Climate Change Data

Environmental Metrics

Climate Goals & Targets

Environmental Challenges

• Litigation has materially adversely affected our business, financial condition, operating results and cash flows and caused unfavorable publicity and is likely to continue to do so.
• If we are unable to retain our existing customers or acquire new customers, our financial condition will suffer.
• Our business operations currently include the collection, on behalf of our customers, of medical co-pays and other payments that are due to our customers from their patients. This business practice has been perceived negatively by the public and this negative perception has adversely affected (and may continue to adversely affect) our business, results of operations and financial condition.
• We operate in a highly competitive industry, and our current or future competitors may be able to compete more effectively than we do, which could have a material adverse effect on our business, revenue, growth rates and market share.
• Delayed or unsuccessful implementation of our technologies or services with our customers or implementation costs that exceed our expectations may harm our financial results.
• Our quarterly results of operations and cash flows fluctuate as a result of many factors, some of which may be outside of our control.
• If we lose key personnel or if we are unable to attract, hire, integrate and retain our key personnel and other necessary employees, our business could be harmed.
• The imposition of legal responsibility for obligations related to our employees or our customers’ employees could adversely affect our business and subject us to liability.
• If we fail to manage our operations effectively, our business would be harmed.
• Disruptions in service or damage to our shared services centers and third-party operated data centers could adversely affect our business.
• Our services involve the storage and transmission of customers’ proprietary information and protected health, financial, payment and other personal information of patients. We rely on proprietary and commercially available systems, software, tools and monitoring, as well as other processes, to provide security for processing, transmission and storage of such information, and because of the sensitivity of this information, the effectiveness of such security efforts is very important.
• We may be liable to our customers or third parties if we make errors in providing our services, and our anticipated net services revenue may be lower if we provide poor service.
• Our growing operations in India expose us to risks that could have a material adverse effect on our costs of operations.
• Negative public perception in the United States regarding offshore outsourcing and proposed legislation may increase the cost of delivering our services.
• We have previously identified material weaknesses in our internal control over financial reporting, and if we cannot maintain an effective system of internal control over financial reporting in the future, our business could be adversely affected.
• Our ability to use our net operating loss carryforwards may be limited.

Mitigation Strategies

• We maintain insurance that may provide coverage for some or all of these expenses, and we have given notice to our insurers of the claims, our insurers have responded by reserving their rights under the policies, including the rights to deny coverage under various policy exclusions.
• We have implemented and maintain physical, technical and administrative safeguards intended to protect all personal data, and have processes in place to assist us in complying with applicable laws and regulations regarding the protection of this data and properly responding to any security incidents.
• We have a business continuity plan and maintain insurance against fires, floods, other natural disasters and general business interruptions to mitigate the adverse effects of a disruption, relocation or change in operating environment at one of our data centers or shared services centers, but the situations we plan for and the amount of insurance coverage we maintain may not be adequate in every particular case.
• We dedicate significant resources to protecting our customers’ confidential and protected health information, or PHI.
• We received, and have maintained since January 2013, a certification status from the Health Information Trust Alliance, or HITRUST.
• We devote significant efforts, through training of personnel and monitoring, to establish and maintain compliance with all regulatory requirements that we believe are applicable to our business and the services we offer.
• We have implemented and maintain physical, technical and administrative safeguards intended to protect all personal data and have processes in place to assist us in complying with applicable laws and regulations regarding the protection of this data and properly responding to any security incidents or breaches.
• We voluntarily sought, and received, HITRUST certification to help ensure compliance.
• We seek to structure our business relationships and activities to avoid any activity that could be construed to implicate the federal healthcare anti-kickback law and similar laws.
• During 2014, 2015 and 2016, numerous changes were made throughout our organization and significant actions have been undertaken to reinforce the importance of a strong control environment, including training and other steps designed to strengthen and enhance our control culture.
• Our plan used to remediate these deficiencies included the following actions: • adopted new accounting policies for revenue recognition and software capitalization; • implemented periodic reviews with the relevant internal process owners of tangible and intangible asset acquisitions and dispositions to ensure proper accounting; • established a contract governance committee to oversee all contracting activity; • completed the implementation of a robust contract governance structure to assure appropriate administration, compliance and accounting treatment for new or amended contract terms; • established a contracting boundaries protocol to clarify the delegation of contracting authority to personnel involved in establishing customer contract terms; • appointed experienced professionals to key leadership positions; • established a new reporting structure with more clearly defined accountabilities; • hired additional accounting personnel with appropriate backgrounds and skill sets, including professionals with certified public accountant qualifications, master’s degrees and public accounting experience and created new positions for a Director of Revenue and a Director of Taxes; • implemented a new internal reporting model and performance metrics based on cash flow performance; • centralized certain accounting functions and revised organizational structures to enhance accurate reporting and ensure appropriate accountability; • established a formal delegation of authority from the Board of Directors to management with further delegation to accountable personnel; • expanded the use of our financial reporting systems to facilitate more robust analysis of operating performance, budgeting and forecasting; • strengthened our current disclosure committee with formalized processes to enhance the transparency of our external financial reporting; • finalized our transition to the 2013 Committtee of Sponsoring Organizations, or COSO, framework; • strengthened our information technology general controls; • implemented and executed a year round internal controls testing and monitoring program; and • enhanced our Sarbanes-Oxley compliance procedures.

Supply Chain Management

Climate-Related Risks & Opportunities

Environmental Metrics

ESG Focus Areas

• Not disclosed

Environmental Achievements

• Not disclosed

Social Achievements

• Not disclosed

Governance Achievements

• Completed the conversion of preferred shares into common shares in January 2021

Climate Goals & Targets

Environmental Challenges

• COVID-19 pandemic impact on patient volumes and operational costs

Mitigation Strategies

• Digitization and automation efforts, corporate cost savings initiative (closed 12 office locations), streamlined corporate functions

Supply Chain Management

Supplier Audits: Not disclosed

Responsible Procurement

• Not disclosed

Climate-Related Risks & Opportunities

Physical Risks

• Not disclosed

Transition Risks

• Not disclosed

Opportunities

• Not disclosed

Reporting Standards

Frameworks Used: Null

Certifications: Null

Third-party Assurance: Not disclosed

UN Sustainable Development Goals

• Not disclosed

Not disclosed

Sustainable Products & Innovation

• Not disclosed

Awards & Recognition

• R1 recognized as Best in KLAS for Ambulatory RCM Services in the “2021 Best in KLAS - Software and Services Report.”

Environmental Metrics

Social Achievements

• Received a 100% score on the Human Rights Campaign's Corporate Equality Index for the second year in a row.
• Supported over 835 community organizations and contributed over 17,400 volunteer hours in 2023.

Climate Goals & Targets

Environmental Challenges

• Tight labor market and increased turnover rates.
• High inflation and high interest rates.
• Increased cybersecurity incidents in the healthcare industry.

Mitigation Strategies

• Investing in technology to offset increased labor costs.
• Monitoring the financial health of customers and increasing allowance for credit losses as needed.
• Implementing and maintaining a comprehensive Cybersecurity Program.

Supply Chain Management

Climate-Related Risks & Opportunities

Awards & Recognition

• Three Best in KLAS categories for 2024