Item 1. Business
Item
1. Business
Overview
CareCloud,
Inc., (together with its consolidated subsidiaries, “CareCloud”, the “Company,” “we,” “us”
and/or “our”) is a leading provider of technology-enabled services and solutions that redefine the healthcare revenue cycle
management process. We provide technology-enabled revenue cycle management and a full suite of proprietary cloud-based solutions to healthcare
providers, from small practices to enterprise medical groups, hospitals, and health systems throughout the United States. Healthcare
organizations today operate in highly complex and regulated environments. Our suite of technology-enabled solutions helps our clients
increase financial and operational performance, streamline clinical workflows, and improve the patient experience.
Our
portfolio of proprietary software and business services includes: technology-enabled business solutions that maximize revenue cycle management
and create efficiencies through platform agnostic AI-driven applications; cloud-based software that helps providers manage their practice
and patient engagement while leveraging analytics to improve provider performance; digital health services to address value-based care
and enable the delivery of remote patient care; healthcare IT professional services & staffing to address physician burnout, staffing
shortages and leverage consulting expertise to transition into the next generation of healthcare; and, medical practice management services
to assist medical providers with operating models and the tools needed to run their practice.
Our
high-value business services, such as revenue cycle management, are often paired with our cloud-based software, premiere healthcare consulting
and implementation services, and on-demand workforce staffing capabilities for high-performance medical groups and health systems nationwide.
Our
technology-enabled business solutions can be categorized as follows:
● Technology-enabled
revenue cycle management:
○ Revenue
Cycle Management (“RCM”) services including end-to-end medical billing, eligibility,
analytics, and related services, all of which can be provided utilizing our technology platform
and robotic process automation tools or leveraging a third-party system;
○ Medical
coding and credentialing services to improve provider collections, back-end cost containment,
and drive total revenue realization for our healthcare clients; and
○ Healthcare
claims clearinghouse which enables our clients to electronically scrub and submit claims
and process payments from insurance companies.
● Cloud-based
software :
○ Electronic
Health Records, which are easy to use and sometimes integrated with our business services,
and enable our healthcare provider clients to deliver better patient care, streamline their
clinical workflows, decrease documentation errors, and potentially qualify for government
incentives;
○ Practice
Management (“PM”) software and related capabilities, which support our clients’
day-to-day business operations and financial workflows, including automated insurance eligibility
software, a robust billing and claims rules engine, and other automated tools designed to
maximize reimbursement;
○ Artificial
intelligence (“AI”):
● CareCloud
cirrusAI is designed to serve as a digital healthcare assistant, helping to enhance clinical
decision-making, streamline workflows, reduce administrative burdens, optimize revenue management,
and promote patient-centered care. The functions include:
● AI-Powered
Clinical Decision Support: CareCloud cirrusAI Guide automates clinical data input, and assists
clinicians in workflow tasks, providing real-time, evidence-based recommendations and personalized
suggestions via Vertex AI’s generative AI tools for providers to consider. This innovation
can lead to enhanced diagnosis accuracy and treatment planning.
● AI-Powered
Virtual Support Assistant: CareCloud cirrusAI Chat facilitates natural language conversations
with practice staff members, offering valuable assistance in navigating CareCloud Electronic
Health Records (“EHR”) workflows. This tool streamlines post-training and onboarding
for new staff, reducing response times and providing real-time assistance, ultimately saving
time.
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● AI-Driven
Appeals: CareCloud cirrusAI Appeals generates customized appeal letters by analyzing patient
claim details, the appeal’s reason, and the specific payer involved for healthcare
workers to review, edit, and send. This functionality supports CareCloud’s RCM teams
in optimizing providers’ RCM and securing proper reimbursement.
● CareCloud
cirrusAI integrates with CareCloud’s EHR solution, talkEHR, making it easily accessible
to providers of all sizes.
○ Patient
Experience Management (“PXM”) solutions designed to transform interactions between
patients and their clinicians, including smartphone applications that assist patients and
healthcare providers in the provision of healthcare services, contactless digital check-in
solutions, messaging, and online appointment scheduling tools;
○ Business
Intelligence (“BI”) and healthcare analytics platforms that allow our clients
to derive actionable insights from their vast amount of data; and
○ Customized
applications, interfaces, and a variety of other technology solutions that support our healthcare
clients.
● Digital
health:
○ Chronic
care management is a program that supports care for patients with chronic conditions by certified
care managers that operate under the supervision of the patient’s regular physician;
○ Remote
patient monitoring enables patient data collected outside the clinical setting through remote
devices to be fed into their provider’s EHR to enable proactive patient care; and
○ Telemedicine
solutions which allow healthcare providers to conduct remote patient visits and extend the
timely delivery of care to patients unable to travel to a provider’s office.
● Healthcare
IT professional services & staffing:
○ Professional
services consisting of a broad range of consulting services including full software implementations
and activation, revenue cycle optimization, data analytic services, and educational training
services;
○ Strategic
advisory services to manage system evaluations and selection, provide interim management,
and operational assessments; and
○ Workforce
augmentation and on-demand staffing to support our clients as they expand their businesses,
seek highly trained personnel, or struggle to address staffing shortages.
Our
medical practice management solutions include:
● Medical
practice management:
○ Medical
practice management services are provided to medical practices. In this service model, we
provide the medical practice with appropriate facilities, equipment, supplies, support services,
nurses and administrative support staff. We also provide management, bill-paying and financial
advisory services.
The
modernization of the healthcare industry, along with the increased adoption of value-based care models, is transforming nearly every
aspect of a healthcare organization from policy to providers; clinical care to member services, devices to data, and ultimately the quality
of the patient’s experience as a healthcare consumer.
Our
solutions enable clients to increase financial and operational performance, streamline clinical workflows, get better insight through
data, and make better business and clinical decisions, resulting in improvement in patient care and collections while reducing administrative
burdens and operating costs.
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We
create elegant, user-friendly applications that solve many of the challenges facing healthcare organizations. We partner with organizations
to develop customized, best-in-class solutions to solve their specific challenges while ensuring they also meet future regulatory and
organizational requirements and market demands.
Market
Overview
In
June 2023, Centers for Medicare & Medicaid Services (“CMS”) 1 reported that over 2022-2031 the average National
Health Expenditures (“NHE”) growth (5.4%) is projected to outpace that of average Gross Domestic Product (“GDP”)
growth (4.6%) resulting in an increase in the health spending share of GDP from 18.3% in 2021 to 19.6% in 2031.
Additionally,
analysts from The Brainy Research have estimated the U.S. Healthcare IT industry market to be approximately $105 billion in 2022 and
is projected to reach $370.5 billion by 2032, growing at a 13.4% compound annual growth rate (“CAGR”). 2 Its largest
sub-segment, RCM, is reported to be nearly $140 billion in 2022 and is estimated to grow at a 10% CAGR through 2030 according to Grand
View Research. 3 The U.S. EHR market is expected to be valued at $40 billion by 2030 with a CAGR of 12.5% from 2022 to 2030. 4
The Telehealth market is estimated to be approximately $30 billion in 2022 with a CAGR of 23% from 2023 to 2030. 5
Our
Market Opportunity
Considering
the evolving needs of our clients and the market, we believe we continue to be uniquely positioned to provide tremendous value and support
for our clients. We believe there are dynamics at play that are significantly increasing the market need for our products and services.
These market dynamics present opportunities for us to innovate and focus on impacting the day-to-day challenges our clients face as they
work to provide excellent patient care, all while managing and expanding their businesses.
Medical
practices and health systems alike are transitioning to increasingly complex reimbursement delivery models. As an example, the industry
has been gradually shifting from fee-for-service payments to value-based/clinical outcomes-based care payments. This transition comes
in a multitude of forms including reimbursement models associated with quality incentive programs, capitation payments models, bundled
payments, and at-risk payer contracts.
There
are continuing legislative and regulatory reform efforts, as well as growing compliance requirements mandated by the federal government
and other governmental agencies. This ever-evolving regulatory landscape increases the pressure placed on healthcare organizations to
stay abreast of these changes and to remain in compliance. The complexities associated with emerging reimbursement models and continued
government regulations present opportunities for us as healthcare organizations seek out partners that offer a broad range of software
and services to help meet their needs.
Our
clients also have to account for the rising cost of health insurance, changes in health benefit plan design, and the impact that these
factors have had on the increase in patient consumerism. Patients are seeking lower cost care in response to insurance carriers shifting
more of the cost burden onto patients, causing healthcare organizations to reconsider the full patient experience. Healthcare providers
now need to think more deeply about patient expectations. This is especially true as COVID-19 has reshaped the sector and accelerated
its digital transformation.
Further
compounding the burden of rising health insurance cost is the ongoing shift in patient demographics. As the national population ages
into Medicare eligibility, the reimbursement received for procedures and services provided to these patients decreases. Medicaid is now
the largest insurance product in the country and continues to grow. Reimbursements overall are not increasing at the same rate as costs,
driving providers and practices to search for increased efficiencies and savings wherever possible.
Strategic-thinking
healthcare organizations across the country are aggressively addressing these new realities and are finding opportunities for growth
and expansion. We see medical groups across the country and within all specialties and market segments, growing through consolidation
and investing in their businesses at an accelerated pace. This is also leading clients to focus on delivering emerging and disruptive
care delivery settings. Much of this change is driving executives and leaders to assess their IT and data strategy and reevaluate their
adoption of next generation healthcare solutions. The healthcare industry has seen tremendous change over the last three years, with
COVID-19 ushering in a new era of digital health. Our study of the evolving needs of our clients leads us to believe that there will
be an increasing need for our services and products and emerging needs for the products and services that we are already developing.
1
CMS – National Health Expenditure Historical
2
The Brainy Research – US Healthcare IT Market
3
U.S. Revenue Cycle Management Market Size Report, 2030 (grandviewresearch.com)
4
US Electronic Health Record Market Set to Surge to $39.993 Billion by 2030 with Notable CAGR of 12.5% (yahoo.com)
5
Healthcare IT Market in US Size, Share, Trends | Report 2030 (alliedmarketresearch.com)
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These
trends will fuel growth over the next several years. In order for healthcare organizations to continue to succeed, these new realities
require robust solutions and careful execution. Legacy tools that once powered these healthcare organizations are insufficient to support
their growth and long-term strategies. Our solutions facilitate the transition needed by these organizations to adopt the next generation
of healthcare solutions to drive their future growth. Our expansive product and services portfolio enables us to displace competitors
and gain market share across a vast array of specialties, care settings and customer segments across the country.
Our
Business Strategy
The
Company is focused on reducing costs, returning to profitability and generating positive free cash flow in order to resume paying the
Preferred Stock dividends. CareCloud is a market leading provider of technology-enabled and integrated end-to-end Software-as-a-Service
(“SaaS”) solutions that help our clients with the business of medicine. Our mission is to redefine the next generation of
technology-enabled revenue cycle solutions. To that end, we invest significant resources toward improving our current offerings and building
new solutions that help transform our clients’ organizations with next generation technology. We expect to have increased software
capabilities and offer additional complementary business services that will address the needs of the ever-changing, dynamic market conditions
of the U.S. healthcare space.
To
achieve our objective and mission, we employ the following strategies:
Providing
comprehensive next generation RCM solutions to medical practices and hospitals. We believe that healthcare providers are in need
of an integrated, end-to-end solution and a flexible service delivery model to manage the different facets of their businesses, from
care delivery software, to claim submission, financial reporting, and data analytics.
Enhancing
our solutions. We intend to continue to enhance our solutions with new functionality and features leveraging our own teams, partnerships,
and acquisitions. We will continue to dedicate resources to research and development to bolster our existing applications and drive new
opportunities for innovation on behalf of our clients.
Expanding
into new categories/specialties/markets. We are focused on always reassessing the market landscape, seeking new opportunities
to meet the needs of the clients in our addressable market with our products and services. This means developing new and exciting technologies,
launching new services, entering new specialties that can leverage our solutions and enabling growth for our clients or expanding into
adjacent markets that we may not serve today.
Relentlessly
driving organic growth to expand our client base. We believe the market for our expansive value proposition is underserved, and
we will continue to make investments to create awareness of our brand, optimize our sales and implementation lifecycles, and capture
greater market share. We are investing in our sales and marketing activities, partners, and products to expand our client footprint.
Extending
our relationships with existing clients. Our CareCloud Wellness offerings have been well-received allowing us to generate additional
recurring revenue from existing clients. We intend to increase the number of SaaS subscription licenses and services purchased by our
current clients as they use our solutions. We are also focused on converting SaaS clients into higher revenue per client offerings such
as revenue cycle management and other business services. This expansion of services typically represents a 3-4x increase in overall revenue
per client.
Leveraging
significant cost advantages provided by our technology and global workforce. Our unique business model includes our cloud-based
software and a cost-effective offshore workforce located in our Offshore Offices. We believe this operating model provides us with significant
cost advantages compared to other revenue cycle management companies and it allows us to significantly reduce the operational costs of
the companies we acquire.
Developing
our partner ecosystem. We offer an integrated partner ecosystem providing healthcare organizations access to a variety of innovative
solutions that complement our suite of products and services. Our partner ecosystem is a comprehensive collection of apps, services,
specialty solutions, and clinical connections. This is an integral part of our vision to be the premier cloud-based platform for healthcare.
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As
the market continues to evolve, we may choose to build or partner for some or all of these solutions in order to broaden our product
set. In the longer term, we also envision how this will allow for frictionless flow of information and care-coordination capabilities
between medical providers and their patients.
Additionally,
given the nature of our large data repository, which is ever-growing as each patient encounter is captured, opportunities exist to potentially
monetize this data in an identified manner to help improve clinical outcomes and other financial metrics.
Our
Offerings
Our
solutions are designed to systematically drive clinical quality and patient outcomes, streamline staff and provider workflows and reimbursements,
as well as support different settings of care and healthcare models. Our product and service strategy is simple: we build products and
deliver solutions that meet our clients’ needs.
Through
the combination of our continued development of next generation solutions and strategic acquisition strategy, we provide comprehensive
products and services tailored for small medical practices, large physician groups and health systems, as well as industry partners.
We continue to optimize our technology offerings by integrating them into our application ecosystem and with other industry solutions.
The interconnectivity of our solutions will continue driving a consolidation of brands within our product architecture, aimed at improving
the awareness and alignment of our products to targeted industry segments.
Our
robust product and service portfolio allows us to be both methodical and nimble across the healthcare organizations and market segments
we serve while providing a framework to create solution sets for the market today and more importantly, for what our clients will need
tomorrow.
We
believe that our fully integrated solutions uniquely address the challenges in the industry. In most cases the standard fee for our complete,
integrated, end-to-end solution is based upon a percentage of each client’s healthcare-related revenues, with a monthly minimum
fee, plus a nominal one-time setup fee, which is competitively priced.
Research
and Development
Our
research and development focuses are on enhancing and expanding our service offerings while ensuring all offerings meet regulatory compliance
standards. We continually update our software and technology infrastructures, regularly execute releases of new software enhancements,
and adapt our offerings to better serve our medical group and health system clients confronting rapid changes in the healthcare market
space.
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Our
agile software development methodology is designed to ensure that each software release is properly designed, built, tested, and released.
Our product, engineering, quality assurance, and development operations teams are located both onshore and offshore. We complement our
internal efforts with services from third-party technology providers for infrastructure, healthcare ecosystem connectivity needs such
as prescriptions, clinical laboratories, or specific application requirements.
We
also employ product management, user experience, and product marketing personnel who work continually on improvements to our products
and services design.
Clients
We
estimate that as of December 31, 2023, we provided software and services to approximately 40,000 providers (which we define as physicians,
nurses, nurse practitioners, therapists, physician assistants and other clinicians that render bills for their services) practicing in
approximately 2,600 independent medical practices and hospitals, representing 80 specialties and subspecialties in 50 states allowing
for low revenue concentration risk.
In
addition, we served approximately 150 clients that are not medical practices, but are primarily service organizations who serve the healthcare
community. The foregoing numbers include clients leveraging any of our products or services and are based in part upon estimates where
the precise number of practices or providers is unknown.
We
service clients ranging from small practices to large groups and health systems. Our clients span from the single doctor independent
medical practices to large medical groups, including an enterprise specialty-specific healthcare organization with more than 3,000 providers
located across multiple states. We also service large major academic medical institutions, small and large hospitals and health systems
with service areas covering millions of patients.
Sales
and Marketing
Over
the past several years, organic growth has been a company-wide focus. We have developed sales and marketing capabilities aimed at driving
the growth of our client base, including small medical practices, large groups, and health systems. We expect to expand by selling our
complete suite of software and services to new clients and up-selling additional solutions into our existing client base. We have a direct
sales force including team members focused on specific functional or divisional areas, such as CareCloud Force (workforce augmentation)
and medSR (healthcare IT consulting). This direct sales force is supplemented by offshore staff who support our sales and marketing efforts
24 hours per day. In addition, our direct sales are augmented through our partner initiatives and marketing campaigns. We continue to
leverage and optimize various digital channels to present our solutions, identify national events to demonstrate our integrated capabilities
and expand our participation in thought leadership and social communications to connect with the healthcare community.
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Our
Growth Levers
We
believe that we are in a good position to grow through organic growth and partnerships.
Organic
Growth and Direct Sales
We
have organized our sales force into different segments to promote the respective products and services for that segment and best address
our clients’ needs and our markets. With this design, our sales team can address a client’s specific needs, whether a new
client is seeking our products or services for the first time, or a current client is in need of additional solutions.
Our
marketing team operates in support of our sales force and provides specialized demand generation capabilities for sales efforts, product
marketing to align solutions and segments, customer communication and upselling initiatives, and drives a national tradeshow strategy
to showcase our brand. Our sales approach is consultative in nature for most of our offerings, which generally includes an analysis based
on a prospective client’s needs, crafting service proposals, and negotiating contracts that culminate in the commencement of services.
Our
go-to-market strategy is designed to meet our customers’ needs. Our vast array of products and services allow us to craft solutions
that can meet our customers’ unique needs within a specific product category, client segment, or both.
Growth
through Partnerships
In
addition to our direct sales force, we maintain business relationships with third parties that utilize, promote, or support our sales
or services within specific industries or geographic regions. Some of these partners are customers through CareCloud Force and others
are more traditional channel partners who help promote our solutions. We believe we can further accelerate organic growth through industry
participants, whereby we utilize them as channel partners to offer integrated solutions to their clients. We have entered into such engagements
with industry participants, and developed application interfaces with numerous EHR systems, together with device and lab integration
to support these relationships.
Competition
The
market for RCM, practice management, EHR solutions, and related services is highly competitive, and we expect competition to increase
in the future. We face competition from other providers of both integrated and stand-alone RCM providers, practice management, and EHR
solutions, including competitors who utilize a web-based platform and providers of locally installed software systems.
Many
of our competitors have longer operating histories, greater brand recognition and greater financial marketing. We also compete with various
regional RCM companies, some of which may continue to consolidate and expand into broader markets. We expect that competition will continue
to increase as a result of incentives provided by various governmental initiatives, and consolidation in both the information technology
and healthcare industries. Large groups and health systems that have grown through consolidation often realize economies of scale by
establishing billing and management offices to perform many of the services we offer themselves. In addition, our competitive edge could
be diminished or completely lost if our competition develops similar offshore operations in Pakistan or other countries, such as India
and the Philippines, where labor costs are lower than those in the U.S. (although higher than in Pakistan). Pricing pressures could negatively
impact our margins, growth rate and market share.
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We
believe we have a competitive advantage, as we are able to deliver our industry-leading solutions at competitive prices because we leverage
a combination of our proprietary software, which automates our workflows and increases efficiency, together with a global team that includes
more than 300 experienced health industry experts onshore. These experts are supported by our highly educated and specialized offshore
workforce of approximately 3,200 team members at labor costs that we believe are approximately one-tenth the cost of comparable U.S.
employees.
Our
unique business model has allowed us to become a leading consolidator in our industry sector, gaining us a reputation for acquiring and
positively transforming distressed competitors into an accretive acquisition.
Employees
Including
the employees of our subsidiaries, as of December 2023, the Company employed approximately 3,600 people worldwide on a full-time basis.
Approximately 71% of our employees are focused on service and client delivery functions, approximately 10% are assigned to research and
development, and approximately 2% are engaged in sales and marketing. The balance of the employees is classified as general and administrative,
which includes support staff to maintain our offshore offices, a function that many businesses in other geographies might choose to outsource.
We also utilize the services of a small number of part-time employees. In addition, all officers of the Company work on a full-time basis.
During 2024, we anticipate further reducing our employee count.
Voting
Rights of Our Directors, Executive Officers, and Principal Stockholders
As
of December 31, 2023, approximately 38% of both the shares of our common stock and voting power of our common stock are held by our directors
and executive officers. Therefore, they have the ability to control the outcome of matters submitted to our stockholders for approval,
including the election of our directors, as well as the overall management and direction of our Company.
Corporate
Information
We
were incorporated in Delaware on September 28, 2001, under the name Medical Transcription Billing, Corp., and legally changed our name
to MTBC, Inc. in February 2019. On March 29, 2021, we legally changed the name of the Company to CareCloud, Inc. Our principal executive
offices are located at 7 Clyde Road, Somerset, New Jersey 08873, and our telephone number is (732) 873-5133. Our website address is www.CareCloud.com.
Information contained on, or that can be accessed through, our website is not incorporated by reference into this Annual Report on Form
10-K, and you should not consider information on our website to be part of this document.
CareCloud.com,
CareCloud, MTBC, A Unique Healthcare IT Company, and other trademarks and service marks of CareCloud appearing in this Annual Report
on Form 10-K are the property of CareCloud. Trade names, trademarks and service marks of other companies appearing in this Annual Report
on Form 10-K are the property of their respective holders.
We
are a smaller reporting company. As a smaller reporting company, we may take advantage of specified reduced reporting requirements and
are relieved of certain other significant requirements that are otherwise generally applicable to public companies. As a smaller reporting
company, we have reduced disclosure obligations regarding executive compensation in our Annual Report, periodic reports and proxy statements
and providing only two years of audited financial statements in our Annual Report and our periodic reports. This year the Company is
not required to comply with the auditor attestation requirements of Section 404 of the Sarbanes-Oxley Act of 2002, as amended. The Company
is a non-accelerated filer.
Where
You Can Find More Information
Our
website, which we use to communicate important business information, can be accessed at: www.CareCloud.com. We make our Annual Reports
on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K and all amendments to those reports available free of charge
on or through our website as soon as reasonably practicable after such material is electronically filed with or furnished to the Securities
and Exchange Commission (“SEC”). Materials we file with or furnish to the SEC may also be read and copied at the SEC’s
Public Reference Room at 100 F Street, NE, Washington, D.C. 20549. Information on the operation of the Public Reference Room may be obtained
by calling the SEC at 1-800-SEC-0330. Also, the SEC’s website (www.sec.gov) contains reports, proxy and information statements,
and other information that we file electronically with the SEC.
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