Depreciation and amortization expense

25,343

 

16,955

 

64,215

 

30,746

EBITDA

$   (71,469)

 

$   (31,316)

 

$   (18,943)

 

$   (50,897)

Stock-based compensation

11,041

 

9,451

 

42,641

 

13,130

De novo (1)

24,282

 

10,178

 

59,567

 

24,561

Transaction costs (2)

6,733

 

12,503

 

24,445

 

39,297

Restructuring and other (3)

5,245

 

2,123

 

8,846

 

5,513

Change in fair value of contingent consideration

900

 

(3,940)

 

(9,525)

 

(4,152)

Loss on extinguishment of debt

—

 

—

 

1,428

 

13,225

Change in fair value of warrant liabilities

65,721

 

14,650

 

8,383

 

(24,565)

Adjusted EBITDA

$     42,453

 

$     13,649

 

$   116,842

 

$    16,112

______________________

(1) De novo losses include those costs associated with the ramp up of new medical centers and losses incurred after the opening of a new facility. These costs collectively are higher than comparable expenses incurred once such a facility has been opened and is generating revenue, and would not have been incurred unless a new facility was being opened.

 

(2) Acquisition transaction costs included $1.7 million and $1.3 million for the three months ended June 30, 2022 and 2021, respectively, and $4.3 million and $3.0 million for the six months ended June 30, 2022 and 2021, respectively, of corporate development payroll costs. Corporate development payroll costs include those expenses directly related to the additional staff needed to support our acquisition activity.

 

(3) Restructuring and other included $5.0 million  for the three and nine months ended September 30, 2022 related to a one-time professional services fee.

Key Metrics

 
   

Three Months Ended

 September 30,

   
   

2022

 

2021

 

% Change

Members:

           

   Medicare Advantage

 

128,731

 

112,309

 

14.6 %

   Medicare DCE

 

39,615

 

7,777

 

409.4 %

Total Medicare

 

168,346

 

120,086

 

40.2 %

Medicaid

 

73,865

 

63,871

 

15.6 %

ACA

 

52,385

 

26,706

 

96.2 %

Total members

 

294,596

 

210,663

 

39.8 %

             

Member months:

           

   Medicare Advantage

 

383,645

 

337,724

 

13.6 %

   Medicare DCE

 

119,936

 

22,715

 

428.0 %

Total Medicare

 

503,581

 

360,439

 

39.7 %

Medicaid

 

218,807

 

187,212

 

16.9 %

ACA

 

149,872

 

81,437

 

84.0 %

Total member months

 

872,260

 

629,088

 

38.7 %

             

Per Member Per Month ("PMPM"):

           

   Medicare Advantage

 

$             1,127

 

$             1,151

 

(2.1) %

   Medicare DCE

 

$             1,215

 

$             1,349

 

(9.9) %

Total Medicare

 

$             1,148

 

$             1,163

 

(1.3) %

Medicaid

 

$                191

 

$                271

 

(29.5) %

ACA

 

$                  40

 

$                  47

 

(14.9) %

Total PMPM

 

$                718

 

$                753

 

(4.6) %

             

Medical centers

 

151

 

113

   

Key Metrics

 
   

Nine Months Ended

 September 30,

   
   

2022

 

2021

 

% Change

Members:

           

   Medicare Advantage

 

128,731

 

112,309

 

14.6 %

   Medicare DCE

 

39,615

 

7,777

 

409.4 %

Total Medicare

 

168,346

 

120,086

 

40.2 %

Medicaid

 

73,865

 

63,871

 

15.6 %

ACA

 

52,385

 

26,706

 

96.2 %

Total members

 

294,596

 

210,663

 

39.8 %

             

Member months:

           

   Medicare Advantage

 

1,102,625

 

820,881

 

34.3 %

   Medicare DCE

 

367,326

 

46,639

 

687.6 %

Total Medicare

 

1,469,951

 

867,520

 

69.4 %

Medicaid

 

627,634

 

321,581

 

95.2 %

ACA

 

411,138

 

195,290

 

110.5 %

Total member months

 

2,508,723

 

1,384,391

 

81.2 %

             

Per Member Per Month ("PMPM"):

           

   Medicare Advantage

 

$             1,189

 

$             1,053

 

12.9 %

   Medicare DCE

 

$             1,320

 

$             1,283

 

2.9 %

Total Medicare

 

$             1,222

 

$             1,066

 

14.6 %

Medicaid

 

$                223

 

$                414

 

(46.1) %

ACA

 

$                  48

 

$                  36

 

33.3 %

Total PMPM

 

$                780

 

$                769

 

1.4 %

             

Medical centers

 

151

 

113

   

SOURCE Cano Health, Inc.

21%

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