Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
Unless otherwise indicated or the context otherwise requires, references in this report (this “Quarterly Report”) to “we,” “our,” “us,” “UpHealth” or the “Company” and other similar terms refer to UpHealth, Inc. and its consolidated subsidiaries. The following discussion and analysis of our financial condition and results of operations should be read in conjunction with our unaudited condensed consolidated financial statements and the notes thereto contained elsewhere in this Quarterly Report. Certain information contained in the discussion and analysis set forth below includes forward-looking statements that involve risks and uncertainties.
Special Note Regarding Forward-Looking Statements
This Quarterly Report includes “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Exchange Act that are not historical facts, and involve risks and uncertainties that could cause actual results to differ materially from those expected and projected. All statements, other than statements of historical fact included in this Quarterly Report including, without limitation, statements in this “Management’s Discussion and Analysis of Financial Condition and Results of Operations” regarding the company’s financial position, business strategy and the plans and objectives of management for future operations, are forward-looking statements. Words such as “expect,” “believe,” “anticipate,” “intend,” “estimate,” “seek,” “may,” “might,” “plan,” “possible,” “potential,” “should, “would” and similar words and expressions are intended to identify such forward-looking statements. Such forward-looking statements relate to future events or future performance, but reflect management’s current beliefs, based on information currently available. A number of factors could cause actual events, performance or results to differ materially from the events, performance and results discussed in the forward-looking statements. For information identifying important factors that could cause actual results to differ materially from those anticipated in the forward-looking statements, please refer to the “Risk Factors” section in Part II, Item 1A. of this Quarterly Report, the “Risk Factors” section in our Annual Report on Form 10-K for the fiscal year ended December 31, 2022 filed with the SEC on March 31, 2023 (our “Annual Report”) and in any more recent filings with the SEC. The Company’s securities filings can be accessed on the EDGAR section of the SEC’s website at www.sec.gov. Except as expressly required by applicable securities law, the company disclaims any intention or obligation to update or revise any forward-looking statements whether as a result of new information, future events or otherwise.
UpHealth, Inc. Business Overview
In 2022, after undergoing a process launched in the second half of 2021 designed to help us determine how to tie the various components of the businesses brought together between November 2020 and June 2021, we turned to transforming our business strategy to create a company that can profitably fulfill our mission as an integrated whole. By considering our previous financial performance, we determined that it was necessary for us to pivot and to focus on fewer investments for growth. As a result, we sought to establish a company that will deliver high-quality, predictable revenue streams, conserve cash and readjust our operating expenses, and improve operational excellence. This led us to make the following decisions with regard to our reporting segments:
•As a result of the previously disclosed ongoing control issues and legal proceedings with Glocal, we deconsolidated Glocal in July 2022. These issues and disputes are described in our Current Reports on Form 8-K filed with the SEC on October 3, 2022 and November 14, 2022, and in our Quarterly Report on Form 10-Q for the fiscal quarter ended September 30, 2022 filed with the SEC on December 29, 2022, as well as in Part II, Item 1, Legal Proceedings, of this Quarterly Report. Accordingly, the financial results of Glocal in the three and six months ended June 30, 2022 are included in the discussion of our financial results for the Virtual Care Infrastructure segment, but are excluded in the discussion in the three and six months ended June 30, 2023. As of June 30, 2023, the operations of Glocal remain deconsolidated from the rest of UpHealth as we continue to pursue all legal recourse against the founders of that business.
•On February 26, 2023, UpHealth Holdings agreed to sell 100% of the outstanding capital stock of Innovations Group to Belmar MidCo, Inc., a Delaware corporation (“Belmar”) and a wholly owned subsidiary of Belmar Holdings, Inc., a Delaware corporation, a portfolio company of Webster Capital IV, L.P., a Delaware limited partnership, pursuant to a stock purchase agreement, dated February 26, 2023, by and among UpHealth, UpHealth Holdings, Innovations Group, and Belmar. The sale closed on May 11, 2023 for gross proceeds of $56.0 million, subject to working capital, closing debt, and other adjustments. Accordingly, the financial results of Innovations Group for the period from April 1, 2023 through May 10, 2023, the period from January 1, 2023 through May 10, 2023, and the three and six months ended June 30, 2022 are included in the discussion of our financial results for the Services segment.
•At the start of 2023, we made the decision to integrate BHS into our legacy TTC operations and wind-down our provider practice in Missouri, which was substantially completed in the three months ended June 30, 2023. The financial results of BHS in the three and six months ended June 30, 2023 and 2022 are included in the discussion of our financial results for the Services segment.
Following all of these changes, our reporting structure remains the same. We have three business segments: (a) Integrated Care Management, which uses the SyntraNetTM technology platform; (b) Virtual Care Infrastructure, which consists of our U.S. Telehealth business; and (c) Services, which consists of our Behavioral business.
Going forward, we will offer patient-centric digital health technologies and technology-enabled services to manage health and behavioral health across our strategic businesses. We are focused on integrating the value streams represented across these three product and service lines, and focusing on building more data and analytics capabilities to complement our technology. Additionally, we are working on a partnership to incorporate artificial intelligence (“AI”) into our core product offerings.
Virtual Care Infrastructure Segment
Overview
The Virtual Care Infrastructure segment consists of the U.S. Telehealth business, a technology and technology-enabled services business that connects healthcare systems with platforms, analytics, and services that make clinical and administrative processes simpler and more efficient. Hospital systems, physicians, and patients depend on us to help them improve performance, reduce costs and advance care quality through technology-enabled services built directly into clinical workflows.
The U.S. Telehealth business is a provider of unified telehealth solutions and digital health tools aimed at increasing access to healthcare and resolving health disparities across the care continuum. Through our MarttiTM platform, which serves as the digital front door to in-hospital care, the U.S. Telehealth business provides digital health infrastructure enabling its partners to implement unique, private-label telehealth strategies customized to their specific needs and markets, with language access built-in. The MarttiTM platform has one of the largest installed user bases in the nation, performing more than 300,000 encounters per month on over 40,000 video endpoints at over 2,800 healthcare venues in over 250 languages across the United States.
In 2022, the U.S. Telehealth business expanded its operations by leveraging its existing platform to include other telemedicine use cases such as telestroke, teleneurology, and telepsychiatry. We also launched a home health virtual visit platform enabling healthcare system partners to see their patients remotely on any device, at any time, anywhere the patient may be, and in any language they may speak.
The U.S. Telehealth’s products and services are sold primarily through a direct sales force. The U.S. Telehealth’s products are also supported and distributed through an array of alliances and business partnerships with other technology vendors, who integrate and interface our products with their applications. The U.S. Telehealth's business offers an expanding suite of telehealth use cases, which are delivered under multi-year contracts that include fixed minimums with upside attributable to usage-based fees. Our client base includes hospitals and health systems, federally qualified healthcare clinics (“FQHCs”), urgent care centers, stand-alone clinics, and medical practices.
As discussed in Note 1, Organization and Business, in the Notes to Condensed Consolidated Financial Statements of this Quarterly Report, we deconsolidated Glocal, which comprised the International Telehealth business, in the three months ended September 30, 2022. Accordingly, the financial results of Glocal in the three and six months ended June 30, 2022 are included in our unaudited condensed consolidated financial statements, and the financial position of Glocal as of June 30, 2023 and the financial results of Glocal in the three and six months then ended are not included in our unaudited condensed consolidated financial statements.
Components of Results of Operations
Revenues
Services. Services revenues from the U.S. Telehealth business are generated primarily from the sale of subscription-based fixed monthly minute and variable rate per unit of service medical language interpretation services. Ancillary revenues are also generated from the rental of Martti™ devices and from the provision of information technology services that include connectivity and ongoing support of the Martti™ software platform. Generally, medical language interpretation and information technology services are invoiced monthly. Fixed monthly minute medical language interpretation subscription and information technology services fees are invoiced in advance in the period preceding the service. Variable rate per unit medical language interpretation and information technology services fees (including overage fees related to minutes used by the customer in excess of the fixed monthly minute subscription) are invoiced monthly in arrears. Martti™ device leases are invoiced monthly in advance in the period preceding the usage. Invoiced amounts are typically due within 30 days of the invoice date.
In the three and six months ended June 30, 2022, services revenues also included revenues from the International Telehealth business, which were generated primarily from operating hospitals and clinics, including pharmacy and medicine sales, and transaction fees per telemedicine consultation.
Products. Products revenues consist of the sale of Martti™ devices to its customers. Sale of Martti™ devices are generally invoiced at contract execution (50%) and upon the delivery of the devices to the customer (50%). Invoiced amounts are typically due within 30 days of the invoice date.
In the three and six months ended June 30, 2022, products revenues also included revenues from the International Telehealth business, which were generated primarily from the sale of HelloLyf CX digital dispensaries and the construction of HelloLyf HX digital hospitals.
Cost of Revenues
Cost of revenues primarily consist of costs related to supporting and hosting the product offerings and delivering services, and include the cost of maintaining data centers, customer support team, and professional services staff, in addition to third-party service provider costs such as data center and networking expenses, amortization of capitalized software development costs, the cost of purchased equipment inventory sold to customers, and an allocation of facilities, information technology, and depreciation costs.
In the three and six months ended June 30, 2022, cost of revenues also included cost of revenues from the International Telehealth business, which primarily consisted of costs of building and operating hospitals, including costs for the purchase of medicines, professional/doctor fees, the cost to build HelloLyf CX digital dispensaries and HelloLyf HX digital hospitals, and an allocation of information technology and depreciation costs.
Operating Expenses
Sales and Marketing (S&M) Expenses. S&M expenses consist of compensation and benefits, costs related to advertising, marketing programs, and events, and an allocation of facilities, information technology, and depreciation costs.
General and Administrative (G&A) Expenses. G&A expenses consist of compensation and benefits expense, and other administrative costs, related to its executive, finance, human resources, legal, facilities, and information technology teams, net of allocations to cost of revenues and S&M.
Depreciation and Amortization Expenses. Depreciation expense relates to the depreciation of computer equipment, purchased software, furniture and fixtures, and office equipment, net of amounts allocated to cost of revenues. Amortization expense relates to the amortization of intangible assets from the acquisitions of the Virtual Care Infrastructure businesses.
Services Segment
Overview
The Services segment consists of the Behavioral business, which provides behavioral health services in the United States and is critically important to managing whole person care and its associated costs. The Services segment also included the Pharmacy business until we sold Innovations Group, a compounding pharmacy business, on May 11, 2023.
Our Behavioral business is powered by our UpHealth BehavioralTM platform, which provides evidence-based and tech-enabled behavioral health and substance abuse services via onsite care delivery and telehealth. Our UpHealth BehavioralTM platform is working to deliver an increasing volume of services, including telehealth services, to existing customers, as well as clients belonging to the Integrated Care Management and Virtual Care Infrastructure platforms. In the three months ended June 30, 2023, we substantially completed the wind-down of a company within our Behavioral business in our Services segment.
UpHealth BehavioralTM provides comprehensive patient-centered care, addressing the physical, mental, and social well-being of our clients. We engage people in the most appropriate care settings, including clinical sites, out-patient and virtual. UpHealth BehavioralTM delivers behavioral health services; helps patients and providers navigate and address complex, chronic behavioral health needs; offers post-acute care planning services; and serves consumers and care providers through advanced, on-demand digital health technologies, such as telehealth. UpHealth BehavioralTM works directly with consumers, care delivery systems, providers, payors, and public-sector entities to provide high quality, accessible and equitable care with improved health outcomes and reduced total cost of care.
UpHealth BehavioralTM sells its products primarily through its direct sales force, and strategic collaborations in two key areas: payors including health plans, third-party administrators; and public entities including the U.S. Departments of Veterans Affairs and other federal, state, and local health care agencies.
The Pharmacy business consisted of Innovations Group and was powered by MedQuest Pharmacy, a full-service retail and compounding pharmacy licensed in all 50 U.S. states and the District of Columbia that dispensed prescribed medications shipped directly to patients. It was capable of serving as a retail or national fulfillment center. Other services and products were also available, such as lab and testing services, nutritional supplements, and education and training for medical practitioners. On February 26, 2023, UpHealth Holdings agreed to sell 100% of the outstanding capital stock of Innovations Group. The sale closed on May 11, 2023. Accordingly, the financial results of Innovations Group for the period from April 1, 2023 through May 10, 2023, the period from January 1, 2023 through May 10, 2023, and the three and six months ended June 30, 2022 are included in the discussion of our financial results for the Services segment.
Components of Results of Operations
Revenues
Services. Services revenues from the Behavioral business are generated primarily through services provided to clients in both inpatient and outpatient treatment settings. Third-party payors are billed weekly for the services provided in the prior week. Client-related revenues, such as inpatient and outpatient programs, are generally recognized over time as the performance obligation is satisfied at the estimated net realizable value amount from clients, third-party payors, and others for services provided. The majority of payments are received from commercial payors at out-of-network rates. Client service revenues are recorded at established billing rates, less adjustments to estimate net realizable value. Provisions for estimated third party payor reimbursements are provided in the period related services are rendered and adjusted in future periods when actual reimbursements are received. A significant or sustained decrease in reimbursement rates could have a material adverse effect on operating results.
Diagnostic laboratory testing service revenues are recognized over time as the performance obligation is satisfied at the estimated net realizable value amount from clients, third-party payors, and others for services provided. Diagnostic laboratory service revenues are recorded at established billing rates, less adjustments to estimate net realizable value. Provisions for estimated third party payor reimbursements are provided in the period related services are rendered and adjusted in future periods when actual reimbursements are received.
Services revenues are also generated by providing psychiatric and mental health services and billing services. Although the underlying tasks will vary by service and by patient, medical professionals perform inquiries, obtain vital statistics, perform certain lab tests, administer therapy, and provide any additional goods and services as necessary depending on the information obtained. In addition, services revenues are generated from CME educational courses.
Products. For the period from April 1, 2023 through May 10, 2023, the period from January 1, 2023 through May 10, 2023, and the three and six months ended June 30, 2022, products revenues through our Pharmacy business were generated primarily from the sale of prescription medications directly to patients, as well as through the sale of supplemental products to providers. The majority of the customer revenues were billed and collected before the medications and products are shipped from the facility. The Pharmacy business generated approximately 60% of its revenue from sales of compounded medications and approximately 40% of its revenue from sales of manufactured medications and supplements. Products revenues are also generated by providing retail pharmacy services in the Behavioral business.
Cost of Revenues
Services. Cost of revenues consist primarily of provider compensation expenses, the cost of pharmaceutical medications sold to patients, the cost of operating the facilities, professional/medical fees, and an allocation of facilities, information technology, and depreciation costs. Provider compensation expenses include consulting payments to healthcare providers, including medical doctors in psychiatry, psychologists, nurse practitioners, and clinical social workers, based on an incentive-based compensation plan with provider agreements that compensate the providers based upon a percentage of revenue generated and ultimately collected for services provided. Pharmaceutical medications are primarily purchased through a large industry distributor with many suppliers, but also purchases some directly from other suppliers.
Products. For the period from April 1, 2023 through May 10, 2023, the period from January 1, 2023 through May 10, 2023, and the three and six months ended June 30, 2022, cost of revenues at the Pharmacy business primarily consisted of costs of raw ingredients and materials to compound various drugs and supplements, the cost of manufactured product purchased directly from the distributors for resale, the cost of fulfillment and shipping services and an allocation of facilities, information technology, and depreciation costs. The Pharmacy business purchased these items through a large industry distributor with many suppliers and also sources products and supplies directly with manufacturers. The Pharmacy business was also able to leverage the size of its operations to purchase larger quantities of certain ingredients and materials at lower prices.
Operating Expenses
Sales and Marketing Expenses. S&M expenses consist of cost related to compensation and benefits, advertising and marketing programs, events, fees paid to third party marketing firms, and an allocation of facilities, information technology, and depreciation cost.
General and Administrative Expenses. G&A expenses include compensation and benefits expense, and other administrative costs, related to its executive, finance, human resources, legal, facilities, and information technology teams, net of allocations to cost of revenues and S&M expenses.
Depreciation and Amortization Expenses. Depreciation expense relates to the depreciation of computer equipment, purchased software, furniture and fixtures, office equipment, and leasehold improvements, net of amounts allocated to cost of revenues. Amortization expense relates to the amortization of intangible assets from the acquisitions of the Services businesses.
Integrated Care Management Segment
Overview
Integrated Care Management is a healthcare technology business that serves organizations that pay for healthcare, including health plans and state, federal and municipal agencies that ensure the people they sponsor receive high-quality care, administered and delivered efficiently and effectively, all while driving health equity so that every individual, family, and community has access to the care they need.
The Integrated Care Management business is powered by the SyntraNetTM technology platform and applications. SyntraNetTM is a configurable integrated health management platform that enables clinical and community-based care teams to share information, coordinate care, manage utilization, and improve health outcomes and costs for individuals and populations – especially individuals with complex medical, behavioral health, and social needs.
SyntraNetTM creates virtual “care communities” – logical networks of organizations, care managers and service providers – that function as an integrated care team to deploy programs to improve health, quality, performance, efficiency, and costs.
Core features of the platform include the ability to:
• Create virtual, cross-sector care communities;
• Integrate and organize information from a wide range of health and social health data sources;
• Gain insight into health, risks, and opportunities with advanced analytics;
• Qualify and enroll groups into programs;
• Coordinate care teams across the continuum of care; and
• Analyze and report on various measures of success.
SyntraNetTM provides health plans and provider groups the ability to manage health with new value-based models of care. Our clients include the largest public health plan in the United States, entities that are part of the nation’s most comprehensive “whole person care” initiatives, and one of the fastest growing value-based pharmacy benefit managers.
Products are sold primarily through a direct sales force, strategic collaborations and external producers in two key areas: payors including health plans and third-party administrators and public entities including state and local health care agencies. Revenues are derived from license fees, recurring subscription fees, and professional services for implementation.
Components of Results of Operations
Revenues
Integrated Care Management derives revenues broadly from the sales of (a) products—with associated license, subscription, and hosting fees and (b) services—largely to implement, configure, and extend the technology, and train and on-board users on the use of the platform and applications.
Licenses and Subscriptions Revenues. License revenues are typically associated with rights granted to customers to deploy the platform to a certain number of care communities of a certain size, usually measured as the total population of patients that can be included within a care community. License revenues are recognized based on the nature of the license provided, either fully on the date license rights are granted to the customer if there are no further performance obligations or ratably over the license term beginning on the effective date of each contract, the date the customer takes possession of the license rights.
Subscription fees are recurring fees charged for access to the platform and applications. Subscription fees are typically pegged to a measure of use, such as population size, number of providers, members enrolled in programs, or number of members managed by applications. Subscription fees can grow as customers subscribe to additional application features or launch additional programs. Revenues from subscription fees are recognized ratably over the subscription term.
Services. The majority of contracts to provide professional services are priced on a time and materials basis, whereby revenues are recognized as the services are rendered. In some cases, professional services contracts are entered into where professional services fees are defined for specific milestones, whereby revenues are recognized upon achievement of the milestones.
Cost of Revenues
Cost of revenues include: costs related to hosting SyntraNetTM in a HIPAA-compliant cloud environment; costs of third-party product licenses embedded with SyntraNetTM; costs of a core professional services team; and an allocation of facilities, information technology, and
depreciation costs. Added compliance requirements for security infrastructure is likely to add some additional costs for hosting services. In addition, costs will increase for third-party licenses that will be added as the scope and footprint of the technology platform expands.
Hosting Infrastructure. Technology and solutions are designed to be agnostic to any particular cloud services provider. Currently, customer environments are hosted through contracts with two cloud service providers.
As the capabilities of cloud service providers continues to grow, and costs become increasingly competitive, we will continue to evaluate offerings in the marketplace to determine the optimum mix of security, reliability, scalability, and performance to meet customer needs. Hosting infrastructure costs are related to the number and size of environments deployed for customers and also on the service level agreements (“SLAs”) negotiated with customers. As the average size of customers continues to grow, hosting infrastructure costs are expected to grow as a percentage of revenue.
Third-Party Product Licenses. SyntraNetTM embeds certain third-party technology components to support some of its technology capabilities. There are multiple vendors for these components, and we are not dependent on any specific vendor.
Professional Services Team. A professional services team works closely with the product team and is best understood as an “A-team” created to lead showcase implementations. The goal is to keep the professional services team small in order to focus it on deploying reference customers and facilitating the on-boarding and coaching of systems integration partners.
Operating Expenses
Sales and Marketing Expenses. S&M expenses include an internal sales and marketing team and contracts with business development consultants to generate and qualify leads, and an allocation of facilities, information technology, and depreciation costs.
Research and Development (“R&D”) Expenses. The core R&D team consists of a small team of very experienced software developers. R&D expenses also includes an allocation of facilities, information technology, and depreciation costs.
General and Administrative Expenses. G&A expenses include compensation and benefits expense, and other administrative costs, related to its executive, finance, human resources, legal, facilities, and information technology teams, net of allocations to cost of revenues, S&M expenses, and R&D expenses.
Depreciation and Amortization Expenses. Depreciation expense relates to the depreciation of computer equipment, purchased software, furniture and fixtures, and office equipment, net of amounts allocated to cost of revenues. Amortization expense relates to the amortization of intangible assets from the acquisition of the Integrated Care Management business.
UpHealth, Inc. Consolidated Results of Operations
Operating Results
As discussed in Note 1, Organization and Business, in the Notes to Condensed Consolidated Financial Statements of this Quarterly Report, we deconsolidated Glocal in the three months ended September 30, 2022. Accordingly, the financial results of Glocal in the three and six months ended June 30, 2022 are included in the discussion of our financial results for the Virtual Care Infrastructure segment in the three and six months ended June 30, 2022, but are excluded in the discussion in the three and six months ended June 30, 2023.
As discussed in Note 3, Significant Transactions, we completed the sale of Innovations Group, which comprised our Pharmacy operations, on May 11, 2023. Accordingly, the financial results of Innovations Group for the period from April 1, 2023 through May 10, 2023, the period from January 1, 2023 through May 10, 2023, and the three and six months ended June 30, 2022 are included in the discussion of our financial results for the Services segment.
In addition, we substantially completed the wind-down of a company within our Behavioral business in our Services segment in the three months ended June 30, 2023.
The following table sets forth our consolidated results of operations:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
(Unaudited, in thousands) | Three Months Ended June 30, | | | | Six Months Ended June 30, | | | | |
| 2023 | | 2022 | | $ Change | | % Change | | 2023 | | 2022 | | $ Change | | % Change |
Revenues: | | | | | | | | | | | | | | | |
Services | $ | 31,087 | | | $ | 28,096 | | | $ | 2,991 | | | 11 | % | | $ | 62,028 | | | $ | 53,782 | | | $ | 8,246 | | | 15 | % |
Licenses and subscriptions | 2,852 | | | 6,812 | | | (3,960) | | | (58) | % | | 4,788 | | | 8,593 | | | (3,805) | | | (44) | % |
Products | 3,884 | | | 8,760 | | | (4,876) | | | (56) | % | | 13,152 | | | 17,265 | | | (4,113) | | | (24) | % |
Total revenues | 37,823 | | | 43,668 | | | (5,845) | | | (13) | % | | 79,968 | | | 79,640 | | | 328 | | | — | % |
Costs of revenues: | | | | | | | | | | | | | | | |
Services | 14,954 | | | 16,232 | | | (1,278) | | | (8) | % | | 28,698 | | | 31,990 | | | (3,292) | | | (10) | % |
License and subscriptions | 403 | | | 217 | | | 186 | | | 86 | % | | 722 | | | 450 | | | 272 | | | 60 | % |
Products | 2,490 | | | 6,296 | | | (3,806) | | | (60) | % | | 7,896 | | | 12,286 | | | (4,390) | | | (36) | % |
Total costs of revenues | 17,847 | | | 22,745 | | | (4,898) | | | (22) | % | | 37,316 | | | 44,726 | | | (7,410) | | | (17) | % |
Gross profit | 19,976 | | | 20,923 | | | (947) | | | (5) | % | | 42,652 | | | 34,914 | | | 7,738 | | | 22 | % |
Operating expenses: | | | | | | | | | | | | | | | |
Sales and marketing | 2,421 | | | 3,539 | | | (1,118) | | | (32) | % | | 7,040 | | | 6,973 | | | 67 | | | 1 | % |
Research and development | 848 | | | 2,011 | | | (1,163) | | | (58) | % | | 2,133 | | | 3,769 | | | (1,636) | | | (43) | % |
General and administrative | 12,765 | | | 12,880 | | | (115) | | | (1) | % | | 23,774 | | | 24,347 | | | (573) | | | (2) | % |
Depreciation and amortization | 1,736 | | | 4,700 | | | (2,964) | | | (63) | % | | 3,347 | | | 9,936 | | | (6,589) | | | (66) | % |
Stock-based compensation | 1,058 | | | 1,088 | | | (30) | | | (3) | % | | 2,047 | | | 2,462 | | | (415) | | | (17) | % |
Impairment of goodwill, intangible assets, and other long-lived assets | 8,246 | | | — | | | 8,246 | | | — | % | | 8,741 | | | 6,249 | | | 2,492 | | | 40 | % |
Acquisition, integration, and transformation costs | 3,644 | | | 6,749 | | | (3,105) | | | (46) | % | | 7,090 | | | 9,133 | | | (2,043) | | | (22) | % |
Total operating expenses | 30,718 | | | 30,967 | | | (249) | | | (1) | % | | 54,172 | | | 62,869 | | | (8,697) | | | (14) | % |
Loss from operations | (10,742) | | | (10,044) | | | (698) | | | 7 | % | | (11,520) | | | (27,955) | | | 16,435 | | | (59) | % |
Other expense: | | | | | | | | | | | | | | | |
Interest expense | (7,136) | | | (6,603) | | | (533) | | | 8 | % | | (13,994) | | | (13,598) | | | (396) | | | 3 | % |
Other income, net, including interest income | 126 | | | 1,950 | | | (1,824) | | | (94) | % | | 127 | | | 6,858 | | | (6,731) | | | (98) | % |
Total other expense | (7,010) | | | (4,653) | | | (2,357) | | | 51 | % | | (13,867) | | | (6,740) | | | (7,127) | | | 106 | % |
Loss before income tax benefit (expense) | (17,752) | | | (14,697) | | | (3,055) | | | 21 | % | | (25,387) | | | (34,695) | | | 9,308 | | | (27) | % |
Income tax benefit (expense) | (867) | | | 2,232 | | | (3,099) | | | (139) | % | | (867) | | | 4,525 | | | (5,392) | | | (119) | % |
Net loss | (18,619) | | | (12,465) | | | (6,154) | | | 49 | % | | (26,254) | | | (30,170) | | | 3,916 | | | (13) | % |
Less: net income (loss) attributable to noncontrolling interests | 508 | | | (27) | | | 535 | | | (1,981) | % | | 956 | | | (287) | | | 1,243 | | | (433) | % |
Net loss attributable to UpHealth, Inc. | $ | (19,127) | | | $ | (12,438) | | | $ | (6,689) | | | 54 | % | | $ | (27,210) | | | $ | (29,883) | | | $ | 2,673 | | | (9) | % |
The following table sets forth our consolidated results of operations as a percentage of total revenue:
| | | | | | | | | | | | | | | | | | | | | | | |
| Three Months Ended June 30, | | Six Months Ended June 30, |
| 2023 | | 2022 | | 2023 | | 2022 |
Revenues: | | | | | | | |
Services | 82 | % | | 64 | % | | 78 | % | | 68 | % |
Licenses and subscriptions | 8 | % | | 16 | % | | 6 | % | | 11 | % |
Products | 10 | % | | 20 | % | | 16 | % | | 22 | % |
Total revenues | 100 | % | | 100 | % | | 100 | % | | 100 | % |
Costs of revenues: | | | | | | | |
Services | 40 | % | | 37 | % | | 36 | % | | 40 | % |
License and subscriptions | 1 | % | | — | % | | 1 | % | | 1 | % |
Products | 7 | % | | 14 | % | | 10 | % | | 15 | % |
Total costs of revenues | 47 | % | | 52 | % | | 47 | % | | 56 | % |
Gross profit | 53 | % | | 48 | % | | 53 | % | | 44 | % |
Operating expenses: | | | | | | | |
Sales and marketing | 6 | % | | 8 | % | | 9 | % | | 9 | % |
Research and development | 2 | % | | 5 | % | | 3 | % | | 5 | % |
General and administrative | 34 | % | | 29 | % | | 30 | % | | 31 | % |
Depreciation and amortization | 5 | % | | 11 | % | | 4 | % | | 12 | % |
Stock-based compensation | 3 | % | | 2 | % | | 3 | % | | 3 | % |
| | | | | | | |
Impairment of goodwill, intangible assets, and other long-lived assets | 22 | % | | — | % | | 11 | % | | 8 | % |
Acquisition, integration, and transformation costs | 10 | % | | 15 | % | | 9 | % | | 11 | % |
Total operating expenses | 81 | % | | 71 | % | | 68 | % | | 79 | % |
Loss from operations | (28) | % | | (23) | % | | (14) | % | | (35) | % |
Other expense: | | | | | | | |
Interest expense | (19) | % | | (15) | % | | (17) | % | | (17) | % |
Other income, net, including interest income | — | % | | 4 | % | | — | % | | 9 | % |
Total other expense | (19) | % | | (11) | % | | (17) | % | | (8) | % |
Loss before income tax benefit (expense) | (47) | % | | (34) | % | | (32) | % | | (44) | % |
Income tax benefit (expense) | (2) | % | | 5 | % | | (1) | % | | 6 | % |
Net loss | (49) | % | | (29) | % | | (33) | % | | (38) | % |
Less: net income (loss) attributable to noncontrolling interests | 1 | % | | — | % | | 1 | % | | — | % |
Net loss attributable to UpHealth, Inc. | (51) | % | | (28) | % | | (34) | % | | (38) | % |
Due to the deconsolidation of Glocal in the third quarter of 2022, as well as the sale of Innovations Group on May 11, 2023, the numbers presented above are not directly comparable between periods.
Three months ended June 30, 2023 and 2022
Revenues
In the three months ended June 30, 2023, revenues were $37.8 million, representing a decrease of $5.8 million, or 13%, compared to $43.7 million in the three months ended June 30, 2022.
Services revenues increased $3.0 million due to an increase in the Integrated Care Management segment of $1.6 million, the Services segment of $1.2 million and the Virtual Care Infrastructure segment of $0.2 million. The increase in the Integrated Care Management segment was primarily due to an increase in professional services revenue for existing customers. The increase in the Services segment was primarily due to a $3.2 million increase in revenues in our Behavioral business, attributed to higher census and improved payor mix, partially offset by a $1.8 million decrease in revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023. The increase in the Virtual Care Infrastructure segment was primarily due to a $3.7 million increase in revenues resulting from an increase in minutes from both new and existing U.S. Telehealth customers, partially offset by no revenues being recognized for Glocal in the three months ended June 30, 2023 as a result of its deconsolidation in the third quarter of 2022.
Licenses and subscriptions revenues decreased $4.0 million in the Integrated Care Management segment in the three months ended June 30, 2023. The decrease was primarily due to a one-time license fee that occurred in the second quarter of 2022.
Products revenues decreased $4.9 million, due to a decrease in the Services segment of $4.7 million and a decrease in the Virtual Care Infrastructure segment of $0.2 million. The decrease in the Services segment was primarily due to a $3.8 million decrease in the sales of prescriptions in the Pharmacy business due to the strategic sale of Innovations Group on May 11, 2023.
Cost of Revenues
In the three months ended June 30, 2023, cost of revenues was $17.8 million, a decrease of $4.9 million, or 22%, compared to $22.7 million in the three months ended June 30, 2022.
Services cost of revenues decreased $1.3 million, primarily due to decreases in the Virtual Care Infrastructure segment of $1.0 million and the Services segment of $0.9 million, partially offset by increases in the Integrated Care Management segment of $0.6 million. The decrease in the Virtual Care Infrastructure segment was primarily due to no revenues being recognized for Glocal in the three months ended June 30, 2023 as a result of its deconsolidation in the third quarter of 2022, partially offset by a $1.8 million increase in cost of revenues associated with higher revenues and a shift in mix from audio to video minutes in the U.S. Telehealth business. The decrease in the Services segment was primarily due to a $1.5 million decrease in cost of revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023, partially offset by a $0.7 million increase in costs of revenues at the remaining Behavioral business due to higher census and improved mix of services.
License and subscriptions cost of revenues increased $0.2 million in the Integrated Care Management segment in the three months ended June 30, 2023.
Products cost of revenues decreased $3.8 million due to a decrease in the Services segment of $3.6 million and the Virtual Care Infrastructure segment of $0.2 million. The decrease in the Services segment was primarily due to a $3.0 million decrease in cost of revenues from the sale of prescriptions in the Pharmacy business primarily due to the strategic sale of Innovations Group on May 11, 2023 and a $0.6 million decrease in cost of revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023.
Operating Expenses
Sales and Marketing. In the three months ended June 30, 2023, S&M expenses were $2.4 million, representing a decrease of $1.1 million, or 32%, compared to $3.5 million in the three months ended June 30, 2022, primarily due to a net decrease in compensation, benefits, and contractor expenses as a result of the strategic sale of Innovations Group on May 11, 2023, and reversal of a $0.7 million accrual as a result of a settlement.
Research and Development. In the three months ended June 30, 2023, R&D expenses were $0.8 million, representing a decrease of $1.2 million, or 58%, compared to $2.0 million in the three months ended June 30, 2022, primarily due to an increase in capitalized software development costs and reduced headcount.
General and Administrative. In the three months ended June 30, 2023, G&A expense were $12.8 million, representing a decrease of $0.1 million, or 1%, compared to $12.9 million in the three months ended June 30, 2022.
Depreciation and Amortization. In the three months ended June 30, 2023, depreciation and amortization expenses were $1.7 million, primarily consisting of $1.1 million of amortization of intangible assets and $0.6 million of depreciation related to property and equipment, net of allocations to cost of revenues. In the three months ended June 30, 2022 depreciation and amortization expenses were $4.7 million, primarily consisting of $4.2 million of amortization of intangible assets and $0.5 million of depreciation related to property and equipment, net of allocations to cost of revenues. The decrease in depreciation and amortization expenses was due to the deconsolidation of Glocal in the third quarter of 2022, the impairment of intangible assets in the Integrated Care Management segment in the third quarter of 2022, and no depreciation and amortization expense being recorded at Innovations Group in the three months ended June 30, 2023 due to its sale, partially offset by increased amortization related to an increase in capitalized software development costs and increased depreciation related to additions to property and equipment.
Stock-Based Compensation. In the three months ended June 30, 2023, stock-based compensation was $1.1 million, remaining consistent with $1.1 million recognized in the three months ended June 30, 2022.
Impairment of Goodwill, Intangible Assets and Other Long-Lived Assets. An impairment charge of $8.2 million was recognized in the three months ended June 30, 2023, consisting of a $6.4 million goodwill impairment resulting from the decision to wind-down a company within our Behavioral business, $1.4 million from the remeasurement of the Innovations Group disposal group to the expected proceeds, less cost to sell, and a $0.4 million right-of-use asset impairment in our Integrated Care Management segment. No impairment charges were recognized in the three months ended June 30, 2022.
Acquisition, Integration and Transformation Costs. In the three months ended June 30, 2023 and 2022, acquisition, integration and transformation costs were $3.6 million and $6.7 million, respectively, primarily related to legal and litigation expenses associated with the prior acquisitions, as well as costs related to our integration and transformation of the businesses.
Other Expense
In the three months ended June 30, 2023, other expense was $7.0 million, primarily consisting of $7.1 million of interest expense. In the three months ended June 30, 2022, other expense was $4.7 million, primarily consisting of $6.6 million of interest expense, partially offset by a $1.8 million gain on fair value of derivative liability and a $0.1 million gain on fair value of warrants.
Income Tax Benefit (Expense)
In the three months ended June 30, 2023, income tax expense was $0.9 million. In the three months ended June 30, 2022, income tax benefit was $2.2 million.
Income tax benefit (expense) reflects management’s best assessment of estimated current and future taxes to be paid. The objectives for accounting for income taxes, as prescribed by the relevant accounting guidance, are to recognize the amount of taxes payable or refundable for the current year and deferred tax assets and liabilities for future tax consequences of events that have been recognized in our financial statements. Consistent with our conclusion as of December 31, 2022, we continue to believe that it is not more likely than not that the deferred tax assets will be realized and we therefore maintained a full valuation allowance against the deferred tax assets as of June 30, 2023. However, we expect to suffer minimal income tax expense due to U.S. tax rules related to the utilization of net operating loss carryforwards. Additionally, in the three months ended June 30, 2023, we recorded discrete tax items totaling $0.6 million related to the sale of Innovations Group.
Six months ended June 30, 2023 and 2022
Revenues
In the six months ended June 30, 2023, revenues were $80.0 million, representing an increase of $0.3 million, or 0.4%, compared to $79.6 million in the six months ended June 30, 2022.
Services revenues increased $8.2 million due to an increase in the Services segment of $3.4 million, the Integrated Care Management segment of $2.7 million and the Virtual Care Infrastructure segment of $2.1 million. The increase in the Services segment was primarily due to a $6.2 million increase in revenues in the Behavioral business attributed to higher census and improved payor mix, partially offset by a $2.8 million decrease in revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023. The increase in the Integrated Care Management segment was primarily due to an increase in professional services revenue for existing customers. The increase in the Virtual Care Infrastructure segment was primarily due to a $8.9 million increase in revenues resulting from an increase in minutes from both new and existing U.S. Telehealth customers, partially offset by no revenues being recognized for Glocal in the three months ended June 30, 2023 as a result of its deconsolidation in the third quarter of 2022.
Licenses and subscriptions revenues decreased $3.8 million in the Integrated Care Management segment in the six months ended June 30, 2023. The decrease was primarily due to a one-time license fee recognized in the second quarter of 2022.
Products revenues decreased $4.1 million, due to a decrease in the Services segment of $3.8 million and the Virtual Care Infrastructure segment of $0.3 million. The decrease in the Services segment was primarily due to a $2.8 million decrease in the sale of prescriptions in the Pharmacy business due to the strategic sale of Innovations Group on May 11, 2023. The decrease in the Virtual Care Infrastructure segment was primarily due to the shift away from equipment sales to incorporating into service rates in the U.S. Telehealth business, as well as no revenues being recognized for Glocal in the six months ended June 30, 2023 as a result of its deconsolidation in the third quarter of 2022.
We expect revenues to decrease in the year ending December 31, 2023 compared to the year ended December 31, 2022, primarily as a result of a decrease in revenues in our Services segment due to a partial year of revenues to be recognized at Innovations Group as a result of its sale on May 11, 2023 and the wind-down of a company within our Behavioral business, partially offset by increased revenues at the remaining Behavioral business. We also expect a decline in revenues in our Integrated Care Management segment in the year ending December 31, 2023 compared to the year ended December 31, 2022. We expect these decreases will be partially offset by increased revenues in the Virtual Care Infrastructure segment as we continue to add new customers and integrate and develop our technology platforms across each of our segments, partially offset by no revenues being recognized for Glocal in the year ending December 31, 2023 as a result of its deconsolidation in July 2022.
Cost of Revenues
In the six months ended June 30, 2023, cost of revenues was $37.3 million, a decrease of $7.4 million, or 17%, compared to $44.7 million in the six months ended June 30, 2022.
Services cost of revenues decreased $3.3 million, primarily due to decreases in the Virtual Care Infrastructure segment of $2.8 million and the Services segment of $1.3 million, partially offset by increases in the Integrated Care Management segment of $0.8 million. The decrease in the Virtual Care Infrastructure segment was primarily due to no cost of revenues being recognized for Glocal in the six months ended June 30, 2023 as a result of its deconsolidation in July 2022, partially offset by a $2.6 million increase in cost of revenues associated with higher revenues and a shift in mix from audio to video minutes in the U.S. Telehealth business. The decrease in the Services segment was primarily due to a $2.4 million decrease in cost of revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023, partially offset by a $1.1 million increase in cost of revenues at the remaining Behavioral business due to higher census and improved mix of services.
License and subscriptions cost of revenues increased $0.3 million in the Integrated Care Management segment in the six months ended June 30, 2023.
Products cost of revenues decreased $4.4 million due to a decrease in the Services segment of $4.1 million and the Virtual Care Infrastructure segment of $0.3 million. The decrease in the Services segment was primarily due to a $3.1 million decrease in cost of revenues from the sale of prescriptions in the Pharmacy business primarily due to the strategic sale of Innovations Group on May 11, 2023 and a $1.0 million decrease in cost of revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023.
We expect cost of revenues to decrease in the year ending December 31, 2023 compared to the year ended December 31, 2022, commensurate with the decrease in revenues. Cost of revenues from our Services segment is expected to decrease due to a partial year of cost of revenues to be recognized at Innovations Group as a result of its sale on May 11, 2023, and the wind-down of a Behavioral business, partially offset by increased cost of revenues at the remaining Behavioral business, commensurate with the expected growth in revenues. We also expect a decline in costs of revenues in our Integrated Care Management segment, commensurate with the expected decline in revenues. We expect these decreases will be partially offset by increased cost of revenues in the Virtual Care Infrastructure segment commensurate with the expected increase in revenues in the U.S. Telehealth business, partially offset by no cost of revenues being recognized for Glocal in the year ending December 31, 2023 as a result of its deconsolidation in July 2022. Our cost of revenues may fluctuate as a percentage of our total revenue (gross margin %) from period to period due to the changes in the percentage of revenue contributed by each of our segments.
Operating Expenses
Sales and Marketing. In the six months ended June 30, 2023, S&M expenses were $7.0 million, remaining flat compared to $7.0 million in the six months ended June 30, 2022, primarily due to an increase in compensation, benefits, and contractor expenses, partially reduced as a result of the strategic sale of Innovations Group on May 11, 2023, and reversal of a $0.7 million on accrual as a result of a settlement.
We expect S&M expenses to decrease in the year ending December 31, 2023 compared to the year ended December 31, 2022 as we continue to consolidate our sales and marketing teams. Our S&M expenses may fluctuate as a percentage of our total revenues from period to period due to the timing and extent we promote our brands through a variety of marketing and public relations activities.
Research and Development. In the six months ended June 30, 2023, R&D expenses were $2.1 million, representing a decrease of $1.6 million, or 43%, compared to $3.8 million in the six months ended June 30, 2022, primarily due to a increase in capitalized software development costs and reduced headcount.
We expect our R&D expenses to decrease in the year ending December 31, 2023 compared to the year ended December 31, 2022, as we decrease R&D efforts in certain segments, while also increasing our capitalization of software development costs. Our R&D expenses may fluctuate as a percentage of our total revenues from period to period due to the timing and extent of our technology and development expenses, including the ability to capitalize software development costs.
General and Administrative. In the six months ended June 30, 2023, G&A expense were $23.8 million, representing a decrease of $0.6 million, or 2%, compared to $24.3 million in the six months ended June 30, 2022, primarily due to a decrease in compensation, benefits, and contractor expenses.
We expect G&A expenses to decrease in the year ending December 31, 2023 compared to the year ended December 31, 2022, primarily as a result of a decrease in legal and other professional fees. Our G&A expenses may fluctuate as a percentage of our total revenues from period to period due to the timing and extent of our G&A expenses.
Depreciation and Amortization. In the six months ended June 30, 2023, depreciation and amortization expenses were $3.3 million, primarily consisting of $2.3 million of amortization of intangible assets and $1.0 million of depreciation related to property and equipment, net of allocations to cost of revenues. In the six months ended June 30, 2022 depreciation and amortization expenses were $9.9 million, primarily consisting of $9.3 million of amortization of intangible assets and $0.6 million of depreciation related to property and equipment, net of allocations to cost of revenues. The decrease in depreciation and amortization expenses was due to the deconsolidation of Glocal in the third
quarter of 2022, the impairment of intangible assets in the Integrated Care Management segment in the third quarter of 2022, and no depreciation and amortization expense being recorded at Innovations Group in the six months ended June 30, 2023 due to its classification as held-for-sale in Q1 2023 and subsequent sale on May 11, 2023, partially offset by increased amortization related to an increase in capitalized software development costs and increased depreciation related to additions to property and equipment.
We expect depreciation and amortization expenses to decrease in the year ended December 31, 2023 compared to the year ending December 31, 2022 due to decreased amortization expense related to the decrease in intangible assets, partially offset by an increase in amortization related to capitalized software development costs and an increase in depreciation from purchases of property and equipment.
Stock-Based Compensation. In the six months ended June 30, 2023, stock-based compensation expenses were $2.0 million, representing a decrease of $0.4 million, or 17%, compared to $2.5 million in the six months ended June 30, 2022. We expect stock-based compensation expenses to decrease in the year ending December 31, 2023, primarily due to lower equity grants outstanding and fewer new grants expected to be made in the second half of 2023.
Impairment of Goodwill, Intangible Assets, and Other Long-Lived Assets. An impairment charge of $8.7 million was recognized in the six months ended June 30, 2023, consisting of a $6.4 million goodwill impairment resulting from the decision to wind-down a company within our Behavioral business, $1.9 million from the remeasurement of the Innovations Group disposal group to the expected proceeds, less cost to sell, and a $0.4 million right-of-use asset impairment in our Integrated Care Management segment. An impairment charge of $6.2 million was recognized in the six months ended June 30, 2022, primarily consisting of a $5.5 million measurement period adjustment at Glocal that was immediately impaired, and a $0.7 million trade name intangible asset impairment at a company within our Behavioral business.
Acquisition, Integration and Transformation Costs. In the six months ended June 30, 2023, acquisition, integration and transformation costs were $7.1 million, primarily related to legal and litigation expenses associated with the prior acquisitions, as well as costs related to our integration and transformation of the businesses. In the six months ended June 30, 2022, acquisition, integration and transformation costs were $9.1 million, primarily related to legal and litigation expenses associated with the prior acquisitions, costs related to our integration and transformation of the businesses, and a lease abandonment accrual in the amount of $0.1 million related to office spaces we vacated in the period.
Other Expense
In the six months ended June 30, 2023, other expense was $13.9 million, primarily consisting of $14.0 million of interest expense. In the six months ended June 30, 2022, other expense was $6.7 million, primarily consisting of $13.6 million of interest expense, partially offset by a $6.7 million gain on fair value of derivative liability and a $0.2 million gain on fair value of warrants.
Income Tax Benefit (Expense)
In the six months ended June 30, 2023, income tax expense was $0.9 million. In the six months ended June 30, 2022, income tax benefit was $4.5 million.
Income tax benefit (expense) reflects management’s best assessment of estimated current and future taxes to be paid. The objectives for accounting for income taxes, as prescribed by the relevant accounting guidance, are to recognize the amount of taxes payable or refundable for the current year and deferred tax assets and liabilities for future tax consequences of events that have been recognized in our financial statements. Consistent with our conclusion as of December 31, 2022, we continue to believe that it is not more likely than not that the deferred tax assets will be realized and we therefore maintained a full valuation allowance against the deferred tax assets as of June 30, 2023. However, we expect to suffer minimal income tax expense due to U.S. tax rules related to the utilization of net operating loss carryforwards. Additionally, in the six months ended June 30, 2023, we recorded discrete tax items totaling $0.6 million related to the sale of Innovations Group.
Segment Information
We evaluate performance based on several factors, of which revenues and gross profit by operating segment are the primary financial measures.
Revenues
Revenues by segment consisted of the following:
| | | | | | | | | | | | | | | | | | | | | | | |
| Three Months Ended June 30, | | Six Months Ended June 30, |
In thousands | 2023 | | 2022 | | 2023 | | 2022 |
Virtual Care Infrastructure | $ | 16,838 | | | $ | 16,815 | | | $ | 34,296 | | | $ | 32,445 | |
Services | 15,503 | | | 19,030 | | | 36,317 | | | 36,760 | |
Integrated Care Management | 5,482 | | | 7,823 | | | 9,355 | | | 10,435 | |
Total revenues | $ | 37,823 | | | $ | 43,668 | | | $ | 79,968 | | | $ | 79,640 | |
Three Months Ended June 30, 2023 and 2022. Revenues from the Virtual Care Infrastructure segment remained flat, consisting of a $0.2 million increase in services revenues, offset by a $0.2 million decrease in products revenues. There were no revenues from Glocal, which was deconsolidated in the third quarter of 2022, compared to $3.6 million of revenue in the second quarter of 2022, partially offset by services and products revenues in the U.S. Telehealth business, which increased $3.6 million resulting from an increase in minutes from both new and existing U.S. Telehealth customers.
Revenues from the Services segment decreased $3.5 million, consisting of a $4.7 million decrease in products revenues, partially offset by a $1.2 million increase in services revenues. The decrease was primarily due to the strategic sale of Innovations Group on May 11, 2023. The increase in services revenues, which was in our Behavioral business, was attributed to higher census and improved payor mix, partially offset by a $1.8 million decrease in revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023.
Revenues from the Integrated Care Management segment decreased $2.3 million, consisting of a $4.0 million decrease in licenses and subscriptions revenues due to a one-time license fee recognized in the second quarter of 2022, partially offset by a $1.6 million increase in services revenues primarily due to an increase in professional services for existing customers.
Six Months Ended June 30, 2023 and 2022. Revenues from the Virtual Care Infrastructure segment increased $1.9 million, consisting of a $2.1 million increase in services revenues, partially offset by a $0.3 million decrease in products revenues. The overall segment increase was due to an increase in minutes from both new and existing U.S. Telehealth customers, partially offset by no revenues from Glocal, which was deconsolidated in the third quarter of 2022, compared to $6.9 million of revenue in the six months ended June 30, 2022.
Revenues from the Services segment decreased $0.4 million, consisting of a $3.8 million decrease in products revenues, partially offset by a $3.4 million increase in services revenues. The decrease in products revenue was primarily due to the strategic sale of Innovations Group on May 11, 2023 and the decision to wind-down a company within our Behavioral business in the second quarter of 2023. The increase in services revenues, which was in our Behavioral business, was attributed to higher census and improved payor mix, partially offset by a $2.8 million decrease in revenues resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023.
Revenues from the Integrated Care Management segment decreased $1.1 million, consisting of a $3.8 decrease in licenses and subscriptions revenue due to a one-time license fee in the second quarter of 2022, partially offset by a $2.7 million increase in services revenue primarily due to an increase in professional services revenue for existing customers.
Gross profit
Gross profit by segment consisted of the following:
| | | | | | | | | | | | | | | | | | | | | | | |
| Three Months Ended June 30, | | Six Months Ended June 30, |
In thousands | 2023 | | 2022 | | 2023 | | 2022 |
Virtual Care Infrastructure | $ | 8,470 | | | $ | 7,255 | | | $ | 18,655 | | | $ | 13,756 | |
Services | 7,728 | | | 6,774 | | | 17,639 | | | 12,626 | |
Integrated Care Management | 3,778 | | | 6,894 | | | 6,358 | | | 8,532 | |
Total gross profit | $ | 19,976 | | | $ | 20,923 | | | $ | 42,652 | | | $ | 34,914 | |
Three Months Ended June 30, 2023 and 2022. Gross profit from the Virtual Care Infrastructure segment increased $1.2 million, primarily due to a $1.2 million increase in services gross profit as a result in the shift in mix from audio to video minutes in the U.S. Telehealth business, partially offset by no revenues being recognized for Glocal, which was deconsolidated in the third quarter of 2022.
Gross profit from the Services segment increased $1.0 million, consisting of a $2.0 million increase in services gross profit, partially offset by a $1.1 million decrease in products gross profit. The increase in services gross profit, which was in our Behavioral business, was attributed to higher census and improved payor mix, partially offset by a decrease in gross profit resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023. The decrease in products gross profit was primarily due to the strategic sale of Innovations Group on May 11, 2023.
Gross profit from the Integrated Care Management segment decreased $3.1 million, as a result of a $4.1 million decrease in licenses and subscriptions gross profit resulting from a one-time license fee recognized in the second quarter of 2022, partially offset by a $1.0 million increase in services gross profit from increased professional services performed at higher margins.
Six Months Ended June 30, 2023 and 2022. Gross profit from the Virtual Care Infrastructure segment increased $4.9 million, primarily due to a $4.9 million increase in services gross profit as a result in the shift in mix from audio to video minutes in the U.S. Telehealth business, partially offset by no revenue being recognized for Glocal, which was deconsolidated in the third quarter of 2022.
Gross profit from the Services segment increased $5.0 million, consisting of a $4.7 million increase in services gross profit and a $0.3 million increase in products gross profit. The increase in services gross profit, which was in our Behavioral business, was attributed to higher census and improved payor mix, partially offset by a decrease in gross profit resulting from the decision to wind-down a company within our Behavioral business in the second quarter of 2023. The increase in products gross profit was primarily due increased gross profit at Innovations Group, until its strategic sale on May 11, 2023.
Gross profit from the Integrated Care Management segment decreased $2.2 million, as a result of a $4.1 million decrease in licenses and subscriptions gross profit resulting from a one-time license fee recognized in the second quarter of 2022, partially offset by a $1.9 million increase in services gross profit from increased professional services performed at higher margins.
Liquidity and Capital Resources
As of June 30, 2023 and December 31, 2022, we had free cash on hand of $46.8 million and $15.6 million, respectively. Excluded from cash and cash equivalents as of June 30, 2023 and December 31, 2022, was $7.0 million in funds held in a designated “Share Account” maintained with a leading bank in India in the name of Glocal for which our Chief Financial Officer is the sole authorized signatory. As of June 30, 2023 and December 31, 2022, we had no restricted cash included in our unaudited condensed consolidated balance sheets.
We believe our current cash and expected cash collections will be sufficient to fund our operations for at least twelve months after the filing date of this Quarterly Report.
Cash Flows
The following tables summarize cash flows in the six months ended June 30, 2023 and 2022 (unaudited):
| | | | | | | | | | | |
| Six Months Ended June 30, |
(In thousands) | 2023 | | 2022 |
Net cash used in operating activities | $ | (12,053) | | | $ | (7,841) | |
Net cash provided by (used in) investing activities | 51,943 | | | (3,783) | |
Net cash used in financing activities | (8,644) | | | (23,580) | |
Effect of exchange rate changes on cash and cash equivalents | — | | | (460) | |
Net increase (decrease) in cash and cash equivalents | $ | 31,246 | | | (35,664) | |
Due to the deconsolidation of Glocal in the third quarter of 2022, as well as the sale of Innovations Group on May 11, 2023, the numbers presented above are not directly comparable between periods.
In the six months ended June 30, 2023, cash used in operating activities was $12.1 million, primarily attributed to the net loss of $26.3 million and the changes in operating assets and liabilities, net of effects of acquisitions, of $8.8 million, partially offset by $23.0 million of net non-cash items (debt issuance cost amortization, depreciation, intangible amortization, stock-based compensation, impairments, provision for credit losses, loss (gain) on fair value of warrant liabilities, loss (gain) on fair value of derivative liability and operating lease right-of-use asset amortization). The changes in operating assets and liabilities, net of effects of acquisitions, were primarily due to a decrease in accounts payable and accrued expenses of $5.7 million, an increase in accounts receivable of $0.4 million resulting from increased revenues in our Virtual Care Infrastructure segment, a decrease in operating lease liabilities of $1.2 million and an increase in prepaid expenses and other current assets of $1.0 million.
In the six months ended June 30, 2022, cash used in operating activities was $7.8 million, primarily attributed to the net loss of $30.2 million, partially offset by $16.1 million of non-cash items (impairments, depreciation, intangible amortization, debt issuance cost amortization and stock-based compensation) and the changes in operating assets and liabilities, net of effects of acquisitions, of $6.2 million. The changes in operating assets and liabilities, net of effects of acquisitions, was primarily due to an increase in accounts payable and accrued expenses of $8.3 million due to delayed payments to vendors and an increase in deferred revenue of $3.8 million, partially offset by a decrease in accounts receivable of $6.2 million due to net collections of receivables.
In the six months ended June 30, 2023, cash provided investing activities was $51.9 million, primarily consisting of proceeds from sale of business, net of expenses, of $54.9 million, partially offset by purchases of property and equipment and capitalized software development costs of $2.9 million. In the six months ended June 30, 2022, cash used in investing activities was $3.8 million, primarily consisting of purchases of property and equipment.
In the six months ended June 30, 2023, cash used in financing activities was $8.6 million, primarily consisting of repayments of debt of $10.3 million, payments of finance lease obligations of $1.8 million and distribution to noncontrolling interest of $0.7 million, partially offset by proceeds from equity issuance of $4.2 million.
In the six months ended June 30, 2022, cash used in financing activities was $23.6 million, primarily consisting of the repayment of the forward share purchase of $18.5 million, repayments of debt obligations of $3.2 million and payments of capital lease obligations of $1.6 million.
Debt
See Note 8, Debt, in the Notes to Condensed Consolidated Financial Statements of this Quarterly Report for our debt.
Contractual Obligations and Commitments
See Note 15, Leases, and Note 16, Commitments and Contingencies, in the Notes to Condensed Consolidated Financial Statements of this Quarterly Report for information about our operating lease obligations and our non-cancellable contractual service and licensing obligations.
Off-Balance Sheet Arrangements
As of June 30, 2023, we have not entered into any off-balance sheet financing arrangements, established any additional special purpose entities, guaranteed any debt or commitments of other entities, or purchased any non-financial assets.
Recent Accounting Pronouncements
See Note 2, Summary of Significant Accounting Policies, in the Notes to Condensed Consolidated Financial Statements of this Quarterly Report for the recently issued accounting standards that could have an effect on us.
Critical Accounting Policies
The preparation of financial statements and related disclosures in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, disclosure of contingent assets and liabilities at the date of the financial statements, and income and expenses in the periods reported. These estimates and assumptions are based on current facts, historical experience, and various other factors that we believe are reasonable under the circumstances to determine reported amounts of assets, liabilities, revenues and expenses that are not readily apparent from other sources. To the extent there are material differences between our estimates and the actual results, our future consolidated results of comprehensive income (loss) may be affected.
Among our significant accounting policies, which are described in Note 2, Summary of Significant Accounting Policies, in the Notes to Condensed Consolidated Financial Statements of this Quarterly Report, as well as Note 2, Summary of Significant Accounting Policies, in the Notes to Consolidated Financial Statements for the year ended December 31, 2022 included in our Annual Report, the following accounting policies and specific estimates involve a greater degree of judgment and complexity:
•Business combinations;
•Identification and reporting of variable interest entities (“VIEs”);
•Accounting for equity investments;
•Goodwill and intangible assets;
•Revenue recognition; and
•Income taxes.