0000950170-22-014819 | 10-Q | XBRL Viewer

Ending Balance at Jun. 30, 2021

33,285

$ 0

33,285

Equity repurchase

(1,474)

340,380

$ 188

829,221

(489,044)

Ending Balance, Shares at Jun. 30, 2021

187,273,782

Beginning Balance at Mar. 31, 2021

354,252

$ 188

798,346

(444,282)

Beginning Balance, Shares at Mar. 31, 2021

187,273,782

Net loss attributable to Alignment Healthcare, Inc.

(44,762)

$ 0

(44,762)

Noncontrolling interest attributable to subsidiary

Common stock issuance costs

(12)

Ending Balance at Jun. 30, 2021

30,887

340,380

$ 188

829,221

(489,044)

Ending Balance, Shares at Jun. 30, 2021

187,273,782

Beginning Balance at Dec. 31, 2021

$ 306,055

$ 187

888,547

(582,694)

Beginning Balance, Shares at Dec. 31, 2021

187,193,613

Net loss attributable to Alignment Healthcare, Inc.

$ (52,397)

$ 0

(52,397)

Issuance of common stock upon vesting of restricted stock units

432,484

Forfeitures

$ 0

Forfeitures, shares

(354,786)

Repurchase of noncontrolling interest attributable to subsidiary

40,146

$ 0

40,146

(100)

(85)

(15)

Ending Balance at Jun. 30, 2022

$ 293,704

$ 187

928,608

(635,091)

Ending Balance, Shares at Jun. 30, 2022

187,271,311

Beginning Balance at Mar. 31, 2022

$ 293,285

$ 187

916,594

(623,511)

Beginning Balance, Shares at Mar. 31, 2022

187,414,057

Net loss attributable to Alignment Healthcare, Inc.

(11,580)

$ 0

(11,580)

Issuance of common stock upon vesting of restricted stock units

48,976

Forfeitures

$ 0

Forfeitures, shares

(191,722)

Repurchase of noncontrolling interest attributable to subsidiary

12,099

$ 0

12,099

(100)

(85)

(15)

Ending Balance at Jun. 30, 2022

$ 293,704

$ 187

$ 928,608

$ (635,091)

$ 0

Ending Balance, Shares at Jun. 30, 2022

187,271,311

[1]

The consolidated balances as of December 31, 2020 were derived from the audited consolidated financial statements as of that date and were retroactively adjusted, including shares and per share amounts, as a result of the Reorganization. See Note 1 to the condensed consolidated financial statements for additional details.

Condensed Consolidated Statements of Stockholders' Equity (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2021	Jun. 30, 2021	Mar. 30, 2021
Common stock issuance costs	$ (12)
IPO
Stock price (in dollars per share)	$ 18.00	$ 18.00	$ 18.00
Common stock issuance costs		$ 29,011

Condensed Consolidated Statements of Cash Flows (Unaudited) $ in Thousands	6 Months Ended
	Jun. 30, 2022 USD ($)	Jun. 30, 2021 USD ($)
Operating Activities:
Net loss	$ (52,397)	$ (101,636)
Adjustments to reconcile net loss to net cash used in operating activities:
Provision for credit loss	111	46
Loss on sublease	509	0
Depreciation and amortization	8,222	7,751
Amortization-debt issuance costs and investment discount	1,140	1,110
Payment-in-kind interest	2,170	2,054
Equity-based compensation and common stock payments	40,146	51,275
Non-cash lease expense	1,415	1,314
Changes in operating assets and liabilities:
Accounts receivable	(39,609)	(25,503)
Prepaid expenses and other current assets	(6,586)	(14,393)
Other assets	(150)	6
Medical expenses payable	47,985	23,105
Accounts payable and accrued expenses	(3,152)	(2,368)
Accrued compensation	940	(2,529)
Lease liabilities	(2,028)	(1,788)
Net cash used in operating activities	(1,284)	(61,556)
Investing Activities:
Purchase of business, net of cash received	(1,113)	0
Asset acquisition, net of cash received	0	(1,405)
Purchase of investments	(1,100)	(800)
Sale of investments	1,000	800
Acquisition of property and equipment	(10,769)	(9,462)
Net cash used in investing activities	(11,982)	(10,867)
Financing Activities:
Repurchase of noncontrolling interest	(100)	15
Equity repurchase	0	(1,474)
Issuance of common stock	0	390,600
Common stock issuance costs	0	(29,011)
Net cash (used in) provided by financing activities	(100)	360,130
Net increase (decrease) in cash	(13,366)	287,707
Cash and restricted cash at beginning of period	468,350	207,811
Cash and restricted cash at end of period	454,984	495,518
Supplemental disclosure of cash flow information:
Cash paid for interest	5,565	5,413
Supplemental non-cash investing and financing activities:
Acquisition of property in accounts payable	232	418
Purchase of business in accounts payable	240	0
Reconciliation of cash, cash equivalents and restricted cash as shown in the statement of cash flows:
Cash	453,234	494,618
Restricted cash in other assets	1,750	900
Total	$ 454,984	$ 495,518

Organization

6 Months Ended

Jun. 30, 2022

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization

1. Organization

Alignment Healthcare, Inc. (collectively, “we” or “us” or “our” or the “Company”), is a next generation, consumer-centric health care platform that is purpose-built to provide seniors with high quality, affordable care with a vastly improved consumer experience. Enabled by our innovative technology and care delivery model, the Company focuses on improving outcomes in the Medicare Advantage sector. The Company’s operations primarily consist of Medicare Advantage Plans in the states of California, North Carolina, Nevada, and Arizona.

Reorganization

We historically operated as a Delaware limited liability company under the name Alignment Healthcare Holdings, LLC. On March 17, 2021, Alignment Healthcare Holdings, LLC converted to a Delaware corporation pursuant to a statutory conversion and we changed our name to Alignment Healthcare, Inc. for purposes of completing an initial public offering ("IPO") ("the Reorganization"). As part of the Reorganization, Alignment Healthcare Partners, LP ("the Parent"), the sole unitholder of Alignment Healthcare Holdings, LLC, exchanged its membership units for our common stock and became the sole holder of our shares of common stock. Prior to the closing of the IPO, the Parent merged with and into the Company with Alignment Healthcare, Inc. surviving the merger.

The membership units that were owned by the Parent prior to the Reorganization were converted to our common stock using an approximately 1 to 260 common stock split. All share and per share amounts in these condensed consolidated financial statements and related notes have been retroactively adjusted, where applicable, for all periods presented to give effect to the common stock split and exchange ratio applied in connection with the Reorganization. As a result, we reclassified the capital contributions associated with the issuance of the membership units to additional paid-in capital and common stock using a par value of $0.001 for all periods presented within the condensed consolidated financial statements.

Initial Public Offering

On March 25, 2021, our Registration Statement on Form S-1 for the initial public offering of 27,200,000 shares of common stock was declared effective by the Securities and Exchange Commission. Our common stock began trading on March 26, 2021 on the Nasdaq Global Select Market under the ticker symbol “ALHC."

We completed an IPO through issuing and selling 21,700,000 shares of common stock and certain stockholders selling 5,500,000 shares of common stock, in each case at a price of $18.00 per share. We received proceeds of $361,589 after deducting underwriting discounts and commissions of $24,389 and deferred offering costs of $4,622. Deferred direct offering costs were capitalized and consisted of fees and expenses incurred in connection with the sale of our common stock in the IPO, including legal, accounting, printing and other offering related costs. Upon completion of the IPO, these deferred offering costs were reclassified from prepaid and other current assets to stockholders' equity and recorded against the net proceeds from the offering.

On April 6, 2021, pursuant to a partial exercise of the underwriters' over-allotment option, certain selling stockholders sold an additional 3,314,216 shares of common stock at the IPO price. The Company did not receive any proceeds from the sale of shares of common stock by the selling stockholders in the IPO. On November 18, 2021, certain selling stockholders, including certain of our principal stockholders, sold an additional 9,200,000 shares of our common stock. The Company did not sell any shares and did not receive any proceeds from the sale of shares by the selling stockholders. We incurred $1,045 in transaction costs in connection with this offering.

Summary of Significant Accounting Policies

6 Months Ended

Jun. 30, 2022

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

2. Summary of Significant Accounting Policies

Basis of Presentation

The accompanying condensed consolidated financial statements and accompanying notes have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). The condensed consolidated financial statements include the accounts of the Company, our subsidiaries, and four immaterial variable interest entities in which we are the

primary beneficiary. All intercompany transactions have been eliminated in consolidation. Noncontrolling interest is presented within the equity section of the condensed consolidated balance sheets.

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net income (loss) for all periods presented.

Subsequent to the issuance of the consolidated financial statements for the year ended December 31, 2021 we determined that $7,837 reflected in the accumulated deficit beginning balance as of January 1, 2019 should have been reflected as additional paid-in capital. As such, the balances at January 1, 2021 in the Consolidated Statement of Stockholders' Equity were corrected resulting in an increase in accumulated deficit and additional paid-in capital for the corresponding amount. Management has concluded that the correction is not material to the previously issued consolidated financial statements.

Use of Estimates

The preparation of the condensed consolidated financial statements requires management to make estimates and judgments that affect the amounts reported in the condensed consolidated financial statements. Our significant estimates include, but are not limited to, the determination of medical expenses payable; the impact of risk adjustment provisions related to our Medicare contracts; collectability of receivables; valuation of related impairment recognition of long-lived assets, including goodwill and intangible assets; equity-based compensation expense; and contingent liabilities. Estimates and judgments are based upon historical information and on various other assumptions that are believed to be reasonable under the circumstances. Actual results could differ materially from those estimates and the impact of any change in estimates is included in earnings in the period in which the estimate is adjusted.

Segments

We have determined that our chief executive officer is the chief operating decision maker (“CODM”) who regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating financial performance. We operate and manage the business as one reportable segment and one operating segment, which is to provide healthcare services to our seniors. Factors used in determining the reportable segment include the nature of operating activities, our organizational and reporting structure, and the type of information reviewed by the CODM to allocate resources and evaluate financial performance. All of our assets are located in the United States.

Fair Value Measurements

Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Our current assets and current liabilities approximate fair value because of the short-term nature of these financial instruments. Financial instruments measured at fair value on a recurring basis were based upon a three-tier hierarchy as follows:

Level 1 - Quoted prices in active markets for identical assets or liabilities

Level 2 - Other inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the asset or liability

Level 3 - Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date

The fair value of cash and restricted cash was determined based on Level 1 inputs. The fair value of U.S. Treasury bills and certificate of deposits, which were included in other assets in the condensed consolidated balance sheets, was determined based on Level 2 inputs. There were no assets or liabilities measured at fair value using Level 3 inputs as of June 30, 2022 and December 31, 2021. Our long-term debt was reported at carrying value.

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue for the three and six months ended June 30, 2022 and 2021 were as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
	2022		2021		2022		2021
Premium	$	351,107	$	293,435	$	681,985	$	558,148
Capitation		15,073		15,304		29,487		17,591
	$	366,180	$	308,739	$	711,472	$	575,739

Premium revenue is derived monthly from the federal government based on our contracts with the Centers for Medicare and Medicaid Services (“CMS”). In accordance with these arrangements, we assume the responsibility for the outcomes and the economic risk of funding our members’ health care, supplemental benefits and related administration costs. We recognize premium revenue in the month that members are entitled to receive health care services, and premiums collected in advance are deferred. The monthly reimbursement includes a fixed payment per member per month (“PMPM”), which is adjusted based on certain risk factors derived from medical diagnoses and conditions of our members. The adjustments are estimated by projecting the ultimate annual premium and are recognized ratably during the year, with adjustments each period to reflect changes in the estimated ultimate premium. Premiums are also recorded net of estimated uncollectible amounts and retroactive membership adjustments.

Capitation revenue consists primarily of capitated fees for medical care services provided by us under arrangements with third-party payors and from CMS related to our Direct Contracting Entity ("DCE").

Under those arrangements with third-party payors, we receive a PMPM payment for a defined member population, and we are responsible for providing health care services to the member population over the contract period. We are solely responsible for the cost of health care services related to the member population and in some cases, we are financially responsible for the supplemental benefits provided by us to the members. We act as a principal in arranging for and controlling the services provided by our provider network and we are at risk for arranging and providing health care services.

The premium and capitation payments we receive monthly from CMS for our members are determined from our annual bid or similarly from third-party payors under our capitation arrangement. These payments represent revenues for providing health care coverage, including Medicare Part D benefits. Under the Medicare Part D program, our members and the members of the third-party payors receive standard drug benefits. We may also provide enhanced benefits at our own expense. We recognize premium or capitation revenue for providing this insurance coverage in the month that members are entitled to receive health care services and any premium or capitation collected in advance is deferred. Our CMS payment related to Medicare Part D is subject to risk sharing through the Medicare Part D risk corridor provisions.

On April 1, 2021, we began participating in the CMS Innovation’s Direct Contracting Model. CMS serves as the claim adjudicator for institutional and specialists care, and directly pays for such fee for service claims. The DCE is responsible for the cost of health care services related to the patient population attributed to the DCE by participating in 100% savings/losses via the risk share model and in some cases, are financially responsible for the supplemental benefits provided to the patients. The DCE acts as a principal in arranging for and controlling services provided directly by their contracts with primary care physicians, as well as services provided by preferred institutional care providers and specialists. Capitation payments for the DCE program are determined from an annual benchmark established by CMS. These payments, which are adjusted for variable considerations, represent revenue for providing health care service, including primary care as well as institutional and specialist care. The DCE recognizes capitation revenue for providing these services in the period in which the performance obligations are satisfied by transferring services to the members. Revenue recognized by the DCE for the three and six months ended June 30, 2022 was $13,110, and $25,412, respectively. Revenue recognized by the DCE for the three and six months ended June 30, 2021 was $13,452.

Revenue Adjustments

Payments by CMS to health plans are determined via a competitive bidding process with CMS and are based upon the cost of care in a local market and the average utilization of services by the member enrolled. These payments are subject to periodic adjustments under CMS’ “risk adjustment model,” which compensates health plans based on the health severity and certain demographic factors of each individual member. Members diagnosed with certain conditions are paid at a higher monthly payment than members who are healthier. Under this risk adjustment model, CMS calculates the risk adjustment payment using diagnosis data from hospital inpatient, hospital outpatient, and physician treatment settings. The Company and health care providers collect, capture, and submit the necessary and available diagnosis data to CMS within prescribed deadlines. Both premium and capitation revenues (including Medicare Part D) are subject to adjustments under the risk adjustment model.

Throughout the year, we estimate risk adjustment payments based upon the diagnosis data submitted and expected to be submitted to CMS. Those estimated risk adjustment payments are recorded as an adjustment to premium and capitation revenue. Our risk adjustment data is also subject to review by the government, including audit by regulators.

Our recognized premium revenue for our Medicare Advantage Plans in California, North Carolina, Nevada, and Arizona are each subject to a minimum annual medical loss ratio (“MLR”) of 85%. The MLR represents medical costs as a percentage of premium revenue. The Code of Federal Regulations defines what constitutes medical costs and premium revenue, including certain additional expenses related to improving the quality of care provided, and the exclusion of certain taxes and fees, in each case as permitted or required by CMS and applicable regulatory requirements. If the minimum MLR is not met, we are required to remit a portion of the premiums back to the federal government. The amount remitted, if any, is recognized as an adjustment to premium revenues in the condensed consolidated statements of operations. The Company recorded an immaterial payable for the MLR as of June 30, 2022. There were no amounts payable for the MLR as of December 31, 2021.

Medicare Part D payments are also subject to a federal risk corridor program, which limits a health plan’s overall losses or profit if actual spending for basic Medicare Part D benefits is much higher or lower than what was anticipated. Risk corridor is recorded within premium revenue. The risk corridor provisions compare costs targeted in our bids or third-party payors’ bids to actual prescription drug costs, limited to actual costs that would have been incurred under the standard coverage as defined by CMS. Variances exceeding certain thresholds may result in CMS or third-party payors making additional payments to us or require us to refund a portion of the premiums we received. We estimate and recognize an adjustment to premiums revenue related to these provisions based upon pharmacy claims experience. We record a receivable or payable at the contract level and classify the amount as current or long-term in our condensed consolidated balance sheet based on the timing of expected settlement.

Variable consideration estimates related to DCE contract revenue are based on the most likely outcome method and that a significant reversal in the amount of cumulative revenue recognized would not occur.

Receivables, including risk adjusted premium due from the government or through third-party payors, pharmacy rebates, and other receivables, are shown net of allowances for credit losses and retroactive membership adjustments.

Property and Equipment—Net

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description		Estimated Service Lives (years)
Computer and equipment		5
Office equipment and furniture		5-7
Software		3-5
Leasehold improvements		15 (or lease term, if shorter)

Depreciation expense related to property and equipment used to service our members or at our clinics are included within medical expenses in the condensed consolidated statements of operations.

Medical Expenses

Medical expenses include claim payments, capitation payments, pharmacy costs net of rebates, allocations of certain centralized expenses, internal care delivery expenses and various other costs incurred to provide health insurance coverage and care to members, as well as estimates of future payments to hospitals and others for medical care and other supplemental benefits provided.

We have contracts with a network of hospitals, physicians, and other providers and compensate those providers and ancillary organizations based on contractual arrangements or CMS Medicare compensation guidelines. We pay these contracting providers either through fee-for-service arrangement in which the provider is paid negotiated rates for specific services provided or a capitation payment, which represent monthly contractual fees disbursed for each member regardless of medical services provided to the member. We are responsible for the entirety of the cost of health care services related to the member population, in addition to supplemental benefits provided by us to our seniors. We also record claims expenses related to our institutional and specialist care related to our DCE program with CMS as we act as the principal in the transaction.

Capitation-related expenses are recorded on an accrual basis during the coverage period. Expenses related to fee-for-service contracts are recorded in the period in which the related services are dispensed.

Pharmacy costs represent payments for members’ prescription drug benefits, net of rebates from drug manufacturers. Receivables for such pharmacy rebates are included in accounts receivable in the condensed consolidated balance sheets.

Medical Expenses Payable

Medical expenses payable includes estimates of our obligations for medical care services that have been rendered on behalf of our members and the members of the third-party payors, but for which claims have either not yet been received or processed, loss adjustment expense reserve for the expected costs of settling these claims, and for liabilities related to physician, hospital, and other medical cost disputes.

We develop estimates for medical expenses incurred but not yet paid (“IBNP”), which includes an estimate for claims incurred but not reported (“IBNR”) and a payable for adjudicated claims. IBNR is estimated using an actuarial process that is consistently applied and centrally controlled. Medical expenses payable also includes an estimate for the costs necessary to process unpaid claims at the end of each period. We estimate the IBNR liability using actuarial methods that are commonly used by health insurance actuaries and meet Actuarial Standards of Practice. These actuarial methods consider factors, such as cost trends and completion factors that are assessed based on historical data for payment patterns, product mix, seasonality, utilization of health care services, and other relevant factors. Each period, we re-examine previously established IBNR estimates based on actual claim submissions and other changes in facts and circumstances. As the IBNR estimates recorded in prior periods develop, we adjust the amount of the estimates and include the changes in estimates in medical expenses in the period in which the change is identified.

Actuarial Standards of Practice generally require that the IBNP estimates be adequate to cover obligations under moderately adverse conditions. Moderately adverse conditions are situations in which the actual claims are expected to be higher than the otherwise estimated value of such claims at the time of estimate. In many situations, the claims amount ultimately settled will be different than the estimate that satisfies the Actuarial Standards of Practice. We include in our IBNP an estimate for medical claims liability under moderately adverse conditions, which represents the risk of adverse deviation of the estimates in our actuarial method of reserving. We believe that medical expenses payable is adequate to cover future claims payments required. However, such estimates are based on knowledge of current events and anticipated future events. Therefore, the actual liability could differ materially from the amounts provided.

We reassess the profitability of contracts for providing coverage to members when current operating results or forecasts indicate probable future losses. A premium deficiency reserve is established in current operations to the extent that the sum of expected future costs, claim adjustment expenses, and maintenance costs exceed related future premiums under contracts without consideration of investment income. For purposes of determining premium deficiencies, contracts are grouped in a manner consistent with the method of acquiring, servicing, and measuring the profitability of such contracts. Losses recognized as a premium deficiency result in a beneficial effect in subsequent periods as operating losses under these contracts are charged to the liability previously established.

Part D Subsidies

We also receive advance payments each month from CMS related to Catastrophic Reinsurance, Coverage Gap Discount, and the Low-Income Member Cost Sharing Subsidy (“Subsidies”). Reinsurance subsidies represent funding from CMS for our portion of prescription drug costs, which exceed the member’s out-of-pocket threshold or the catastrophic coverage level. Low-income cost subsidies represent funding from CMS for all or a portion of the deductible, the coinsurance and co-payment amounts above the out-of-pocket threshold for low-income beneficiaries. Additionally, the Health Care Reform Law mandates consumer discounts of 75% on brand-name prescription drugs for Part D plan participants in the coverage gap. The majority of the discounts are funded by the pharmaceutical manufacturers, while we fund a smaller portion and administer the application of the total discount. These Subsidies represent cost reimbursements under the Medicare Part D program and are recorded as deposits or payables.

These Subsidies received in excess of, or less than, actual subsidized benefits paid are refundable to or recoverable from CMS through an annual reconciliation process following the end of the contract year.

Shared Risk Reserve Arrangements

We established a fund (also referred to as “a pool”) for risk and profit-sharing with various independent physician associations (“IPAs”). The pool enables us and our IPAs to share in the financial responsibility and/or upside associated with providing covered medical expenses to our members. The risk pool is based on a contractually agreed upon medical budget, typically based upon a percentage of revenue. If actual medical expenses are less than the budgeted amount, this results in a surplus. Conversely, if actual medical expenses are greater than the budgeted amount, this results in a deficit. We will distribute the surplus, or a portion thereof, to each IPA based upon contractual terms. Deficits are charged to shared risk providers’ risk pool as per the contractual term and evaluated for collectability at each reporting period.

We record risk-sharing receivables and payables on a gross basis on the condensed consolidated balance sheet. Throughout the year, we evaluate expected losses on risk-sharing receivables and record the resulting expected losses to the reserve. We systematically build and release reserves based on adequacy and its assessment of expected losses on a monthly basis. Credit loss associated with risk share

deficit receivables are recorded within medical expense in the condensed consolidated statements of operations. As of June 30, 2022 and December 31, 2021, we recorded a valuation allowance for substantially all of the risk-sharing receivable balance due to collection risk related to the balance. The risk-sharing payable is included within medical expenses payable on the condensed consolidated balance sheet.

Concentrations of Credit Risk

Financial instruments that potentially subject us to concentrations of credit risk consist primarily of cash deposits and restricted investments with financial institutions. Accounts at each financial institution are insured by the Federal Deposit Insurance Corporation (“FDIC”) up to certain limits. At June 30, 2022 and December 31, 2021, there was $451,766 and $465,824, respectively, in excess of FDIC-insured limits.

Equity-Based Compensation

Equity-based compensation expense is measured and recognized based on the grant date fair value of the awards. The grant date fair value of stock options is estimated using the Black-Scholes option pricing model. The grant date fair value of restricted stock units (“RSUs”) and restricted stock awards (“RSAs”) is estimated based on the fair value of our underlying common stock.

The Black-Scholes option pricing model requires the use of highly subjective assumptions, including the award’s expected term, the fair value of the underlying common stock, the expected volatility of the price of the common stock, risk-free interest rates, and the expected dividend yield of the common stock. The assumptions used to determine the fair value of the stock-based awards are management’s best estimates and involve inherent uncertainties and the application of judgment. The expected term represents the period the stock-based awards are expected to be outstanding. As we do not have sufficient historical experience for determining the expected term of the stock option awards granted, we utilize the simplified method available under U.S. GAAP. As we do not have a substantial trading history, volatility assumptions were developed using a combination of the Company's historical volatility and the historical volatilities of a set of peer companies, adjusted for debt-equity leverage. Equity-based compensation expense for awards with service-based vesting only is recognized on a graded vesting schedule over the requisite service period of the awards, which is generally four years. We account for forfeitures as they occur.

Equity-based compensation is recorded within selling, general and administrative expenses, and medical expenses based on the function of the applicable employee and non-employee.

Noncontrolling interest

Noncontrolling interest represents the portion of equity ownership in a subsidiary that is not attributable to Alignment Healthcare, Inc. The noncontrolling interest in a subsidiary is initially recognized at estimated fair value on April 1, 2021 and is presented within total equity in the Company's condensed consolidated balance sheets. There was no net loss attributable to the noncontrolling interest for the three and six months ended June 30, 2022 and 2021 as the Company was responsible for 100% of the net loss in the first year of operations of that subsidiary. During the three months ended June 30, 2022, the Company purchased the noncontrolling interest. Therefore, as of June 30, 2022, there was no longer a noncontrolling interest in a subsidiary.

Net Loss per Share

Net loss per share is calculated based on net loss attributable to Alignment Healthcare, Inc.'s shareholders. The following table sets forth the computation of basic and diluted net loss per share for the three and six months ended June 30, 2022 and 2021:


	Three Months Ended June 30,						Six Months Ended June 30,
	2022			2021			2022			2021
Numerator:
Net loss attributable to common stockholders	$	(11,580	)	$	(44,762	)	$	(52,397	)	$	(101,636	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		187,287,230			187,273,782			187,189,940			176,502,293
Less: Restricted shares of common stock		(6,024,590	)		(10,431,660	)		(7,114,926	)		(10,803,311	)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		181,262,640			176,842,122			180,075,014			165,698,982
Net loss per share:
Net loss per share - basic and diluted	$	(0.06	)	$	(0.25	)	$	(0.29	)	$	(0.61	)

Basic net loss per share is the same as diluted net loss per share for certain periods presented as the inclusion of all potentially dilutive shares would have been anti-dilutive.

In addition to the restricted shares of common stock, we also excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share as of June 30, 2022 and 2021:


	June 30,
	2022		2021
Stock options		10,657,366		11,117,724
Restricted stock units		4,152,692		1,637,450
Total		14,810,058		12,755,174

Recent Accounting Pronouncements Adopted

From time to time, new accounting pronouncements are issued by the Financial Accounting Standards Board ("FASB") or other standard setting bodies that are adopted by the Company as of the specified effective date. Unless otherwise discussed, the Company believes that the impact of recently issued standards that are not yet effective will not have a material impact on the Company’s consolidated financial position or results of operations upon adoption.

Fair Value

6 Months Ended

Jun. 30, 2022

Fair Value Disclosures [Abstract]

Fair Value

3. Fair Value

U.S. Treasury bills and certificate of deposits are reported at amortized costs which is equivalent to fair value. The following tables present the carrying value and fair value of these financial instruments as of June 30, 2022 and December 31, 2021:


	June 30, 2022
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
US Treasury bills	$	1,376	$	—	$	1,376	$	—
Certificate of deposits		1,173		—		1,173		—
Total	$	2,549	$	—	$	2,549	$	—


	December 31, 2021
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	1,375	$	—	$	1,375	$	—
Certificate of deposits		1,071		—		1,071		—
Total	$	2,446	$	—	$	2,446	$	—

The carrying value of long-term debt represents the outstanding balance, net of unamortized debt issuance costs. As of June 30, 2022, the fair value of our long-term debt approximates the carrying value. As of December 31, 2021, the carrying value and fair value of our long-term debt was $150,620 and $154,367, respectively.

The fair value of our long-term debt is classified as a Level 3 financial instrument because certain inputs used to determine its fair value are not observable. The fair value was estimated using a discounted cash flow (“DCF”) methodology. The discount rate used in the DCF model was estimated based on a synthetic credit rating analysis for us, and a screening of market data to identify market yields of instruments within the range of identified credit ratings and with otherwise similar features.

Our nonfinancial assets and liabilities, which include goodwill, intangible assets, property, and equipment, are not required to be measured at fair value on a recurring basis. However, on a periodic basis, or whenever events or changes in circumstances indicate that their carrying value may not be recoverable, we assess these assets for impairment. There was no such impairment as of June 30, 2022 and December 31, 2021.

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

Accounts Receivable, after Allowance for Credit Loss [Abstract]

Accounts Receivable

6 Months Ended

Jun. 30, 2022

Accounts Receivable

4. Accounts Receivable

Accounts receivable consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022			December 31, 2021
Government receivables	$	45,211		$	19,685
Pharmacy rebate receivables		48,856			34,376
Other receivables		4,137			4,562
Total accounts receivable		98,204			58,623
Allowance for credit losses		(177	)		(111	)
Accounts receivable, net	$	98,027		$	58,512

The allowance for expected credit losses for accounts receivable is based primarily on past collections experience relative to the length of time receivables are past due. However, when available evidence reasonably supports an assumption that future economic conditions will differ from current and historical payment collections, an adjustment is reflected in the allowance for expected credit losses. We record pharmacy rebates and other receivables based on contractual terms and expected collections and our estimation process for contractual allowances for such balances generally results in an allowance for balances outstanding greater than 90 days or if expected credit risks are known.

Receivables and any associated allowance are written off only when all collection attempts have failed and such amounts are determined unrecoverable. We regularly review the adequacy of these allowances based on a variety of factors, including age of the outstanding receivable and collection history. When circumstances related to specific collection patterns change, estimates of the recoverability of receivables are adjusted. Because substantially all of our receivable amounts are readily determinable and a large portion of our creditors are governmental authorities, our allowance for credit losses is insignificant.

We recorded credit loss related to accounts receivable of $58 and $38 during the three months ended June 30, 2022 and 2021, respectively, and $111 and $46 during the six months ended June 30, 2022 and 2021, respectively. The amounts were recorded in selling general, and administrative expenses in the condensed consolidated statements of operations.

Property and Equipment

6 Months Ended

Jun. 30, 2022

Property, Plant and Equipment [Abstract]

Property and Equipment

5. Property and Equipment

Property and equipment consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022			December 31, 2021
Computers and equipment	$	9,818		$	9,164
Office equipment and furniture		4,445			4,416
Software		108,329			98,031
Leasehold improvements		6,196			6,196
Construction in progress		779			753
Subtotal		129,567			118,560
Less accumulated depreciation		(96,162	)		(88,202	)
Property and equipment-net	$	33,405		$	30,358

Depreciation expense for the three months ended June 30, 2022 and 2021 was $4,133 and $3,875, respectively, of which $49 and $54, respectively, were included in medical expenses. Depreciation expense for the six months ended June 30, 2022 and 2021 was $8,029 and $7,582, respectively, of which $92 and $106, respectively, were included in medical expenses.

Goodwill and Intangible Assets

6 Months Ended

Jun. 30, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

6. Goodwill and Intangible Assets

Intangible assets consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	30,629	$	—		$	30,629	—
License (indefinite lived)		4,917		—			4,917	—
Plan member relationships		2,700		(2,448	)		252	9 years
Other		1,050		(599	)		451	2 - 10 years
	$	39,296	$	(3,047	)	$	36,249


	December 31, 2021
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	29,303	$	—		$	29,303	—
License (indefinite lived)		4,917		—			4,917	—
Plan member relationships		2,700		(2,311	)		389	9 years
Other		1,050		(543	)		507	2 - 10 years
	$	37,970	$	(2,854	)	$	35,116

Amortization expense relating to intangible assets for the three months ended June 30, 2022 and 2021, was $96 and $87, respectively. Amortization expense relating to intangible assets for the six months ended June 30, 2022 and 2021, was $193 and $169, respectively. Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2022	$	193
2023		226
2024		82
2025		60
2026		60
Thereafter		82
	$	703

There were no impairment charges related to goodwill and intangible assets for the three or six months ended June 30, 2022 and 2021.

Medical Expenses Payable

6 Months Ended

Jun. 30, 2022

Insurance [Abstract]

Medical Expenses Payable

7. Medical Expenses Payable

The following table is a detail of medical expenses payable as of June 30, 2022 and December 31, 2021:


	June 30, 2022		December 31, 2021
Claims incurred but not paid	$	84,667	$	77,073
Capitation payable, risk-sharing payable, and other		89,204		48,813
	$	173,871	$	125,886

Each period, we re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. As more complete claim information becomes available, we adjust the amount of the estimates and include the changes in estimates in claim costs in the period in which the change is identified. Substantially, all of the total claims paid by us are known and settled within the first year from the date of service, and substantially, all remaining claim amounts are paid within a three-year period.

The following table presents components of the change in medical expenses payable as of June 30, 2022 and 2021:


	June 30, 2022			June 30, 2021
Claims incurred but not paid - beginning balance	$	77,073		$	82,391
Incurred related to:
Current year		189,468			164,620
Prior years		(14,657	)		(3,016	)
Total incurred, net of reinsurance		174,811			161,604
Payments related to:
Current year		112,674			100,606
Prior years		54,543			66,015
Total payments, net of reinsurance		167,217			166,621
Claims incurred but not paid - ending balance		84,667			77,374
Capitation payable, risk-sharing payable, and other		89,204			59,104
Total medical expenses payable	$	173,871		$	136,478

In March 2020, the COVID-19 outbreak was declared a pandemic. The COVID-19 virus disproportionately impacts older adults, especially those with chronic illnesses, which describes many of the seniors we serve. For the six months ended June 30, 2021, we experienced higher claims costs due to COVID-19 related inpatient admissions. However, for the remainder of 2021 we saw a decline in COVID-related utilization (compared to the first half of the year) as vaccination rates improved across our senior population. The Delta and Omicron variants caused a rebound in COVID-related inpatient utilization during the second half of 2021 and first quarter of 2022, however, the increase in utilization did not reach first quarter of 2021 levels. While COVID had a less significant impact on the second quarter of 2022 medical expense relative to our first quarter of 2021 medical expense, we remain cautious of the potential impact of the COVID-19 in the future. The ultimate impact of COVID-19 to us and our financial condition is presently unknown, and we continue to monitor the impact of COVID-19 on our claims reserve estimate.

We re-examine previously established outstanding claims reserve estimates based on actual claims submissions and other changes in facts and circumstances. We recognized a favorable prior year development, excluding provision for adverse deviation, of $4,905 and $10,780 for the three and six months ended June 30, 2022, respectively. The favorable prior year development was primarily due to better than expected claims recoveries and actual claims expense being less than expected.

Long-Term Debt

6 Months Ended

Jun. 30, 2022

Debt Disclosure [Abstract]

Long-Term Debt

8. Long-Term Debt

Long-term debt is recorded at carrying value in the condensed consolidated balance sheets. The carrying value of long-term debt outstanding, net of unamortized debt issuance costs, consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022			December 31, 2021
Long-term debt	$	156,282		$	154,112
Less unamortized debt issuance costs		(2,351	)		(3,492	)
Long-term debt-net of amortization		153,931			150,620
Less current portion of long-term debt		—			—
Long-term debt - net of current portion	$	153,931		$	150,620

As of June 30, 2022, the total long-term debt balance of $156,282 included the principal balance of $135,000, the initial commitment fee of $6,750, and the payment-in-kind interest on the principal balance of $14,122. The payment-in-kind interest on the principal balance is also subject to the commitment fee which was $410 as of June 30, 2022. This amount was also included in the long-term debt balance.

Subsequent to the balance sheet date we extended the maturity of the term loan to September 30, 2023. There were no other changes to the terms of the term loan. This extension had no impact on the long-term debt balance.

In addition, the term loan includes financial covenants regarding the maintenance of minimum liquidity of $6,000 of operating cash, as defined, on a consolidated basis, at least $10,000 in its cash accounts on a daily basis and minimum consolidated revenue amounts. The term loan also contains certain nonfinancial covenants. As of June 30, 2022 and December 31, 2021, we were in compliance with all financial and nonfinancial covenants.

The term loan was entered into by our wholly owned subsidiary and is also guaranteed by certain of our wholly owned subsidiaries and collateralized by all unrestricted assets of our subsidiaries.

Income Taxes

6 Months Ended

Jun. 30, 2022

Income Tax Disclosure [Abstract]

Income Taxes

9. Income Taxes

There was no income tax expense for the three and six months ended June 30, 2022 and 2021.

We have cumulative net operating losses ("NOLs") as of June 30, 2022 and December 31, 2021. Given the history of losses, and after consideration for the risk associated with estimates of future taxable income, we established a full valuation allowance against net deferred tax assets at June 30, 2022 and 2021. As a result of the Tax Cuts and Jobs Act (“TCJA”), the federal NOLs generated in 2018 through 2020 will be carried forward indefinitely and are limited to an 80% deduction of taxable income. The 80% limitation is not applicable to NOLs generated before 2018. An exception to the TCJA federal NOL modification applies to nonlife insurance companies (e.g., Alignment Health Plan Inc.). Alignment Health Plan Inc.’s NOL treatment is the same as those NOLs generated in tax years 2017 and prior.

Additionally, an “ownership change” as defined under Section 382 of the Internal Revenue Code ("IRC"), could potentially limit the ability to utilize certain tax attributes including the Company’s substantial NOLs. Ownership change is generally defined as any significant change in ownership of more than 50% of its stock over a three-year testing period. If, as a result of current or future transactions involving our common stock, we undergo cumulative ownership changes which exceed 50% over the testing period, our ability to utilize our NOL carryforwards would be subject to additional limitations under IRC Section 382. We continue to monitor changes in ownership with respect to these income tax provisions.

Share-Based Payment Arrangement [Abstract]

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 21
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32857-109319

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-URI https://asc.fasb.org/extlink&oid=122134291&loc=d3e330215-122817

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 17
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32809-109319

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-URI https://asc.fasb.org/extlink&oid=122134291&loc=d3e330036-122817

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 10
-Section 50
-Paragraph 14
-URI https://asc.fasb.org/extlink&oid=121826272&loc=d3e32705-109319

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 270
-Section 50
-Paragraph 1
-URI https://asc.fasb.org/extlink&oid=6424409&loc=d3e44925-109338

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-URI https://asc.fasb.org/topic&trid=2144680

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 740
-SubTopic 30
-Section 50
-Paragraph 2
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=6424122&loc=d3e41874-109331

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-URI https://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

Equity-Based Compensation

6 Months Ended

Jun. 30, 2022

Equity-Based Compensation

10. Equity-Based Compensation

Equity Awards

Stock options

Stock options generally vest 25% annually over four years and generally expire 10 years from the date of the grant. The 2021 Equity Incentive Plan provides that stock option grants will be made with an exercise price at no less than the estimated fair value of common stock at the date of the grant.

The following is a summary of the stock option transactions as of and for the three and six months ended June 30, 2022:


	Stock Options Outstanding
(amounts in thousands, except shares and per share amount)	Shares Subject to Options Outstanding			Weighted- Average Exercise Price per Option		Weighted- Average Remaining Contractual Terms (in years)		Aggregate Intrinsic Value
Balances as of December 31, 2021		10,938,521		$	18.02	$	9.17	$	—
Options granted		1,269,156			8.95
Options exercised		—			—
Options forfeited / expired		(282,595	)		18.02
Balances as of March 31, 2022		11,925,082			17.05		9.03		2,896
Options granted		55,557			10.02
Options exercised		—			—
Options forfeited / expired		(1,323,273	)		17.94
Balances as of June 30, 2022		10,657,366			16.91	$	8.79		3,156
Vested and Exercisable as of June 30, 2022		2,474,774			18.01		8.67		—

Aggregate intrinsic value represents the difference between the exercise price of the option and the closing price of our common stock. For the three months ended June 30, 2022 and 2021 and six months ended June 30, 2022 and 2021 no options were exercised. The aggregate fair value of options granted during the three months ended June 30, 2022 and 2021 was $260 and $158, respectively. The aggregate fair value of options granted during the six months ended June 30, 2022 and 2021 was $5,295 and $84,140, respectively.

The weighted-average assumptions used to determine the fair value of stock options granted during the period were as follows:


	Six Months Ended June 30,
	2022
Expected term (in years)(1)		6.25
Expected volatility(2)	39.5% - 44.5%
Risk-free interest rate(3)	1.4% - 3.0%
Dividend yield(4)		0.0	%

(1)

An estimated expected life of 6.25 years before exercise was used based on the midpoint of the vesting date and the full contractual term (known as the simplified method). We do not have sufficient history of exercise for similar awards.

(2)

The expected volatility for new options granted was estimated based on a combination of the historical daily price changes of our common stock and our peer companies’ common stock over the most recent period equal to the expected term of the option, adjusted for debt-equity leverage.

(3)

The risk-free interest rate for period equal to the expected term of the option was based on the rate of treasury securities with the same term as the option as of the grant date.

(4)

An expected dividend yield of 0% was used because we have not historically paid dividends.

Restricted Stock Awards

Our outstanding RSAs that were granted following the IPO generally vest 25% annually over four years. RSAs converted from pre-IPO awards generally vest on the later of the fourth anniversary of the original vesting commencement date or 50% annually on the first and second anniversary of the IPO (see “Pre-IPO Equity” and "Modifications" sections below for details).

The following is a summary of RSA transactions for the three and six months ended June 30, 2022:


	Restricted Shares			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2021		8,613,780		$	10.32
Vested		(2,148,391	)		15.80
Forfeited		(163,064	)		3.69
Unvested and outstanding as of March 31, 2022		6,302,325			8.63
Vested		(129,053	)		0.42
Forfeited		(191,722	)		7.57
Unvested and outstanding as of June 30, 2022		5,981,550		$	8.84

Restricted Stock Units

Restricted stock units ("RSU") generally vest 25% annually over four years.

The following is a summary of RSU transactions for the three and six months ended June 30, 2022:


	Restricted Stock Units			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2021		1,662,282		$	18.54
Granted		3,064,412			9.15
Vested(1)		(406,176	)		18.54
Cancelled/forfeited		(36,288	)		18.01
Unvested and outstanding as of March 31, 2022		4,284,230			11.83
Granted		138,239			10.11
Vested		(48,976	)		18.00
Cancelled/forfeited		(220,801	)		14.93
Unvested and outstanding as of June 30, 2022		4,152,692		$	11.53

(1) Includes 22,668 shares that vested, but the issuance and delivery of the shares was deferred

Equity-Based Compensation Expense

Total equity-based compensation expense was presented on the statement of operations as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
(amounts in thousands)	2022		2021		2022		2021
Selling, general and administrative expenses	$	10,381	$	28,430	$	35,307	$	53,651
Medical expenses		1,718		2,457		4,839		9,023
Total equity-based compensation expense	$	12,099	$	30,887	$	40,146	$	62,674

As of June 30, 2022, there was $87,615 in unrecognized compensation expense related to all non-vested awards (RSAs, options and RSUs) that will be recognized over the weighted-average period of 1.79 years.

Regulatory Requirements and Restricted Funds

6 Months Ended

Jun. 30, 2022

Regulated Operations [Abstract]

Regulatory Requirements and Restricted Funds

11. Regulatory Requirements and Restricted Funds

Our health plans or risk-bearing entities are required to maintain minimum capital requirements prescribed by various regulatory authorities in each of the states in which it operates.

Risk-Based Capital Regulatory

The National Association of Insurance Commissioners has adopted rules, which, if implemented by the states, set minimum capitalization requirements for insurance companies, health maintenance organizations ("HMOs"), and other entities bearing risk for health care coverage. The requirements take the form of risk-based capital (“RBC”) rules, which may vary from state to state. Certain states in which our health plans or risk bearing entities operate in have adopted the RBC rules. Our health plans or risk-bearing entities were in compliance with the minimum capital requirements for all periods presented.

Tangible Net Equity

Our health plan in California is required to comply with the tangible net equity (“TNE”) requirements. The required amount is the larger of: (1) $1,000; (2) 2% of the first $150,000 of annualized premium revenue, plus 1% of annualized premium revenue in excess of $150,000; or (3) 8% of the first $150,000 of annualized health care expenditures, except for those paid on a capitated or managed hospital payment basis, plus 4% of the annualized health care expenditures in excess of $150,000, except those paid on a capitated or managed hospital payment basis, plus 4% of annualized hospital expenditures paid on a managed hospital payment basis. We were in compliance with the TNE requirement for all periods presented.

We have the ability to provide additional capital to each of our health plans or risk-bearing entities when necessary to ensure that the RBC and TNE requirements are met.

Certain states regulate the payment of dividends, loans, or other cash transfers from our regulated subsidiaries to our non-regulated subsidiaries and parent company. Such payments may require approval by state regulatory authorities and are limited based on certain financial criteria, such as the entity’s level of statutory income and statutory capital and surplus, or the entity’s level of tangible net equity or net worth, amongst other measures. These regulations vary by state. We were in compliance with the RBC and TNE requirements as of June 30, 2022 and December 31, 2021.

Restricted Assets

Pursuant to the regulations governing our subsidiaries, we maintain certain deposits required by the government authorities in the form of certificate of deposits and Treasury bills as protection in the event of insolvency. The use of funds from these investments is limited as required by regulation in the various states in which we operate, or as needed in the event of insolvency. Therefore, these deposits are reported within other assets on the condensed consolidated balance sheets.

We hold these assets until maturity, at which time these assets will renew or are invested in a similar type of investment instrument. Given the regulatory requirements, we expect to hold these investments for long-term. As a result, we do not expect the value of these investments to decline significantly due to a sudden change in market interest rates. These investments are carried at amortized cost, which approximates fair value.

Commitments and Contingencies

6 Months Ended

Jun. 30, 2022

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

12. Commitments and Contingencies

Legal Proceedings

We record a liability and accrue the costs for a loss when an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings. While the liability and accrued costs reflect our best estimate, the actual amounts may materially be different.

We may be involved in various litigation matters in the ordinary course of business. In the opinion of management, the ultimate resolution of legal proceedings is not expected to have a material adverse effect on the condensed consolidated financial statements. Amounts accrued for legal proceedings were not material as of June 30, 2022 and December 31, 2021.

Summary of Significant Accounting Policies (Policies)

6 Months Ended

Jun. 30, 2022

Accounting Policies [Abstract]

Basis of Presentation

primary beneficiary. All intercompany transactions have been eliminated in consolidation. Noncontrolling interest is presented within the equity section of the condensed consolidated balance sheets.

We have no components of other comprehensive income (loss), and accordingly, comprehensive income (loss) is the same as the net income (loss) for all periods presented.

Use of Estimates

Segments

Fair Value Measurements

Level 1 - Quoted prices in active markets for identical assets or liabilities

Level 2 - Other inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the asset or liability

Level 3 - Unobservable inputs that reflect management’s best estimate of what market participants would use in pricing the asset or liability at the measurement date

Revenue and Accounts Receivable

Earned premium revenue consisted of premium revenue and capitation revenue for the three and six months ended June 30, 2022 and 2021 were as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
	2022		2021		2022		2021
Premium	$	351,107	$	293,435	$	681,985	$	558,148
Capitation		15,073		15,304		29,487		17,591
	$	366,180	$	308,739	$	711,472	$	575,739

Revenue Adjustments

Property and Equipment—Net

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description		Estimated Service Lives (years)
Computer and equipment		5
Office equipment and furniture		5-7
Software		3-5
Leasehold improvements		15 (or lease term, if shorter)

Depreciation expense related to property and equipment used to service our members or at our clinics are included within medical expenses in the condensed consolidated statements of operations.

Medical Expenses and Medical Expenses Payable

Medical Expenses

Medical Expenses Payable

Part D Subsidies

Shared Risk Reserve Arrangements

Concentrations of Credit Risk

Equity-Based Compensation

Equity-based compensation is recorded within selling, general and administrative expenses, and medical expenses based on the function of the applicable employee and non-employee.

Noncontrolling Interest

Noncontrolling interest

Net Income (Loss) per Share

Net Loss per Share


	Three Months Ended June 30,						Six Months Ended June 30,
	2022			2021			2022			2021
Numerator:
Net loss attributable to common stockholders	$	(11,580	)	$	(44,762	)	$	(52,397	)	$	(101,636	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		187,287,230			187,273,782			187,189,940			176,502,293
Less: Restricted shares of common stock		(6,024,590	)		(10,431,660	)		(7,114,926	)		(10,803,311	)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		181,262,640			176,842,122			180,075,014			165,698,982
Net loss per share:
Net loss per share - basic and diluted	$	(0.06	)	$	(0.25	)	$	(0.29	)	$	(0.61	)

Basic net loss per share is the same as diluted net loss per share for certain periods presented as the inclusion of all potentially dilutive shares would have been anti-dilutive.


	June 30,
	2022		2021
Stock options		10,657,366		11,117,724
Restricted stock units		4,152,692		1,637,450
Total		14,810,058		12,755,174

Recent Accounting Pronouncements Adopted

Summary of Significant Accounting Policies (Tables)

6 Months Ended

Jun. 30, 2022

Accounting Policies [Abstract]

Schedule of Earned Revenue

Earned premium revenue consisted of premium revenue and capitation revenue for the three and six months ended June 30, 2022 and 2021 were as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
	2022		2021		2022		2021
Premium	$	351,107	$	293,435	$	681,985	$	558,148
Capitation		15,073		15,304		29,487		17,591
	$	366,180	$	308,739	$	711,472	$	575,739

Schedule of Property and Equipment Estimated Useful Lives

Depreciation expense is computed using the straight-line method generally based on the following estimated useful lives:


Description		Estimated Service Lives (years)
Computer and equipment		5
Office equipment and furniture		5-7
Software		3-5
Leasehold improvements		15 (or lease term, if shorter)

Schedule of Computation of Basic and Diluted Net Loss Per Share

The following table sets forth the computation of basic and diluted net loss per share for the three and six months ended June 30, 2022 and 2021:


	Three Months Ended June 30,						Six Months Ended June 30,
	2022			2021			2022			2021
Numerator:
Net loss attributable to common stockholders	$	(11,580	)	$	(44,762	)	$	(52,397	)	$	(101,636	)
Denominator:
Total weighted-average common shares outstanding - basic and diluted		187,287,230			187,273,782			187,189,940			176,502,293
Less: Restricted shares of common stock		(6,024,590	)		(10,431,660	)		(7,114,926	)		(10,803,311	)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted		181,262,640			176,842,122			180,075,014			165,698,982
Net loss per share:
Net loss per share - basic and diluted	$	(0.06	)	$	(0.25	)	$	(0.29	)	$	(0.61	)

Schedule of Computation of Diluted Net Loss Per Share


	June 30,
	2022		2021
Stock options		10,657,366		11,117,724
Restricted stock units		4,152,692		1,637,450
Total		14,810,058		12,755,174

Fair Value (Tables)

6 Months Ended

Jun. 30, 2022

Fair Value Disclosures [Abstract]

Schedule of Carrying Value and Fair Value of Financial Instruments


	June 30, 2022
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
US Treasury bills	$	1,376	$	—	$	1,376	$	—
Certificate of deposits		1,173		—		1,173		—
Total	$	2,549	$	—	$	2,549	$	—


	December 31, 2021
			Fair Value
	Carrying Value		Level 1		Level 2		Level 3
U.S. Treasury bills	$	1,375	$	—	$	1,375	$	—
Certificate of deposits		1,071		—		1,071		—
Total	$	2,446	$	—	$	2,446	$	—

Accounts Receivable (Tables)

6 Months Ended

Jun. 30, 2022

Accounts Receivable, after Allowance for Credit Loss [Abstract]

Schedule of Accounts Receivable

Accounts receivable consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022			December 31, 2021
Government receivables	$	45,211		$	19,685
Pharmacy rebate receivables		48,856			34,376
Other receivables		4,137			4,562
Total accounts receivable		98,204			58,623
Allowance for credit losses		(177	)		(111	)
Accounts receivable, net	$	98,027		$	58,512

Property and Equipment (Tables)

6 Months Ended

Jun. 30, 2022

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022			December 31, 2021
Computers and equipment	$	9,818		$	9,164
Office equipment and furniture		4,445			4,416
Software		108,329			98,031
Leasehold improvements		6,196			6,196
Construction in progress		779			753
Subtotal		129,567			118,560
Less accumulated depreciation		(96,162	)		(88,202	)
Property and equipment-net	$	33,405		$	30,358

Goodwill and Intangible Assets (Tables)

6 Months Ended

Jun. 30, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets

Intangible assets consisted of the following as of June 30, 2022 and December 31, 2021:


	June 30, 2022
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	30,629	$	—		$	30,629	—
License (indefinite lived)		4,917		—			4,917	—
Plan member relationships		2,700		(2,448	)		252	9 years
Other		1,050		(599	)		451	2 - 10 years
	$	39,296	$	(3,047	)	$	36,249


	December 31, 2021
	Gross Carrying Value		Accumulated Amortization			Net Carrying Value		Weighted Average Life
Goodwill	$	29,303	$	—		$	29,303	—
License (indefinite lived)		4,917		—			4,917	—
Plan member relationships		2,700		(2,311	)		389	9 years
Other		1,050		(543	)		507	2 - 10 years
	$	37,970	$	(2,854	)	$	35,116

Schedule of Estimated Amortization Expense Related to Intangible Assets

Estimated amortization expense relating to intangible assets for each of the next five years ending December 31, is as follows:


Remainder of 2022	$	193
2023		226
2024		82
2025		60
2026		60
Thereafter		82
	$	703

Medical Expenses Payable (Tables)

6 Months Ended

Jun. 30, 2022

Insurance [Abstract]

Schedule of Medical Expenses Payable

The following table is a detail of medical expenses payable as of June 30, 2022 and December 31, 2021:


	June 30, 2022		December 31, 2021
Claims incurred but not paid	$	84,667	$	77,073
Capitation payable, risk-sharing payable, and other		89,204		48,813
	$	173,871	$	125,886

Components of Change in Medical Expenses Payable

The following table presents components of the change in medical expenses payable as of June 30, 2022 and 2021:


	June 30, 2022			June 30, 2021
Claims incurred but not paid - beginning balance	$	77,073		$	82,391
Incurred related to:
Current year		189,468			164,620
Prior years		(14,657	)		(3,016	)
Total incurred, net of reinsurance		174,811			161,604
Payments related to:
Current year		112,674			100,606
Prior years		54,543			66,015
Total payments, net of reinsurance		167,217			166,621
Claims incurred but not paid - ending balance		84,667			77,374
Capitation payable, risk-sharing payable, and other		89,204			59,104
Total medical expenses payable	$	173,871		$	136,478

Long-Term Debt (Tables)

6 Months Ended

Jun. 30, 2022

Debt Disclosure [Abstract]

Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs


	June 30, 2022			December 31, 2021
Long-term debt	$	156,282		$	154,112
Less unamortized debt issuance costs		(2,351	)		(3,492	)
Long-term debt-net of amortization		153,931			150,620
Less current portion of long-term debt		—			—
Long-term debt - net of current portion	$	153,931		$	150,620

Equity-Based Compensation (Tables)

6 Months Ended

Jun. 30, 2022

Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]

Summary of Stock Option Activity Transactions

The following is a summary of the stock option transactions as of and for the three and six months ended June 30, 2022:


	Stock Options Outstanding
(amounts in thousands, except shares and per share amount)	Shares Subject to Options Outstanding			Weighted- Average Exercise Price per Option		Weighted- Average Remaining Contractual Terms (in years)		Aggregate Intrinsic Value
Balances as of December 31, 2021		10,938,521		$	18.02	$	9.17	$	—
Options granted		1,269,156			8.95
Options exercised		—			—
Options forfeited / expired		(282,595	)		18.02
Balances as of March 31, 2022		11,925,082			17.05		9.03		2,896
Options granted		55,557			10.02
Options exercised		—			—
Options forfeited / expired		(1,323,273	)		17.94
Balances as of June 30, 2022		10,657,366			16.91	$	8.79		3,156
Vested and Exercisable as of June 30, 2022		2,474,774			18.01		8.67		—

Schedule of Equity-Based Compensation Expense

Total equity-based compensation expense was presented on the statement of operations as follows:


	Three Months Ended June 30,				Six Months Ended June 30,
(amounts in thousands)	2022		2021		2022		2021
Selling, general and administrative expenses	$	10,381	$	28,430	$	35,307	$	53,651
Medical expenses		1,718		2,457		4,839		9,023
Total equity-based compensation expense	$	12,099	$	30,887	$	40,146	$	62,674

Stock Options

Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]

Schedule of Weighted-Average Assumptions Used to Determine the Fair value of Stock Options Granted

The weighted-average assumptions used to determine the fair value of stock options granted during the period were as follows:


	Six Months Ended June 30,
	2022
Expected term (in years)(1)		6.25
Expected volatility(2)	39.5% - 44.5%
Risk-free interest rate(3)	1.4% - 3.0%
Dividend yield(4)		0.0	%

(1)

(2)

(3)

The risk-free interest rate for period equal to the expected term of the option was based on the rate of treasury securities with the same term as the option as of the grant date.

(4)

An expected dividend yield of 0% was used because we have not historically paid dividends.

Restricted Stock Awards

Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]

Summary of Restricted Stock Transactions

The following is a summary of RSA transactions for the three and six months ended June 30, 2022:


	Restricted Shares			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2021		8,613,780		$	10.32
Vested		(2,148,391	)		15.80
Forfeited		(163,064	)		3.69
Unvested and outstanding as of March 31, 2022		6,302,325			8.63
Vested		(129,053	)		0.42
Forfeited		(191,722	)		7.57
Unvested and outstanding as of June 30, 2022		5,981,550		$	8.84

Restricted Stock Units

Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]

Summary of Restricted Stock Transactions

The following is a summary of RSU transactions for the three and six months ended June 30, 2022:


	Restricted Stock Units			Weighted-Average Grant Date Fair Value
Unvested and outstanding as of December 31, 2021		1,662,282		$	18.54
Granted		3,064,412			9.15
Vested(1)		(406,176	)		18.54
Cancelled/forfeited		(36,288	)		18.01
Unvested and outstanding as of March 31, 2022		4,284,230			11.83
Granted		138,239			10.11
Vested		(48,976	)		18.00
Cancelled/forfeited		(220,801	)		14.93
Unvested and outstanding as of June 30, 2022		4,152,692		$	11.53

(1) Includes 22,668 shares that vested, but the issuance and delivery of the shares was deferred

Organization - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands					6 Months Ended
	Nov. 18, 2021	May 17, 2021	Mar. 30, 2021	Mar. 25, 2021	Jun. 30, 2021	Jun. 30, 2022	Dec. 31, 2021
Subsidiary Sale Of Stock [Line Items]
Issuance of common stock, net of issuance costs, Shares	9,200,000
Common stock, par value						$ 0.001	$ 0.001
Proceeds from sale of stock, net	$ 0
Issuance of common stock, net of issuance costs	$ 1,045				$ 361,589
IPO
Subsidiary Sale Of Stock [Line Items]
Issuance of common stock, net of issuance costs, Shares			21,700,000	27,200,000
Common stock split		1 to 260 common stock split
Common stock, par value		$ 0.001
Number of shares sold (in shares)			5,500,000
Stock price (in dollars per share)			$ 18.00		$ 18.00
Proceeds from sale of stock, net			$ 361,589
Underwriting discounts and commissions			24,389
Deferred offering costs			$ 4,622

Summary of Significant Accounting Policies - Additional Information (Details)	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2022 USD ($)	Jun. 30, 2021 USD ($)	Jun. 30, 2022 USD ($) Entity Segment	Jun. 30, 2021 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2018 USD ($)
Accounting Policies [Line Items]
Number of consolidated variable interest entities \| Entity			4
Additional Paid in Capital, Common Stock						$ 7,837,000
Number of reporting segments \| Segment			1
Number of operating segments \| Segment			1
Assets, fair value disclosure	$ 2,549,000		$ 2,549,000		$ 2,446,000
Net loss attributable to noncontrolling interest	0	$ 0	0	$ 0
Federal deposit insurance corporation premium expense			$ 451,766,000		465,824,000
Award requisite service period			4 years
Revenues	366,180,000	308,739,000	$ 711,472,000	575,739,000
Level 3
Accounting Policies [Line Items]
Assets, fair value disclosure	0		0		0
Liabilities, fair value disclosure	0		0		0
Directly from CMS
Accounting Policies [Line Items]
Revenues	$ 13,110,000	$ 13,452,000	$ 25,412,000	$ 13,452,000
Medicare Advantage Plan
Accounting Policies [Line Items]
Minimum loss ratio amounts payable					$ 0
Percentage of consumer discounts on brand name			75.00%
Medicare Advantage Plan \| Minimum
Accounting Policies [Line Items]
Loss ratio			85.00%

Summary of Significant Accounting Policies - Schedule of Earned Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Disaggregation of Revenue [Line Items]
Total revenues	$ 366,180	$ 308,739	$ 711,472	$ 575,739
Premium
Disaggregation of Revenue [Line Items]
Total revenues	351,107	293,435	681,985	558,148
Capitation
Disaggregation of Revenue [Line Items]
Total revenues	$ 15,073	$ 15,304	$ 29,487	$ 17,591

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI https://asc.fasb.org/extlink&oid=126901519&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI https://asc.fasb.org/extlink&oid=126920106&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI https://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Summary of Significant Accounting Policies - Schedule of Property and Equipment Estimated Useful Lives (Details)	6 Months Ended
	Jun. 30, 2022
Computer and equipment
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Office equipment and furniture \| Minimum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Office equipment and furniture \| Maximum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	7 years
Software \| Minimum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	3 years
Software \| Maximum
Property Plant and Equipment [Line Items]
Estimated service lives (years)	5 years
Leasehold improvements
Property Plant and Equipment [Line Items]
Estimated service lives (years)	15 (or lease term, if shorter)

Summary of Significant Accounting Policies - Schedule of Computation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Numerator:
Net loss attributable to common stockholders	$ (11,580)	$ (44,762)	$ (52,397)	$ (101,636)
Denominator:
Weighted Average Number of Shares Outstanding, Basic and Diluted	187,287,230	187,273,782	187,189,940	176,502,293
Less: Restricted shares of common stock	(6,024,590)	(10,431,660)	(7,114,926)	(10,803,311)
Total weighted-average common shares outstanding, net of restricted shares of common stock - basic and diluted	181,262,640	176,842,122	180,075,014	165,698,982
Earnings Per Share, Basic [Abstract]
Net loss per share - basic	$ (0.06)	$ (0.25)	$ (0.29)	$ (0.61)
Earnings Per Share, Diluted [Abstract]
Net loss per share - diluted	$ (0.06)	$ (0.25)	$ (0.29)	$ (0.61)

Summary of Significant Accounting Policies - Schedule of Computation of Dilured Net Loss Per Share (Details) - shares	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Weighted Average Number of Shares Outstanding, Diluted	14,810,058	12,755,174
Restricted Stock Units
Weighted Average Number of Shares Outstanding, Diluted	4,152,692	1,637,450
Stock Option
Weighted Average Number of Shares Outstanding, Diluted	10,657,366	11,117,724

Fair Value - Schedule of Carrying Value and Fair Value of Financial Instruments (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 2,549	$ 2,446
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	2,549	2,446
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
US Treasury Bills
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,376	1,375
US Treasury Bills \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
US Treasury Bills \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,376	1,375
US Treasury Bills \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
Certificate of Deposits
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,173	1,071
Certificate of Deposits \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	0	0
Certificate of Deposits \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	1,173	1,071
Certificate of Deposits \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Assets, fair value disclosure	$ 0	$ 0

Fair Value - Additional Information (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2022	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Long term debt carrying value	$ 153,931	$ 150,620
Long-term debt fair value		154,367
Asset Impairment Charges	$ 0	$ 0

Amount, excluding unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

Accounts Receivable - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Government receivables	$ 45,211	$ 19,685
Pharmacy rebate receivables	48,856	34,376
Other receivables	4,137	4,562
Total accounts receivable	98,204	58,623
Allowance for credit losses	(177)	(111)
Accounts receivable, net	$ 98,027	$ 58,512

Accounts Receivable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Mar. 31, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Accounts Receivable, after Allowance for Credit Loss [Abstract]
Credit loss related to accounts receivable	$ 58	$ 38	$ 111	$ 46

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Property Plant and Equipment [Line Items]
Subtotal	$ 129,567	$ 118,560
Less accumulated depreciation	(96,162)	(88,202)
Property and equipment-net	33,405	30,358
Computer and equipment
Property Plant and Equipment [Line Items]
Subtotal	9,818	9,164
Office equipment and furniture
Property Plant and Equipment [Line Items]
Subtotal	4,445	4,416
Software
Property Plant and Equipment [Line Items]
Subtotal	108,329	98,031
Leasehold improvements
Property Plant and Equipment [Line Items]
Subtotal	6,196	6,196
Construction in progress
Property Plant and Equipment [Line Items]
Subtotal	$ 779	$ 753

Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Property Plant and Equipment [Line Items]
Depreciation expense	$ 4,133	$ 3,875	$ 8,029	$ 7,582
Medical Expenses
Property Plant and Equipment [Line Items]
Depreciation expense	$ 49	$ 54	$ 92	$ 106

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2022	Dec. 31, 2021
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 39,296	$ 37,970
Accumulated Amortization	3,047	(2,854)
Finite Lived Intangible Assets Net	$ 36,249	$ 35,116
Weighted Average Life
Goodwill, Gross Carrying Value	$ 30,629	$ 29,303
Goodwill, Accumulated Amortization	0	0
Goodwill, Net Carrying Value	30,629	29,303
License (indefinite lived)
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	4,917	4,917
Accumulated Amortization	0	0
Finite Lived Intangible Assets Net	$ 4,917	$ 4,917
Weighted Average Life
Plan Member Relationship
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 2,700	$ 2,700
Accumulated Amortization	2,448	(2,311)
Finite Lived Intangible Assets Net	$ 252	$ 389
Weighted Average Life	9 years	9 years
Other
Indefinite Lived Intangible Assets By Major Class [Line Items]
Gross Carrying Value	$ 1,050	$ 1,050
Accumulated Amortization	599	(543)
Finite Lived Intangible Assets Net	$ 451	$ 507
Other \| Minimum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Weighted Average Life	2 years	2 years
Other \| Maximum
Indefinite Lived Intangible Assets By Major Class [Line Items]
Weighted Average Life	10 years	10 years

Goodwill and Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
Indefinite-Lived Intangible Assets [Line Items]
Intangible assets	$ 36,249		$ 36,249		$ 35,116
Amortization expense	96	$ 87	193	$ 169
Impairment charges	$ 0	$ 0	$ 0	$ 0

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense Related to Intangible Assets (Details) $ in Thousands	Jun. 30, 2022 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2022	$ 193
2023	226
2024	82
2025	60
2026	60
Thereafter	82
Estimated Amortization Expense Related to Intangible Assets, Total	$ 703

Medical Expenses Payable - Schedule of Medical Expenses Payable (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021	Jun. 30, 2021	Dec. 31, 2020
Insurance [Abstract]
Claims incurred but not paid	$ 84,667	$ 77,073	$ 77,374	$ 82,391
Capitation payable, risk-sharing payable, and other	89,204	48,813	59,104
Total medical expenses payable	$ 173,871	$ 125,886	$ 136,478

Medical Expenses Payable - Components of Change in Medical Expenses Payable (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Dec. 31, 2021
Insurance [Abstract]
Claims incurred but not paid - beginning balance	$ 77,073	$ 82,391
Incurred related to:
Current year	189,468	164,620
Prior years	(14,657)	(3,016)
Total incurred, net of reinsurance	174,811	161,604
Payments related to:
Current year	112,674	100,606
Prior years	54,543	66,015
Total payments, net of reinsurance	167,217	166,621
Claims incurred but not paid - ending balance	84,667	77,374
Capitation payable, risk-sharing payable, and other	89,204	59,104	$ 48,813
Total medical expenses payable	$ 173,871	$ 136,478	$ 125,886

Medical Expenses Payable - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2022
Insurance [Abstract]
Claims reserve estimates, excluding provision	$ 4,905	$ 10,780
Remaining claim amounts payment period		3 years

Long-Term Debt - Schedule of Long-Term Debt Outstanding, Net of Unamortized Debt Issuance Costs (Details) - USD ($) $ in Thousands	Jun. 30, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
Long-term debt	$ 156,282	$ 154,112
Less unamortized debt issuance costs	(2,351)	(3,492)
Long-term debt-net of amortization	153,931	150,620
Less current potion of long-term debt	0	0
Long-term debt - net of current portion	$ 153,931	$ 150,620

Amount, excluding unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

Long-Term Debt - Additional Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Long-term debt	$ 156,282	$ 154,112
Debt instrument principal outstanding	135,000
Commitment fee	6,750
Payment in kind interest on principal balance	14,122
Payment-in-kind interest on the principal balance, commitment fee.	$ 410
Term Loan
Debt Instrument [Line Items]
Term loan facility maturity date	Sep. 30, 2023
Minimum liquidity balance on operating cash	$ 6,000
Minimum liquidity balance on operating cash in cash account on daily basis	$ 10,000
Debt description	The term loan was entered into by our wholly owned subsidiary and is also guaranteed by certain of our wholly owned subsidiaries and collateralized by all unrestricted assets of our subsidiaries

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021	Jun. 30, 2022	Jun. 30, 2021
Operating Loss Carryforwards [Line Items]
Income tax expense	$ 0	$ 0	$ 0	$ 0
Domestic Tax Authority
Operating Loss Carryforwards [Line Items]
Taxable income deduction limit percentage			80.00%

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.