Longer-term, the hope is that CMAX identifies more high-performing providers and transitions them to owned clinic/hybrid models. The focus on patient density is a key positive for newbuild economics, as it reduces the initial cash burn and allows for better complementarity between new clinics and the company's overall MSO growth. With the acquisition of Steward assets, CMAX will not only gain entry into new markets but also the opportunity to reprioritize clinic builds around MSO density, focusing on overlap with strategic partners like Elevance Health ( ELV) and privately-owned Related. Longer-Term Growth Ambitions Boosted by New Credit Line This could entail considerable equity dilution ahead for CMAX shareholders, but as the dilution is tied to the material improvements in the EBITDA profile of CMAX, shareholders likely come out with meaningful accretion anyway. 20% equity stake if the company can successfully convert 100k members to at-risk VBC arrangements post-acquisition and sustain an 85% medical expense ratio for consecutive quarters. Worth noting, however, that Steward shareholders stand to gain an additional c. Similarly, the expected revenue growth seems realistic as they are mainly driven by the conversion of MA partial risk and MA Fee-for-Service contracts into MA full-risk contracts. Importantly, the Steward EBITDA projections also reflect additional operating expenses to professionalize membership and, therefore, will fully accrue to CMAX. As such, using the base case medium-term projection would imply an undemanding c. From $10-13 million in fiscal 2022 and $15-20 million in fiscal 2023, the acquired assets are guided to generate an impressive $100-115 million of EBITDA by fiscal 2025 (implying a 100+% CAGR). But Steward's EBITDA projections are guided to ramp up further. $135 million consideration amounts to a 7-9x EV/EBITDA multiple. Relative to the projected fiscal 2023 EBITDA of $15-20 million, the initial c. As things stand, the transaction is expected to close in H2 '22. While the incremental revenue contribution stands at only $35-40 million/year under the current shared-savings accounting, the targeted conversion of 100+k lives to MA capitation would produce a considerably larger $1.6-1.7 billion revenue opportunity by fiscal 2025. At close, this would imply a total of over 200k beneficiaries and over 2k providers across ten states for CMAX, with new states reached including Arizona, Pennsylvania, and Texas, among others. The patient breakdown is as follows - 112k from MSSP ("Multipurpose Senior Services Program"), 50k from MA ("Medicare Advantage"), and 9k from DCE ("Direct Contracting"). Post-acquisition, CMAX will be the exclusive value-based MSO for Steward's Medicare Network, comprising 170k VBC beneficiaries and 1.8k providers to Steward's healthcare programs. The earnout would, however, be dependent on the conversion of 100k Medicare lives to value-based risk arrangements while maintaining an 85% MLR ratio for consecutive quarters. Steward shareholders also have the option of an earnout of additional CMAX Class A shares - a scenario that could see its current shareholders owning a sizeable c. 21% of Class A shares outstanding pre-deal), which implies a c. $25 million cash consideration and 23.5 million Class A shares (equivalent to c. As part of the deal, CMAX will provide a c. A Closer Look at the Steward Health Care System AcquisitionĬMAX recently announced the acquisition of the Medicare VBC business of Steward Health Care System. With growth funding needs also accounted for with a new credit line and CMAX's industry-leading MLR ("medical loss ratio") intact, I see plenty of upside to the shares at the current c. Strategically, acquiring Steward also widens CMAX's MSO ("Managed Services Organization") membership, significantly accelerating the path to profitability via operating leverage as the company expands its revenue base. $135 million purchase price and steady EBITDA generation ($110-115 million projected by fiscal 2025), as well as the aligned incentives (performance-linked earnout), make this a compelling deal for shareholders. CareMax ( NASDAQ: CMAX), a value-based care provider to seniors, looks set to further capitalize on secular tailwinds in the Medicare Advantage global capitation primary care space with the addition of the Medicare VBC ("value-based care") business of Steward Health Care System.
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