10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

Form 10-Q

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE

SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, 2021

OR

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE

SECURITIES EXCHANGE ACT OF 1934

For the transition period from                      to                     

Commission file number 001-37888

Tabula Rasa HealthCare, Inc.

(Exact name of registrant as specified in its charter)

Delaware (State of incorporation)	46-5726437 (I.R.S. Employer Identification No.)
228 Strawbridge Drive, Suite 100 Moorestown, NJ 08057 (Address of Principal Executive Offices, including Zip Code)	(866) 648 - 2767 (Registrant’s Telephone Number, Including Area Code)

Securities registered pursuant to Section 12(b) of the Act:

Title of each class:	Trading Symbol	Name of each exchange on which registered:
Common Stock, par value $0.0001 per share	TRHC	The Nasdaq Stock Market

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No  ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes   ☒   No   ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of "large accelerated filer," "accelerated filer," "smaller reporting company," and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer  ☒	Accelerated filer   ☐	Non-accelerated filer   ☐	Smaller reporting company   ☐
			Emerging growth company   ☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐  No ☒

As of April 23, 2021, the Registrant had 24,843,284 shares of Common Stock outstanding.

TABULA RASA HEALTHCARE, INC.

QUARTERLY REPORT ON FORM 10-Q

For the period ended March 31, 2021

TABLE OF CONTENTS

		Page
		Number
PART I	Financial Information	3
Item 1.	Financial Statements	3
	Unaudited Consolidated Balance Sheets as of March 31, 2021 and December 31, 2020	3
	Unaudited Consolidated Statements of Operations for the three months ended March 31, 2021 and 2020	4
	Unaudited Consolidated Statements of Stockholders’ Equity for the three months ended March 31, 2021 and 2020	5
	Unaudited Consolidated Statements of Cash Flows for the three months ended March 31, 2021 and 2020	6
	Notes to Unaudited Consolidated Financial Statements	7
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	26
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	40
Item 4.	Controls and Procedures	40
PART II	Other Information	41
Item 1.	Legal Proceedings	41
Item 1A.	Risk Factors	41
Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	41
Item 3.	Defaults Upon Senior Securities	41
Item 4.	Mine Safety Disclosures	41
Item 5.	Other Information	41
Item 6.	Exhibits	42
Signatures		43

2

PART I – FINANCIAL INFORMATION

Item 1. Financial Statements

TABULA RASA HEALTHCARE, INC.

UNAUDITED CONSOLIDATED BALANCE SHEETS

(In thousands, except share and per share amounts)

	March 31,		December 31,
	2021		2020
Assets
Current assets:
Cash	$	16,899	$	23,362
Restricted cash		3,294		5,170
Accounts receivable, net of allowance of $324 and $224, respectively		29,365		32,516
Inventories		4,084		4,261
Prepaid expenses		3,933		3,739
Client claims receivable		15,336		14,412
Other current assets		11,972		9,752
Total current assets		84,883		93,212
Property and equipment, net		14,240		15,070
Operating lease right-of-use assets		21,047		21,711
Software development costs, net		30,745		27,882
Goodwill		170,835		170,862
Intangible assets, net		175,755		183,094
Other assets		5,085		2,609
Total assets	$	502,590	$	514,440
Liabilities and stockholders’ equity
Current liabilities:
Current portion of finance leases	$	1	$	4
Current operating lease liabilities		4,238		4,402
Acquisition-related contingent consideration		—		166
Acquisition-related notes payable		9,340		16,662
Accounts payable		6,730		11,245
Client claims payable		6,075		7,773
Accrued expenses and other liabilities		35,164		31,968
Total current liabilities		61,548		72,220
Line of credit		17,500		10,000
Long-term debt, net		318,316		239,285
Noncurrent operating lease liabilities		19,836		20,381
Deferred income tax liability, net		1,063		3,354
Other long-term liabilities		703		671
Total liabilities		418,966		345,911
Commitments and contingencies (Note 16)
Stockholders' equity:
Preferred stock, $0.0001 par value; 10,000,000 shares authorized; no shares issued and outstanding at March 31, 2021 and December 31, 2020		—		—
Common stock, $0.0001 par value; 100,000,000 shares authorized, 25,077,681 and 24,222,674 shares issued and 24,840,805 and 24,004,896 shares outstanding at March 31, 2021 and December 31, 2020, respectively		2		2
Treasury stock, at cost; 236,876 and 217,778 shares at March 31, 2021 and December 31, 2020, respectively		(4,292)		(4,018)
Additional paid-in capital		288,698		352,445
Accumulated deficit		(200,784)		(179,900)
Total stockholders’ equity		83,624		168,529
Total liabilities and stockholders’ equity	$	502,590	$	514,440

See accompanying notes to unaudited consolidated financial statements.

3

TABULA RASA HEALTHCARE, INC.

UNAUDITED CONSOLIDATED STATEMENTS OF OPERATIONS

(In thousands, except share and per share amounts)

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

See accompanying notes to unaudited consolidated financial statements.

4

TABULA RASA HEALTHCARE, INC.

UNAUDITED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY

(In thousands, except share amounts)

	Stockholders' Equity
	Three Months Ended March 31, 2021
	Common Stock			Treasury Stock			Additional		Accumulated		Stockholders'
	Shares	Amount		Shares	Amount		Paid-in Capital		Deficit		Equity
Balance, January 1, 2021	24,222,674	$	2	(217,778)	$	(4,018)	$	352,445	$	(179,900)	$	168,529
Cumulative effect of change in accounting policy	—		—	—		—		(74,850)		(1,392)		(76,242)
Issuance of common stock awards	1,416		—	—		—		—		—		—
Issuance of restricted stock	629,088		—	—		—		—		—		—
Forfeitures of restricted shares	—		—	(12,880)		—		—		—		—
Exercise of stock options, net of shares withheld	224,503		—	(6,218)		(274)		2,501		—		2,227
Stock-based compensation expense	—		—	—		—		8,602		—		8,602
Net loss	—		—	—		—		—		(19,492)		(19,492)
Balance, March 31, 2021	25,077,681	$	2	(236,876)	$	(4,292)	$	288,698	$	(200,784)	$	83,624

	Stockholders' Equity
	Three Months Ended March 31, 2020
	Common Stock			Treasury Stock			Additional		Accumulated		Stockholders'
	Shares	Amount		Shares	Amount		Paid-in Capital		Deficit		Equity
Balance, January 1, 2020	22,496,999	$	2	(175,689)	$	(3,865)	$	288,345	$	(98,934)	$	185,548
Issuance of common stock awards	14,386		—	—		—		—		—		—
Issuance of restricted stock	388,108		—	—		—		—		—		—
Forfeitures of restricted shares	—		—	(33,371)		—		—		—		—
Exercise of stock options	116,288		—	(1,681)		(91)		1,244		—		1,153
Share adjustment	—		—	12,500		—		—		—		—
Stock-based compensation expense	—		—	—		—		7,137		—		7,137
Net loss	—		—	—		—		—		(14,437)		(14,437)
Balance, March 31, 2020	23,015,781	$	2	(198,241)	$	(3,956)	$	296,726	$	(113,371)	$	179,401

See accompanying notes to unaudited consolidated financial statements.

5

TABULA RASA HEALTHCARE, INC.

UNAUDITED CONSOLIDATED STATEMENTS OF CASH FLOWS

(In thousands)

	Three Months Ended
	March 31,
	2021		2020
Cash flows from operating activities:
Net loss	$	(19,492)	$	(14,437)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization		11,625		9,913
Amortization of deferred financing costs and debt discount		635		3,252
Deferred taxes		174		(3,367)
Stock-based compensation		8,602		7,137
Change in fair value of acquisition-related contingent consideration		—		700
Acquisition-related contingent consideration paid		(67)		—
Changes in operating assets and liabilities, net of effect from acquisitions:
Accounts receivable, net		3,151		(7,114)
Inventories		177		(1,435)
Prepaid expenses and other current assets		(1,247)		4,625
Client claims receivables		(924)		—
Other assets		(2,610)		54
Accounts payable		(4,448)		1,528
Accrued expenses and other liabilities		2,012		(1,633)
Client claims payables		(1,698)		—
Other long-term liabilities		32		(20)
Net cash used in operating activities		(4,078)		(797)
Cash flows from investing activities:
Purchases of property and equipment		(522)		(763)
Software development costs		(5,863)		(4,228)
Net cash used in investing activities		(6,385)		(4,991)
Cash flows from financing activities:
Proceeds from exercise of stock options		2,226		1,153
Borrowings on line of credit		7,500		—
Payment of acquisition-related notes payable		(7,500)		—
Payments of acquisition-related contingent consideration		(99)		—
Repayments of long-term debt and finance leases		(3)		(49)
Net cash provided by financing activities		2,124		1,104
Net decrease in cash and restricted cash		(8,339)		(4,684)
Cash and restricted cash, beginning of period		28,532		46,581
Cash and restricted cash, end of period	$	20,193	$	41,897
Supplemental disclosure of cash flow information:
Purchases of property and equipment and software development included in accounts payable and accrued expenses	$	116	$	223
Cash paid for interest	$	3,045	$	2,844
Cash paid for taxes	$	3	$	49
Interest costs capitalized to property and equipment and software development costs	$	57	$	64
Reconciliation of cash and restricted cash:
Cash	$	16,899	$	38,134
Restricted cash		3,294		3,763
Total cash and restricted cash	$	20,193	$	41,897

See accompanying notes to unaudited consolidated financial statements.

6

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

1.      Nature of Business

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

2.      Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements

Basis of Presentation

The accompanying unaudited consolidated financial statements of the Company have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (the “SEC”) regarding interim financial reporting. The unaudited interim consolidated financial statements have been prepared on the same basis as the annual audited consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting of normal recurring accruals and adjustments) necessary to present fairly the Company's interim consolidated financial position for the periods indicated. The interim results for the three months ended March 31, 2021 are not necessarily indicative of results to be expected for the year ending December 31, 2021, any other interim periods, or any future year or period. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the audited consolidated financial statements and accompanying notes included in the Company’s annual report on Form 10-K filed on February 26, 2021 (“2020 Form 10-K”).

The Company operates its business through two segments, CareVention HealthCare and MedWise HealthCare. See Note 17 for a discussion of the Company’s reportable segments.

Risks Related to the COVID-19 Pandemic

On January 30, 2020, the World Health Organization (“WHO”) announced a global health emergency caused by a new strain of coronavirus (“COVID-19”), originating in Wuhan, China and the risks to the international community. In March 2020, the WHO classified the COVID-19 outbreak as a pandemic (“COVID-19 pandemic), based on the rapid increase in exposure globally. The full impact of the COVID-19 pandemic continues to evolve as of the date these consolidated financial statements were issued. As such, the full magnitude of the impact that the pandemic will have on the Company’s future results of operations remains uncertain. Management is actively monitoring the global situation and the ramification on the Company’s financial condition, liquidity, operations, suppliers, industry, and workforce. Given the daily evolution of the COVID-19 pandemic and the global responses to curb its spread, the Company is not able to estimate the effects that the COVID-19 pandemic may have on the Company’s results of operations, financial condition, or liquidity for 2021. However, the Company is dependent on its workforce to sell and deliver its products and services. Social distancing and shelter-in-place directives could impact the Company’s ability to deploy its workforce effectively. These same developments may affect the operations of the Company’s suppliers and customers, as their own workforces and operations are disrupted by this virus.

7

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

As a result of the ongoing COVID-19 pandemic, the Company has experienced challenges with revenue growth. During 2020, the pandemic had delayed the closing of contracts across both the Company’s CareVention HealthCare and MedWise HealthCare segments and, in some cases, shifted project priorities and timelines, which management believed resulted in fewer business wins during 2020 and reduced future revenue. Overall census growth for Programs of All-Inclusive Care for the Elderly (“PACE”) had remained below historical levels during 2020 and into the first quarter of 2021, which has affected the Company’s CareVention HealthCare segment growth. During 2020, the Company’s MedWise HealthCare segment had experienced delays in the timing of implementation and closing of new business and a negative impact from COVID-19 on medication adherence initiatives. The Company does not yet know the full extent of potential delays or impacts on its business, financing or other activities, or on the broader healthcare industry or the global economy as a whole. These effects could have a material impact on the Company’s liquidity, capital resources, operations and business and those of the third parties on which it relies.

Summary of Significant Accounting Policies

There have been no changes to the Company's significant accounting policies described in the 2020 Form 10-K that have had a material impact on the consolidated financial statements and related notes.

Recent Accounting Pronouncements

In August 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40) (“ASU 2020-06”). ASU 2020-06 provides new guidance to simplify the accounting for convertible instruments by eliminating the cash conversion model. As compared with the current accounting standards, more convertible debt instruments will be reported as a single liability instrument and the interest rate of more convertible debt instruments will be closer to the coupon interest rate. ASU 2020-06 also aligns the consistency of diluted earnings per share calculations for convertible instruments by requiring that (1) an entity use the if-converted method and (2) share settlement be included in the diluted earnings per share calculation for both convertible instruments and equity contracts when those contracts include an option of cash settlement or share settlement. The treasury stock method will no longer be permitted. ASU 2020-06 is effective for financial statements issued for fiscal years beginning after December 15, 2021 and early adoption is permitted.

Under ASC 470-20 Debt with Conversion and Other Options (“ASC 470-20”), the Company separately accounted for the liability and equity components of its 1.75% convertible senior subordinated notes (the “2026 Notes”), which may be settled entirely or partly in cash upon conversion. The equity component was required to be included in the additional paid-in capital section of stockholders’ equity on the Company’s consolidated balance sheet, and the value of the equity component was treated as original issue discount for purposes of accounting for the debt component of the 2026 Notes. As a result, the Company was required to record a greater amount of non-cash interest expense in previous periods presented related to the amortization of the discounted carrying value of the 2026 Notes to their face amount over the term of the 2026 Notes. Because the Company intends to settle the 2026 Notes entirely or partly in cash, the Company had used the treasury stock method when calculating their potential dilutive effect, if any.

ASU 2020-06 allows adoption through either a modified retrospective method or fully retrospective method of transition. The Company early adopted ASU 2020-06 effective January 1, 2021 using the modified retrospective method. In applying the modified retrospective transition method, the cumulative effect of the accounting change is recognized as an adjustment to the opening balance of retained earnings at the date of adoption. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. See Note 12 for further details on the 2026 Notes.

8

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

3.     Revenue

The Company generates revenue from its CareVention HealthCare and MedWise HealthCare segments. See Note 17 for additional discussion of the Company’s reportable segments.

Client contracts generally have a term of one to five years and generally renew at the end of the initial term. In most cases, clients may terminate their contracts with a notice period ranging from 0 to 180 days without cause, thereby limiting the term in which the Company has enforceable rights and obligations. Revenue is recognized in an amount that reflects the consideration that is expected in exchange for the goods or services. Generally, there are not significant differences between the timing of revenue recognition and billing. Consequently, the Company has determined that client contracts do not include a financing component.

The Company does not disclose the amount of variable consideration that the Company expects to recognize in future periods as the variable consideration in the Company’s contracts is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct good or service that forms part of a single performance obligation, and the terms of that variable consideration relate specifically to the Company’s efforts to transfer the distinct service, or to a specific outcome from transferring the distinct service. The Company’s contracts primarily include monthly fees associated with unspecified quantities of members, claims, medication safety reviews, or user subscriptions that fluctuate throughout the contract. See below for a description of the Company’s revenues by segment.

CareVention HealthCare

PACE Product Revenue

The Company provides medication fulfillment pharmacy services to PACE, and, while the majority of medications are routinely filled in order to treat chronic conditions, the mix and quantity of medications can vary. Revenue from medication fulfillment services is generally billed monthly or weekly, depending on whether the PACE organization is contracted with a pharmacy benefit manager, and recognized when medications are delivered and control has passed to the client. At the time of delivery, the Company has performed substantially all of its performance obligations under its client contracts. The Company does not experience a significant level of returns or reshipments.

PACE Solutions

The Company provides medication safety services and health plan management services to PACE organizations. These services include risk adjustment services, third party administration services, pharmacy benefit management (“PBM”) solutions, and electronic health records software. Revenue related to these services primarily consists of a fixed monthly fee assessed based on number of members served (“per member per month”), a fee for each claim adjudicated, and subscription fees. These fees are recognized when the Company satisfies its performance obligation to stand ready to provide PACE services, which occurs when the Company’s clients have access to the PACE services. The Company generally bills for PACE services on a monthly basis.

MedWise HealthCare

Product Revenue

The Company provides COVID-19 test kits to pharmacies and other clients. Revenue from the sale of these products is generally billed when test kits are shipped and is recognized as the Company satisfies its performance obligations to deliver the test kits and provide the test results. The Company does not experience a significant level of returns or reshipments.

9

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

Medication Safety Services

The Company provides medication safety services, which include identification of high-risk individuals, medication regimen reviews including patient and prescriber counseling, and targeted interventions to increase adherence and close gaps in care. Revenue related to these services primarily consists of per member per month fees and fees for each medication review and assessment completed. Revenue is recognized when the Company satisfies its performance obligation to stand ready to provide medication safety services, which occurs when the Company’s clients have access to the medication safety services, and when medication reviews and assessments are completed. The Company generally bills for the medication safety services on a monthly basis.

Software Subscription

The Company provides software as a service (“SaaS”) solutions, which allow for the identification of individuals with high medication-related risk, for patient communication and engagement, for documentation of clinical interventions, for optimizing medication therapy, for targeting adherence improvement, and for precision dosing. Revenues related to these software services primarily consist of monthly subscription fees and are recognized monthly as the Company meets its performance obligation to provide access to the software. Revenue for implementation and set up services is generally recognized over the contract term as the software services are provided. The Company generally bills for the software services on a monthly basis.

Disaggregation of Revenue

In the following table, revenue is disaggregated by reportable segment. Substantially all of the Company’s revenue is recognized in the U.S.

	Three Months Ended
	March 31,
		2021		2020
CareVention HealthCare:
PACE product revenue	$	41,842	$	37,087
PACE solutions		13,919		11,571
	$	55,761	$	48,658
MedWise HealthCare:
Product revenue	$	136	$	—
Medication safety services		10,725		14,320
Software subscription and services		10,058		9,849
	$	20,919	$	24,169
Total revenue	$	76,680	$	72,827

10

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

Contract Balances

Assets and liabilities related to the Company’s contracts are reported on a contract-by-contract basis at the end of each reporting period. Contract balances consist of contract assets and contract liabilities. Contract assets are recorded when the right to consideration for services is conditional on something other than the passage of time. Contract assets relating to unbilled receivables are transferred to accounts receivable when the right to consideration becomes unconditional. Contract assets are classified as current or non-current based on the timing of the Company’s rights to the unconditional payments. Contract assets are generally classified as current and recorded within other current assets on the Company’s consolidated balance sheets.

Contract liabilities include advance customer payments and billings in excess of revenue recognized. The Company generally classifies contract liabilities in accrued expenses and other current liabilities and in other long-term liabilities on the Company’s consolidated balance sheets. The Company anticipates that it will satisfy most of its performance obligations associated with its contract liabilities within one year.

The following table provides information about the Company’s contract assets and contract liabilities from contracts with clients as of March 31, 2021 and December 31, 2020.

	March 31,		December 31,
	2021		2020
Contract assets	$	8,948	$	7,601
Contract liabilities		5,287		3,876

Significant changes in the contract assets and the contract liabilities balances during the period are as follows:

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

During the three months ended March 31, 2020, the Company recognized $2,618 of revenue that was included in the December 31, 2019 contract liability balance of $4,930.

11

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

4.     Net Loss per Share

Basic and diluted net loss per share is computed by dividing net loss by the weighted average number of shares of common stock of the Company outstanding during the period.

The following table presents the calculation of basic and diluted net loss per share for the Company’s common stock:

	Three Months Ended
	March 31,
	2021		2020
Numerator (basic and diluted):
Net loss	$	(19,492)	$	(14,437)
Denominator (basic and diluted):
Weighted average shares of common stock outstanding, basic and diluted		23,010,531		21,374,897
Net loss per share, basic and diluted	$	(0.85)	$	(0.68)

The following potential common shares, presented based on amounts outstanding for the three months ended March 31, 2021 and 2020, were excluded from the calculation of diluted net loss per share for the periods indicated because including them would have had an anti-dilutive effect.

	March 31,
	2021	2020
Stock options to purchase common stock	1,846,707	2,627,493
Unvested restricted stock	1,651,806	1,314,635
Common stock warrants	4,646,393	4,646,393
Conversion of convertible senior subordinated notes	4,646,393	—
Contingently issuable shares	—	63,320
	12,791,299	8,651,841

For the three months ended March 31, 2021, shares related to the conversion of the convertible senior subordinated notes were included in the table above under the if-converted method. For the three months ended March 31, 2020, shares associated with the conversion of the convertible senior subordinated notes were excluded from the table above as the Company assumed the notes would be settled entirely or partly in cash.

5.     Acquisitions

Personica

On October 5, 2020, the Company entered into a Membership Interest Purchase Agreement (the “Purchase Agreement”) with TRHC Group, Personica Holdings, Inc., a Wisconsin corporation, and other seller parties, whereby the Company completed the acquisition of all the issued and outstanding membership interests of Personica, LLC, a Delaware limited liability company (“Personica”), and its subsidiaries, a provider of PBM solutions and pharmacy services, including 340B and Medicare Part D administration solutions to the PACE market. The purchase price consisted of (i) cash consideration of $10,000, subject to certain customary post-closing adjustments, (ii) the issuance of 555,555 shares of the Company’s common stock valued at $23,589, and (iii) the delivery of promissory notes (collectively, the “Notes”) for the payment of (a) $7,500 in cash paid in January 2021, (b) $5,500 in cash paid in April 2021, and (c) $4,000 in cash within two business days following October 5, 2021. The Company may set off amounts due under the Notes to the extent the Company is entitled to indemnification under the Purchase Agreement or in respect of adjustments to the purchase price.

12

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

Revenue from Personica includes medication fulfillment pharmacy services to PACE organizations. Revenue for these services, and the related costs, is recognized when medications are delivered and control has passed to the client, and is included in product revenue and cost of revenue – product cost, respectively, in the Company’s consolidated statements of operations. Revenue from Personica is also comprised of monthly fees per adjudicated claim for PBM solutions. Revenue for these services, and the related costs, is recognized each month as performance obligations are satisfied and costs are incurred, and is included in service revenue and cost of revenue – service cost, respectively, in the Company’s consolidated statements of operations.

The Company continues to evaluate the fair value of certain assets acquired and liabilities assumed related to the acquisition. Additional information, which existed as of the acquisition date, but was at that time unknown to the Company, may become known during the remainder of the measurement period. Changes to amounts recorded as a result of the final determination may result in a corresponding adjustment to these assets and liabilities, including goodwill. The determination of the estimated fair values of all assets acquired is expected to be completed within one year from the date of acquisition.

Pro forma

The unaudited pro forma results presented below include the results of the Personica acquisition as if it had been consummated as of January 1, 2019. The unaudited pro forma results include the amortization associated with acquired intangible assets, interest expense on the debt incurred to fund these acquisitions, stock-based compensation expense related to equity awards granted to employees of the acquired companies, and the estimated tax effect of adjustments to income (loss) before income taxes. Material nonrecurring charges, including direct acquisition costs, directly attributable to the transactions are excluded. In addition, the unaudited pro forma results do not include any expected benefits of the acquisitions. Accordingly, the unaudited pro forma results are not necessarily indicative of either future results of operations or results that might have been achieved had the acquisition been consummated as of January 1, 2019.

	Three Months Ended
	March 31,
	2020
Revenue	$	75,671
Net loss		(14,206)

6.     Other Current Assets

As of March 31, 2021 and December 31, 2020, other current assets consisted of the following:

	March 31, 2021		December 31, 2020
Contract assets	$	8,948	$	7,601
Non-trade receivables		1,421		647
Other		1,603		1,504
Total other current assets	$	11,972	$	9,752

7.       Property and Equipment

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

13

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

8.       Software Development Costs

The Company capitalizes certain costs incurred in connection with obtaining or developing its proprietary software platforms, which are used to support its service contracts, including external direct costs of material and services, payroll costs for employees directly involved with the software development, and interest expense related to the borrowings attributable to software development. As of March 31, 2021 and December 31, 2020, capitalized software costs consisted of the following:

	March 31, 2021		December 31, 2020
Software development costs	$	54,414	$	48,548
Less: accumulated amortization		(23,669)		(20,666)
Software development costs, net	$	30,745	$	27,882
Capitalized software development costs included above not yet subject to amortization	$	5,823	$	4,382

Amortization expense for the three months ended March 31, 2021 and 2020 was $3,003 and $1,823, respectively.

9.      Goodwill and Intangible Assets

The Company’s goodwill and related changes during the three months ended of March 31, 2021 were as follows:

		CareVention HealthCare		MedWise HealthCare		Total
Balance at January 1, 2021	$	115,350	$	55,512	$	170,862
Adjustments to goodwill related to prior year acquisition		(27)		—		(27)
Balance at March 31, 2021	$	115,323	$	55,512	$	170,835

Intangible assets consisted of the following as of March 31, 2021 and December 31, 2020:

	Weighted Average
	Amortization Period			Accumulated		Intangible
	(in years)	Gross Value		Amortization		Assets, net
March 31, 2021
Trade names	3.6	$	11,955	$	(8,844)	$	3,111
Client relationships	12.2		152,654		(35,591)		117,063
Non-competition agreements	5.0		6,892		(4,321)		2,571
Developed technology	8.0		67,369		(27,054)		40,315
Patient database	5.0		21,700		(9,042)		12,658
Domain name	10.0		59		(22)		37
Total intangible assets		$	260,629	$	(84,874)	$	175,755

14

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

	Weighted Average
	Amortization Period			Accumulated		Intangible
	(in years)	Gross Value		Amortization		Assets, net
December 31, 2020
Trade names	3.7	$	11,955	$	(8,286)	$	3,669
Client relationships	12.2		152,654		(32,437)		120,217
Non-competition agreements	5.0		6,892		(3,976)		2,916
Developed technology	8.0		67,369		(24,858)		42,511
Patient database	5.0		21,700		(7,957)		13,743
Domain name	10.0		59		(21)		38
Total intangible assets		$	260,629	$	(77,535)	$	183,094

Amortization expense for intangible assets for the three months ended March 31, 2021 and 2020 was $7,339 and $6,822, respectively.

The estimated amortization expense for the remainder of 2021 and each of the next five years and thereafter is as follows:

Years Ending December 31,
2021 (April 1 - December 31)	$	21,105
2022		27,089
2023		25,804
2024		18,521
2025		14,038
2026		12,830
Thereafter		56,368
Total estimated amortization expense	$	175,755

10.      Notes Payable Related to Acquisition

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

15

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

11.       Accrued Expenses and Other Liabilities

As of March 31, 2021 and December 31, 2020, accrued expenses and other liabilities consisted of the following:

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

*This amount represents clients’ funds held by the Company, with an offsetting amount included in restricted cash.

12.      Lines of Credit and Long-Term Debt

(a)    Lines of Credit

On September 6, 2017, the Company entered into an Amended and Restated Loan and Security Agreement (the “2015 Line of Credit”), whereby the Company amended and restated its revolving line of credit, originally entered into with Bridge Bank (now Western Alliance Bank) in 2015 and had subsequently amended. The 2015 Line of Credit provided for borrowing availability in an aggregate amount up to $60,000 to be used for general corporate purposes, with a $1,000 sublimit for cash management services, letters of credit and foreign exchange transactions. The 2015 Line of Credit matured pursuant to its terms on December 6, 2020.

On December 18, 2020, the Company and its subsidiaries entered into a Loan and Security Agreement with Western Alliance Bank, which provides for a $120,000 secured revolving credit facility, with a $1,000 sublimit for cash management services and letters of credit and foreign exchange transactions (the “2020 Credit Facility”), and replaced the 2015 Line of Credit.

Amounts under the 2020 Credit Facility may be borrowed, repaid, and re-borrowed from time to time until the maturity date on May 16, 2025, and may be used for, among other things, working capital and other general corporate purposes. Loans under the 2020 Credit Facility will bear interest at a rate equal to the LIBOR rate plus 3.25%. The obligations under the 2020 Credit Facility are secured by all of the Company’s assets, subject to certain exceptions and exclusions as set forth in the Loan and Security Agreement.

The Loan and Security Agreement contains certain affirmative and negative covenants that are binding on the Company, including, but not limited to, restrictions (subject to specified exceptions and qualifications) on the Company’s ability to incur indebtedness, create liens, merge or consolidate, make dispositions, pay dividends or make distributions, make investments, pay any subordinated indebtedness, enter into certain transactions with affiliates, or make capital expenditures. In addition, the Loan and Security Agreement imposes certain financial covenants, including that the Company (i) maintain unrestricted cash balances with Western Alliance Bank, plus amounts available for draw under the 2020 Credit Facility of at least $10,000 at all times, and (ii) maintain a leverage ratio of less than 3.00:1.00, on a trailing twelve-month basis, measured quarterly. The 2020 Credit Facility is subject to a commitment fee of 0.50% of the total commitment under the 2020 Credit Facility payable on the closing date, and 0.25% of the total commitment under the 2020 Credit Facility payable on each anniversary thereafter. Additionally, the 2020 Credit Facility is subject to an unused line fee.

16

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

As of March 31, 2021, the Company was in compliance with all of the financial covenants related to the 2020 Credit Facility, and management expects that the Company will be able to maintain compliance with its covenants.

As of March 31, 2021, the Company had $17,500 outstanding under the 2020 Credit Facility, plus an outstanding letter of credit of $100 issued in connection with the Company’s lease agreement for its office space in Moorestown, NJ. The letter of credit renews annually and expires in September 2027, and reduces amounts available under the 2020 Credit Facility. As of March 31, 2021, amounts available for borrowings under the 2020 Credit Facility were $102,400.

As of March 31, 2021, the interest rate on the 2020 Credit Facility was 3.36% and the effective rate for the unused line fee was 0.45%. Interest expense on the 2020 Credit Facility was $261 for the three months ended March 31, 2021. As of March 31, 2020, the interest rate on the 2015 Line of Credit was 5.58%. No interest expense was incurred for the three months ended March 31, 2020 as there were no aggregate borrowings outstanding during the three months ended March 31, 2020.

In connection with the 2020 Credit Facility, the Company recorded deferred financing costs of $1,176. The Company is amortizing the deferred financing costs associated with the 2020 Credit Facility to interest expense using the effective-interest method over the term of the 2020 Credit Facility. The Company amortized $133 to interest expense for the three months ended March 31, 2021. During the three months ended March 31, 2020, the Company amortized $100 to interest expense for deferred financing costs related to the 2015 Line of Credit. Deferred financing costs of $1,005 and $1,156, net of accumulated amortization, are included in other assets on the accompanying consolidated balance sheets as of March 31, 2021 and December 31, 2020, respectively.

(b)    Convertible Senior Subordinated Notes

On February 12, 2019, the Company issued and sold an aggregate principal amount of $325,000 of 1.75% convertible senior subordinated notes (the “2026 Notes”) in a private placement pursuant to Rule 144A under the Securities Act of 1933, as amended. The 2026 Notes bear interest at a rate of 1.75% per year, payable semiannually in arrears on February 15 and August 15 of each year, beginning on August 15, 2019. The notes will mature on February 15, 2026, unless earlier converted or repurchased. The initial conversion rate for the notes is 14.2966 shares of the Company’s common stock per $1 principal amount of notes. This conversion rate is equal to an initial conversion price of approximately $69.95 per share of the Company’s common stock.

Holders may convert all or any portion of their 2026 Notes at any time prior to the close of business on the business day immediately preceding August 15, 2025 only under the following circumstances: (1) during any calendar quarter commencing after March 31, 2019 (and only during such calendar quarter), if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any five consecutive trading day period (the measurement period) in which the trading price (as defined in the indenture governing the 2026 Notes) per $1 principal amount of 2026 Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events, including certain distributions, the occurrence of a fundamental change or make-whole fundamental change (as defined in the indenture governing the 2026 Notes) or a transaction resulting in the Company’s common stock converting into other securities or property or assets. On or after August 15, 2025 until the close of business on the first scheduled trading day immediately preceding the maturity date, a holder may convert all or any portion of its 2026 Notes regardless of the foregoing circumstances. Upon conversion, the Company will pay or deliver shares of our common stock, cash or a combination thereof at the Company’s option. As of March 31, 2021, none of the conditions allowing holders of the 2026 Notes to convert had been met.

17

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

In the initial accounting for the issuance of the 2026 Notes, the Company separated the 2026 Notes into liability and equity components. The carrying amount of the equity component representing the conversion option was $102,900 and was determined by deducting the fair value of the liability component from the par value of the 2026 Notes. The equity component was not remeasured as long as it continued to meet the conditions for equity classification. The initial associated deferred tax effect of $25,884 was recorded as a reduction of additional paid-in capital because the equity component was not currently expected to be deductible for income tax purposes. The excess of the principal amount of the liability component over its carrying amount (“debt discount”) was amortized to interest expense over the term of the 2026 Notes at an effective interest rate of 8.05% over the contractual term. Debt issuance costs related to the 2026 Notes of $9,372 were allocated to the liability and equity components of the 2026 Notes based on their relative values. Issuance costs attributable to the liability component were $6,405 and were amortized to interest expense using the effective interest method over the contractual term. Issuance costs attributable to the equity component were netted with the equity component in stockholders’ equity.

As described in Note 2, the Company adopted ASU 2020-06 using the modified retrospective method effective January 1, 2021. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. Effective on January 1, 2021, debt issuance costs related to the 2026 Notes of $7,008 were allocated to the liability component of the 2026 Notes and will be amortized to interest expense using the effective interest method over the contractual term, resulting in an effective interest rate of 2.20%.

During the three months ended March 31, 2021, the Company recognized $1,746 of interest expense related to the 2026 Notes, of which $1,422 was paid or accrued, and $324 was non-cash accretion of the debt discounts recorded. During the three months ended March 31, 2020, under the previous accounting standard, the Company recognized $4,573 of interest expense related to the 2026 Notes, of which $1,421 was paid or accrued, and $3,152 was non-cash accretion of the debt discounts recorded.

In addition, unpaid additional interest payable as a result of the failure to remove the restrictive legend on the 2026 Convertible Notes had accrued on the 2026 Convertible Notes from and including February 17, 2020, but ceased accruing on February 16, 2021 as a result of the restrictive legend being removed. The Company recorded $212 of additional interest expense for the three months ended March 31, 2021 and the total amount of accrued additional interest was $1,625 as of March 31, 2021. As a result, total accrued interest payable related to the 2026 Notes was $2,336 as of March 31, 2021, which is included in accrued expenses and other liabilities on the consolidated balance sheets. The 2026 Notes have a carrying value of $318,316 as of March 31, 2021.

The 2026 Notes are classified as long-term debt on the Company’s consolidated balance sheets, and will be until such Notes are within one year of maturity

(c)    Convertible Note Hedge and Warrant Transactions

In connection with the offering of the 2026 Notes, the Company entered into convertible note hedge transactions with affiliates of certain of the initial purchasers (the “option counterparties”) of the 2026 Notes pursuant to the terms of call option confirmations. The Company has the option to purchase a total of 4,646,393 shares of its common stock at a price of approximately $69.95 per share. The total premiums paid for the note hedges were $101,660. The Company also entered into warrant transactions with the option counterparties whereby they have the option to purchase 4,646,393 shares of the Company’s common stock at a price of $105.58 per share. The Company received $65,910 in cash proceeds from the sale of the warrants. As these instruments are considered indexed to the Company's own stock and are considered equity classified, the convertible note hedges and warrants are recorded in stockholders’ equity, are not accounted for as derivatives and are not remeasured each reporting period. The net costs incurred in connection with the convertible note hedge and warrant transactions were recorded as a reduction to additional paid-in capital on the Company’s consolidated balance sheets.

18

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

The convertible note hedge transactions are expected generally to reduce the potential dilution to the Company’s common stock upon conversion of the 2026 Notes and/or offset any potential cash payments the Company is required to make in excess of the principal amount of converted 2026 Notes, as the case may be. The warrant transactions could separately have a dilutive effect on the Company’s common stock to the extent that the market price per share of the Company’s common stock exceeds the strike price of the warrants.

As of March 31, 2021, no warrants have been exercised and all warrants to purchase shares of the Company’s common stock were outstanding.

(d)    Long-Term Debt

The following table represents the total long-term debt obligations of the Company at March 31, 2021 and December 31, 2020:

	March 31, 2021		December 31, 2020
Convertible senior subordinated notes	$	325,000	$	325,000
Unamortized discount, including debt issuance costs, on convertible senior subordinated notes		(6,684)		(85,715)
Convertible senior subordinated notes, net		318,316		239,285
Finance leases		1		4
Total long-term debt and finance leases, net		318,317		239,289
Less current portion of finance leases		(1)		(4)
Total long-term debt, net	$	318,316	$	239,285

13.      Income Taxes

On February 12, 2021, the Company received a private letter ruling from the Internal Revenue Service, which determined, based on information submitted and representations made by the Company, that the Company met the requirements to deduct the interest expense resulting from the amortization of the debt discount associated with the 2026 Notes. As a result, during the three months ended March 31, 2021, the Company recorded a deferred tax asset of $23,628 and a corresponding $23,628 increase to its valuation allowance. As of March 31, 2021, the Company has recorded a full valuation allowance against its deferred tax assets.

For the three months ended March 31, 2021, the Company recorded income tax expense of $199 primarily related to indefinite-lived deferred tax liabilities for goodwill amortization, which resulted in an effective tax rate of (1.0)%. The effective tax rate differs from the U.S. statutory tax rate primarily due to the full valuation allowance recorded that is currently limiting the realizability of our net deferred tax assets as of March 31, 2021. Accordingly, the tax benefit was limited due to unbenefited losses in the three months ended March 31, 2021. The Company calculates its provision for income taxes during its interim periods by applying the estimated annual effective tax rate for the full year ordinary income or loss to the respective reporting period’s year to date income or loss, while also adding any income tax expense or benefit related to discrete items occurring within that interim period.

For the three months ended March 31, 2020, the Company recorded an income tax benefit of $3,367, which resulted in an effective tax rate of 18.9%. The tax benefit primarily consisted of $3,031 based on the estimated effective tax rate for the full year and $336 of windfall tax benefits generated from the vesting of restricted stock, disqualifying dispositions and exercising of nonqualified stock options during the period.

19

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

14.     Stock-Based Compensation

In September 2016, the Company adopted the 2016 Equity Compensation Plan (“2016 Plan”). During the term of the 2016 Plan, the share reserve will automatically increase on the first trading day in January of each calendar year by an amount equal to the lesser of 5% of the total number of outstanding shares of common stock on the last trading day in December of the prior calendar year or such other number set by the Board. In accordance with the terms of the 2016 Plan, the share reserve increased by 1,200,244 shares on January 2, 2021. As of March 31, 2021, 1,785,765 shares were available for future grants under the 2016 Plan.

Restricted Common Stock

The following table summarizes the restricted stock award activity under the 2016 Plan for the three months ended March 31, 2021:

		Weighted
		average
	Number	grant-date
	of shares	fair value
Outstanding at December 31, 2020	1,386,908		44.14
Granted	629,088		54.92
Vested	(351,310)		49.42
Forfeited	(12,880)		57.48
Outstanding at March 31, 2021	1,651,806	$	47.02

For the three months ended March 31, 2021 and 2020, $6,275 and $4,139 of expense was recognized related to restricted stock awards, excluding performance-based restricted stock awards described below, respectively. As of March 31, 2021, there was unrecognized compensation expense of $65,755 related to non-vested restricted stock awards, excluding performance-based restricted stock awards described below, under the 2016 Plan, which is expected to be recognized over a weighted average period of 3.1 years.

Performance-Based Stock Award

On May 4, 2020, pursuant to the 2016 Plan, the Board approved grants totaling 10,686 shares of restricted stock to an employee. The grants vest subject to certain performance conditions being achieved during the two-year period ending March 2, 2022. The awards have a grant-date fair value of $56.14 per share based on the Company’s closing stock price on the grant date. Stock-based compensation costs associated with these grants are recognized over the service period based upon the Company’s assessment of the probability that the performance conditions will be achieved. The Company recognized no stock-based compensation expense related to these grants for the three months ended March 31, 2021 as the achievement of the underlying performance conditions was considered unlikely. As of March 31, 2021, there was $600 of unrecognized compensation expense related to these performance-based restricted stock awards.

On October 29, 2020, pursuant to the 2016 Plan, the Board approved grants totaling 26,400 shares of restricted stock to certain employees. The grants vest subject to the achievement of certain milestones. The awards have a grant-date fair value of $35.95 per share based on the Company’s closing stock price on the grant date. Stock-based compensation costs associated with these grants are recognized over the service period based upon the Company’s assessment of the probability that the performance conditions will be achieved. The Company recognized $214 of stock-based compensation expense related to these grants for the three months ended March 31, 2021. As of March 31, 2021, there was $583 of unrecognized compensation expense related to these performance-based restricted stock awards.

20

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

Other Stock Awards

During the first quarter of 2021, the Board approved the grant of stock awards to certain non-employee directors and to a consultant pursuant to the 2016 Plan. The awards provided for the issuance of 1,416 shares of the Company’s common stock, which immediately vested on the grant date. These grants had a weighted average grant-date fair value of $40.85 per share. For the three months ended March 31, 2021, the Company recorded $58 of expense related to these stock awards.

During the first quarter of 2020, the Board approved the grant of stock awards to select employees pursuant to the 2016 Plan. The awards provided for the issuance of 9,386 shares of the Company’s common stock, which immediately vested on the grant date. These grants had a weighted average grant-date fair value of $52.29 per share. For the three months ended March 31, 2020, the Company recorded $491 of expense related to these stock awards.

Stock Options

The Company recorded $2,055 and $2,507 of stock-based compensation expense related to employee and non-employee stock options for the three months ended March 31, 2021 and 2020, respectively. The Company records forfeitures as they occur.

The table below sets forth the weighted average assumptions for employee grants during the three months ended March 31, 2021 and 2020:

	Three Months Ended
	March 31,
Valuation assumptions:	2021		2020
Expected volatility	58.57	%	56.10	%
Expected term (years)	5.48		5.25
Risk-free interest rate	0.50	%	1.22	%
Dividend yield	—		—

The weighted average grant date fair value of employee options granted during the three months ended March 31, 2021 and 2020 was $28.26 and $33.78 per share, respectively.

The following table summarizes stock option activity under the 2016 Plan for the three months ended March 31, 2021:

				Weighted
		Weighted		average
		average		remaining	Aggregate
	Number	exercise		contractual	intrinsic
	of shares	price		term	value
Outstanding at December 31, 2020	2,096,556		27.74
Granted	2,500		55.01
Exercised	(224,503)		11.14
Forfeited	(27,846)		39.51
Outstanding at March 31, 2021	1,846,707	$	29.62	6.1	$	37,286
Options vested and expected to vest at March 31, 2021	1,846,707	$	29.62	6.1	$	37,286
Exercisable at March 31, 2021	1,479,329	$	24.29	5.7	$	36,092

21

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the Company’s closing stock price or estimated fair value on the last trading day of the fiscal quarter for those stock options that had exercise prices lower than the fair value of the Company's common stock. This amount changes based on the fair market value of the Company’s stock. The total intrinsic value of options exercised during the three months ended March 31, 2021 and 2020 was $7,768 and $4,581, respectively.

As of March 31, 2021, there was $10,833 of total unrecognized compensation cost related to nonvested stock options granted under the 2016 Plan, which is expected to be recognized over a weighted average period of 1.7 years.

Cash received from option exercises for the three months ended March 31, 2021 and 2020 was $2,226 and $1,153, respectively.

The Company recorded total stock-based compensation expense for the three months ended March 31, 2021 and 2020 in the following expense categories of its consolidated statements of operations:

	Three Months Ended
	March 31,
	2021		2020
Cost of revenue - product	$	259	$	182
Cost of revenue - service		1,079		763
Research and development		1,435		1,409
Sales and marketing		1,068		528
General and administrative		4,761		4,255
Total stock-based compensation expense	$	8,602	$	7,137

15.     Fair Value Measurements

The Company’s financial instruments consist of accounts receivable, contract assets, accounts payable, contract liabilities, accrued expenses, acquisition-related contingent consideration, acquisition-related notes payable, line of credit, and long-term debt, which includes the Company’s convertible senior subordinated notes and finance leases. The carrying values of accounts receivable, contract assets, accounts payable, contract liabilities, accrued expenses, and acquisition-related notes payable are representative of their fair value due to the relatively short-term nature of those instruments. See below for additional information on the Company’s convertible senior subordinated notes.

In connection with the 2018 acquisition of the Cognify business, additional consideration was payable by the Company based on a multiple of the excess of certain PACE solutions’ 2021 revenues and Adjusted EBITDA over their 2018 revenues and Adjusted EBITDA, as defined in the stock purchase agreement. The Cognify acquisition-related contingent consideration, which was liability-classified, was recorded at the estimated fair value at the acquisition date of October 19, 2018. The Company, with the assistance of a third-party appraiser, utilized a Monte Carlo simulation to derive estimates of the contingent consideration payments as of the acquisition date and at each subsequent reporting period.

The acquisition-related contingent consideration liability represented the estimated fair value of the additional cash and equity consideration payable that was contingent upon the achievement of certain financial and performance milestones. In accordance with ASC 805, Business Combinations, all changes in liability-classified contingent consideration subsequent to the initial acquisition-date measurement were recorded in net income or loss.

The acquisition-related contingent consideration was measured at fair value on a recurring basis and included the use of significant unobservable inputs, hence, these instruments represented Level 3 measurements within the fair value hierarchy. During the third quarter of 2020, pursuant to the terms of the stock purchase agreement, the Company elected to accelerate the payment of the acquisition-related contingent consideration for an aggregate payment amount of $13,413. Due to the accelerated payment of the Cognify acquisition-related contingent consideration, the acquisition-related contingent consideration payment amount was fixed and was no longer classified within the fair value hierarchy. The acquisition-related contingent consideration was partially paid during 2020 by cash payments of $6,394 and the

22

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

issuance of 135,434 shares of the Company’s common stock, with a fair value of $6,853. The Company made the final cash payment of $166 in full satisfaction of the remaining acquisition-related contingent consideration liability in January 2021.

During the three months ended March 31, 2020, the Company recorded a $700 charge for the change in the fair value of Cognify acquisition-related contingent consideration primarily due to a decreased discount period to the final measurement date.

The following table presents the financial instruments that are not carried at fair value but require fair value disclosure as of March 31, 2021:

	Face Value		Carrying Value		Fair Value
1.75% Convertible Senior Subordinated Notes due 2026	$	325,000	$	318,316	$	325,133

The fair value of the 2026 Notes at each balance sheet date is determined based on recent quoted market prices for these notes which is a Level 2 measurement. As discussed in Note 12, the 2026 Notes are carried at their aggregate face value of $325,000, less any unamortized debt issuance costs. 

16.     Commitments and Contingencies

(a)    Legal Proceedings

The Company is not currently involved in any significant claims or legal actions that, in the opinion of management, are expected to have a material adverse impact on the Company.

(b)    Vendor Purchase Agreements

On March 29, 2019, the Company entered into an Affiliated Pharmacy Agreement and Pharmaceutical Program Supply Agreement (the “Prior Thrifty Drug Agreements”) with Thrifty Drug Stores, Inc. (“Thrifty Drug”). On July 1, 2020, the Company entered into a new Affiliated Pharmacy Agreement and Pharmaceutical Program Supply Agreement with Thrifty Drug (the “Thrifty Drug Agreements”) to replace the Prior Thrifty Drug Agreements, which, among other things, extended the Company’s agreement with Thrifty Drug through September 30, 2023. Pursuant to the terms of the Thrifty Drug Agreements, the Company has agreed to purchase not less than 98% of the Company’s total prescription product requirements from Thrifty Drug. The Company commenced purchasing prescription products under the Prior Thrifty Drug Agreements in May 2019 and has continued to do so under the Thrifty Drug Agreements beginning in July 2020. Both the Prior Thrifty Drug Agreements and the Thrifty Drug Agreements authorize Thrifty Drug to hold a security interest in all of the products purchased by the Company under the respective agreements.

As of March 31, 2021 and December 31, 2020 the Company had $1,285 and $1,985 due to Thrifty Drug as a result of prescription drug purchases.

In December 2019, the Company entered into an updated agreement with its data aggregation partner related to the Company’s pharmacy cost management services. The agreement is effective January 1, 2020 with a three-year term expiring December 31, 2022 and commits the Company to a monthly minimum purchase obligation of $30.

23

TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

17.    Segment Reporting

The Company operates its business through two segments. The Company's chief operating decision maker (“CODM”), the Chief Executive Officer, allocates resources and assesses performance based upon financial information at the reportable segment level. Substantially all revenues are generated and substantially all tangible assets are held in the U.S. The Company classifies its operations into two reportable segments as follows:

CareVention HealthCare primarily provides services to PACE organizations that include medication fulfillment pharmacy services and PACE solutions such as medication safety services, pharmacy benefit management solutions, and health plan management services.

MedWise HealthCare clients include health plans, pharmacies, and non-PACE healthcare providers. Services provided to these clients include medication safety services and software subscription solutions, which identify individuals with high medication-related risk, improve patient communication and engagement, and allow for documentation of clinical interventions. These services optimize medication therapy, improve adherence, and enable precision dosing.

Shared services primarily consist of unallocated corporate sales and marketing expenses and general and administrative expenses associated with the management and administration of the Company’s business objectives.

The CODM uses revenue in accordance with U.S. GAAP and Adjusted EBITDA as the relevant segment performance measures to evaluate the performance of the segments and allocate resources.

Adjusted EBITDA is a segment performance financial measure that offers a useful view of the overall operation of the Company’s businesses and may be different from similarly titled segment performance financial measures used by other companies.

Adjusted EBITDA consists of net loss plus certain other expenses, which includes interest expense, income tax expense or benefit, depreciation and amortization, change in fair value of acquisition-related contingent consideration expense, acquisition-related expense, and stock-based compensation expense. The Company considers acquisition-related expense to include nonrecurring direct transaction and integration costs, severance, and the impact of purchase accounting adjustments related to the fair value of acquired deferred revenue.

Management considers revenue and Adjusted EBITDA to be the appropriate metrics to evaluate and compare the ongoing operating performance of the Company’s segments on a consistent basis across reporting periods as they eliminate the effect of items which are not indicative of each segment's core operating performance.

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TABULA RASA HEALTHCARE, INC.

NOTES TO UNAUDITED CONSOLIDATED FINANCIAL STATEMENTS

(Amounts in thousands, except share and per share data)

The following tables present the Company’s segment information:

	CareVention HealthCare		MedWise HealthCare		Consolidated
Revenue:
Three Months Ended March 31, 2021
Product revenue	$	41,842	$	136	$	41,978
Service revenue
PACE solutions		13,919		—		13,919
Medication safety services		—		10,725		10,725
Software subscription and services		—		10,058		10,058
Total service revenue		13,919		20,783		34,702
Total revenue	$	55,761	$	20,919	$	76,680
Three Months Ended March 31, 2020
Product revenue	$	37,087	$	—	$	37,087
Service revenue
PACE solutions		11,571		—		11,571
Medication safety services		—		14,320		14,320
Software subscription and services		—		9,849		9,849
Total service revenue		11,571		24,169		35,740
Total revenue	$	48,658	$	24,169	$	72,827

	CareVention HealthCare		MedWise HealthCare		Shared Services		Consolidated
Adjusted EBITDA (loss):
Three Months Ended March 31, 2021
Adjusted EBITDA (loss)	$	12,910	$	1,864	$	(11,175)	$	3,599
Three Months Ended March 31, 2020
Adjusted EBITDA (loss)	$	11,748	$	2,831	$	(9,772)	$	4,807

The following table presents the Company’s reconciliation of the segments’ total Adjusted EBITDA to net loss as presented in the consolidated statements of operations:

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

Asset information by segment is not a key measure of performance used by the CODM. Accordingly, the Company has not disclosed asset information by segment.

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Item 2. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

The following discussion and analysis of our financial condition and results of operations should be read together with our unaudited consolidated financial statements and related notes and other financial information included in Part 1, Item 1 of this Quarterly Report on Form 10-Q and with our audited consolidated financial statements and related notes thereto for the year ended December 31, 2020, included in our 2020 Form 10-K.

Forward-Looking Statements

This discussion contains certain 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 are identified by words such as “believe,” “will,” “may,” “estimate,” “continue,” “anticipate,” “intend,” “should,” “plan,” “expect,” “predict,” “could,” “potentially” or the negative of these terms or similar expressions. You should read these statements carefully because they discuss future expectations, contain projections of future results of operations or financial condition, or state other “forward-looking” information. These statements relate to our future plans, objectives, expectations, intentions and financial performance and the assumptions that underlie these statements. These forward-looking statements are subject to certain risks and uncertainties that could cause actual results to differ materially from those anticipated in the forward-looking statements. Factors that might cause such a difference include, but are not limited to, (i) the impacts of the current COVID-19 pandemic and other health epidemics; (ii) our ability to adapt to changes or trends within the market for healthcare in the U.S.; (iii) a significant increase in competition from a variety of companies in the health care industry; (iv) developments and changes in laws and regulations, including increased regulation of the healthcare industry through legislative action and revised rules and standards; (v) the extent to which we are successful in gaining new long-term relationships with clients or retaining existing clients; (vi) the growth and success of our clients, which is difficult to predict and is subject to factors outside of our control; (vii) our ability to maintain relationships with a specified drug wholesaler; (viii) increasing consolidation in the healthcare industry; (ix) managing our growth effectively; (x) fluctuations in operating results; (xi) failure or disruption of our information technology and security systems; (xii) dependence on our senior management and key employees; (xiii) our future indebtedness and our ability to obtain additional financing, reduce expenses or generate funds when necessary; and (xiv) the risks described in Part I, Item 1A of our 2020 Form 10-K. Forward-looking statements are based on our management’s beliefs and assumptions and on information currently available to our management. These statements, like all statements in this report, speak only as of their date, and we undertake no obligation to update or revise these statements in light of future developments, except as required by applicable law. We caution investors that our business and financial performance are subject to substantial risks and uncertainties.

Overview

Tabula Rasa HealthCare, Inc. is a healthcare technology company advancing the safe use of medications by creating solutions designed to empower pharmacists, providers, and patients to optimize medication regimens. Our advanced proprietary technology, MedWise®, identifies the cause of medication-related problems, including adverse drug events, so healthcare professionals can minimize harm and reduce medication-related risks. Our software and services help improve patient outcomes and lower healthcare costs through reduced hospitalizations, emergency department visits, and healthcare utilization. We believe we have the most extensive clinical tele-pharmacy network in the United States, or U.S., with seven call centers across the country, a number of which are tethered to academic institutions. Health plans and pharmacies nationwide use our solutions to assist them in meeting a range of value-based payment requirements. Our vision and mission are supported by our industry-recognized leadership team, our significant investments and collaborations to advance precision pharmacotherapy research and its application in clinical practice, and our culture.

We operate our business through two segments, CareVention HealthCare and MedWise HealthCare, which accounted for 73% and 27% of revenue for the three months ended March 31, 2021, respectively, and for 67% and 33% of revenue for the three months ended March 31, 2020, respectively. Our CareVention HealthCare segment provides our clients, primarily PACE programs, with medication fulfillment services, cloud-based software, pharmacy benefit management solutions, and clinical pharmacist services at the point of care. Our MedWise HealthCare segment provides our clients with cloud-based pharmacy software and clinical pharmacy programs.

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For the three months ended March 31, 2021, our total revenues were $76.7 million compared to $72.8 million for the three months ended March 31, 2020. We incurred a net loss of $19.5 million and a net loss of $14.4 million for the three months ended March 31, 2021 and 2020, respectively. Adjusted EBITDA for the three months ended March 31, 2021 was $3.6 million, compared to $4.8 million for the three months ended March 31, 2020. See “Management's Discussion and Analysis of Financial Condition and Results of Operations — Non-GAAP Financial Measures — Adjusted EBITDA” for our definition of Adjusted EBITDA, why we present Adjusted EBITDA and a reconciliation of net loss to Adjusted EBITDA.

Substantially all of our revenue is recognized in the U.S. and substantially all of our long-lived assets are located in the U.S.

CareVention HealthCare

CareVention HealthCare primarily services PACE, which is a Centers for Medicare & Medicaid Services, or CMS, sponsored program providing comprehensive medical and social services to adults age 55 and older who need a nursing facility level of care but can live safely in community settings. Our clients include ArchCare Senior Life, Trinity Health, Palm Beach PACE, and St. Paul’s PACE. We go to market through a number of different brands, including CareKinesis, Capstone Risk Adjustment Services, PACElogic, TruChart, PeakTPA, PersonifilRx, and Pharmastar.

Our largest CareVention HealthCare offering is our medication fulfillment services, which are built around our novel and proprietary Medication Risk Mitigation Matrix, or MRM Matrix, designed to enable clinicians to increase patient safety, create individualized medication regimens, promote adherence, and eliminate unnecessary prescriptions. Our medication fulfillment and reminder packaging services utilize the MRM Matrix technology to reduce medication-related risk for the high-cost, high-risk PACE population. The CareVention HealthCare suite of offerings also includes risk adjustment services, pharmacy benefit management, or PBM, solutions, cloud-based electronic health records solutions and third-party administration services, which are all specifically tailored to the PACE market. Our CareVention HealthCare segment serves more than 130 healthcare organizations.

The CareVention HealthCare segment revenue model is primarily based on payments on a per-member per-month, or PMPM, basis, payments on a subscription basis, payments on a transaction basis, and charges and dispensing fees for medication fulfillment.

MedWise HealthCare

Our MedWise HealthCare segment is primarily comprised of service offerings from our acquisitions of SinfoníaRx in September 2017 and PrescribeWellness in March 2019. As a result of these acquisitions, we believe we are a leading provider of Medication Therapy Management, or MTM, software and services for Medicare, Medicaid, and commercial health plans, and we are also a leading provider of cloud-based patient engagement software and services to more than 14,000 pharmacies nationwide.

Approximately 14,000 retail pharmacies and more than 280 health plans, including several Blue Cross Blue Shield organizations, Express Scripts, Humana, UnitedHealth Group, and WellCare, utilize our MedWise HealthCare solutions to execute a range of clinical programs. These programs support MTM, Enhanced MTM (a five-year Centers for Medicare & Medicaid Services Innovation Part D pilot that began January 1, 2017), Medicare Part D Star Ratings, Healthcare Effectiveness Data and Information Set (HEDIS) quality measures, and post-hospital discharge care transitions through a combination of our nearly 30,000 PrescribeWellness network pharmacists and/or our clinical tele-pharmacy call centers across the country employing nearly 400 pharmacists. Within our MedWise HealthCare segment, we offer our cloud-based software and clinical pharmacist services through a number of different brands, including MedWise®, SinfoníaRx, RxCompanion, PrescribeWellness, and DoseMeRx.

The MedWise HealthCare segment revenue model is primarily based on payments on a PMPM basis, payments on a subscription basis, and payments on a fee-for-service basis for each clinical intervention.

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Our Strategy

In early 2020, we articulated a long-term growth strategy based on three key tenets:

1) Further penetration of the PACE market by leveraging our existing CareVention HealthCare client base (90% of all PACE organizations utilize at least one of our solutions) and cross-selling to increase our average PMPM fee; organic member growth within our existing clients in part due to the acceleration of the National PACE Association’s PACE 2.0 initiative designed to significantly increase enrollment to 200,000 by 2028; and continued investments in our offerings to attract new PACE clients and, more broadly, Medicare Advantage organizations.

2) Accelerating the adoption of our MedWise software and clinical pharmacy programs by health plans across all lines of business, including Medicare Part C and Part D, Medicaid managed care, and commercial clients with a focus on self-insured employer groups.

3) Increasing the number of pharmacies licensing the entire PrescribeWellness solution set, including our MedWise platform module launched in July 2020, across our growing pharmacy footprint of more than 14,000 pharmacies nationwide.

To supplement our organic growth, we made a total of seven acquisitions from the beginning of 2018 through 2020, and we continue to evaluate strategic acquisitions across both segments of our business. As a result of our most recent acquisition, Personica, in October 2020 and our organic member growth, our PACE clients had a combined patient census of 44,947 at the end of 2020, which compares with 31,820 and 27,690 patients at the end of 2019 and 2018, respectively.

Key Business Metrics

We continually monitor certain corporate metrics, including the following key metrics, that are useful in evaluating and managing our operating performance compared to that of other companies in our industry.

	Three Months Ended
	March 31,				Change
	2021		2020		$		%
		(Dollars in thousands)
Revenues	$	76,680	$	72,827	$	3,853	5	%
Net loss		(19,492)		(14,437)		(5,055)	(35)
Adjusted EBITDA		3,599		4,807		(1,208)	(25)

We monitor the key metrics set forth in the preceding table to help us evaluate trends, establish budgets, measure the effectiveness and efficiency of our operations and gauge our cash generation. We discuss Adjusted EBITDA in more detail in "Non-GAAP Financial Measures — Adjusted EBITDA." We also monitor revenue retention rate on an annual basis, which is described in our 2020 Form 10-K.

Factors Affecting our Future Performance

General

We believe that our future success depends on many factors, including our ability to maintain and grow our relationships with existing clients, expand our client base, continue to enter new markets, and expand our offerings to meet evolving market needs. While these areas present significant opportunity, they also present risks that we must manage to ensure successful results. Please refer to “Item 1A – Risk Factors” in our 2020 Form 10-K for a discussion of certain risks and uncertainties that may impact our future success.

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COVID-19 Pandemic

On January 30, 2020, the World Health Organization, or WHO, announced a global health emergency caused by a new strain of coronavirus, or COVID-19, originating in Wuhan, China and the risks to the international community. In March 2020, the WHO classified the COVID-19 outbreak as a pandemic, or the COVID-19 pandemic, based on the rapid increase in exposure globally. The full impact of the COVID-19 pandemic continues to evolve as of the date these consolidated financial statements were issued. As such, the full magnitude of the impact that the pandemic will have on our future results of operations remains uncertain. Management is actively monitoring the global situation and the ramification on our financial condition, liquidity, operations, suppliers, industry, and workforce. Given the daily evolution of the COVID-19 pandemic and the global responses to curb its spread, we are not able to estimate the effects that the COVID-19 pandemic may have on our results of operations, financial condition, or liquidity for 2021. However, we are dependent on our workforce to sell and deliver our products and services. Social distancing and shelter-in-place directives could impact our ability to deploy its workforce effectively. These same developments may affect the operations of our suppliers and customers, as their own workforces and operations are disrupted by this virus.

As a result of the ongoing COVID-19 pandemic, we have experienced challenges with revenue growth. The pandemic has delayed the closing of contracts across both our CareVention HealthCare and MedWise HealthCare segments and, in some cases, shifted project priorities and timelines, which we believe resulted in fewer business wins during 2020 and reduced future revenue. Overall census growth for PACE had remained below historical levels during 2020 and into the first quarter of 2021, which has affected our CareVention HealthCare segment growth. During 2020, our MedWise HealthCare segment also had experienced delays in the timing of implementation and closing of new business and a negative impact from COVID-19 on medication adherence initiatives. We do not yet know the full extent of potential delays or impacts on our business, financing, or other activities, or on the broader healthcare industry or the global economy as a whole. These effects could have a material impact on our liquidity, capital resources, operations and business and those of the third parties on which we rely.

Components of Our Results of Operations

Revenue

Our revenue is derived from our product sales and service activities under our CareVention HealthCare and MedWise HealthCare segments. For the three months ended March 31, 2021 and 2020, product sales represented 55% and 51% our total revenue, respectively, and service revenue represented 45% and 49% of our total revenue, respectively.

CareVention HealthCare

PACE Product Revenue

We provide medication fulfillment pharmacy services to PACE organizations, and, while the majority of medications are routinely filled in order to treat chronic conditions, the mix and quantity of medications can vary. Revenue from medication fulfillment services is generally billed monthly or weekly, depending on whether the PACE organization is contracted with a pharmacy benefit manager, and recognized when medications are delivered and control has passed to the client. At the time of delivery, we have performed substantially all of our performance obligations under our client contracts. We do not experience a significant level of returns or reshipments.

PACE Solutions

We provide services to PACE organizations, and these services primarily include medication safety services and health plan management services, which consist of risk adjustment services, PBM solutions, electronic health records solutions, and third party administration services. Revenue related to these services primarily consists of a fixed monthly fee assessed based on number of members served, or per member per month, a fee for each claim adjudicated, and subscription fees. These fees are recognized when we satisfy our performance obligation to stand ready to provide PACE services, which occurs when our clients have access to the PACE services. We generally bill for PACE services on a monthly basis as the services are provided.

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MedWise HealthCare

Product Revenue

We provide COVID-19 test kits to pharmacies and other clients. Revenue from the sale of these products is generally billed when test kits are shipped and is recognized as we satisfy our performance obligations to deliver the test kits and provide the test results. We do not experience a significant level of returns or reshipments.

Medication Safety Services

We provide medication safety services, which include identification of high-risk individuals, medication regimen reviews including patient and prescriber counseling, and targeted interventions to increase adherence and close gaps in care. Revenue related to these services primarily consists of per member per month fees and fees for each medication review and assessment completed. Revenue is recognized when we satisfy our performance obligation to stand ready to provide medication safety services, which occurs when our clients have access to the medication safety services, and when medication reviews and assessments are completed. We generally bill for the medication safety services on a monthly basis.

Software Subscription and Services

We provide software as a service, or SaaS, solutions, which allow for the identification of individuals with high medication-related risk, for patient communication and engagement, for documentation of clinical interventions, for optimizing medication therapy, for targeting adherence improvement, and for precision dosing. Revenues related to these software services primarily consist of monthly subscription fees and are recognized monthly as we meet our performance obligation to provide access to the software. Revenue for implementation and set up services is generally recognized over the contract term as the software services are provided. We generally bill for the software services on a monthly basis.

Cost of Revenue (exclusive of depreciation and amortization)

Product Cost

Cost of product revenue includes all costs directly related to the fulfillment and distribution of medications under our CareVention HealthCare offerings. Costs consist primarily of the purchase price of the prescription medications we dispense, which for the three months ended March 31, 2021 and 2020, represented 80% of our total product costs. In addition to costs incurred to purchase the medications we dispense, other costs include shipping; packaging; expenses associated with operating our medication fulfillment centers, including salaries and related costs, such as stock-based compensation for personnel; technology expenses; direct overhead expenses; and allocated indirect overhead costs. We allocate indirect overhead costs among functions based on employee headcount.

Service Cost

Cost of service revenue includes all costs directly related to servicing our CareVention HealthCare and MedWise HealthCare service contracts. These costs primarily consist of labor costs, including stock-based compensation, outside contractors, expenses related to supporting our software platforms, direct overhead expenses, and allocated indirect overhead costs. We allocate indirect overhead costs among functions based on employee headcount.

Research and Development Expenses

Our research and development expenses consist primarily of salaries and related costs, including stock-based compensation, for personnel in our research and development functions. These personnel includes employees engaged in scientific research, healthcare analytics, and the design and development of new scientific algorithms and the enhancement of our software and technology platforms. Research and development expenses also include fees paid to third-party consultants, costs related to quality assurance and testing, and other allocated facility-related overhead and expenses.

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We capitalize certain costs incurred in connection with obtaining or developing the proprietary software platforms that support our product and service contracts, including third-party contractors and payroll costs for employees directly involved with the software development. Capitalized software development costs are amortized beginning when the software project is substantially complete and the asset is ready for its intended use. Costs incurred during the preliminary project stage and post implementation stage, as well as maintenance and training costs, are expensed as incurred. We continue to focus our research and development efforts on adding new features and applications to increase the functionality and enhance the ease of use of our existing suite of software solutions.

We expect our research and development expenses will increase in absolute dollars as we increase our research and development efforts to further strengthen and enhance our software solutions and service offerings, but will decrease as a percentage of revenue in the long term as we expect our revenue to increase at a greater rate than such expenses.

Sales and Marketing Expenses

Sales and marketing expenses consist principally of salaries, commissions, bonuses, and stock-based compensation and employee benefits for sales, marketing, and account management personnel, as well as travel costs related to sales, marketing, and account management activities. Marketing costs also include costs for communication and branding materials, conferences, trade shows, public relations, and allocated overhead.

We expect our sales and marketing expenses to increase in absolute dollars as we strategically invest to grow our sales, account management, and marketing infrastructure as we introduce new products and enter new markets, but decrease as a percentage of revenue in the long term.

General and Administrative Expenses

General and administrative expenses consist principally of employee-related expenses, including salaries, benefits, and stock-based compensation, for employees who are responsible for information systems, administration, human resources, finance, strategy, legal and executive management as well as other corporate expenses associated with these functional areas. General and administrative expenses also include professional fees for legal, consulting and accounting services and allocated overhead. General and administrative expenses are expensed when incurred.

We expect that our general and administrative expenses will increase in absolute dollars as we expand our infrastructure and continue to comply with the requirements applicable to public companies, but decrease as a percentage of revenue in the long term.

Depreciation and Amortization Expenses

Depreciation and amortization expenses are primarily attributable to our capital investment in equipment, our capitalized software, and acquisition-related intangibles.

Interest Expense

Interest expense is primarily attributable to interest expense associated with our 2026 Convertible Notes, our 2020 Credit Facility, the promissory notes related to the Personica acquisition purchase consideration, and our finance lease obligations. Interest expense also includes the amortization of debt discount and debt issuance costs related to our various debt arrangements.

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Results of Operations

The following table summarizes our results of operations for the three months ended March 31, 2021 and 2020 (in thousands):

	Three Months Ended
	March 31,				Change
	2021		2020		$		%
Revenue:
Product revenue	$	41,978	$	37,087	$	4,891	13	%
Service revenue		34,702		35,740		(1,038)	(3)
Total revenue		76,680		72,827		3,853	5
Cost of revenue, exclusive of depreciation and amortization shown below:
Product cost		31,471		27,199		4,272	16
Service cost		22,556		20,874		1,682	8
Total cost of revenue, exclusive of depreciation and amortization		54,027		48,073		5,954	12
Operating expenses:
Research and development		3,987		4,828		(841)	(17)
Sales and marketing		6,245		5,540		705	13
General and administrative		17,542		16,967		575	3
Change in fair value of acquisition-related contingent consideration expense		—		700		(700)	(100)
Depreciation and amortization		11,625		9,913		1,712	17
Total operating expenses		39,399		37,948		1,451	4
Loss from operations		(16,746)		(13,194)		(3,552)	(27)
Interest expense, net		2,547		4,610		(2,063)	(45)
Loss before income taxes		(19,293)		(17,804)		(1,489)	(8)
Income tax expense (benefit)		199		(3,367)		3,566	106
Net loss	$	(19,492)	$	(14,437)	$	(5,055)	(35)

Comparison of the Three Months Ended March 31, 2021 and 2020

Product Revenue

Product revenue increased $4.9 million, or 13%, to $42.0 million for the three months ended March 31, 2021 compared to the same period in 2020. New business acquired from the October 2020 Personica acquisition contributed approximately $2.1 million to this increase. New CareVention HealthCare clients that started services after the end of the first quarter in 2020 contributed $1.1 million to the increase. Increased medication fulfillment volume from growth in the number of patients served by our existing clients, medication mix of prescriptions filled, and payer mix contributed $1.7 million to the increase.

Service Revenue

Service revenue decreased $1.0 million, or 3%, to $34.7 million for the three months ended March 31, 2021 from $35.7 million for the three months ended March 31, 2020.

Service revenues generated by our MedWise HealthCare segment decreased by approximately $3.4 million, or 14%, to $20.8 million for the three months ended March 31, 2021, as compared to the same period in 2020. Medication safety services decreased $3.6 million primarily as a result of a large client contract client that did not renew in 2021 and a shift in the timing of delivery of MTM clinical interventions to be more balanced throughout the year. This decrease was offset by an increase in software subscription and software-related services revenue of $209 thousand due to growth within existing clients.

CareVention HealthCare service revenues increased by approximately $2.3 million, or 20%, to $13.9 million for the three months ended March 31, 2021 as compared to the same period in 2020. The acquisition of Personica in October 2020 contributed $2.1 million to the increase. The remaining increase was attributable to growth in our PACE services as a result of new clients and growth with existing clients added since the first quarter of 2020.

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Cost of Product Revenue

Cost of product revenue increased $4.3 million, or 16%, to $31.5 million for the three months ended March 31, 2021 as compared to the same period in 2020. New business acquired from the Personica acquisition contributed approximately $2.0 million to the increase. New clients in our CareVention HealthCare segment added since the first quarter of 2020 contributed $552 thousand to the increase. In addition, increased medication volume from growth in the number of patients served by our existing customers contributed approximately $1.1 million to the change. The increase in cost of product revenue was also due to a $201 thousand increase in distribution charges related to higher shipping volume for the medications we fulfilled. The remaining increase in cost of product revenue was primarily attributable to an increase in employee compensation costs, including stock-based compensation, to support our overall growth.

Cost of Service Revenue

Cost of service revenue increased $1.7 million, or 8%, to $22.6 million for the three months ended March 31, 2021 from $20.9 million for the three months ended March 31, 2020.

Cost of service revenue related to our CareVention HealthCare segment increased $2.8 million, or 40%, to $9.8 million for the three months ended March 31, 2021, as compared to the same period in 2020. Of the total increase, $1.1 million related to the acquisition of Personica in October 2020. The remaining increase was primarily attributable to investments in infrastructure in order to better scale the delivery of third party administrative services into markets outside of PACE.

Cost of service revenue related to our MedWise HealthCare segment decreased $1.1 million, or 8%, to $12.8 million for the three months ended March 31, 2021, as compared to the same period in 2020. This decrease is primarily driven by fewer clinical interventions performed, and comprised of lower employee compensation costs due to a decrease in headcount, a decrease in the use of contracted resources to deliver medication safety services, and reduced printing and postage expenses.

Research and Development Expenses

Research and development expenses decreased $841 thousand, or 17%, to $4.0 million for the three months ended March 31, 2021 as compared to the same period in 2020. Employee compensation costs decreased $561 thousand and professional services decreased $308 thousand primarily due to the capitalization of additional development initiatives to enhance our software, specifically the software supporting our CareVention offerings.

Sales and Marketing Expenses

Sales and marketing expenses increased $705 thousand, or 13%, to $6.2 million for the three months ended March 31, 2021 from $5.5 million for the three months ended March 31, 2020. The increase is primarily attributable to a $704 thousand increase in employee compensation costs, of which $540 thousand relates to an increase in stock-based compensation expense compared to 2020.

General and Administrative Expenses

General and administrative expenses increased $575 thousand, or 3%, to $17.5 million for the three months ended March 31, 2021 as compared to the same period in 2020. The acquisition of Personica contributed $174 thousand to the increase in expenses, which consisted primarily of employee compensation costs, including stock-based compensation, and consulting expenses. Excluding costs related to the acquisition, general and administrative expenses increased by approximately $401 thousand.

The increase in general and administrative expenses was primarily attributable to an increase in professional fees, which included audit and consulting services, acquisition-related expenses for the Personica integration, and higher business insurance premiums to support our business growth. Together, these expenses represented an increase of approximately $628 thousand. This increase was partially offset by a decrease in conference and other travel-related expenses primarily related to the COVID-19 pandemic.

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Acquisition-related Contingent Consideration Expense

During the three months ended March 31, 2020, we recorded a $700 thousand charge to increase the fair value of the Cognify acquisition-related contingent consideration primarily due to a decreased discount period to the final measurement date. No charges were incurred during the three months ended March 31, 2021 as the final amount of the Cognify acquisition-related contingent consideration liability was determined and fixed as of December 31, 2020. In the first quarter of 2021, we made the final cash payment of $166 thousand in full satisfaction of the remaining acquisition-related contingent consideration liability.

Depreciation and Amortization Expenses

Depreciation and amortization expenses increased $1.7 million, or 17%, to $11.6 million for the three months ended March 31, 2021 from $9.9 million for the three months ended March 31, 2020. This increase was due to a $1.2 million increase in the amortization of capitalized software related to new software functionality placed into service since 2020 to support our CareVention HealthCare and MedWise HealthCare segments. Amortization expense also increased by $517 thousand primarily due to intangible assets from the Personica acquisition.

Interest Expense

Interest expense for the three months ended March 31, 2021 was $2.5 million, a decrease of $2.1 million compared to the three months ended March 31, 2020. Of the total decrease, approximately $2.8 million relates to the adoption of ASU 2020-06 on January 1, 2021, which significantly reduced the amount of debt discount to be amortized. The decrease was partially offset by $261 thousand of interest expense on the 2020 Credit Facility and $254 thousand of interest expense on the acquisition-related notes payable related to the Personica acquisition.

Income Taxes

On February 12, 2021, we received a private letter ruling from the Internal Revenue Service, which determined, based on information submitted and representations made by us, that we met the requirements to deduct the interest expense resulting from the amortization of the debt discount associated with the 2026 Notes. As a result, during the three months ended March 31, 2021, we recorded a deferred tax asset of $23.6 million and a corresponding $23.6 million increase to our valuation allowance. As of March 31, 2021, we have recorded a full valuation allowance against our deferred tax assets.

For the three months ended March 31, 2021, we recorded income tax expense of $199 thousand primarily related to indefinite-lived deferred tax liabilities for goodwill amortization, which resulted in an effective tax rate of (1.0)%. The effective tax rate differs from the U.S. statutory tax rate primarily due to the full valuation allowance recorded that is currently limiting the realizability of our net deferred tax assets as of March 31, 2021. Accordingly, the tax benefit was limited due to unbenefited losses in the three months ended March 31, 2021. We calculate the provision for income taxes during interim periods by applying the estimated annual effective tax rate for the full year ordinary income or loss to the respective reporting period’s year-to-date income or loss, while also adding any income tax expense or benefit related to discrete items occurring within that interim period.

For the three months ended March 31, 2020, we recorded an income tax benefit of $3.4 million, which resulted in an effective tax rate of 18.9%. The tax benefit primarily consisted of $3.1 million based on the estimated effective tax rate for the full year and $0.3 million of windfall tax benefits generated from the vesting of restricted stock, disqualifying dispositions and exercising of nonqualified stock options during the period.

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NON-GAAP FINANCIAL MEASURES

Adjusted EBITDA

To provide investors with additional information about our financial results, we disclose Adjusted EBITDA, a non-GAAP financial measure. Adjusted EBITDA consists of net loss plus certain other expenses, which includes interest expense, provision (benefit) for income tax, depreciation and amortization, change in fair value of acquisition-related contingent consideration expense, acquisition-related expense, and stock-based compensation expense. We consider acquisition-related expense to include nonrecurring direct transaction and integration costs, severance, and the impact of purchase accounting adjustments related to the fair value of acquired deferred revenue. We present Adjusted EBITDA because it is one of the measures used by our management and board of directors to understand and evaluate our core operating performance, and we consider it an important supplemental measure of performance. We believe this metric is commonly used by the financial community, and we present it to enhance investors' understanding of our operating performance and cash flows. We believe Adjusted EBITDA provides investors and other users of our financial information consistency and comparability with our past financial performance and facilitates period-to-period comparisons of operations.

Our management uses Adjusted EBITDA:

● as a measure of operating performance to assist in comparing performance from period to period on a consistent basis;

● to prepare and approve our annual budget; and

● to develop short- and long-term operational plans.

Adjusted EBITDA is not in accordance with, or an alternative to, measures prepared in accordance with GAAP. In addition, this non-GAAP measure is not based on any comprehensive set of accounting rules or principles. As a non-GAAP measure, Adjusted EBITDA has limitations in that it does not reflect all of the amounts associated with our results of operations as determined in accordance with GAAP. In particular:

● although depreciation and amortization are non-cash charges, the assets being depreciated and amortized may have to be replaced in the future, and Adjusted EBITDA does not reflect cash capital expenditure requirements for such replacements or for new capital expenditure requirements;

● Adjusted EBITDA does not reflect cash interest income or expense;

● Adjusted EBITDA does not reflect changes in, or cash requirements for, our working capital needs;

● Adjusted EBITDA does not reflect the potentially dilutive impact of stock-based compensation;

● Adjusted EBITDA does not reflect tax payments that may represent a reduction in cash available to us; and

● other companies, including companies in our industry, may calculate Adjusted EBITDA or similarly titled measures differently, which reduces its usefulness as a comparative measure.

Because of these and other limitations, you should consider Adjusted EBITDA alongside other GAAP-based financial performance measures, including various cash flow metrics, net loss and our other GAAP financial results and not in isolation from, or as a substitute for, financial information prepared in accordance with GAAP. You should be aware that in the future we may incur expenses that are the same as or similar to some of the adjustments in the presentation, and we do not intend to imply that our future results will be unaffected by unusual or non-recurring items.

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The following is a reconciliation of Adjusted EBITDA to our net loss for the periods presented:

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

Adjusted Diluted Net Income (Loss) Per Share, or Adjusted Diluted EPS

Adjusted Diluted EPS excludes the impact of certain items and, therefore, has not been calculated in accordance with GAAP. We believe the exclusion of these items assists in providing a more complete understanding of our underlying operations, results and trends and allows for comparability with our peer company index and industry and to be more consistent with our expected capital structure on a going forward basis. Our management uses this measure along with corresponding GAAP financial measures to manage our business and to evaluate our performance compared to prior periods and the marketplace. We define Adjusted Diluted EPS as net loss before fair value adjustments for acquisition-related contingent consideration, amortization of acquired intangibles, amortization of debt discount and issuance costs, acquisition-related expense, stock-based compensation expense, and the tax impact using a normalized tax rate on pre-tax income adjusted for those items expressed on a per share basis using weighted average diluted shares outstanding. We consider acquisition-related expense to include nonrecurring direct transaction and integration costs, severance, and the impact of purchase accounting adjustments related to the fair value of acquired deferred revenue.

Adjusted Diluted EPS is a non-GAAP financial measure and should not be considered in isolation or as a substitute for financial information provided in accordance with GAAP. This non-GAAP financial measure may not be computed in the same manner as similarly titled measures used by other companies. In the future, we may incur expenses that are the same as or similar to some of the adjustments in the presentation, and we do not intend to imply that our future results will be unaffected by unusual or non-recurring items.

The following table reconciles net loss per share on a diluted basis, the most directly comparable GAAP measure, to Adjusted Diluted EPS:

	Three Months Ended March 31,
	2021				2020
	(In thousands except per share amounts)
Reconciliation of diluted net loss per share to Adjusted Diluted EPS
GAAP net loss, basic and diluted, and net loss per share, basic and diluted	$	(19,492)	$	(0.85)	$	(14,437)	$	(0.68)
Adjustments:
Change in fair value of acquisition-related contingent consideration expense		—				700
Amortization of acquired intangibles		7,339				6,822
Amortization of debt discount and issuance costs		502				3,152
Acquisition-related expense		118				251
Stock-based compensation expense		8,602				7,137
Impact to income taxes (1)		920				(3,435)
Adjusted net (loss) income and Adjusted Diluted EPS	$	(2,011)	$	(0.09)	$	190	$	0.01

(1) The impact to taxes was calculated using a normalized statutory tax rate applied to pre-tax income or loss adjusted for the respective items above and then subtracting the tax provision as determined for GAAP purposes.

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The following table reconciles the diluted weighted average shares of common stock outstanding used to calculate net loss per share on a diluted basis for GAAP purposes to the diluted weighted average shares of common stock outstanding used to calculate Adjusted Diluted EPS:

	Three Months Ended
	March 31,
	2021	2020
Reconciliation of weighted average shares of common stock outstanding, diluted, to weighted average shares of common stock outstanding, diluted for Adjusted Diluted EPS
Weighted average shares of common stock outstanding, basic and diluted for GAAP	23,010,531	21,374,897
Adjustments:
Weighted average dilutive effect of stock options	—	1,384,878
Weighted average dilutive effect of restricted stock	—	484,979
Weighted average dilutive effect of contingent shares	—	75,569
Weighted average shares of common stock outstanding, diluted for Adjusted Diluted EPS (1)	23,010,531	23,320,323

(1) For the three months ended March 31, 2021, we accounted for the convertible senior subordinated notes utilizing the if-converted method in accordance with the guidance under ASU 2020-06 effective January 1, 2021 (see Note 2 in the notes to the consolidated financial statements). Under this method, we are required to presume that the convertible senior subordinated notes are converted at the beginning of the current period and settled entirely in our common stock. However, no potential shares are assumed outstanding and are excluded from the diluted EPS calculation if including them would have an anti-dilutive effect. For the three months ended March 31, 2021, there was no impact on diluted EPS from the convertible senior subordinated notes as the conversion would have had an anti-dilutive effect.

For the three months ended March 31, 2020, under the previous accounting standard, we accounted for the convertible senior subordinated notes utilizing the treasury stock method. Under this method, we presumed that we would settle the notes entirely or partly in cash. The underlying shares issuable upon conversion of the notes were excluded from the calculation of diluted EPS, except to the extent that the average stock price for the reporting period exceeded their conversion price of $69.95 per share. For the three months ended March 31, 2020, there was no impact on diluted EPS from the convertible senior subordinated notes as the conversion price exceeded our average stock price.

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Liquidity and Capital Resources

We incurred a net loss of $19.5 million and $14.4 million for the three months ended March 31, 2021 and 2020, respectively. Our primary liquidity and capital requirements are for research and development, sales and marketing, general and administrative expenses, debt service obligations, and strategic business acquisitions. We have funded our operations, working capital needs, and investments with cash generated through operations, issuance of stock, and borrowings under our credit facilities. At March 31, 2021, we had unrestricted cash of $16.9 million.

Summary of Cash Flows

The following table shows a summary of our cash flows for the three months ended March 31, 2021 and 2020:

	Three Months Ended
	March 31,
	2021		2020
Net cash used in operating activities	$	(4,078)	$	(797)
Net cash used in investing activities		(6,385)		(4,991)
Net cash provided by financing activities		2,124		1,104
Net decrease in cash and restricted cash	$	(8,339)	$	(4,684)

Operating Activities

Net cash used in operating activities was $4.1 million for the three months ended March 31, 2021 and consisted primarily of our net loss of $19.5 million and changes in our operating assets and liabilities totaling $5.6 million, offset by the addition of noncash items of $21.0 million. The noncash items primarily included $11.6 million of depreciation and amortization expense, $8.6 million of stock-based compensation expense, $635 thousand of amortization of deferred financing costs and debt discounts primarily related to the 2026 Notes and acquisition-related notes payable, and a $174 thousand change in net deferred taxes, offset by acquisition-related contingent consideration paid of $67 thousand related to the Cognify acquisition. The change in operating assets and liabilities was primarily due to a decrease in accounts payable, an increase in other assets, an increase in prepaid expenses and other current assets, and a decrease in client claims payable. The decrease in accounts payable was primarily due to the timing of vendor payments. The increase in other assets was primarily due to an increase in nontrade receivables. The increase in prepaid expenses and other current assets was primarily due to an increase in contract assets related to rebate administration services under our pharmacy benefit management solutions. The change in operating assets and liabilities was partially offset by an increase in accrued expenses and other liabilities and a decrease in accounts receivable.

Net cash used in operating activities was $797 thousand for the three months ended March 31, 2020 and consisted primarily of our net loss of $14.4 million and changes in our operating assets and liabilities totaling $4.0 million, offset by the addition of noncash items of $17.6 million. The noncash items primarily included $9.9 million of depreciation and amortization expense, $7.1 million of stock-based compensation expense, $3.3 million of amortization of deferred financing costs and debt discounts primarily related to the 2026 Notes, and $700 thousand related to the change in fair value of the Cognify acquisition-related contingent consideration, offset by changes in net deferred taxes of $3.4 million. The change in operating assets and liabilities was primarily due to an increase in accounts receivable, an increase in inventory, and a decrease in accrued expenses and other liabilities. The increase in accounts receivable was attributable to growth across our business lines as a result of new clients and growth in existing clients as well as timing of client payments. The decrease in accrued expenses and other liabilities was primarily due to interest payments made related to the 2026 Notes and lower accrued employee compensation, partially offset by increased contract liability balances related to performance obligations for our services. The change in operating assets and liabilities was partially offset by a decrease in prepaid expenses and other current assets due to payments received related to prior year contract asset balances, and an increase in accounts payable.

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Investing Activities

Net cash used in investing activities was $6.4 million for the three months ended March 31, 2021 and $5.0 million for the three months ended March 31, 2020. Net cash used in investing activities for the three months ended March 31, 2021 reflected $5.9 million in software development costs for our CareVention HealthCare and MedWise HealthCare technologies. Net cash used in investing activities also included $522 thousand in purchases of property, equipment, and leasehold improvements for our new office space in Eden Prairie, Minnesota to support our health plan management services and for our Moorestown, New Jersey headquarters to support growth in corporate operations.

Net cash used in investing activities for the three months ended March 31, 2020 reflected $4.2 million in software development costs for our CareVention HealthCare and MedWise HealthCare technologies and $763 thousand in purchases of equipment and leasehold improvements primarily for our new call center space in Tucson, Arizona to support our medication safety services.

Financing Activities

Net cash provided by financing activities was $2.1 million for the three months ended March 31, 2021 compared to net cash provided by financing activities of $1.1 million for the three months ended March 31, 2020. Financing activities for the three months ended March 31, 2021 primarily reflected $7.5 million of borrowings on our 2020 Credit Facility to fund the repayment of the first promissory note in connection with the Personica acquisition, and $2.2 million of proceeds received from the exercise of stock options. Net cash provided by financing activities for the three months ended March 31, 2021 was partially offset by a $7.5 million repayment of the first promissory note in connection with the Personica acquisition and $99 thousand for the payment of the Cognify acquisition-related contingent purchase price consideration.

Financing activities for the three months ended March 31, 2020 primarily reflected $1.2 million of proceeds received from the exercise of stock options, which was partially offset by $49 thousand in payments of long-term debt.

Funding Requirements

On December 18, 2020, we entered into a Loan and Security Agreement with Western Alliance Bank, or the 2020 Credit Facility, which provides for a $120.0 million secured revolving credit facility, with a $1.0 million sublimit for cash management services and letters of credit and foreign exchange transactions. The 2020 Credit Facility matures on May 16, 2025. We have $102.4 million available for borrowings under the 2020 Credit Facility, and we were in compliance with all financial and operating covenants related to the 2020 Credit Facility as of March 31, 2020.

We believe that our unrestricted cash of $16.9 million as of March 31, 2021, borrowing capacity under our 2020 Credit Facility, and cash flows from continuing operations will be sufficient to fund our planned operations through at least May 2022. Our ability to maintain successful operations will depend on, among other things, new business, the retention of clients, and the effectiveness of sales and marketing initiatives.

We may seek additional funding through public or private debt or equity. There can be no assurance that additional capital resources, including debt and equity financing, will be available to us on terms that we find acceptable, or at all.

Contractual Obligations and Commitments

During the three months ended March 31, 2021, there were no material changes to our contractual obligations and commitments as compared to those described under “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Contractual Obligations and Commitments” in our 2020 Form 10-K.

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Critical Accounting Policies and Significant Judgments and Estimates

Our management’s discussion and analysis of our financial condition and results of operations is based on our consolidated financial statements, which have been prepared in accordance with United States generally accepted accounting principles. The preparation of these consolidated financial statements requires us to make estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the consolidated financial statements, as well as the reported revenue generated and expenses incurred during the reporting periods. Our estimates are based on our historical experience and on various other factors that we believe are reasonable under the circumstances, the results of which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates under different assumptions or conditions.

There have been no material changes in our critical accounting policies during the three months ended March 31, 2021, as compared to those disclosed in the “Management’s Discussion and Analysis of Financial Condition and Results of Operations—Critical Accounting Policies and Significant Judgments and Estimates” in our 2020 Form 10-K.

Recent Accounting Pronouncements

See Note 2 in this Quarterly Report on Form 10-Q and Note 2 in the Annual Financial Statements in our 2020 Form 10-K for the year ended December 31, 2020 for a description of new accounting pronouncements. As of January 1, 2021, we adopted Accounting Standards Update No. 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40).

Item 3. Quantitative and Qualitative Disclosure about Market Risk

There have been no material changes in our primary market risk exposures or how those exposures are managed from the information disclosed in our 2020 Form 10-K.

Item 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures

As required by Rule 13a-15(b) and Rule 15d-15(b) of the Exchange Act, our management, including our principal executive officer and our principal financial officer, conducted an evaluation as of the end of the period covered by this Quarterly Report on Form 10-Q of the effectiveness of the design and operation of our disclosure controls and procedures.

Based on that evaluation, our principal executive officer and principal financial officer concluded that, as of March 31, 2021, our disclosure controls and procedures are effective at the reasonable assurance level in ensuring that information required to be disclosed by us in the reports that we file or submit under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed by us in the reports we file under the Exchange Act is accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate to allow timely decisions regarding required disclosure.

Inherent Limitations on Effectiveness of Controls and Procedures

Internal control over financial reporting may not prevent or detect all errors and all fraud. A control system, no matter how well conceived and operated, can provide only reasonable, not absolute, assurance that the objectives of the control system are met. Also, projections of any evaluation of effectiveness of internal control to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate. Accordingly, our disclosure controls and procedures are designed to provide reasonable, not absolute, assurance that the objectives of our disclosure control system are met.

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Changes in Internal Control over Financial Reporting

There have been no changes in our internal control over financial reporting (as defined in Rules 13a-15(f) and 15d-15(f) of the Exchange Act) that occurred during the first quarter of fiscal 2021 that have materially affected, or are reasonably likely to materially affect, the Company’s internal control over financial reporting.

PART II - OTHER INFORMATION

Item 1. Legal Proceedings

We are not currently party to any material legal proceedings. From time to time, however, we may be a party to litigation and subject to claims in the ordinary course of business. Regardless of the outcome, litigation can have an adverse impact on us because of defense and settlement costs, diversion of management resources, and other factors.

Item 1A. Risk Factors

Stockholders and potential investors in our securities should carefully consider the risk factors set forth in Part I, “Item 1A. Risk Factors” of our 2020 Form 10-K for the year ended December 31, 2020, which was filed with the Securities and Exchange Commission on February 26, 2021. We have identified these risk factors as important factors that could cause our actual results to differ materially from those contained in any written or oral forward-looking statements made by us or on our behalf. There have been no material changes to such risk factors previously disclosed in our 2020 Form 10-K.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

There were no unregistered sales of equity securities during the three months ended March 31, 2021.

Item 3. Defaults Upon Senior Securities

Not applicable.

Item 4. Mine Safety Disclosures

Not applicable.

Item 5. Other Information

Not applicable.

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Item 6. Exhibits

		Incorporated by Reference			Filed Herewith
Exhibit No.	Exhibit Description	Form	Filing Date	Exhibit Number
3.1	Amended and Restated Certificate of Incorporation of Tabula Rasa HealthCare, Inc.	8-K	8/4/2016	3.1
3.2	Amended and Restated Bylaws of Tabula Rasa HealthCare, Inc.	8-K	8/4/2016	3.2
31.1	Certification of Chief Executive Officer (Principal Executive Officer) required by Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002				X
31.2	Certification of Chief Financial Officer (Principal Financial Officer) required by Rule 13a-14(a) or Rule 15d-14(a) of the Securities Exchange Act of 1934, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002				X
32.1**	Certification of Chief Executive Officer (Principal Executive Officer) and Chief Financial Officer (Principal Financial Officer), as required by Rule 13a-14(b) or Rule 15d-14(b) and Section 1350 of Chapter 63 of Title 18 of the United States Code (18 U.S.C. §1350), as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002				X
101.INS	XBRL Instance Document				X
101.SCH	XBRL Taxonomy Extension Schema Document				X
101.CAL	XBRL Taxonomy Extension Calculation Linkbase				X
101.DEF	XBRL Taxonomy Extension Definition Linkbase				X
101.LAB	XBRL Taxonomy Extension Label Linkbase				X
101.PRE	XBRL Taxonomy Extension Presentation Linkbase				X
104	The cover page from the Company’s Quarterly Report on Form 10-Q for the quarter ended March 31 2021, formatted in Inline XBRL (contained in Exhibit 101)				X

** This certification attached as Exhibit 32.1 that accompanies this Quarterly Report on Form 10-Q is not deemed filed with the Securities and Exchange Commission and is not to be incorporated by reference into any filing of Tabula Rasa HealthCare, Inc. under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended (whether made before or after the date of this Form 10-Q), irrespective of any general incorporation language contained in such filing.

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Signatures

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

	TABULA RASA HEALTHCARE, INC.
Date: May 7, 2021	By:	/s/ DR. CALVIN H. KNOWLTON
	Name:	Dr. Calvin H. Knowlton
	Title:	Chief Executive Officer (Principal Executive Officer)
Date: May 7, 2021	By:	/s/ BRIAN W. ADAMS
	Name:	Brian W. Adams
	Title:	Chief Financial Officer
		(Principal Financial Officer)
Date: May 7, 2021	By:	/s/ ANDREA C. SPEERS
	Name:	Andrea C. Speers
	Title:	Chief Accounting Officer
		(Principal Accounting Officer)

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EX-31.1

Exhibit 31.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER

Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

I, Calvin H. Knowlton, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q of Tabula Rasa HealthCare, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: May 7, 2021	/s/ DR. CALVIN H. KNOWLTON
	Dr. Calvin H. Knowlton Chief Executive Officer Principal Executive Officer

EX-31.2

Exhibit 31.2

CERTIFICATION OF CHIEF FINANCIAL OFFICER

Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

I, Brian W. Adams, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q of Tabula Rasa HealthCare, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: May 7, 2021	/s/ BRIAN W. ADAMS
	Brian W. Adams Chief Financial Officer Principal Financial Officer

EX-32.1

Exhibit 32.1

CERTIFICATION OF CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER

PURSUANT TO

18 U.S.C. SECTION 1350,

AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Tabula Rasa HealthCare, Inc. (the “Company”) on Form 10-Q for the fiscal quarter ended March 31, 2021 as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Calvin H. Knowlton, Chief Executive Officer of the Company, and I, Brian W. Adams, Chief Financial Officer of the Company, each hereby certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that, to my knowledge:

1. The Report fully complies with the requirements of Section 13(a) or Section 15(d) of the Securities Exchange Act of 1934, as amended; and

2. The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: May 7, 2021	By:	/s/ DR. CALVIN H. KNOWLTON
	Name:	Dr. Calvin H. Knowlton
	Title:	Chief Executive Officer (Principal Executive Officer)

Date: May 7, 2021	By:	/s/ BRIAN W. ADAMS
	Name:	Brian W. Adams
	Title:	Chief Financial Officer (Principal Financial Officer)

*This certification accompanies the Form 10-Q to which it relates, is not deemed filed with the Securities and Exchange Commission and is not to be incorporated by reference into any filing of Tabula Rasa HealthCare, Inc. under the Securities Act of 1933, as amended, or the Securities Exchange Act of 1934, as amended (whether made before or after the date of the Form 10-Q), irrespective of any general incorporation language contained in such filing

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

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

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

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

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

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

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

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Nature of Business

3 Months Ended

Mar. 31, 2021

Nature of Business

Nature of Business

1.      Nature of Business

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

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Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements

3 Months Ended

Mar. 31, 2021

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements

2.      Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements

Basis of Presentation

The accompanying unaudited consolidated financial statements of the Company have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (the “SEC”) regarding interim financial reporting. The unaudited interim consolidated financial statements have been prepared on the same basis as the annual audited consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting of normal recurring accruals and adjustments) necessary to present fairly the Company's interim consolidated financial position for the periods indicated. The interim results for the three months ended March 31, 2021 are not necessarily indicative of results to be expected for the year ending December 31, 2021, any other interim periods, or any future year or period. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the audited consolidated financial statements and accompanying notes included in the Company’s annual report on Form 10-K filed on February 26, 2021 (“2020 Form 10-K”).

The Company operates its business through two segments, CareVention HealthCare and MedWise HealthCare. See Note 17 for a discussion of the Company’s reportable segments.

Risks Related to the COVID-19 Pandemic

On January 30, 2020, the World Health Organization (“WHO”) announced a global health emergency caused by a new strain of coronavirus (“COVID-19”), originating in Wuhan, China and the risks to the international community. In March 2020, the WHO classified the COVID-19 outbreak as a pandemic (“COVID-19 pandemic), based on the rapid increase in exposure globally. The full impact of the COVID-19 pandemic continues to evolve as of the date these consolidated financial statements were issued. As such, the full magnitude of the impact that the pandemic will have on the Company’s future results of operations remains uncertain. Management is actively monitoring the global situation and the ramification on the Company’s financial condition, liquidity, operations, suppliers, industry, and workforce. Given the daily evolution of the COVID-19 pandemic and the global responses to curb its spread, the Company is not able to estimate the effects that the COVID-19 pandemic may have on the Company’s results of operations, financial condition, or liquidity for 2021. However, the Company is dependent on its workforce to sell and deliver its products and services. Social distancing and shelter-in-place directives could impact the Company’s ability to deploy its workforce effectively. These same developments may affect the operations of the Company’s suppliers and customers, as their own workforces and operations are disrupted by this virus.

As a result of the ongoing COVID-19 pandemic, the Company has experienced challenges with revenue growth. During 2020, the pandemic had delayed the closing of contracts across both the Company’s CareVention HealthCare and MedWise HealthCare segments and, in some cases, shifted project priorities and timelines, which management believed resulted in fewer business wins during 2020 and reduced future revenue. Overall census growth for Programs of All-Inclusive Care for the Elderly (“PACE”) had remained below historical levels during 2020 and into the first quarter of 2021, which has affected the Company’s CareVention HealthCare segment growth. During 2020, the Company’s MedWise HealthCare segment had experienced delays in the timing of implementation and closing of new business and a negative impact from COVID-19 on medication adherence initiatives. The Company does not yet know the full extent of potential delays or impacts on its business, financing or other activities, or on the broader healthcare industry or the global economy as a whole. These effects could have a material impact on the Company’s liquidity, capital resources, operations and business and those of the third parties on which it relies.

Summary of Significant Accounting Policies

There have been no changes to the Company's significant accounting policies described in the 2020 Form 10-K that have had a material impact on the consolidated financial statements and related notes.

Recent Accounting Pronouncements

In August 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40) (“ASU 2020-06”). ASU 2020-06 provides new guidance to simplify the accounting for convertible instruments by eliminating the cash conversion model. As compared with the current accounting standards, more convertible debt instruments will be reported as a single liability instrument and the interest rate of more convertible debt instruments will be closer to the coupon interest rate. ASU 2020-06 also aligns the consistency of diluted earnings per share calculations for convertible instruments by requiring that (1) an entity use the if-converted method and (2) share settlement be included in the diluted earnings per share calculation for both convertible instruments and equity contracts when those contracts include an option of cash settlement or share settlement. The treasury stock method will no longer be permitted. ASU 2020-06 is effective for financial statements issued for fiscal years beginning after December 15, 2021 and early adoption is permitted.

Under ASC 470-20 Debt with Conversion and Other Options (“ASC 470-20”), the Company separately accounted for the liability and equity components of its 1.75% convertible senior subordinated notes (the “2026 Notes”), which may be settled entirely or partly in cash upon conversion. The equity component was required to be included in the additional paid-in capital section of stockholders’ equity on the Company’s consolidated balance sheet, and the value of the equity component was treated as original issue discount for purposes of accounting for the debt component of the 2026 Notes. As a result, the Company was required to record a greater amount of non-cash interest expense in previous periods presented related to the amortization of the discounted carrying value of the 2026 Notes to their face amount over the term of the 2026 Notes. Because the Company intends to settle the 2026 Notes entirely or partly in cash, the Company had used the treasury stock method when calculating their potential dilutive effect, if any.

ASU 2020-06 allows adoption through either a modified retrospective method or fully retrospective method of transition. The Company early adopted ASU 2020-06 effective January 1, 2021 using the modified retrospective method. In applying the modified retrospective transition method, the cumulative effect of the accounting change is recognized as an adjustment to the opening balance of retained earnings at the date of adoption. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. See Note 12 for further details on the 2026 Notes.

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Revenue

3 Months Ended

Mar. 31, 2021

Revenue

Revenue

3.     Revenue

The Company generates revenue from its CareVention HealthCare and MedWise HealthCare segments. See Note 17 for additional discussion of the Company’s reportable segments.

Client contracts generally have a term of one to five years and generally renew at the end of the initial term. In most cases, clients may terminate their contracts with a notice period ranging from 0 to 180 days without cause, thereby limiting the term in which the Company has enforceable rights and obligations. Revenue is recognized in an amount that reflects the consideration that is expected in exchange for the goods or services. Generally, there are not significant differences between the timing of revenue recognition and billing. Consequently, the Company has determined that client contracts do not include a financing component.

The Company does not disclose the amount of variable consideration that the Company expects to recognize in future periods as the variable consideration in the Company’s contracts is allocated entirely to a wholly unsatisfied performance obligation or to a wholly unsatisfied promise to transfer a distinct good or service that forms part of a single performance obligation, and the terms of that variable consideration relate specifically to the Company’s efforts to transfer the distinct service, or to a specific outcome from transferring the distinct service. The Company’s contracts primarily include monthly fees associated with unspecified quantities of members, claims, medication safety reviews, or user subscriptions that fluctuate throughout the contract. See below for a description of the Company’s revenues by segment.

CareVention HealthCare

PACE Product Revenue

The Company provides medication fulfillment pharmacy services to PACE, and, while the majority of medications are routinely filled in order to treat chronic conditions, the mix and quantity of medications can vary. Revenue from medication fulfillment services is generally billed monthly or weekly, depending on whether the PACE organization is contracted with a pharmacy benefit manager, and recognized when medications are delivered and control has passed to the client. At the time of delivery, the Company has performed substantially all of its performance obligations under its client contracts. The Company does not experience a significant level of returns or reshipments.

PACE Solutions

The Company provides medication safety services and health plan management services to PACE organizations. These services include risk adjustment services, third party administration services, pharmacy benefit management (“PBM”) solutions, and electronic health records software. Revenue related to these services primarily consists of a fixed monthly fee assessed based on number of members served (“per member per month”), a fee for each claim adjudicated, and subscription fees. These fees are recognized when the Company satisfies its performance obligation to stand ready to provide PACE services, which occurs when the Company’s clients have access to the PACE services. The Company generally bills for PACE services on a monthly basis.

MedWise HealthCare

Product Revenue

The Company provides COVID-19 test kits to pharmacies and other clients. Revenue from the sale of these products is generally billed when test kits are shipped and is recognized as the Company satisfies its performance obligations to deliver the test kits and provide the test results. The Company does not experience a significant level of returns or reshipments.

Medication Safety Services

The Company provides medication safety services, which include identification of high-risk individuals, medication regimen reviews including patient and prescriber counseling, and targeted interventions to increase adherence and close gaps in care. Revenue related to these services primarily consists of per member per month fees and fees for each medication review and assessment completed. Revenue is recognized when the Company satisfies its performance obligation to stand ready to provide medication safety services, which occurs when the Company’s clients have access to the medication safety services, and when medication reviews and assessments are completed. The Company generally bills for the medication safety services on a monthly basis.

Software Subscription

The Company provides software as a service (“SaaS”) solutions, which allow for the identification of individuals with high medication-related risk, for patient communication and engagement, for documentation of clinical interventions, for optimizing medication therapy, for targeting adherence improvement, and for precision dosing. Revenues related to these software services primarily consist of monthly subscription fees and are recognized monthly as the Company meets its performance obligation to provide access to the software. Revenue for implementation and set up services is generally recognized over the contract term as the software services are provided. The Company generally bills for the software services on a monthly basis.

Disaggregation of Revenue

In the following table, revenue is disaggregated by reportable segment. Substantially all of the Company’s revenue is recognized in the U.S.

	Three Months Ended
	March 31,
		2021		2020
CareVention HealthCare:
PACE product revenue	$	41,842	$	37,087
PACE solutions		13,919		11,571
	$	55,761	$	48,658
MedWise HealthCare:
Product revenue	$	136	$	—
Medication safety services		10,725		14,320
Software subscription and services		10,058		9,849
	$	20,919	$	24,169
Total revenue	$	76,680	$	72,827

Contract Balances

Assets and liabilities related to the Company’s contracts are reported on a contract-by-contract basis at the end of each reporting period. Contract balances consist of contract assets and contract liabilities. Contract assets are recorded when the right to consideration for services is conditional on something other than the passage of time. Contract assets relating to unbilled receivables are transferred to accounts receivable when the right to consideration becomes unconditional. Contract assets are classified as current or non-current based on the timing of the Company’s rights to the unconditional payments. Contract assets are generally classified as current and recorded within other current assets on the Company’s consolidated balance sheets.

Contract liabilities include advance customer payments and billings in excess of revenue recognized. The Company generally classifies contract liabilities in accrued expenses and other current liabilities and in other long-term liabilities on the Company’s consolidated balance sheets. The Company anticipates that it will satisfy most of its performance obligations associated with its contract liabilities within one year.

The following table provides information about the Company’s contract assets and contract liabilities from contracts with clients as of March 31, 2021 and December 31, 2020.

	March 31,		December 31,
	2021		2020
Contract assets	$	8,948	$	7,601
Contract liabilities		5,287		3,876

Significant changes in the contract assets and the contract liabilities balances during the period are as follows:

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

During the three months ended March 31, 2020, the Company recognized $2,618 of revenue that was included in the December 31, 2019 contract liability balance of $4,930.

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Net Loss per Share

3 Months Ended

Mar. 31, 2021

Net Loss per Share

Net Loss per Share

4.     Net Loss per Share

Basic and diluted net loss per share is computed by dividing net loss by the weighted average number of shares of common stock of the Company outstanding during the period.

The following table presents the calculation of basic and diluted net loss per share for the Company’s common stock:

	Three Months Ended
	March 31,
	2021		2020
Numerator (basic and diluted):
Net loss	$	(19,492)	$	(14,437)
Denominator (basic and diluted):
Weighted average shares of common stock outstanding, basic and diluted		23,010,531		21,374,897
Net loss per share, basic and diluted	$	(0.85)	$	(0.68)

The following potential common shares, presented based on amounts outstanding for the three months ended March 31, 2021 and 2020, were excluded from the calculation of diluted net loss per share for the periods indicated because including them would have had an anti-dilutive effect.

	March 31,
	2021	2020
Stock options to purchase common stock	1,846,707	2,627,493
Unvested restricted stock	1,651,806	1,314,635
Common stock warrants	4,646,393	4,646,393
Conversion of convertible senior subordinated notes	4,646,393	—
Contingently issuable shares	—	63,320
	12,791,299	8,651,841

For the three months ended March 31, 2021, shares related to the conversion of the convertible senior subordinated notes were included in the table above under the if-converted method. For the three months ended March 31, 2020, shares associated with the conversion of the convertible senior subordinated notes were excluded from the table above as the Company assumed the notes would be settled entirely or partly in cash.

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Acquisitions

3 Months Ended

Mar. 31, 2021

Acquisitions

Acquisitions

5.     Acquisitions

Personica

On October 5, 2020, the Company entered into a Membership Interest Purchase Agreement (the “Purchase Agreement”) with TRHC Group, Personica Holdings, Inc., a Wisconsin corporation, and other seller parties, whereby the Company completed the acquisition of all the issued and outstanding membership interests of Personica, LLC, a Delaware limited liability company (“Personica”), and its subsidiaries, a provider of PBM solutions and pharmacy services, including 340B and Medicare Part D administration solutions to the PACE market. The purchase price consisted of (i) cash consideration of $10,000, subject to certain customary post-closing adjustments, (ii) the issuance of 555,555 shares of the Company’s common stock valued at $23,589, and (iii) the delivery of promissory notes (collectively, the “Notes”) for the payment of (a) $7,500 in cash paid in January 2021, (b) $5,500 in cash paid in April 2021, and (c) $4,000 in cash within two business days following October 5, 2021. The Company may set off amounts due under the Notes to the extent the Company is entitled to indemnification under the Purchase Agreement or in respect of adjustments to the purchase price.

Revenue from Personica includes medication fulfillment pharmacy services to PACE organizations. Revenue for these services, and the related costs, is recognized when medications are delivered and control has passed to the client, and is included in product revenue and cost of revenue – product cost, respectively, in the Company’s consolidated statements of operations. Revenue from Personica is also comprised of monthly fees per adjudicated claim for PBM solutions. Revenue for these services, and the related costs, is recognized each month as performance obligations are satisfied and costs are incurred, and is included in service revenue and cost of revenue – service cost, respectively, in the Company’s consolidated statements of operations.

The Company continues to evaluate the fair value of certain assets acquired and liabilities assumed related to the acquisition. Additional information, which existed as of the acquisition date, but was at that time unknown to the Company, may become known during the remainder of the measurement period. Changes to amounts recorded as a result of the final determination may result in a corresponding adjustment to these assets and liabilities, including goodwill. The determination of the estimated fair values of all assets acquired is expected to be completed within one year from the date of acquisition.

Pro forma

The unaudited pro forma results presented below include the results of the Personica acquisition as if it had been consummated as of January 1, 2019. The unaudited pro forma results include the amortization associated with acquired intangible assets, interest expense on the debt incurred to fund these acquisitions, stock-based compensation expense related to equity awards granted to employees of the acquired companies, and the estimated tax effect of adjustments to income (loss) before income taxes. Material nonrecurring charges, including direct acquisition costs, directly attributable to the transactions are excluded. In addition, the unaudited pro forma results do not include any expected benefits of the acquisitions. Accordingly, the unaudited pro forma results are not necessarily indicative of either future results of operations or results that might have been achieved had the acquisition been consummated as of January 1, 2019.

	Three Months Ended
	March 31,
	2020
Revenue	$	75,671
Net loss		(14,206)

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Other Current Assets

3 Months Ended

Mar. 31, 2021

Other Current Assets

Other Current Assets

6.     Other Current Assets

As of March 31, 2021 and December 31, 2020, other current assets consisted of the following:

	March 31, 2021		December 31, 2020
Contract assets	$	8,948	$	7,601
Non-trade receivables		1,421		647
Other		1,603		1,504
Total other current assets	$	11,972	$	9,752

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Property and Equipment

3 Months Ended

Mar. 31, 2021

Property and Equipment.

Property and Equipment

7.       Property and Equipment

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

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Software Development Costs

3 Months Ended

Mar. 31, 2021

Software Development Costs

Software Development Costs

8.       Software Development Costs

The Company capitalizes certain costs incurred in connection with obtaining or developing its proprietary software platforms, which are used to support its service contracts, including external direct costs of material and services, payroll costs for employees directly involved with the software development, and interest expense related to the borrowings attributable to software development. As of March 31, 2021 and December 31, 2020, capitalized software costs consisted of the following:

	March 31, 2021		December 31, 2020
Software development costs	$	54,414	$	48,548
Less: accumulated amortization		(23,669)		(20,666)
Software development costs, net	$	30,745	$	27,882
Capitalized software development costs included above not yet subject to amortization	$	5,823	$	4,382

Amortization expense for the three months ended March 31, 2021 and 2020 was $3,003 and $1,823, respectively.

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Goodwill and Intangible Assets

3 Months Ended

Mar. 31, 2021

Goodwill and Intangible Assets

Goodwill and Intangible Assets

9.      Goodwill and Intangible Assets

The Company’s goodwill and related changes during the three months ended of March 31, 2021 were as follows:

		CareVention HealthCare		MedWise HealthCare		Total
Balance at January 1, 2021	$	115,350	$	55,512	$	170,862
Adjustments to goodwill related to prior year acquisition		(27)		—		(27)
Balance at March 31, 2021	$	115,323	$	55,512	$	170,835

Intangible assets consisted of the following as of March 31, 2021 and December 31, 2020:

	Weighted Average
	Amortization Period			Accumulated		Intangible
	(in years)	Gross Value		Amortization		Assets, net
March 31, 2021
Trade names	3.6	$	11,955	$	(8,844)	$	3,111
Client relationships	12.2		152,654		(35,591)		117,063
Non-competition agreements	5.0		6,892		(4,321)		2,571
Developed technology	8.0		67,369		(27,054)		40,315
Patient database	5.0		21,700		(9,042)		12,658
Domain name	10.0		59		(22)		37
Total intangible assets		$	260,629	$	(84,874)	$	175,755

	Weighted Average
	Amortization Period			Accumulated		Intangible
	(in years)	Gross Value		Amortization		Assets, net
December 31, 2020
Trade names	3.7	$	11,955	$	(8,286)	$	3,669
Client relationships	12.2		152,654		(32,437)		120,217
Non-competition agreements	5.0		6,892		(3,976)		2,916
Developed technology	8.0		67,369		(24,858)		42,511
Patient database	5.0		21,700		(7,957)		13,743
Domain name	10.0		59		(21)		38
Total intangible assets		$	260,629	$	(77,535)	$	183,094

Amortization expense for intangible assets for the three months ended March 31, 2021 and 2020 was $7,339 and $6,822, respectively.

The estimated amortization expense for the remainder of 2021 and each of the next five years and thereafter is as follows:

Years Ending December 31,
2021 (April 1 - December 31)	$	21,105
2022		27,089
2023		25,804
2024		18,521
2025		14,038
2026		12,830
Thereafter		56,368
Total estimated amortization expense	$	175,755

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Notes Payable Related to Acquisition

3 Months Ended

Mar. 31, 2021

Notes Payable Related to Acquisition

Notes Payable Related to Acquisition

10.      Notes Payable Related to Acquisition

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

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Accrued Expenses and Other Liabilities

3 Months Ended

Mar. 31, 2021

Accrued Expenses and Other Liabilities

Accrued Expenses and Other Liabilities

11.       Accrued Expenses and Other Liabilities

As of March 31, 2021 and December 31, 2020, accrued expenses and other liabilities consisted of the following:

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

*This amount represents clients’ funds held by the Company, with an offsetting amount included in restricted cash.

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Lines of Credit and Long-Term Debt

3 Months Ended

Mar. 31, 2021

Lines of Credit and Long-Term Debt

Lines of Credit and Long-Term Debt

12.      Lines of Credit and Long-Term Debt

(a)    Lines of Credit

On September 6, 2017, the Company entered into an Amended and Restated Loan and Security Agreement (the “2015 Line of Credit”), whereby the Company amended and restated its revolving line of credit, originally entered into with Bridge Bank (now Western Alliance Bank) in 2015 and had subsequently amended. The 2015 Line of Credit provided for borrowing availability in an aggregate amount up to $60,000 to be used for general corporate purposes, with a $1,000 sublimit for cash management services, letters of credit and foreign exchange transactions. The 2015 Line of Credit matured pursuant to its terms on December 6, 2020.

On December 18, 2020, the Company and its subsidiaries entered into a Loan and Security Agreement with Western Alliance Bank, which provides for a $120,000 secured revolving credit facility, with a $1,000 sublimit for cash management services and letters of credit and foreign exchange transactions (the “2020 Credit Facility”), and replaced the 2015 Line of Credit.

Amounts under the 2020 Credit Facility may be borrowed, repaid, and re-borrowed from time to time until the maturity date on May 16, 2025, and may be used for, among other things, working capital and other general corporate purposes. Loans under the 2020 Credit Facility will bear interest at a rate equal to the LIBOR rate plus 3.25%. The obligations under the 2020 Credit Facility are secured by all of the Company’s assets, subject to certain exceptions and exclusions as set forth in the Loan and Security Agreement.

The Loan and Security Agreement contains certain affirmative and negative covenants that are binding on the Company, including, but not limited to, restrictions (subject to specified exceptions and qualifications) on the Company’s ability to incur indebtedness, create liens, merge or consolidate, make dispositions, pay dividends or make distributions, make investments, pay any subordinated indebtedness, enter into certain transactions with affiliates, or make capital expenditures. In addition, the Loan and Security Agreement imposes certain financial covenants, including that the Company (i) maintain unrestricted cash balances with Western Alliance Bank, plus amounts available for draw under the 2020 Credit Facility of at least $10,000 at all times, and (ii) maintain a leverage ratio of less than 3.00:1.00, on a trailing twelve-month basis, measured quarterly. The 2020 Credit Facility is subject to a commitment fee of 0.50% of the total commitment under the 2020 Credit Facility payable on the closing date, and 0.25% of the total commitment under the 2020 Credit Facility payable on each anniversary thereafter. Additionally, the 2020 Credit Facility is subject to an unused line fee.

As of March 31, 2021, the Company was in compliance with all of the financial covenants related to the 2020 Credit Facility, and management expects that the Company will be able to maintain compliance with its covenants.

As of March 31, 2021, the Company had $17,500 outstanding under the 2020 Credit Facility, plus an outstanding letter of credit of $100 issued in connection with the Company’s lease agreement for its office space in Moorestown, NJ. The letter of credit renews annually and expires in September 2027, and reduces amounts available under the 2020 Credit Facility. As of March 31, 2021, amounts available for borrowings under the 2020 Credit Facility were $102,400.

As of March 31, 2021, the interest rate on the 2020 Credit Facility was 3.36% and the effective rate for the unused line fee was 0.45%. Interest expense on the 2020 Credit Facility was $261 for the three months ended March 31, 2021. As of March 31, 2020, the interest rate on the 2015 Line of Credit was 5.58%. No interest expense was incurred for the three months ended March 31, 2020 as there were no aggregate borrowings outstanding during the three months ended March 31, 2020.

In connection with the 2020 Credit Facility, the Company recorded deferred financing costs of $1,176. The Company is amortizing the deferred financing costs associated with the 2020 Credit Facility to interest expense using the effective-interest method over the term of the 2020 Credit Facility. The Company amortized $133 to interest expense for the three months ended March 31, 2021. During the three months ended March 31, 2020, the Company amortized $100 to interest expense for deferred financing costs related to the 2015 Line of Credit. Deferred financing costs of $1,005 and $1,156, net of accumulated amortization, are included in other assets on the accompanying consolidated balance sheets as of March 31, 2021 and December 31, 2020, respectively.

(b)    Convertible Senior Subordinated Notes

On February 12, 2019, the Company issued and sold an aggregate principal amount of $325,000 of 1.75% convertible senior subordinated notes (the “2026 Notes”) in a private placement pursuant to Rule 144A under the Securities Act of 1933, as amended. The 2026 Notes bear interest at a rate of 1.75% per year, payable semiannually in arrears on February 15 and August 15 of each year, beginning on August 15, 2019. The notes will mature on February 15, 2026, unless earlier converted or repurchased. The initial conversion rate for the notes is 14.2966 shares of the Company’s common stock per $1 principal amount of notes. This conversion rate is equal to an initial conversion price of approximately $69.95 per share of the Company’s common stock.

Holders may convert all or any portion of their 2026 Notes at any time prior to the close of business on the business day immediately preceding August 15, 2025 only under the following circumstances: (1) during any calendar quarter commencing after March 31, 2019 (and only during such calendar quarter), if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any five consecutive trading day period (the measurement period) in which the trading price (as defined in the indenture governing the 2026 Notes) per $1 principal amount of 2026 Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events, including certain distributions, the occurrence of a fundamental change or make-whole fundamental change (as defined in the indenture governing the 2026 Notes) or a transaction resulting in the Company’s common stock converting into other securities or property or assets. On or after August 15, 2025 until the close of business on the first scheduled trading day immediately preceding the maturity date, a holder may convert all or any portion of its 2026 Notes regardless of the foregoing circumstances. Upon conversion, the Company will pay or deliver shares of our common stock, cash or a combination thereof at the Company’s option. As of March 31, 2021, none of the conditions allowing holders of the 2026 Notes to convert had been met.

In the initial accounting for the issuance of the 2026 Notes, the Company separated the 2026 Notes into liability and equity components. The carrying amount of the equity component representing the conversion option was $102,900 and was determined by deducting the fair value of the liability component from the par value of the 2026 Notes. The equity component was not remeasured as long as it continued to meet the conditions for equity classification. The initial associated deferred tax effect of $25,884 was recorded as a reduction of additional paid-in capital because the equity component was not currently expected to be deductible for income tax purposes. The excess of the principal amount of the liability component over its carrying amount (“debt discount”) was amortized to interest expense over the term of the 2026 Notes at an effective interest rate of 8.05% over the contractual term. Debt issuance costs related to the 2026 Notes of $9,372 were allocated to the liability and equity components of the 2026 Notes based on their relative values. Issuance costs attributable to the liability component were $6,405 and were amortized to interest expense using the effective interest method over the contractual term. Issuance costs attributable to the equity component were netted with the equity component in stockholders’ equity.

As described in Note 2, the Company adopted ASU 2020-06 using the modified retrospective method effective January 1, 2021. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. Effective on January 1, 2021, debt issuance costs related to the 2026 Notes of $7,008 were allocated to the liability component of the 2026 Notes and will be amortized to interest expense using the effective interest method over the contractual term, resulting in an effective interest rate of 2.20%.

During the three months ended March 31, 2021, the Company recognized $1,746 of interest expense related to the 2026 Notes, of which $1,422 was paid or accrued, and $324 was non-cash accretion of the debt discounts recorded. During the three months ended March 31, 2020, under the previous accounting standard, the Company recognized $4,573 of interest expense related to the 2026 Notes, of which $1,421 was paid or accrued, and $3,152 was non-cash accretion of the debt discounts recorded.

In addition, unpaid additional interest payable as a result of the failure to remove the restrictive legend on the 2026 Convertible Notes had accrued on the 2026 Convertible Notes from and including February 17, 2020, but ceased accruing on February 16, 2021 as a result of the restrictive legend being removed. The Company recorded $212 of additional interest expense for the three months ended March 31, 2021 and the total amount of accrued additional interest was $1,625 as of March 31, 2021. As a result, total accrued interest payable related to the 2026 Notes was $2,336 as of March 31, 2021, which is included in accrued expenses and other liabilities on the consolidated balance sheets. The 2026 Notes have a carrying value of $318,316 as of March 31, 2021.

The 2026 Notes are classified as long-term debt on the Company’s consolidated balance sheets, and will be until such Notes are within one year of maturity

(c)    Convertible Note Hedge and Warrant Transactions

In connection with the offering of the 2026 Notes, the Company entered into convertible note hedge transactions with affiliates of certain of the initial purchasers (the “option counterparties”) of the 2026 Notes pursuant to the terms of call option confirmations. The Company has the option to purchase a total of 4,646,393 shares of its common stock at a price of approximately $69.95 per share. The total premiums paid for the note hedges were $101,660. The Company also entered into warrant transactions with the option counterparties whereby they have the option to purchase 4,646,393 shares of the Company’s common stock at a price of $105.58 per share. The Company received $65,910 in cash proceeds from the sale of the warrants. As these instruments are considered indexed to the Company's own stock and are considered equity classified, the convertible note hedges and warrants are recorded in stockholders’ equity, are not accounted for as derivatives and are not remeasured each reporting period. The net costs incurred in connection with the convertible note hedge and warrant transactions were recorded as a reduction to additional paid-in capital on the Company’s consolidated balance sheets.

The convertible note hedge transactions are expected generally to reduce the potential dilution to the Company’s common stock upon conversion of the 2026 Notes and/or offset any potential cash payments the Company is required to make in excess of the principal amount of converted 2026 Notes, as the case may be. The warrant transactions could separately have a dilutive effect on the Company’s common stock to the extent that the market price per share of the Company’s common stock exceeds the strike price of the warrants.

As of March 31, 2021, no warrants have been exercised and all warrants to purchase shares of the Company’s common stock were outstanding.

(d)    Long-Term Debt

The following table represents the total long-term debt obligations of the Company at March 31, 2021 and December 31, 2020:

	March 31, 2021		December 31, 2020
Convertible senior subordinated notes	$	325,000	$	325,000
Unamortized discount, including debt issuance costs, on convertible senior subordinated notes		(6,684)		(85,715)
Convertible senior subordinated notes, net		318,316		239,285
Finance leases		1		4
Total long-term debt and finance leases, net		318,317		239,289
Less current portion of finance leases		(1)		(4)
Total long-term debt, net	$	318,316	$	239,285

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Income Taxes

3 Months Ended

Mar. 31, 2021

Income Taxes

Income Taxes

13.      Income Taxes

On February 12, 2021, the Company received a private letter ruling from the Internal Revenue Service, which determined, based on information submitted and representations made by the Company, that the Company met the requirements to deduct the interest expense resulting from the amortization of the debt discount associated with the 2026 Notes. As a result, during the three months ended March 31, 2021, the Company recorded a deferred tax asset of $23,628 and a corresponding $23,628 increase to its valuation allowance. As of March 31, 2021, the Company has recorded a full valuation allowance against its deferred tax assets.

For the three months ended March 31, 2021, the Company recorded income tax expense of $199 primarily related to indefinite-lived deferred tax liabilities for goodwill amortization, which resulted in an effective tax rate of (1.0)%. The effective tax rate differs from the U.S. statutory tax rate primarily due to the full valuation allowance recorded that is currently limiting the realizability of our net deferred tax assets as of March 31, 2021. Accordingly, the tax benefit was limited due to unbenefited losses in the three months ended March 31, 2021. The Company calculates its provision for income taxes during its interim periods by applying the estimated annual effective tax rate for the full year ordinary income or loss to the respective reporting period’s year to date income or loss, while also adding any income tax expense or benefit related to discrete items occurring within that interim period.

For the three months ended March 31, 2020, the Company recorded an income tax benefit of $3,367, which resulted in an effective tax rate of 18.9%. The tax benefit primarily consisted of $3,031 based on the estimated effective tax rate for the full year and $336 of windfall tax benefits generated from the vesting of restricted stock, disqualifying dispositions and exercising of nonqualified stock options during the period.

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Stock-Based Compensation

3 Months Ended

Mar. 31, 2021

Stock-Based Compensation

Stock-Based Compensation

14.     Stock-Based Compensation

In September 2016, the Company adopted the 2016 Equity Compensation Plan (“2016 Plan”). During the term of the 2016 Plan, the share reserve will automatically increase on the first trading day in January of each calendar year by an amount equal to the lesser of 5% of the total number of outstanding shares of common stock on the last trading day in December of the prior calendar year or such other number set by the Board. In accordance with the terms of the 2016 Plan, the share reserve increased by 1,200,244 shares on January 2, 2021. As of March 31, 2021, 1,785,765 shares were available for future grants under the 2016 Plan.

Restricted Common Stock

The following table summarizes the restricted stock award activity under the 2016 Plan for the three months ended March 31, 2021:

		Weighted
		average
	Number	grant-date
	of shares	fair value
Outstanding at December 31, 2020	1,386,908		44.14
Granted	629,088		54.92
Vested	(351,310)		49.42
Forfeited	(12,880)		57.48
Outstanding at March 31, 2021	1,651,806	$	47.02

For the three months ended March 31, 2021 and 2020, $6,275 and $4,139 of expense was recognized related to restricted stock awards, excluding performance-based restricted stock awards described below, respectively. As of March 31, 2021, there was unrecognized compensation expense of $65,755 related to non-vested restricted stock awards, excluding performance-based restricted stock awards described below, under the 2016 Plan, which is expected to be recognized over a weighted average period of 3.1 years.

Performance-Based Stock Award

On May 4, 2020, pursuant to the 2016 Plan, the Board approved grants totaling 10,686 shares of restricted stock to an employee. The grants vest subject to certain performance conditions being achieved during the two-year period ending March 2, 2022. The awards have a grant-date fair value of $56.14 per share based on the Company’s closing stock price on the grant date. Stock-based compensation costs associated with these grants are recognized over the service period based upon the Company’s assessment of the probability that the performance conditions will be achieved. The Company recognized no stock-based compensation expense related to these grants for the three months ended March 31, 2021 as the achievement of the underlying performance conditions was considered unlikely. As of March 31, 2021, there was $600 of unrecognized compensation expense related to these performance-based restricted stock awards.

On October 29, 2020, pursuant to the 2016 Plan, the Board approved grants totaling 26,400 shares of restricted stock to certain employees. The grants vest subject to the achievement of certain milestones. The awards have a grant-date fair value of $35.95 per share based on the Company’s closing stock price on the grant date. Stock-based compensation costs associated with these grants are recognized over the service period based upon the Company’s assessment of the probability that the performance conditions will be achieved. The Company recognized $214 of stock-based compensation expense related to these grants for the three months ended March 31, 2021. As of March 31, 2021, there was $583 of unrecognized compensation expense related to these performance-based restricted stock awards.

Other Stock Awards

During the first quarter of 2021, the Board approved the grant of stock awards to certain non-employee directors and to a consultant pursuant to the 2016 Plan. The awards provided for the issuance of 1,416 shares of the Company’s common stock, which immediately vested on the grant date. These grants had a weighted average grant-date fair value of $40.85 per share. For the three months ended March 31, 2021, the Company recorded $58 of expense related to these stock awards.

During the first quarter of 2020, the Board approved the grant of stock awards to select employees pursuant to the 2016 Plan. The awards provided for the issuance of 9,386 shares of the Company’s common stock, which immediately vested on the grant date. These grants had a weighted average grant-date fair value of $52.29 per share. For the three months ended March 31, 2020, the Company recorded $491 of expense related to these stock awards.

Stock Options

The Company recorded $2,055 and $2,507 of stock-based compensation expense related to employee and non-employee stock options for the three months ended March 31, 2021 and 2020, respectively. The Company records forfeitures as they occur.

The table below sets forth the weighted average assumptions for employee grants during the three months ended March 31, 2021 and 2020:

	Three Months Ended
	March 31,
Valuation assumptions:	2021		2020
Expected volatility	58.57	%	56.10	%
Expected term (years)	5.48		5.25
Risk-free interest rate	0.50	%	1.22	%
Dividend yield	—		—

The weighted average grant date fair value of employee options granted during the three months ended March 31, 2021 and 2020 was $28.26 and $33.78 per share, respectively.

The following table summarizes stock option activity under the 2016 Plan for the three months ended March 31, 2021:

				Weighted
		Weighted		average
		average		remaining	Aggregate
	Number	exercise		contractual	intrinsic
	of shares	price		term	value
Outstanding at December 31, 2020	2,096,556		27.74
Granted	2,500		55.01
Exercised	(224,503)		11.14
Forfeited	(27,846)		39.51
Outstanding at March 31, 2021	1,846,707	$	29.62	6.1	$	37,286
Options vested and expected to vest at March 31, 2021	1,846,707	$	29.62	6.1	$	37,286
Exercisable at March 31, 2021	1,479,329	$	24.29	5.7	$	36,092

The aggregate intrinsic value of stock options is calculated as the difference between the exercise price of the stock options and the Company’s closing stock price or estimated fair value on the last trading day of the fiscal quarter for those stock options that had exercise prices lower than the fair value of the Company's common stock. This amount changes based on the fair market value of the Company’s stock. The total intrinsic value of options exercised during the three months ended March 31, 2021 and 2020 was $7,768 and $4,581, respectively.

As of March 31, 2021, there was $10,833 of total unrecognized compensation cost related to nonvested stock options granted under the 2016 Plan, which is expected to be recognized over a weighted average period of 1.7 years.

Cash received from option exercises for the three months ended March 31, 2021 and 2020 was $2,226 and $1,153, respectively.

The Company recorded total stock-based compensation expense for the three months ended March 31, 2021 and 2020 in the following expense categories of its consolidated statements of operations:

	Three Months Ended
	March 31,
	2021		2020
Cost of revenue - product	$	259	$	182
Cost of revenue - service		1,079		763
Research and development		1,435		1,409
Sales and marketing		1,068		528
General and administrative		4,761		4,255
Total stock-based compensation expense	$	8,602	$	7,137

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Fair Value Measurements

3 Months Ended

Mar. 31, 2021

Fair Value Measurements

Fair Value Measurements

15.     Fair Value Measurements

The Company’s financial instruments consist of accounts receivable, contract assets, accounts payable, contract liabilities, accrued expenses, acquisition-related contingent consideration, acquisition-related notes payable, line of credit, and long-term debt, which includes the Company’s convertible senior subordinated notes and finance leases. The carrying values of accounts receivable, contract assets, accounts payable, contract liabilities, accrued expenses, and acquisition-related notes payable are representative of their fair value due to the relatively short-term nature of those instruments. See below for additional information on the Company’s convertible senior subordinated notes.

In connection with the 2018 acquisition of the Cognify business, additional consideration was payable by the Company based on a multiple of the excess of certain PACE solutions’ 2021 revenues and Adjusted EBITDA over their 2018 revenues and Adjusted EBITDA, as defined in the stock purchase agreement. The Cognify acquisition-related contingent consideration, which was liability-classified, was recorded at the estimated fair value at the acquisition date of October 19, 2018. The Company, with the assistance of a third-party appraiser, utilized a Monte Carlo simulation to derive estimates of the contingent consideration payments as of the acquisition date and at each subsequent reporting period.

The acquisition-related contingent consideration liability represented the estimated fair value of the additional cash and equity consideration payable that was contingent upon the achievement of certain financial and performance milestones. In accordance with ASC 805, Business Combinations, all changes in liability-classified contingent consideration subsequent to the initial acquisition-date measurement were recorded in net income or loss.

The acquisition-related contingent consideration was measured at fair value on a recurring basis and included the use of significant unobservable inputs, hence, these instruments represented Level 3 measurements within the fair value hierarchy. During the third quarter of 2020, pursuant to the terms of the stock purchase agreement, the Company elected to accelerate the payment of the acquisition-related contingent consideration for an aggregate payment amount of $13,413. Due to the accelerated payment of the Cognify acquisition-related contingent consideration, the acquisition-related contingent consideration payment amount was fixed and was no longer classified within the fair value hierarchy. The acquisition-related contingent consideration was partially paid during 2020 by cash payments of $6,394 and the

issuance of 135,434 shares of the Company’s common stock, with a fair value of $6,853. The Company made the final cash payment of $166 in full satisfaction of the remaining acquisition-related contingent consideration liability in January 2021.

During the three months ended March 31, 2020, the Company recorded a $700 charge for the change in the fair value of Cognify acquisition-related contingent consideration primarily due to a decreased discount period to the final measurement date.

The following table presents the financial instruments that are not carried at fair value but require fair value disclosure as of March 31, 2021:

	Face Value		Carrying Value		Fair Value
1.75% Convertible Senior Subordinated Notes due 2026	$	325,000	$	318,316	$	325,133

The fair value of the 2026 Notes at each balance sheet date is determined based on recent quoted market prices for these notes which is a Level 2 measurement. As discussed in Note 12, the 2026 Notes are carried at their aggregate face value of $325,000, less any unamortized debt issuance costs. 

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Commitments and Contingencies

3 Months Ended

Mar. 31, 2021

Commitments and Contingencies

Commitments and Contingencies

16.     Commitments and Contingencies

(a)    Legal Proceedings

The Company is not currently involved in any significant claims or legal actions that, in the opinion of management, are expected to have a material adverse impact on the Company.

(b)    Vendor Purchase Agreements

On March 29, 2019, the Company entered into an Affiliated Pharmacy Agreement and Pharmaceutical Program Supply Agreement (the “Prior Thrifty Drug Agreements”) with Thrifty Drug Stores, Inc. (“Thrifty Drug”). On July 1, 2020, the Company entered into a new Affiliated Pharmacy Agreement and Pharmaceutical Program Supply Agreement with Thrifty Drug (the “Thrifty Drug Agreements”) to replace the Prior Thrifty Drug Agreements, which, among other things, extended the Company’s agreement with Thrifty Drug through September 30, 2023. Pursuant to the terms of the Thrifty Drug Agreements, the Company has agreed to purchase not less than 98% of the Company’s total prescription product requirements from Thrifty Drug. The Company commenced purchasing prescription products under the Prior Thrifty Drug Agreements in May 2019 and has continued to do so under the Thrifty Drug Agreements beginning in July 2020. Both the Prior Thrifty Drug Agreements and the Thrifty Drug Agreements authorize Thrifty Drug to hold a security interest in all of the products purchased by the Company under the respective agreements.

As of March 31, 2021 and December 31, 2020 the Company had $1,285 and $1,985 due to Thrifty Drug as a result of prescription drug purchases.

In December 2019, the Company entered into an updated agreement with its data aggregation partner related to the Company’s pharmacy cost management services. The agreement is effective January 1, 2020 with a three-year term expiring December 31, 2022 and commits the Company to a monthly minimum purchase obligation of $30.

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Segment Reporting

3 Months Ended

Mar. 31, 2021

Segment Reporting

Segment Reporting

17.    Segment Reporting

The Company operates its business through two segments. The Company's chief operating decision maker (“CODM”), the Chief Executive Officer, allocates resources and assesses performance based upon financial information at the reportable segment level. Substantially all revenues are generated and substantially all tangible assets are held in the U.S. The Company classifies its operations into two reportable segments as follows:

CareVention HealthCare primarily provides services to PACE organizations that include medication fulfillment pharmacy services and PACE solutions such as medication safety services, pharmacy benefit management solutions, and health plan management services.

MedWise HealthCare clients include health plans, pharmacies, and non-PACE healthcare providers. Services provided to these clients include medication safety services and software subscription solutions, which identify individuals with high medication-related risk, improve patient communication and engagement, and allow for documentation of clinical interventions. These services optimize medication therapy, improve adherence, and enable precision dosing.

Shared services primarily consist of unallocated corporate sales and marketing expenses and general and administrative expenses associated with the management and administration of the Company’s business objectives.

The CODM uses revenue in accordance with U.S. GAAP and Adjusted EBITDA as the relevant segment performance measures to evaluate the performance of the segments and allocate resources.

Adjusted EBITDA is a segment performance financial measure that offers a useful view of the overall operation of the Company’s businesses and may be different from similarly titled segment performance financial measures used by other companies.

Adjusted EBITDA consists of net loss plus certain other expenses, which includes interest expense, income tax expense or benefit, depreciation and amortization, change in fair value of acquisition-related contingent consideration expense, acquisition-related expense, and stock-based compensation expense. The Company considers acquisition-related expense to include nonrecurring direct transaction and integration costs, severance, and the impact of purchase accounting adjustments related to the fair value of acquired deferred revenue.

Management considers revenue and Adjusted EBITDA to be the appropriate metrics to evaluate and compare the ongoing operating performance of the Company’s segments on a consistent basis across reporting periods as they eliminate the effect of items which are not indicative of each segment's core operating performance.

The following tables present the Company’s segment information:

	CareVention HealthCare		MedWise HealthCare		Consolidated
Revenue:
Three Months Ended March 31, 2021
Product revenue	$	41,842	$	136	$	41,978
Service revenue
PACE solutions		13,919		—		13,919
Medication safety services		—		10,725		10,725
Software subscription and services		—		10,058		10,058
Total service revenue		13,919		20,783		34,702
Total revenue	$	55,761	$	20,919	$	76,680
Three Months Ended March 31, 2020
Product revenue	$	37,087	$	—	$	37,087
Service revenue
PACE solutions		11,571		—		11,571
Medication safety services		—		14,320		14,320
Software subscription and services		—		9,849		9,849
Total service revenue		11,571		24,169		35,740
Total revenue	$	48,658	$	24,169	$	72,827

	CareVention HealthCare		MedWise HealthCare		Shared Services		Consolidated
Adjusted EBITDA (loss):
Three Months Ended March 31, 2021
Adjusted EBITDA (loss)	$	12,910	$	1,864	$	(11,175)	$	3,599
Three Months Ended March 31, 2020
Adjusted EBITDA (loss)	$	11,748	$	2,831	$	(9,772)	$	4,807

The following table presents the Company’s reconciliation of the segments’ total Adjusted EBITDA to net loss as presented in the consolidated statements of operations:

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

Asset information by segment is not a key measure of performance used by the CODM. Accordingly, the Company has not disclosed asset information by segment.

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Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements (Policies)

3 Months Ended

Mar. 31, 2021

Basis of Presentation, Summary of Significant Accounting Policies, and Recent Accounting Pronouncements

Basis of Presentation

Basis of Presentation

The accompanying unaudited consolidated financial statements of the Company have been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (the “SEC”) regarding interim financial reporting. The unaudited interim consolidated financial statements have been prepared on the same basis as the annual audited consolidated financial statements and, in the opinion of management, reflect all adjustments (consisting of normal recurring accruals and adjustments) necessary to present fairly the Company's interim consolidated financial position for the periods indicated. The interim results for the three months ended March 31, 2021 are not necessarily indicative of results to be expected for the year ending December 31, 2021, any other interim periods, or any future year or period. As such, the information included in this quarterly report on Form 10-Q should be read in conjunction with the audited consolidated financial statements and accompanying notes included in the Company’s annual report on Form 10-K filed on February 26, 2021 (“2020 Form 10-K”).

The Company operates its business through two segments, CareVention HealthCare and MedWise HealthCare. See Note 17 for a discussion of the Company’s reportable segments.

Risks Related to the COVID-19 Pandemic

Risks Related to the COVID-19 Pandemic

On January 30, 2020, the World Health Organization (“WHO”) announced a global health emergency caused by a new strain of coronavirus (“COVID-19”), originating in Wuhan, China and the risks to the international community. In March 2020, the WHO classified the COVID-19 outbreak as a pandemic (“COVID-19 pandemic), based on the rapid increase in exposure globally. The full impact of the COVID-19 pandemic continues to evolve as of the date these consolidated financial statements were issued. As such, the full magnitude of the impact that the pandemic will have on the Company’s future results of operations remains uncertain. Management is actively monitoring the global situation and the ramification on the Company’s financial condition, liquidity, operations, suppliers, industry, and workforce. Given the daily evolution of the COVID-19 pandemic and the global responses to curb its spread, the Company is not able to estimate the effects that the COVID-19 pandemic may have on the Company’s results of operations, financial condition, or liquidity for 2021. However, the Company is dependent on its workforce to sell and deliver its products and services. Social distancing and shelter-in-place directives could impact the Company’s ability to deploy its workforce effectively. These same developments may affect the operations of the Company’s suppliers and customers, as their own workforces and operations are disrupted by this virus.

As a result of the ongoing COVID-19 pandemic, the Company has experienced challenges with revenue growth. During 2020, the pandemic had delayed the closing of contracts across both the Company’s CareVention HealthCare and MedWise HealthCare segments and, in some cases, shifted project priorities and timelines, which management believed resulted in fewer business wins during 2020 and reduced future revenue. Overall census growth for Programs of All-Inclusive Care for the Elderly (“PACE”) had remained below historical levels during 2020 and into the first quarter of 2021, which has affected the Company’s CareVention HealthCare segment growth. During 2020, the Company’s MedWise HealthCare segment had experienced delays in the timing of implementation and closing of new business and a negative impact from COVID-19 on medication adherence initiatives. The Company does not yet know the full extent of potential delays or impacts on its business, financing or other activities, or on the broader healthcare industry or the global economy as a whole. These effects could have a material impact on the Company’s liquidity, capital resources, operations and business and those of the third parties on which it relies.

Recent Accounting Pronouncements

Recent Accounting Pronouncements

In August 2020, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging – Contracts in Entity’s Own Equity (Subtopic 815-40) (“ASU 2020-06”). ASU 2020-06 provides new guidance to simplify the accounting for convertible instruments by eliminating the cash conversion model. As compared with the current accounting standards, more convertible debt instruments will be reported as a single liability instrument and the interest rate of more convertible debt instruments will be closer to the coupon interest rate. ASU 2020-06 also aligns the consistency of diluted earnings per share calculations for convertible instruments by requiring that (1) an entity use the if-converted method and (2) share settlement be included in the diluted earnings per share calculation for both convertible instruments and equity contracts when those contracts include an option of cash settlement or share settlement. The treasury stock method will no longer be permitted. ASU 2020-06 is effective for financial statements issued for fiscal years beginning after December 15, 2021 and early adoption is permitted.

Under ASC 470-20 Debt with Conversion and Other Options (“ASC 470-20”), the Company separately accounted for the liability and equity components of its 1.75% convertible senior subordinated notes (the “2026 Notes”), which may be settled entirely or partly in cash upon conversion. The equity component was required to be included in the additional paid-in capital section of stockholders’ equity on the Company’s consolidated balance sheet, and the value of the equity component was treated as original issue discount for purposes of accounting for the debt component of the 2026 Notes. As a result, the Company was required to record a greater amount of non-cash interest expense in previous periods presented related to the amortization of the discounted carrying value of the 2026 Notes to their face amount over the term of the 2026 Notes. Because the Company intends to settle the 2026 Notes entirely or partly in cash, the Company had used the treasury stock method when calculating their potential dilutive effect, if any.

ASU 2020-06 allows adoption through either a modified retrospective method or fully retrospective method of transition. The Company early adopted ASU 2020-06 effective January 1, 2021 using the modified retrospective method. In applying the modified retrospective transition method, the cumulative effect of the accounting change is recognized as an adjustment to the opening balance of retained earnings at the date of adoption. Upon adoption, the Company recorded a $74,850 decrease to additional paid-in capital, a $78,707 increase to the carrying value of its convertible notes, a $2,465 decrease to the net deferred tax liability, and a $1,392 increase in accumulated deficit. See Note 12 for further details on the 2026 Notes.

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Revenue (Tables)

3 Months Ended

Mar. 31, 2021

Revenue

Schedule of disaggregation of revenue

	Three Months Ended
	March 31,
		2021		2020
CareVention HealthCare:
PACE product revenue	$	41,842	$	37,087
PACE solutions		13,919		11,571
	$	55,761	$	48,658
MedWise HealthCare:
Product revenue	$	136	$	—
Medication safety services		10,725		14,320
Software subscription and services		10,058		9,849
	$	20,919	$	24,169
Total revenue	$	76,680	$	72,827

Schedule of contract assets and contract liabilities from contracts with customers

	March 31,		December 31,
	2021		2020
Contract assets	$	8,948	$	7,601
Contract liabilities		5,287		3,876

Schedule of significant changes in the contract assets and the contract liabilities balances

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

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Net Loss per Share (Tables)

3 Months Ended

Mar. 31, 2021

Net Loss per Share

Schedule of calculation of basic and diluted net (loss) income per share

	Three Months Ended
	March 31,
	2021		2020
Numerator (basic and diluted):
Net loss	$	(19,492)	$	(14,437)
Denominator (basic and diluted):
Weighted average shares of common stock outstanding, basic and diluted		23,010,531		21,374,897
Net loss per share, basic and diluted	$	(0.85)	$	(0.68)

Schedule of shares excluded from the calculation of diluted net loss per share attributable to common stockholders

	March 31,
	2021	2020
Stock options to purchase common stock	1,846,707	2,627,493
Unvested restricted stock	1,651,806	1,314,635
Common stock warrants	4,646,393	4,646,393
Conversion of convertible senior subordinated notes	4,646,393	—
Contingently issuable shares	—	63,320
	12,791,299	8,651,841

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Acquisitions (Tables)

3 Months Ended

Mar. 31, 2021

Acquisitions

Schedule of proforma results

	Three Months Ended
	March 31,
	2020
Revenue	$	75,671
Net loss		(14,206)

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Other Current Assets (Tables)

3 Months Ended

Mar. 31, 2021

Other Current Assets

Schedule of Other Current Assets

	March 31, 2021		December 31, 2020
Contract assets	$	8,948	$	7,601
Non-trade receivables		1,421		647
Other		1,603		1,504
Total other current assets	$	11,972	$	9,752

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Software Development Costs (Tables)

3 Months Ended

Mar. 31, 2021

Software Development Costs

Schedule of capitalized software costs

	March 31, 2021		December 31, 2020
Software development costs	$	54,414	$	48,548
Less: accumulated amortization		(23,669)		(20,666)
Software development costs, net	$	30,745	$	27,882
Capitalized software development costs included above not yet subject to amortization	$	5,823	$	4,382

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Goodwill and Intangible Assets (Tables)

3 Months Ended

Mar. 31, 2021

Goodwill and Intangible Assets

Schedule of goodwill

		CareVention HealthCare		MedWise HealthCare		Total
Balance at January 1, 2021	$	115,350	$	55,512	$	170,862
Adjustments to goodwill related to prior year acquisition		(27)		—		(27)
Balance at March 31, 2021	$	115,323	$	55,512	$	170,835

Schedule of intangible assets

	Weighted Average
	Amortization Period			Accumulated		Intangible
	(in years)	Gross Value		Amortization		Assets, net
March 31, 2021
Trade names	3.6	$	11,955	$	(8,844)	$	3,111
Client relationships	12.2		152,654		(35,591)		117,063
Non-competition agreements	5.0		6,892		(4,321)		2,571
Developed technology	8.0		67,369		(27,054)		40,315
Patient database	5.0		21,700		(9,042)		12,658
Domain name	10.0		59		(22)		37
Total intangible assets		$	260,629	$	(84,874)	$	175,755

	Weighted Average
	Amortization Period			Accumulated		Intangible
	(in years)	Gross Value		Amortization		Assets, net
December 31, 2020
Trade names	3.7	$	11,955	$	(8,286)	$	3,669
Client relationships	12.2		152,654		(32,437)		120,217
Non-competition agreements	5.0		6,892		(3,976)		2,916
Developed technology	8.0		67,369		(24,858)		42,511
Patient database	5.0		21,700		(7,957)		13,743
Domain name	10.0		59		(21)		38
Total intangible assets		$	260,629	$	(77,535)	$	183,094

Schedule of estimated amortization expense

Years Ending December 31,
2021 (April 1 - December 31)	$	21,105
2022		27,089
2023		25,804
2024		18,521
2025		14,038
2026		12,830
Thereafter		56,368
Total estimated amortization expense	$	175,755

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Accrued Expenses and Other Liabilities (Tables)

3 Months Ended

Mar. 31, 2021

Accrued Expenses and Other Liabilities

Schedule of accrued expenses and other liabilities

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

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Lines of Credit and Long-Term Debt (Tables)

3 Months Ended

Mar. 31, 2021

Lines of Credit and Long-Term Debt

Schedule of long-term debt obligations

	March 31, 2021		December 31, 2020
Convertible senior subordinated notes	$	325,000	$	325,000
Unamortized discount, including debt issuance costs, on convertible senior subordinated notes		(6,684)		(85,715)
Convertible senior subordinated notes, net		318,316		239,285
Finance leases		1		4
Total long-term debt and finance leases, net		318,317		239,289
Less current portion of finance leases		(1)		(4)
Total long-term debt, net	$	318,316	$	239,285

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Stock-Based Compensation (Tables)

3 Months Ended

Mar. 31, 2021

Stock-Based Compensation

Summary of restricted stock award activity

		Weighted
		average
	Number	grant-date
	of shares	fair value
Outstanding at December 31, 2020	1,386,908		44.14
Granted	629,088		54.92
Vested	(351,310)		49.42
Forfeited	(12,880)		57.48
Outstanding at March 31, 2021	1,651,806	$	47.02

Schedule of weighted average assumptions for employee grants

	Three Months Ended
	March 31,
Valuation assumptions:	2021		2020
Expected volatility	58.57	%	56.10	%
Expected term (years)	5.48		5.25
Risk-free interest rate	0.50	%	1.22	%
Dividend yield	—		—

Summary of stock option activity

				Weighted
		Weighted		average
		average		remaining	Aggregate
	Number	exercise		contractual	intrinsic
	of shares	price		term	value
Outstanding at December 31, 2020	2,096,556		27.74
Granted	2,500		55.01
Exercised	(224,503)		11.14
Forfeited	(27,846)		39.51
Outstanding at March 31, 2021	1,846,707	$	29.62	6.1	$	37,286
Options vested and expected to vest at March 31, 2021	1,846,707	$	29.62	6.1	$	37,286
Exercisable at March 31, 2021	1,479,329	$	24.29	5.7	$	36,092

Schedule of recorded stock-based compensation expense related to stock options

	Three Months Ended
	March 31,
	2021		2020
Cost of revenue - product	$	259	$	182
Cost of revenue - service		1,079		763
Research and development		1,435		1,409
Sales and marketing		1,068		528
General and administrative		4,761		4,255
Total stock-based compensation expense	$	8,602	$	7,137

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Fair Value Measurements (Tables)

3 Months Ended

Mar. 31, 2021

Fair Value Measurements

Schedule of carrying value and fair value of financial instruments

	Face Value		Carrying Value		Fair Value
1.75% Convertible Senior Subordinated Notes due 2026	$	325,000	$	318,316	$	325,133

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Segment Reporting (Tables)

3 Months Ended

Mar. 31, 2021

Segment Reporting

Schedule of reportable operating segment information

	CareVention HealthCare		MedWise HealthCare		Consolidated
Revenue:
Three Months Ended March 31, 2021
Product revenue	$	41,842	$	136	$	41,978
Service revenue
PACE solutions		13,919		—		13,919
Medication safety services		—		10,725		10,725
Software subscription and services		—		10,058		10,058
Total service revenue		13,919		20,783		34,702
Total revenue	$	55,761	$	20,919	$	76,680
Three Months Ended March 31, 2020
Product revenue	$	37,087	$	—	$	37,087
Service revenue
PACE solutions		11,571		—		11,571
Medication safety services		—		14,320		14,320
Software subscription and services		—		9,849		9,849
Total service revenue		11,571		24,169		35,740
Total revenue	$	48,658	$	24,169	$	72,827

	CareVention HealthCare		MedWise HealthCare		Shared Services		Consolidated
Adjusted EBITDA (loss):
Three Months Ended March 31, 2021
Adjusted EBITDA (loss)	$	12,910	$	1,864	$	(11,175)	$	3,599
Three Months Ended March 31, 2020
Adjusted EBITDA (loss)	$	11,748	$	2,831	$	(9,772)	$	4,807

Schedules of reconciliation of net loss to Adjusted EBITDA

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Lines of Credit and Long-Term Debt - Lines of Credit (Details) - USD ($) $ in Thousands		3 Months Ended
	Dec. 18, 2020	Mar. 31, 2021	Mar. 31, 2020	Dec. 31, 2020	Sep. 06, 2017
Lines of Credit
Amortization of deferred financing costs to interest expense		$ 133	$ 100
Deferred financing costs, net		1,005		$ 1,156
2020 Credit Facility and 2015 Line of Credit
Lines of Credit
Interest expense		261	0
Aggregate borrowings outstanding during the period			$ 0
2015 Line of Credit
Lines of Credit
Maximum borrowing capacity					$ 60,000
Sublimit of loan					$ 1,000
Letter of credit outstanding		100
Interest rate (as a percent)			5.58%
2020 Credit Facility
Lines of Credit
Maximum borrowing capacity	$ 120,000
Sublimit of loan	1,000
Amount available to be maintained for draw	$ 10,000,000
Trailing period	12 months
Commitment fee at closing (as a percent)	0.50%
Commitment fee payable on each anniversary (as a percent)	0.25%
Aggregate borrowings outstanding		17,500
Amounts available for borrowings		$ 102,400
Interest rate (as a percent)		3.36%
Effective rate, unused line fee (as a percent)		0.45%
Deferred financing costs, gross		$ 1,176
2020 Credit Facility | Maximum
Lines of Credit
Leverage ratio	3.00
2020 Credit Facility | LIBOR
Lines of Credit
Spread on variable rate (as a percent)	3.25%

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

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Lines of Credit and Long-Term Debt - Convertible Note Hedge and Warrant Transactions (Details) - USD ($) $ / shares in Units, $ in Thousands		3 Months Ended
	Feb. 12, 2019	Mar. 31, 2021
Warrants and options indexed to Company's stock
Warrants exercised		0
Option indexed to own shares, convertible senior subordinated notes
Warrants and options indexed to Company's stock
Options indexed to Company's stock (in shares)	4,646,393
Price of options indexed to Company's stock (in dollars per share)	$ 105.58
Proceeds from sale of warrants	$ 65,910
Common stock warrants/Convertible note warrants
Warrants and options indexed to Company's stock
Option to purchase	4,646,393
Exercise price (in dollars per share)	$ 69.95
Premiums paid for the note hedges	$ 101,660

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

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

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

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

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Stock-Based Compensation - Performance Based Equity Awards (Details) - USD ($) $ / shares in Units, $ in Thousands			3 Months Ended
	Oct. 29, 2020	May 04, 2020	Mar. 31, 2021	Mar. 31, 2020
Stock-Based Compensation
Stock- based stock awards expense			$ 8,602	$ 7,137
Performance-Based Stock Awards | Award Date, May 4, 2020
Stock-Based Compensation
Granted (in shares)		10,686
Vesting period		2 years
Weighted average grant-date fair value (in dollars per share)		$ 56.14
Stock- based stock awards expense			0
Unrecognized compensation expense (in dollars)			600
Performance-Based Stock Awards | Award Date, October 29, 2020
Stock-Based Compensation
Granted (in shares)	26,400
Weighted average grant-date fair value (in dollars per share)	$ 35.95
Stock- based stock awards expense			214
Unrecognized compensation expense (in dollars)			$ 583

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

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

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

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

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

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

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

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

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

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