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agilon health Reports First Quarter 2024 Results

Revenue increased 52% to $1.6 billion, Medicare Advantage membership increased 43% to 523,000, and total members on the agilon platform grew to 654,000

Continued progress executing performance action plan with focus on driving profitability and enhancing operating efficiency

Maintaining full year 2024 guidance for Medical Margin and Adjusted EBITDA

agilon health, inc. (NYSE: AGL), the trusted partner empowering physicians to transform health care in our communities, announced results for the first quarter ended March 31, 2024.

“Our first quarter results were in-line with our guidance,” said Steve Sell, chief executive officer. “We continue to make tangible progress executing our performance action plan. As payors adjust to the current funding environment for Medicare Advantage, we remain well positioned as our value proposition to primary care doctors and payors is increasingly important and well-recognized.”

First Quarter 2024 Results:

  • Total members on the agilon platform increased to 654,000 as of March 31, 2024, including 523,000 Medicare Advantage members and 131,000 ACO model beneficiaries. Medicare Advantage membership increased 43%, with 7% growth in same partner geographies.
  • Total revenue of $1.60 billion in the first quarter 2024 increased 52% compared to $1.05 billion in the first quarter 2023.
  • Gross profit of $75 million in the first quarter 2024 compared to $73 million in the first quarter 2023. Net loss of $6 million in the first quarter 2024 compared to net income of $16 million in the first quarter 2023.
  • Medical margin of $157 million during the first quarter 2024, compared to $156 million in the first quarter 2023. Medical Margin for the first quarter 2024 included a negative $8.7 million net impact from prior year claims, consisting of $16.5 million in total prior year claims inclusive of $7.8 million in claims development from retro members with offsetting revenue.
  • Adjusted EBITDA of $29 million in the first quarter 2024 increased 21% compared to $24 million in the first quarter 2023.

Key Financial and Operating Metrics ($M):

(First Quarter 2024 vs. 2023)

 

Three Months

Ended March 31,

 

 

Change

 

2024

 

2023

 

% YoY

Medicare Advantage Members1

522,800

 

365,700

 

43%

ACO Model Members1, 2

131,000

 

88,700

 

48%

Total Members Live on Platform1, 2

653,800

 

454,400

 

44%

Avg. Medicare Advantage Members

518,400

 

363,400

 

43%

Total revenues

$1,604

 

$1,054

 

52%

Gross Profit

$75

 

$73

 

3%

Medical Margin

$157

 

$156

 

1%

Net (Loss) Income

($6)

 

$16

 

NM

Adjusted EBITDA3

$29

 

$24

 

21%

Geography Entry Costs

$11

 

$12

 

(5%)

1.

Membership metrics reflect end of period results.

2.

agilon’s ACO model entities are not included within its consolidated financial results.

3.

agilon’s ACO model entities contributed $10 million and $3 million to Adjusted EBITDA during the first quarter 2024 and first quarter 2023, respectively.

Continued Progress on Performance Action Plan

agilon health continues to make progress executing its targeted action plan to improve performance. This plan includes refining payor relationships, expanding onboarding support for newer primary care physicians, improving data visibility and analytics, and accelerating operating efficiency. Management anticipates these actions will support growth in Adjusted EBITDA in 2024 and beyond.

During the first quarter, agilon health reached agreements with certain payors to mitigate 2023 medical margin losses and made the decision to exit certain unprofitable payor contracts effective during the second quarter 2024. The company continues to deploy structured training and education resources to physician partners with 90% of new physicians in mature markets expected to be trained during the first half of 2024. agilon achieved its target of onboarding >55% of member data into the company's financial data pipeline and expects to onboard >75% of member data during the second quarter. The company also continues to make progress driving operating expense efficiency; platform support represented 2.8% of revenue in the first quarter compared to the company’s 3% target for 2024.

Class of 2025 New Partnership Announcement

On May 7, agilon health announced the formation of long-term partnerships with five leading physician groups: Graves Gilbert Clinic in Kentucky, Mankato Clinic in Minnesota, Twin Cities Network in Minnesota, and Springfield Clinic in Illinois, as well as an independent, multi-specialty practice in North Carolina that will be named at a later date. With these new partnerships, agilon will enter the state of Illinois and expand its existing broad footprint in North Carolina, Kentucky and Minnesota.

With the addition of the Class of 2025, agilon’s Physician Network will include over 3,000 primary care physicians (PCPs) who are delivering value-based care to more than 700,000 senior patients in 30+ communities. The Class of 2025 is expected to add more than 60,000 Medicare Advantage members to the agilon platform.

Capital Position and Balance Sheet:

agilon health’s balance sheet as of March 31, 2024 included cash, cash equivalents and marketable securities of $426 million and total debt of $37 million. In addition, agilon health has $26 million of cash associated with the company’s unconsolidated ACO model entities.

Outlook for Fiscal Year 2024 ($M):

Year Ended December 31, 2024

Updated Guidance

 

Previous Guidance

Low

 

High

 

Low

 

High

Medicare Advantage Members1

510,000

 

515,000

 

540,00

 

550,000

ACO Model Members1,2

120,000

 

125,000

 

120,00

 

125,000

Total Members Live on Platform1

630,000

 

640,000

 

660,00

 

675,000

Avg. Medicare Advantage Members

510,000

 

514,000

 

527,00

 

536,000

Total Revenues

$6,125

 

$6,175

 

$6,350

 

$6,465

Medical Margin

$400

 

$450

 

$400

 

$450

Adjusted EBITDA3

($60)

 

($15)

 

($60)

 

($15)

Geography Entry Costs4

$65

 

$55

 

$65

 

$55

1.

Membership reflects management’s outlook for end of period.

2.

agilon’s partnered ACO model entities are not consolidated within its financial results.

3.

Adjusted EBITDA contribution from ACO model is expected to be approximately $35 million for fiscal year 2024.

4.

Geography Entry Costs represent the corresponding expense included in the low-end and high-end of management’s outlook for Adjusted EBITDA.

Outlook for Second Quarter 2024 ($M):

 

Quarter Ended

June 30, 2024

Low

 

High

Medicare Advantage Members1

513,000

 

518,000

ACO Model Members1,2

123,000

 

128,000

Total Members Live on Platform1

636,000

 

646,000

Avg. Medicare Advantage Members

514,000

 

519,000

Total Revenues

$1,550

 

$1,570

Medical Margin

$100

 

$120

Adjusted EBITDA3

($15)

 

$0

Geography Entry Costs4

$18

 

$16

1.

Membership reflects management’s outlook for end of period.

2.

agilon’s partnered ACO model entities are not consolidated within its financial results.

3.

Adjusted EBITDA contribution from ACO model is expected to be approximately $10 million for the second quarter 2024.

4.

Geography Entry Costs represent the corresponding expense included in the low-end and high-end of management’s outlook for Adjusted EBITDA.

We have not reconciled guidance for Medical Margin to Gross Profit or Adjusted EBITDA to net income (loss), the most comparable GAAP measures, and have not provided forward-looking guidance for net income (loss) in each case because of the uncertainty around certain items that may impact Gross Profit or net income (loss), including non-cash stock-based compensation.

Webcast and Conference Call:

agilon health will host a conference call to discuss first quarter 2024 results on Tuesday, May 7, 2024 at 4:30 PM Eastern Time. The conference call can be accessed by dialing (833) 470-1428 for U.S. participants and +1 (929) 526-1599 for international participants and referencing participant code 690899. A simultaneous webcast can be accessed by visiting the “Events & Presentations” section of agilon’s Investor Relations website at https://investors.agilonhealth.com. A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call.

About agilon health

agilon health is the trusted partner empowering physicians to transform health care in our communities. Through our partnerships and purpose-built platform, agilon is accelerating at scale how physician groups and health systems transition to a value-based Total Care Model for their senior patients. agilon provides the technology, people, capital, process, and access to a peer network of 3,000+ PCPs that allow its physician partners to maintain their independence and focus on the total health of their most vulnerable patients. Together, agilon and its physician partners are creating the healthcare system we need – one built on the value of care, not the volume of fees. The result: healthier communities and empowered doctors. agilon is the trusted partner in 30+ diverse communities and is here to help more of our nation's leading physician groups and health systems have a sustained, thriving future. For more information visit www.agilonhealth.com and connect with us on Instagram, LinkedIn and YouTube.

Forward-Looking Statements

Statements in this release that are not historical factual statements are “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 include, among other things, statements regarding our and our officers’ intent, belief or expectation as identified by the use of words such as “believes,” “expects,” “may,” “will,” “shall,” “should,” “would,” “could,” “seeks,” “aims,” “projects,” “is optimistic,” “intends,” “plans,” “estimates,” “anticipates” or the negative versions of these words or other comparable terms. Examples of forward-looking statements include, among other things: statements regarding timing, outcomes and other details relating to current, pending or contemplated new markets, growth opportunities, ability to deliver sustainable long-term value, business environment, long-term opportunities and strategic growth plans, expected revenue, medical costs, net income and gross profit, total and average membership, Adjusted EBITDA, Medical Margin, geography entry costs and other financial projections and assumptions, including our fiscal year and first quarter 2024 guidance. Forward-looking statements reflect our current expectations and views about future events and are subject to risks and uncertainties that could significantly affect our future financial condition and results of operations. While forward-looking statements reflect our good faith belief and assumptions we believe to be reasonable based upon current information, we can give no assurance that our expectations or forecasts will be attained. Forward-looking statements are subject to known and unknown risks and uncertainties, many of which may be outside our control. These risks and uncertainties that could cause actual results and outcomes to differ from those reflected in forward-looking statements include, but are not limited to: our history of net losses and the expectation that our expenses will increase in the future; failure to identify and develop successful new geographies, physician partners and payors, or execute upon our growth initiatives; success in executing our operating strategies or achieving results consistent with our historical performance; medical expenses incurred on behalf of our members may exceed revenues we receive; our ability to secure contracts with Medicare Advantage payors; our ability to grow new physician partner relationships sufficient to recover startup costs; availability of additional capital, on acceptable terms or at all, to support our business in the future; significant reduction in our membership; transition to a Total Care Model may be challenging for physician partners; public health crises, such as COVID-19, could adversely affect us; inaccuracy in estimates of our members’ risk adjustment factors, medical services expense, incurred but not reported claims, and earnings pursuant to payor contracts; the impact of restrictive clauses or exclusivity provisions in some of our contracts with physician partners; our to hire and retain qualified personnel; our ability to realize the full value of our intangible assets; security breaches, cybersecurity attacks, loss of data and other disruptions to our information systems; our ability to protect the confidentiality of our know-how and other proprietary and internally developed information; reliance on our subsidiaries; Environmental, Social, and Governance issues; reliance on a limited number of key payors; the limited terms of contracts with our payors and our ability to renew them upon expiration; reliance on our payors, physician partners and other providers to operate our business; our ability to obtain accurate and complete diagnosis data; reliance on third-party software, data, infrastructure and bandwidth; consolidation and competition in the healthcare industry; the impact of changes to, and dependence on, federal government healthcare programs; uncertain or adverse economic and macroeconomic conditions, including a downturn or decrease in government expenditures; regulation of the healthcare industry and our and our physician partners’ ability to comply such laws and regulations; federal and state investigations, audits and enforcement actions; repayment obligations arising out of payor audits; negative publicity regarding the managed healthcare industry generally; our use, disclosure and processing of personally identifiable information, protected health information, and de-identified data; failure to obtain or maintain an insurance license, a certificate of authority or an equivalent authorization; lawsuits not covered by insurance; changes in tax laws and regulations, or changes in related judgments or assumptions; our indebtedness and our potential to incur more debt; dependence on our subsidiaries for cash to fund all of our operations and expenses; provisions in our governing documents; ability to achieve a return on your investment depends on appreciation in the price of our common stock; the material weakness in our internal control over financial reporting and our ability to remediate such material weakness; and risks related to other factors discussed in our filings with the Securities and Exchange Commission (the “SEC”), including the factors discussed under “Risk Factors” in our Annual Report on Form 10-K for the fiscal year ended March 31, 2024, which can be found at the SEC’s website at www.sec.gov. Except as required by law, we do not undertake, and hereby disclaim, any obligation to update any forward-looking statements, which speak only as of the date on which they are made.

agilon health, inc.

Consolidated Balance Sheets

In thousands, except per share data

 

 

 

 

 

March 31,

2024

 

December 31,

2023

 

(unaudited)

 

 

ASSETS

 

 

 

Current assets:

 

 

 

Cash and cash equivalents

$

111,706

 

 

$

107,570

 

Restricted cash and equivalents

 

6,844

 

 

 

6,759

 

Marketable securities

 

307,359

 

 

 

380,773

 

Receivables, net

 

1,571,143

 

 

 

942,461

 

Prepaid expenses and other current assets, net

 

39,757

 

 

 

42,513

 

Total current assets

 

2,036,809

 

 

 

1,480,076

 

Property and equipment, net

 

27,539

 

 

 

27,576

 

Intangible assets, net

 

72,076

 

 

 

63,769

 

Goodwill

 

24,133

 

 

 

24,133

 

Other assets

 

155,906

 

 

 

145,312

 

Total assets

$

2,316,463

 

 

$

1,740,866

 

LIABILITIES AND STOCKHOLDERS’ EQUITY (DEFICIT)

 

 

 

Current liabilities:

 

 

 

Medical claims and related payables

$

1,266,651

 

 

$

737,724

 

Accounts payable and accrued expenses

 

252,497

 

 

 

233,182

 

Current portion of long-term debt

 

7,500

 

 

 

6,250

 

Total current liabilities

 

1,526,648

 

 

 

977,156

 

Long-term debt, net of current portion

 

29,834

 

 

 

32,308

 

Other liabilities

 

71,495

 

 

 

70,381

 

Total liabilities

 

1,627,977

 

 

 

1,079,845

 

 

 

 

 

Commitments and contingencies

 

 

 

 

 

 

 

Stockholders' equity (deficit):

 

 

 

Common stock, $0.01 par value: 2,000,000 shares authorized; 410,843 and 406,387 shares issued and outstanding, respectively

 

4,108

 

 

 

4,064

 

Additional paid-in capital

 

2,020,803

 

 

 

1,986,899

 

Accumulated deficit

 

(1,332,890

)

 

 

(1,326,826

)

Accumulated other comprehensive income (loss)

 

(2,747

)

 

 

(2,298

)

Total agilon health, inc. stockholders' equity (deficit)

 

689,274

 

 

 

661,839

 

Noncontrolling interests

 

(788

)

 

 

(818

)

Total stockholders’ equity (deficit)

 

688,486

 

 

 

661,021

 

Total liabilities and stockholders’ equity (deficit)

$

2,316,463

 

 

$

1,740,866

 

 

agilon health, inc.

Consolidated Statements of Operations

In thousands, except per share data

(unaudited)

 

 

Three Months Ended

March 31,

 

 

2024

 

 

 

2023

 

 

 

 

 

Revenues:

 

 

 

Medical services revenue

$

1,601,195

 

 

$

1,053,119

 

Other operating revenue

 

3,159

 

 

 

1,193

 

Total revenues

 

1,604,354

 

 

 

1,054,312

 

Expenses:

 

 

 

Medical services expense

 

1,443,842

 

 

 

897,572

 

Other medical expenses

 

85,424

 

 

 

83,617

 

General and administrative (including noncash stock-based compensation expense of $16,909 and $13,585, respectively)

 

76,422

 

 

 

69,752

 

Depreciation and amortization

 

5,844

 

 

 

2,954

 

Total expenses

 

1,611,532

 

 

 

1,053,895

 

Income (loss) from operations

 

(7,178

)

 

 

417

 

Other income (expense):

 

 

 

Income (loss) from equity method investments

 

5,684

 

 

 

1,376

 

Other income (expense), net

 

5,892

 

 

 

7,892

 

Interest expense

 

(1,284

)

 

 

(1,493

)

Income (loss) before income taxes

 

3,114

 

 

 

8,192

 

Income tax benefit (expense)

 

133

 

 

 

1,759

 

Income (loss) from continuing operations

 

3,247

 

 

 

9,951

 

Discontinued operations:

 

 

 

Income (loss) before gain (loss) on sales

 

(518

)

 

 

6,008

 

Gain (loss) on sales of assets, net

 

(8,763

)

 

 

 

Total discontinued operations

 

(9,281

)

 

 

6,008

 

Net income (loss)

 

(6,034

)

 

 

15,959

 

Noncontrolling interests’ share in (earnings) loss

 

(30

)

 

 

63

 

Net income (loss) attributable to common shares

$

(6,064

)

 

$

16,022

 

 

 

 

 

Net income (loss) per common share, basic and diluted

 

 

 

Continuing operations

$

0.01

 

 

$

0.02

 

Discontinued operations

$

(0.02

)

 

$

0.02

 

Weighted average shares outstanding

 

 

 

Basic

 

408,938

 

 

 

413,136

 

Diluted

 

413,437

 

 

 

426,586

 

agilon health, inc.

Consolidated Statements of Cash Flows

In thousands

(unaudited)

 

 

Three Months Ended March 31,

 

 

2024

 

 

 

2023

 

Cash flows from operating activities:

 

 

 

Net income (loss)

$

(6,034

)

 

$

15,959

 

Adjustments to reconcile net income (loss) to net cash used in operating activities:

 

 

 

Depreciation and amortization

 

5,844

 

 

 

4,189

 

Stock-based compensation expense

 

16,909

 

 

 

13,672

 

Loss (income) from equity method investments

 

(5,684

)

 

 

(1,376

)

(Gain) loss on sale of assets, net

 

4,996

 

 

 

 

Other noncash items

 

(472

)

 

 

(1,785

)

Changes in operating assets and liabilities:

 

(63,335

)

 

 

(91,470

)

Net cash provided by (used in) operating activities

 

(47,776

)

 

 

(60,811

)

Cash flows from investing activities:

 

 

 

Purchase of property and equipment

 

(3,139

)

 

 

(3,717

)

Purchase of intangible assets

 

(11,438

)

 

 

 

Funding of loans receivable and other

 

(8,508

)

 

 

(1,301

)

Investments in marketable securities

 

 

 

 

(29,969

)

Proceeds from maturities of marketable securities and other

 

74,523

 

 

 

28,540

 

Net cash paid in business combination

 

 

 

 

(44,367

)

Net cash provided by (used in) investing activities

 

51,438

 

 

 

(50,814

)

Cash flows from financing activities:

 

 

 

Proceeds from equity issuances, net

 

1,809

 

 

 

9,589

 

Repayments of long-term debt

 

(1,250

)

 

 

(1,250

)

Net cash provided by (used in) financing activities

 

559

 

 

 

8,339

 

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

 

4,221

 

 

 

(103,286

)

Cash, cash equivalents and restricted cash and equivalents from continuing operations, beginning of period

 

114,329

 

 

 

475,912

 

Cash, cash equivalents and restricted cash and equivalents from discontinued operations, beginning of period

 

 

 

 

31,768

 

Cash, cash equivalents and restricted cash and equivalents, beginning of period

 

114,329

 

 

 

507,680

 

Cash, cash equivalents and restricted cash and equivalents from continuing operations, end of period

 

118,550

 

 

 

397,023

 

Cash, cash equivalents and restricted cash and equivalents from discontinued operations, end of period

 

 

 

 

7,371

 

Cash, cash equivalents and restricted cash and equivalents, end of period

$

118,550

 

 

$

404,394

 

agilon health, inc.

Key Operating Metrics

In thousands

(unaudited)

GROSS PROFIT

 

 

Three Months Ended

March 31,

 

 

2024

 

 

 

2023

 

Total revenues

$

1,604,354

 

 

$

1,054,312

 

Medical services expense

 

(1,443,842

)

 

 

(897,572

)

Other medical expenses(1)

 

(85,424

)

 

 

(83,617

)

Gross profit

$

75,088

 

 

$

73,123

 

______________________________________________________________

(1)

Represents physician compensation expense related to surplus sharing and other care management expenses that help to create medical cost efficiency. Includes costs in geographies that are in implementation and are not yet generating revenue and investments to grow existing markets. For the three months ended March 31, 2024 and 2023, costs incurred in implementing geographies were $0.6 million and $2.3 million, respectively.

GENERAL AND ADMINISTRATIVE COSTS, INCLUDING PLATFORM SUPPORT COSTS

 

 

Three Months Ended

March 31,

 

 

2024

 

 

2023

Platform support costs

$

45,712

 

$

43,292

Geography entry costs(1)

 

10,459

 

 

9,250

Severance and related costs

 

2,415

 

 

188

Stock-based compensation expense

 

16,909

 

 

13,585

Other(2)

 

927

 

 

3,437

General and administrative

$

76,422

 

$

69,752

______________________________________________________________

(1)

Represents direct geography entry costs, including investments to develop and expand our platform and costs in geographies that are in implementation and are not yet generating revenue and investments to grow existing markets.

(2)

Includes transaction-related costs.

Our platform support costs, which include regionally-based support personnel and other operating costs to support our geographies, are expected to decrease over time as a percentage of revenue as our physician partners add members and our revenue grows. Our operating expenses at the enterprise level include resources and technology to support payor contracting, clinical program development, quality, data management, finance, and legal and compliance functions.

agilon health, inc.

Non-GAAP Financial Measures

In thousands

(unaudited)

MEDICAL MARGIN

 

 

Three Months Ended

March 31,

 

 

2024

 

 

 

2023

 

Gross profit(1)

$

75,088

 

 

$

73,123

 

Other operating revenue

 

(3,159

)

 

 

(1,193

)

Other medical expenses

 

85,424

 

 

 

83,617

 

Medical margin

$

157,353

 

 

$

155,547

 

______________________________________________________________

(1)

Gross profit is defined as total revenues less medical services expense and other medical expenses.

ADJUSTED EBITDA

 

 

Three Months Ended

March 31,

 

 

2024

 

 

 

2023

 

Net income (loss)(1)

$

(6,034

)

 

$

15,959

 

(Income) loss from discontinued operations, net of income taxes

 

9,281

 

 

 

(6,008

)

Interest expense

 

1,284

 

 

 

1,493

 

Income tax expense (benefit)

 

(133

)

 

 

(1,759

)

Depreciation and amortization

 

5,844

 

 

 

2,954

 

Severance and related costs

 

2,415

 

 

 

188

 

Stock-based compensation expense

 

16,909

 

 

 

13,585

 

EBITDA adjustments related to equity method investments

 

3,902

 

 

 

1,967

 

Other(2)

 

(4,414

)

 

 

(4,341

)

Adjusted EBITDA

$

29,054

 

 

$

24,038

 

______________________________________________________________

(1)

Includes direct geography entry costs, including investments to develop and expand our platform and costs in geographies that are in implementation and are not yet generating revenue and investments to grow existing markets. For the three months ended March 31, 2024 and 2023, (i) $0.6 million and $2.3 million, respectively, are included in other medical expenses and (ii) $10.5 million and $9.3 million, respectively, are included in general and administrative expenses.

(2)

Includes interest income and transaction-related costs.

agilon health, inc.

Supplemental Financial Information

In thousands

(unaudited)

 

 

Three Months Ended

March 31, 2024

 

Medicare Advantage (Consolidated)

 

CMS ACO Models (Unconsolidated)

Medical services revenue

$

1,601,195

 

 

$

440,160

 

Other operating revenue

 

3,159

 

 

 

 

Total revenues

 

1,604,354

 

 

 

440,160

 

Medical services expense

 

(1,443,842

)

 

 

(398,792

)

Other medical expenses

 

(85,424

)

 

 

(25,405

)

Gross profit

 

75,088

 

 

 

15,963

 

Other operating revenue

 

(3,159

)

 

 

 

Other medical expenses

 

85,424

 

 

 

25,405

 

Medical margin

$

157,353

 

 

$

41,368

 

Certain of our operations are not consolidated for the period presented because we do not have the ability to control certain activities due to another party’s control of the entities’ board of directors. Although revenues of the unconsolidated operations are not recorded as revenues by us, income (loss) from equity method investments is nonetheless a significant portion of our overall earnings. See Note 14 to the Condensed Consolidated Financial Statements in the Quarterly Report on Form 10-Q for the period ending March 31, 2024 for additional discussion on our equity method investments.

In addition to providing results that are determined in accordance with GAAP, we present Medical Margin and Adjusted EBITDA, which are non-GAAP financial measures.

We define Medical Margin as medical services revenue after medical services expense is deducted. Medical services expense represents costs incurred for medical services provided to our members. As our platform matures over time, we expect Medical Margin to increase in absolute dollars. However, Medical Margin per member per month (PMPM) may vary as the percentage of new members brought onto our platform fluctuates. New membership added to the platform is typically dilutive to Medical Margin PMPM. We believe this metric provides insight into the economics of our capitation arrangements as it includes all medical services expense directly associated with our members’ care.

We define Adjusted EBITDA as net income (loss) adjusted to exclude: (i) income (loss) from discontinued operations, net of income taxes, (ii) interest expense, (iii) income tax expense (benefit), (iv) depreciation and amortization, (v) stock-based compensation expense, (vi) severance and related costs, and (vii) certain other items that are not considered by us in the evaluation of ongoing operating performance. We reflect our share of Adjusted EBITDA for equity method investments by applying our actual ownership percentage for the period to the applicable reconciling items on an entity-by-entity basis.

Gross profit is the most directly comparable GAAP measure to Medical Margin. Net income (loss) is the most directly comparable GAAP measure to Adjusted EBITDA.

We believe Medical Margin and Adjusted EBITDA help identify underlying trends in our business and facilitate evaluation of period-to-period operating performance of our operations by eliminating items that are variable in nature and not considered by us in the evaluation of ongoing operating performance, allowing comparison of our recurring core business operating results over multiple periods. We also believe Medical Margin and Adjusted EBITDA provide useful information about our operating results, enhance the overall understanding of our past performance and future prospects, and allow for greater transparency with respect to key metrics we use for financial and operational decision-making. We believe Medical Margin and Adjusted EBITDA or similarly titled non-GAAP measures are widely used by investors, securities analysts, ratings agencies, and other parties in evaluating companies in our industry as a measure of financial performance. Other companies may calculate Medical Margin and Adjusted EBITDA or similarly titled non-GAAP measures differently from the way we calculate these metrics. As a result, our presentation of Medical Margin and Adjusted EBITDA may not be comparable to similarly titled measures of other companies, limiting their usefulness as comparative measures.

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